Guest Post by Scott Adams
Our system of government has been amazingly robust for hundreds of years, but it fails when you have these two conditions:
1. An issue is too complicated for the public to understand.
2. Big companies are willing to distort the system for profits.
That situation describes the healthcare debate going on in the United States right now. Our undersized brains can’t grasp all the nuances and implications of any particular healthcare plan. And when our brains are confused, we default to our biases (usually party loyalty) or to whatever metric is simple enough to understand. With healthcare, the one metric that matters is how many people will be covered compared to Obamacare. If the Republican plan covers more people, it will pass. If not, it will fail.
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Sure, Republicans will argue that the CBO projections are inaccurate. They will argue that comparing a mandatory plan with an optional one is comparing apples to oranges. They will be right about all of that, but it is irrelevant to the outcome. People will look at the number of people covered and stop there. So any Republican bill that covers fewer people than Obamacare is dead on arrival. That’s where we are now. And we don’t have a system of government that can fix this situation.
But what we do have is an active citizenry and social media. That’s a better system for designing a healthcare system. I’ll describe one way to go about it.
Some of you are aware of Github, a company that lets software developers contribute bits of code that are made available to all other Github users. Github is a big deal, and software developers almost can’t live without it. Perhaps it is time to build a similar system for fixing health insurance in the U.S.
Imagine a website where any interested party can contribute suggestions for improving any individual element of healthcare in the United States, with a focus on lowering costs while improving outcomes. Perhaps you have an idea about lowering drug prices, and I have an idea about online doctors. We submit our ideas, and the Github-for-healthcare users gets to improve on them or ignore them. The system would allow users to rank the ideas. In time, citizens could develop multiple ideas for every element of healthcare. Citizen volunteers could eventually create up to three plans and present them to Congress for a vote.
I’ll get the ball rolling here by framing the problem as an innovation challenge, not a cost issue.
I think Congress can pass a bill that overspends in the short run so long as it comes with a plan (or path) to greater coverage than Obamacare. In my picture above, you see the growing gap between future health care costs and tax revenue. That growing gap can only be closed by some combination of innovation, cutting regulations, improving competition, and improving prevention. Let’s call that a “moon shot” challenge. We don’t know how to get there right now, but Americans are good at figuring out this sort of thing.
My suggestion for getting a healthcare bill passed is for Republicans to create a credible story for how they will cover more people than Obamacare, at a reasonable cost. And the best way to make that case is with visual persuasion, starting with this sort of simple graph and extending to images of startups that promise to lower medical costs.
At the moment, Paul Ryan and the Republicans are trying to sell their plan with facts, concepts, details, and logical arguments. That won’t work. You need an aspirational story about how to get to better coverage than Obamacare via American ingenuity. Everything else is just noise.
I don’t mind letting Congress take its best shot at improving healthcare. But realistically, they can’t. They are not the right form of government for this sort of complexity.
Perhaps citizens can do what congress could not.
Do away with all the Medicaid. It was meant to be a ‘safety net’. Now people are using it their entire lifetimes. I don’t give a fuck what these people are going to do.
Agreed, Dutchy. And in other news:
I thought this had been mentioned, but maybe not.
My view: The “healthcare” benefit provided by employers as a way of adding to an employee’s compensation without causing a bigger tax hit really isn’t insurance, per se, it’s like an addition to an employee’s wages. Medical insurance is also provided as a benefit, but it appears that socialist politicians decided to use this practice by some employers as a way of stirring up envy among people who don’t get those benefits from their employers and among those who don’t work at all but are easy to convince that it ain’t no fair.
The politicians and their meddling will keep this side battle of the class war going until their power to do so is ripped from their greedy, grasping hands. How to take this power from them, I have no idea. Well I do have one idea but I won’t state it.
Get rid of Medicare as well. Old-ass moochers.
How come no one talks about the fact that the US military is what makes the research and safe environment in which healthcare is performed possible. The american tax payer is what makes the US military possible. Therefore healthcare should be available to everyone basically for free. If doctors don’t want to work for rates people can afford they are free to leave the safety of the US and practice elsewhere. If they choose to practice in the US they must see everyone and work for reasonable rates. Doctors are public servants. The fact that we have doctors who only perform cosmetic procedures for the rich while millions of people do not have access to basic healthcare is insane. If we do the same thing for Doctors that we do of lawyers and subsidize the cost of the education in return for a minimum of ten years of public service everyone wins. The cost of med school gets controlled and we eliminate insurance cos ( which are totally useless). Procedures should cost the same everywhere. Medicine is like government, it’s necessary and should not be for profit. Once Doctors perform their mandatory public service they are free to go into private practice and only take cash but must market themselves and are no longer allowed to receive any subsides from the public in terms of insurance and will no longer be part of the govt referral system so if they want patients to come to them it’s the doctors responsibility to create the demand for their services. It’s crazy how doctors just have to be part of insurance programs like Medicaid and they patients come to them without any marketing cost on their side.
Just abolish health insurance. That will do the trick.
Doctors are not public servants. They should be allowed to be part of the capital system as anyone else. Life is worth living when you are able to have quality medical and dental care.
A Doctor is much more important than many, many other professions.
Dear Annon: It looks like Scott was spot on with his assertion that the healthcare equation was just too complicated. Healthcare is a responsibility and a personal one. It is not an obligation for the entire tax paying cohort in the country to insure you have healthcare. Healthcare has morphed into a gordian knot that an overwhelming number of Americans feel that it is owed to them. It is not….and has only gotten so as a political football used deceptively by the socialists to enlarge the government.
Insurance is is a contract in which a company indemnifies you against a specified loss for a fee. Healthcare is your responsibility to the extent that you are responsible for your own health requirements and not your neighbors. If you take care of your health you will live longer and have a higher quality of life. If you don’t then you’re screwed. Go to an airport and watch the people this 4th of July….you will see that at least half if not more are morbidly obese and probably medically critical now.
The healthcare contract should be for critical or catastrophic care like heart attacks, accidents and other “one off” situations and not junior is feeling sick after eating too much. Americans across the board feel that it is owed to them…..it is not. Your healthcare is your responsibility and not mine and you are not going to live forever…….
I am approaching age 65 and have been studying the permutations and combinations of my Medicare start up in October. I bought Phillip Moeller’s book, ” Get What’s Yours for Medicare” to use as a handbook to aid the decision process. On pages 136 and 137 under the topic Medicare’s Great Raid on the Treasury here is a section for you to think about, ” Premiums represent our dollars, too, so perhaps adding what we pay in Medicare premiums will justify the notion that we pay for Medicare. What do you think? Sixty percent? Fifty? Forty? Thirty? How about 21.5 percent, which translates into $80 Billion in Medicare premiums.
It turns out that Medicare payroll taxes fully fund Part A hospital expenses(together with your share of uncovered Part A expenses) but that is hardly where the buck stops. Expenses for Parts B, C, (Medicare Advantage or MA), and Part D (prescription drugs) are paid mostly by Uncle Sam, to the tune of $250 Billion. And this is, by the way not a fixed line item in the federal budget but more of a blank check every year.
If you try the single payer gambit in which even the California Politboro is balking at we can just start printing money to cover everybody to include the 30 to 50 million illegals that already here and all their friends and family back in the old country down south……….who are heading north as fast as they can.
There is a 3rd line missing from that graph: money printing.
Here is the avenue to cure the US health care “crisis”:
1) Require all prices (procedures, visits, drugs, etc.) be posted online and at the reception counter.
2) Use Anti-Trust and RICO laws to throw a few rip-off artists from the insurance companies, hospitals, and drug companies in jail to share a cell with Bubba.
That will right the ship pretty quickly.
Oh wait, that might impact campaign contributions, i.e., bribes, that our elected representatives receive from these fine professions.
Never mind. Not going to happen.
Agree 100+ with you trapped. As for your last line all it would take is some lawyers/politicians taking a long drop from a short rope, should only require 9 or 10 examples being made and this bull crap would be fixed lickety split.
Ditto, Trapped.
“2. Big companies are willing to distort the system for profits.” – First, let me correct this for you Scott – 2. Big companies are actively encouraged to distort the system for profits.
There fixed it for ya. See, this is even more simple Scott, there is an existing system that was invented hundreds of years ago, it is called capitalism. It is a mechanism where a willing buyer (notice the term WILLING), and willing seller meet at a price mutually agreed upon for a good or service.
That is pretty simple isn’t it? Now, where in that simple conceptual design do you see any reference to coercion, (by government gun of course), and one party not EVER being able to know the actual price?
Also, while were at it, lets go a little further down the rabbit hole…Insurance is a concept that was devised to smooth out a risk of an outlier and UNEXPECTED event. Where in today’s “healthcare” does insurance play a part in an unexpected event? Unless of course you feel that car insurance should pay out when you car gets a flat, needs an oil change or is filled with gasoline?
This entire debate is about free shit – The healthcare and insurance industry (and their government cronies) wanting to continue to somehow make Americans whom can barely afford it now, continue paying them TWICE the inflation rate for “coverage” that is only even necessary because the cost and ability to simply go directly, and pay directly to the provider in a real competitive marketplace is deliberately subverted by government and their donors (not voters, donors Scott). I think most of the thinking people in this country know EXACTLY what is going on. We understand perfectly, it is just WE no longer have a voice, as our voting ability of using our wallet has been subverted as well by the Federal Reserve system.
Just read Karl Denninger. In my opinion he sums it up well.
This and other posts.
https://market-ticker.org/akcs-www?post=232164
If the insurance companies & healthcare providers don’t allow an honest fix (as Denninger prescribes), then we’re going to get Medicare For All. Not while the GOP is in control, but as soon as they lose control. That was the plan the whole time.
To many FSA pigs for the tits. Workers pay taxes for Medicaid which got so big it broke Illinois. Workers also pay a payroll tax for health insurance. Insured Patients are charged for their costs plus five times as much to pay for the FSA patients that pay nothing. The real disease is Parasitic Socialism which is killing the FSA’s host, the workers, the governments and the whole damned economic system.
If the healthcare insurance business in the U.S. needs to be fixed, why are the health insurance companies enjoying record profits? Right now, as is. First quarter of 2017: Cigna, 5.76% profit and rising; United, 4.46% profit and rising; Anthem, 4.48% profit and rising. Aetna had a first quarter loss of 2.5%, as a result of a failed attempt to actually acquire Humana, but they project profits of $9.00 per share for the year of 2017. It doesn’t look like any of the big insurance companies have lost money at any time in the last 5 years.
Further, the consumer price index for medical care shows a 3.27% annual increase for the past ten years, and the CBO predicts a 3.2% increase in medical costs through 2020. Not exponential increases. Yet many people believe medical costs are skyrocketing and the insurance market is falling apart. Based on scary scenario, we are being asked to throw more money at healthcare, like its a dire emergency. But based on what evidence? Because some company backed out of some exchange somewhere? Healthcare is over 17 percent of the economy as is. What is wrong with exercising some skepticism?
This grab for cash is one of the oldest games in politics. Show up in front of the legislative committees and tell them your agency or company is going broke, the sky is falling, it is a catastrophe, and more money is needed yesterday. Show them some scary charts. Give a press conference and wipe away tears. Then you get your funding increase and write a big check to the committee chairman’s political action committee on the way out the door.
“Our system of government has been robust for hundreds of years”. Lost me right there Scott you fucking moron. He’s just another dipshit that thinks government can fix what it breaks. Only a truly free market can do that. Ain’t gonna happen.
The only thing that will work is some sorta single-payer plan. The facts are obvious; countries with single-payer pay about 1/3 less for much better results. Our “healthcare” is insurance company based and bloated with about 1/3 too much weaselfart.
Without the implicit rationing of single payer systems, they would go broke too. They have to bring demand down and that is accomplished by rationing. In those other countries, Grandma doesn’t get that free hip surgery at 85 anymore.
Adam’s article assumes the government has a role and then measures success by how many people are covered most efficiently. Most of the comments assume the government has no role. Clearly, the vast majority of Congress accepts the premise that the government has a role. Four or five Republican Senators refuse to vote with the Republicans on the most recent version of a propose healthcare law because they insist that government has no role. The failure to find agreement is based on the refusal to solve the same problem. That creates even more problems such as an inability of Republicans to unify enough to unwind the policies of the radical left in this country. That is a political problem I suspect Trump is attempting to solve in this process. I suggest non-Leftist in this country find agreement on which problems they are going to solve in what order. Otherwise, the Leftist will win. BTW, with regard to the healthcare issues, Congress WILL double down on government involvement with a single payer system if Republicans don’t find a way to agree. For all you ideological purists out there, that means not only do you lose, you lose BIG.
“Clearly, the vast majority of Congress accepts the premise that the government has a role. ” – Well, the captain obvious award goes to you for that statement. OF COURSE the lackeys, whose income and power derive from them being in the middle of everything feel they should have a role in this. See, real capitalism solves this problem by forcing the most efficient means of delivery out to the market. The most efficient means of delivery usually does not involve a third party parasite, unless the third party brings some value to the table. What value has government intervention EVER brought to anything, besides what the founders envisioned through a court system to resolve disputes civilly and a militia (not MIC as today) to protect the homeland from foreign invasion?
We, the purists (productive voters) are always going to lose, simply because the monkeys in Washington, in both parties exist to continue to get in the middle of a willing buyer and seller and skim because they can. Like condoning an armed robber between you and the guy at the counter. You must hand the money to the armed robber, he takes his cut, then hands it to the guy at the counter. Then he gives back your change, of course through giving it to the guy with the gun, then he skims again, then gives it to you. You question the efficiency of handing your money to the armed robber first, and know it is stupid, as does the guy at the counter, but can’t do anything about it because of, well, the GUN. That is what government is….
Even the billionaires (.001%) know this. They just want to make sure that the gun toting robber is more on their side than yours, and they get a piece of the skim.
I have a solution. Everyone gets free health insurance. The deductible will be based on a sliding scale representative of your overall health age and previous conditions. 450 lbs with a previous untreated heart condition and diabetes would have higher deductible than a marathon runner. Take care of yourself, pay less money.
This article completely ignores the “elephant in the room”. The ‘boomer’ generation has done this to everything they’ve touched. Example: Boomer gets job, joins union, pays union dues. Boomer then votes for union leaders who promise to steal union dues to pay for the things the Boomer wants now (e.g. wages, insurance, etc.). Boomer reaches retirement age and demands his promised payout for ‘paying his dues’.
1-3 does not have a positive outcome, regardless of your needs and wants. Boomers are sucking the healthcare system dry, just like they have everything they’ve touched in their lifetimes. They are leaving behind a legacy of indebted surfs and empty promises. As a Gen-x’r I’ve already come to the realization that I’ll never retire, wait until this becomes a ‘common’ realization, then watch the real shit hit the fan.
Gen-x’rs and Millenials, you will work till you die….you will deal with increasing costs….you will deal with decreasing wages….you will have sub-par heath insurance. Sound familiar? Get used to it, it’s the ‘new normal’, or as I like to term it it’s the ‘Boomer legacy’. Leeches.
Hey Gilnut! You are absolutely correct about the Gen-Xers getting screwed over, but the Boomers don’t deserve all the blame. Most of the Boomers have yet to retire, and the funds they have been promised (and have been paying in on) have already been stolen and spent by “The Greatest Generation”. Yep… the same people who are so well spoken of for their fight in WWII are the ones who set up the current system, the ones who promised the Boomers a good retirement and medical care. Think HW Bush. Think LBJ. Think Hubert Humphrey. Think Nixon. (I am leaving out Reagan; sure a bunch of stuff passed during his Presidency, but personally, I think HW Bush was running the show already.) The scam is obvious in retrospect. Get the Boomers to pay in a bunch by promising them even MORE in benefits, and then steal what they paid in. Stick in a bunch of IOUs instead. The current sucking-dry of the Gen-Xers is just the last gasp of the system to keep going a little bit longer while the early Boomers get paid off. Paying off the early Boomers is not altruism, it is just a way to keep the illusion going so that the rest of the Boomers will keep paying. At some point, people will realize that they have been robbed, but by the time that happens, all The Greatest Generation (at least those who ran the political system) will have died with their billions of dollars. But you are right about the Gen-Xers getting screwed. It may not help, but as Boomer myself, I don’t think it is fair to you guys, and if I could stop the theft, I would.
The youth are being brainwashed to hate and support a communist revolution. Dope doesn’t help matters.
Talk about market distortion! The business of insurance is one of the largest and most corrupt, twisted scams ever devised by the mind of man!
The one and only way to keep “health care” costs down is to stay healthier. The current “health care” system is really a sick care system. One of the ways to keep people healthier is to mandate coverage for:
1. Naturopaths
2. Chiropractors
3. Nutritional supplements