UA-43475823-1

The Wrongologist

Geopolitics, Power and Political Economy

Is a Single-Payer Experiment on the Horizon?

The Daily Escape:

Breaking the Ramadan fast, Dubai – photo by Francois Nel

From Sarah Kliff:

Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status.

This is “Medicaid for All”, not “Medicare for All”, which several Democrats have proposed over the years. Medicare for all has always fizzled out, due to a lack of political support.

Medicaid for all offers an interesting alternative. Medicaid coverage generally costs less than Medicare for all because the program pays doctors lower rates. This could make it cheaper for low-income price-sensitive consumers who can’t afford the Obamacare monthly premiums. More from Sarah Kliff:

Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.

Under the Nevada bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for credits would be able to use their own money to buy in. It is likely that the plan would be sold on Nevada’s health insurance marketplace, making it a public option that competed against the private health insurance plans selling there.

Early versions of the Affordable Care Act included a buy-in provision. But the Senate was forced to drop the Medicare buy-in from its bill when it couldn’t get the entire Democratic caucus behind the idea. Health insurers fought aggressively against the idea, which disadvantages insurers by reducing their market share.

After Trump’s election, health policy experts started to explore whether it might make more sense to build a national health care system around Medicaid rather than Medicare.

Medicaid and Medicare are similar programs in that they are large and publicly run, covering 62 million and 43 million Americans, respectively. They use their large membership to negotiate lower prices with hospitals and doctors. Medicaid tends to have the lowest payment rates. On average, Medicaid pays 66% of what Medicare pays doctors. In Nevada, Medicaid pays 81% of Medicare rates.

This means Medicaid is a relatively lower-cost program, but some doctors do not accept Medicaid’s lower rates. A recent federal survey estimates that 69% of doctors are accepting new Medicaid patients, compared to 85% accepting new patients with private insurance.

States have significant control over how their health insurance programs work and whom they cover. Thirty-two states participate in a Medicaid buy-in program that lets certain disabled Americans who don’t otherwise qualify for coverage, buy into the program.

This flexibility provides an opportunity for states that want to experiment with a public program by tacking on a buy-in option. If Nevada’s bill does become law, it will show other states how such a program might work, and if it works well, other states may be inclined to try it.

States that want to enroll new populations into their Medicaid programs will need permission from the federal government. This means that the Trump administration — which has proposed slashing the Medicaid budget in half — would need to get on board with a significant expansion of the program, perhaps a doubtful possibility. But as Kliff says: (brackets by the Wrongologist)

The Nevada idea in theory shouldn’t expand federal costs. Individuals would be responsible for paying their own way onto the program, although it will likely be a challenge to set the right premium [rates] to ensure this outcome.

California is considering a single-payer bill as well. Whether other states might follow the Nevada example will depend on what outcomes it produces.

Here is another tune from the One Love Manchester concert. Watch “Happy” by Pharrell Williams and Miley Cyrus, who turn the song into a soul number, something closer to Motown than to Disney. They make it something more than it was when it was so popular. Also, the whole audience sings along, and that’s fun:

Those who read the Wrongologist in email can view the video here.

Facebooklinkedinrss

Buffett: Focus on Lower Health Care Costs, Not Corporate Taxes

The Daily Escape:

Ribbon Chapel, Onomichi Japan – photo by Koji Fujii

Andrew Ross Sorkin wrote about Warren Buffet and the Berkshire Hathaway annual meeting in Omaha. Thousands of people attend these meetings, which are known as “Woodstock for capitalists.” Sorkin reports that Buffet made this comment:

The tax system is not crippling our business around the world.

Sorkin said that Mr. Buffett, was blunt and pointed, implicitly rebuking his fellow chief executives, who have been lobbying the Trump administration and Washington lawmakers to lower corporate taxes. Buffett said that those who have been single-focused on seeking relief from their tax bills would be smart to shift their attention to health care costs, which are growing and swallowing evermore corporate profits. The Kaiser Family Foundation reports that 49% of Americans, about 156 million, are insured by their employer. More from Sorkin:

The need for corporate tax relief has become the lodestar of the corner office, with CEOs rhapsodizing  over President Trump’s plan to try to stimulate growth by cutting tax rates for businesses.

But as Mr. Buffett pointed out, these chief executives are missing the bigger issue: As a percentage of our GDP, the cost of maintaining our American health care system is rising at an alarming rate. And Corporate America pays a big (and growing) chunk of that bill.

Buffett wasn’t talking about the cost of health insurance, which is a fraction of the total cost of health care. He suggests that today’s corporate tax rates are a distraction, not a true impediment to growth:

If you go back to 1960 or thereabouts, corporate taxes were about 4% of GDP…And now, they’re about 2 % of GDP.

While tax rates have fallen as a share of gross domestic product, health care costs ballooned:

About 50 years ago, health care was 5% of GDP, and now it’s about 17%.

Buffett is a smart guy. He raises an argument for focusing on the underlying costs of our health care system, something that goes far beyond the debate around the Affordable Care Act, or what will replace it. Buffett says that our global competitiveness has fallen largely because our businesses were paying far more for health care — a tax by another name — than those in other countries.

As Buffett said: (brackets by the Wrongologist)

When American business talks about [corporate taxes] strangling our competitiveness, or that sort of thing, they’re talking about something that as a percentage of GDP has gone down…While medical costs, which are borne to a great extent by business, have swelled.

Here are the facts:

  • In 1960, corporate taxes in the US were about 4% of GDP. The percentage fell steadily, reaching a bottom in 1983 before rising slightly over the last few decades. Today, it is 1.9%.
  • In the meantime, health care costs as a percent of GDP have skyrocketed. Today our health care costs are 17.1% of GDP, up from 13.1% in 1995.
  • Germany’s cost is 11.3%, up from 9.4% during the same period. Japan’s is 10.2%, up from 6.6%. Britain’s health care costs are 9.1% of GDP, up from 6.7% percent in 1995.

That makes our health care cost disadvantage far greater than our tax differential. It harms American companies in particular, since they bear such a large share of those costs, which firms in our competitor countries do not. US Corporations spend $12,591 on average for coverage of a family of four, up 54% since 2005, according to a study by the Kaiser Family Foundation.

But Congress avoids the issue, and CEOs don’t talk about it. A final quote from Warren:

It’s very tough for political parties to attack it…it’s basically a political subject…

In fact, Buffett’s partner, Charlie Munger, is the rare Republican (Buffett is a Democrat) who has advocated for a single-payer health care system. Under his plan, the US would enact a sort of universal type of coverage for all citizens — perhaps along the lines of the Medicaid system.

Which brings Wrongo to his final point: Medicaid expansion is the one part of Obamacare that can be said unequivocally to work. It’s a single payer program funded by the Federal government. So it’s bitterly ironic that the Republican’s reaction to Obamacare is to assault and roll back an existing Federal program, from LBJ days.

Of course, kicking poor people who benefit from Medicaid will always be popular with Republicans. So, Republicans, by making Medicaid worse, will try to restore their natural order of things.

Lazy, uninformed voters = Lazy, uninformed legislators = Lazy, uninformed policy.

It’s that simple.

Facebooklinkedinrss

Saturday Soother – May 6, 2017

The Daily Escape:

Tulips, Lisse Netherlands, April 2017 – photo by Peter Dejong

We ended the week with Republicans in the House passing the latest version of Trumpcare by a vote of 217-213. All Democrats voted against it, with 20 Republican members defecting to join them. The changes Republicans made to get this version of bill through the House will not be what passes in the Senate. It’s up to Mitch McConnell to craft a bill that can get through the Senate using the budget reconciliation process, which will require 51 votes to pass.

That will most likely be the “real” bill, and then the negotiations between the House and Senate versions will begin.

The problem for America is that the Senate has to pass something awful enough that the House will still vote for it. We are a long way from replacing Obamacare, but Republicans now own the process whereby tens of millions of Americans losing health insurance.

If that isn’t enough to worry about, Buzzfeed has a long read about tiny drones that can be used in a swarm to kill people:

A very, very small quadcopter, one inch in diameter can carry a one- or two-gram shaped charge. You can order them from a drone manufacturer in China…A one-gram shaped charge can punch a hole in nine millimeters of steel…You can fit about three million of those in a semi-tractor-trailer. You can drive up I-95 with three trucks and have 10 million weapons attacking New York City. They don’t have to be very effective, only 5 or 10% of them have to find the target.

The concept is achievable, while the potential consequences are unthinkable:

There will be manufacturers producing millions of these weapons that people will be able to buy just like you can buy guns now, except millions of guns don’t matter unless you have a million soldiers. You need only three guys to write the program and launch them. So you can just imagine that in many parts of the world humans will be hunted…This is the ever-present cloud of lethal autonomous weapons.

They could be here in two to three years.

— Stuart Russell, professor of computer science at the University of California Berkeley

They are called lethal autonomous weapons systems (LAWS); weapons that have the ability to independently select and engage targets once a human releases the machine to perform: no supervision, no recall, and no stop function.

Can we prevent them? Nope, they already exist. Many countries including the US already have (much larger) systems with autonomous modes that can select and attack targets without human intervention: Israel’s Harpy and second-generation Harop, can enter an area, hunt for enemy radar, and kamikaze into it, regardless of where they are set up, as long as the radars are operating.

The Pentagon now is testing drone swarm technology: Weapons moving in large formations with one controller somewhere far away on the ground clicking computer keys. Think hundreds of small drones moving as one, like a lethal flock of bees. You can see a YouTube video of a US drone swarm test here. 103 mini drones were released from two US fighter jets during the test. The drones operate autonomously and share a distributed brain. These drones will make it economical to target people (troops?) in other countries, en masse, without having to send in our own soldiers, or declare war.

Why are we wasting even more human potential devising even more ways to kill each another?

Sorry, this story adds to your stress levels after a tough week, but Wrongo thought you should know. OTOH, with all that is going on, you really need soothing. Wrongo is going for some Stumptown Colombia El Admirador coffee and a listen to “Spring”, from Vivaldi’s Four Seasons, arranged for four pianos.

The pianos are played by Yuja Wang, Emanuel Ax, Nelson Goerner, and Julien Quentin. The performance was recorded at the Salle Médran in Verbier, Switzerland, in 2009:

Those who read the Wrongologist in email can view the video here.

Bonus video in honor of Trumpcare: Jimmy Reed singing “Get Your Insurance” from 1959:

Those who read in email can view the video here.

Facebooklinkedinrss

Sunday Cartoon Blogging – March 26, 2017

From the NYT: (brackets by the Wrongologist)

33 Republicans stopped the [Trumpcare] bill. 15 were from the “Freedom Caucus,” 10 were “moderates” mostly from the Northeast (the “Tuesday Group”), some of whose districts went for Clinton, and 8 were miscellaneous (“One said he was concerned about its changes to Medicaid expansion, another preferred a full repeal and a third said he was worried about the bill’s impact on treatment for opioid abuse”).

Republicans control 237 seats of the 435 seats in the House. It requires 218 votes to pass a bill. When Paul Ryan and Donald Trump lost 33 Republican votes, the bill couldn’t pass, and had to be withdrawn. That means the GOP really doesn’t control the House, and that’s unchanged since John Boehner was Speaker.

The Republicans have majority control of the House and the Senate. They also have the self-proclaimed greatest deal-maker sitting in the Oval Office.  They have been talking about repealing Obamacare for seven years since it was signed into law, and they couldn’t get their own party to fall in line.

But Trump isn’t a deal maker, he’s a salesman.

And that’s a huge difference. Savvy business people seem willing to buy whatever he is selling. He seems to have the charisma and persuasiveness that in his prior life, made him a top earner as a real estate mogul.

But there’s a difference between making a sale and making a deal. Deal making is hard; you have to build trust, you have to establish real relationships, you need a mastery of your deal points and those of the person on the other side. It can be slow, grinding work.

Trump doesn’t do that, he’s never done that. His entire career is a lurch from one deal to the next, and his Presidency is no different. Trump closed the sale with the American people, but once elected, his job is to make deals.

On to cartoons.

A funny thing happened on the way to the Obamacare execution:

GOP’s Health Care March Madness bracket is now busted:

Boehner shows Ryan how to cope with Freedom Caucus:

Expect the GOP to keep trying to replace Obamacare until we all do this:

Sen. Menendez (D-NJ) burns the GOP:

Sadly, Menendez is also a joke of a Senator. He is about to go on trial for public corruption. Still, the tweet is funny.

Gorsuch epic head-fakes are now a required course in sports:

Trump’s Poodle, Devin Nunes can’t be counted on to keep secrets well, secret:

Facebooklinkedinrss

The CBO and the Ides of March

The Daily Escape:

(Provence – Photo by Veronika K. Ko.)

The Ides of March are today. The Netherlands holds its parliamentary election, the US debt ceiling agreement expires, and Trump is gonna get a ton of postcards.

Congressional Budget Office estimates for Trumpcare (AHCA) came out on Monday, and they’re worse than expected.  Sarah Kliff, Vox’s healthcare reporter, has this:

  • CBO estimates 14 million would lose coverage in 2018. The report projects that much of the early coverage loss would stem from repealing Obamacare’s mandate that all Americans purchase coverage or pay a fine.
  • After that, increases in the uninsured would be from Medicaid cuts. After 2018, CBO thinks that most of the increase in the number of uninsured would stem from changes the AHCA would make to Obamacare’s expansion of Medicaid, an expansion that allowed many more low-income adults to enroll in the program.
  • The bill would “freeze” enrollment in that program on January 1, 2020. Medicaid enrollees would trickle off the rolls as their incomes changed. And this would lead to another big decline in coverage.
  • The number of uninsured, CBO projects, would rise by 21 million in 2020 and hit 24 million in 2026.
  • The CBO projects that as the individual market shrinks, premiums would rise between 10% and 15% as some healthy people flee in 2018. But over the next few years, the agency expects premiums to go down to 10% lower than under Obamacare.
  • CBO thinks more young people will come into the market, as the GOP plan offers incentives to make the market more appealing to younger, (healthier) enrollees.
  • AHCA would be a huge cut to Medicaid. CBO estimates it would reduce spending on the health program for low-income Americans by $880 billion over the next decade. This helps explain why AHCA would reduce the deficit: The bill spends a lot less money on entitlement programs.

When Paul Ryan’s talking points are that their plan will reduce the deficit, and that premiums will go down by 10% OVER THE LONG TERM, you know that he doesn’t care that 24 million people will lose healthcare insurance.

That the GOP is choosing deficit reduction over covering American citizens is what the public will remember. When you kick out the poor and older folks, of course premiums will go down. But premiums will remain high for those in the 50-64 age bracket, and their premiums will be higher than currently.

The CBO report also finds that this legislation will provide massive tax relief, and make the most fundamental entitlement reform in more than a generation, if throwing people off Medicaid truly is “reform”.

Even before the CBO report was released, the Trump administration began laying the groundwork to discredit the agency and their report. White House press secretary Sean Spicer:

If you’re looking at the CBO for accuracy, you’re looking in the wrong place…they were way, way off last time in terms of how they scored and projected Obamacare.

Since this is the Ides of March, you should have expected some stabbing.

Their criticism is centered on the fact that CBO previously overestimated the number of people who would enroll in the marketplaces. That’s true: Earlier CBO reports estimated that the Obamacare marketplaces would have 26 million enrollees this year. Last year, CBO revised that estimate to 15 million.

Critics don’t mention that the CBO also underestimated how many people Medicaid expansion would cover. The overestimate and the underestimate essentially cancel each other out: Obamacare is covering just about as many people as CBO expected back in 2013.

Curiously, Trump said his health care plan would cover EVERYONE, and it would be much cheaper and much better. Except it won’t.

When you think about bad data, remember that Trump said we shouldn’t trust the Bureau of Labor Statistics numbers on monthly employment last year, he said they were fake. Now, Trump says the numbers in this month’s data release are real. You be the judge:

Obama in February 2016 — 237,000 new jobs
Trump in February 2017 — 235,000 new jobs

Trump: Making America a Slightly Less Great Again.

Your daily musical interlude appropriately is from the group the Ides of March. Here is “Vehicle”, their only hit, originally published in 1970, and performed live at the Chicago House of Blues in 2014:

That 70 year-old guy can still sing.

Those who read the Wrongologist in email can view the video here.

Sample Lyrics:

Well, I’m the friendly stranger in the black sedan

Won’t you hop inside my car?

I got pictures, candy, I’m a lovable man

And I can take you to the nearest star

 

Kinda like the GOP promises on healthcare.

Facebooklinkedinrss

First Person Report From the Women’s March

(Below is a guest post from Nicole Dodd, a recent graduate from UC Santa Barbara. She has moved to Washington DC to begin a career in government service. The photos below are ©Nicole Dodd)

“Women’s rights are human rights.” Hillary Rodham Clinton, 1995

This past Saturday, I was one of almost 500,000 women and men participating in the Women’s March on Washington. From 8 am until well after 8 pm, the streets were crowded with women wearing pink ‘pussy hats,’ carrying indignant signs, and chanting out against our newest president.

The movement was powerful, and greatly exceeded expectations: the Washington March itself had almost 2.5x the amount of people it was projected to have, and the sister marches across the States and the world had incredible turnout. After having seen so many red “Make America Great Again” caps and rioters in the streets just twenty-four hours earlier, I was encouraged to see an influx of pink hats participating in a protest that remained peaceful and could spark a global movement.

From an outside perspective, it may seem that the Women’s March had no direction and no goal. Millions of people took to the streets to protest, but for what? On the Women’s March website, it lists the ‘unifying principles’ of the march: ending violence, reproductive rights, LGBTQIA rights, worker’s rights, civil rights, disability rights, immigrant rights, and even environmental justice. From what I saw, participants in the March held signs that advocated for each of the unifying principles of the March. However, the heart of the matter is this: President Trump was elected without a majority popular vote, and while he has promised to be ‘a president for all Americans,’ his words and actions have proven that he will not.

While January 21st was an important first step in the fight against the Orange Overlord’s administration, the fight in no way stops here. As a pragmatist, I realize that many women and men will walk away after this weekend thinking that they’ve completed their democratic duty by simply showing up and chanting angrily for a few hours.

Despite this, I am extremely hopeful. Many speakers at the Washington March implored the participants to get politically active. We were told to write our representatives every single day, join and become active in the organizations that we were working to support, and finally, to run for public office. Protesters held signs echoing those same sentiments, urging us to vote and to get involved. To top it off, the Women’s March website published an article outlining what exactly we can do during Trump’s first 100 days to make sure our voices are heard in the Capitol.

In the same way that it is our democratic responsibility to vote in local, state and national elections, it is also our democratic responsibility to peacefully protest and make sure that our representatives are accurately representing our interests. It’s hard to evaluate if the Women’s March will lead to concrete actions – the commitment of the crowd could easily be attributed to mob mentality, and people lose resolve over time. Still, the Women’s March was the largest protest to ever occur over the inauguration of a US President, and that fact cannot go unnoticed. My hope is that, with clear guidance and resources from the Women’s March administrators, the majority of participants in Saturday’s movement will abandon their excuses and take it upon themselves to exercise their democratic rights and responsibilities.

I can promise you that this protester will refuse to sit by idly, and will take action.

My favorite chant from Saturday sums up the movement perfectly:  “This is what democracy looks like”. Here are a few photos from the DC March. This one shows size of the crowd:

Sign from person near the Smithsonian:

One of the main purposes of the March was to address reproductive rights:

I’m with her” sign shows marchers’ solidarity. View towards the Washington Monument:

Facebooklinkedinrss

Sunday Cartoon Blogging – January 22, 2017

Did everyone remember to turn their clocks back by 50 years last night? The dust has settled on the Women’s March on Washington. The turnout was very impressive, not only in Washington, but in other cities across the US. Let us remember that women protesting ultimately led to them getting the right to vote. They helped bring about civil rights legislation, a minimum-wage, and the abolition of child labor in this country. This is both their right and their obligation.

Women’s March outdraws the Inauguration:

And people said Clinton’s slogan “Stronger Together” was terrible:

What to expect after inaugurating the Overlord:

The torch was passed:

There was a chill in the White House on Trump’s first day:

Most federal regulations exist to implement legislation. Certainly there are regulations that aren’t working as intended, that are more burdensome than needed to address the problem, that prove counter-productive in practice, and so need fixing. But ideologues have no interest in rational governance. Anti-regulatory zeal is like religious dogma to them, but driven by greed.

Trump’s real change is to make Monopoly great again:

 

Facebooklinkedinrss

Saturday Soother – January 14, 2017

You may have noticed that the Wrongologist has not posted a column since Monday. Life intervened, as we began a to-the-studs kitchen renovation this week. Think about it, no kitchen in January in the Northeast. It’s like camping, but you sleep in your own bed, and use your own shower.

This week, the Trumpathon marched forward, with each day giving us something unique to consider, to react to with disbelief as our Overlord moves to fully take the reins of power.

The commonly accepted story is that the Russians hacked Podesta and the DNC, and that might have helped Trump defeat Clinton. Then there is the “Dossier” of possibly incriminating info that the Russians may, or may not, have on Trump. The story could be false or true, and there is no solid evidence either way.

Trump’s plan to place his business in “trust” is ridiculous, but he has no plan to abide by the spirit of a blind trust, and he’s exempt from the rules for other public servants, so deal with it.

The Democrats didn’t lose to the Republicans because of a Russian conspiracy, but because they didn’t do a good job of governing, for two reasons: First, the economy hasn’t recovered for quite a few Americans. Second, Obama’s record on foreign policy is at best, mixed and is possibly a failure.

Despite his success with Obamacare, we should remember that insurance coverage is not health care. Consider that the US mortality rate is going up. And there is still considerable economic uncertainty: Elevate’s Center for the New Middle Class looked at how much money in the form of an unexpected expense would be a crisis for ordinary Americans. Their study asked 502 nonprime (credit score below 700) and 525 prime Americans (credit score of 700 or above) how they could handle an unexpected expense. They found that:

A bill becomes a crisis for nonprime Americans at $1,400. For Primes, it’s $2,900…

160 million Americans come under the nonprime category, according to the study. That’s half of our population who would have difficulty paying for a trip to the emergency room with a broken arm. Two-thirds of Americans would struggle to cover a $1000 emergency expense. Half of Americans find it hard to pay over $100 a month for health insurance, while the average price nationally in 2017 for a bronze plan is $311 per month for a 30-year-old nonsmoker who does not qualify for subsidies. That means without subsidies, half of America is at serious risk of being uninsured under repeal and replace.

This speaks to our uneven economic recovery better than any average wage or unemployment statistics.

In short, Democrats lost to a very flawed person because they (Dems) ran the country badly for people like those in this study, and those people are upset.

If that didn’t bring you down far enough, there are just six days until the inauguration.

Wow, with all this going on, we need something to help us relax. Today’s soother is Samuel Barber’s “Knoxville: Summer of 1915“, with soprano Dawn Upshaw and the Orchestra of St. Luke’s. Barber was a 20th century American composer, perhaps our best. He was twice awarded the Pulitzer Prize for Music.

He wrote this piece in 1947, based on a prose poem by James Agee. Agee would later use the poem as a preamble to his Pulitzer Prize-winning book, A Death in the Family, published posthumously in 1957. Agee was also the screenwriter for the movie, the African Queen. Here is Knoxville: Summer of 1915:

While this feels operatic, the lyrics are in English. Here is a sample:

It has become that time of evening when people sit on their porches, rocking gently and talking gently and watching the street…People go by; things go by. A horse, drawing a buggy, breaking his hollow iron music on the asphalt; a loud auto; a quiet auto; people in pairs, not in a hurry, scuffling, switching their weight of aestival body, talking casually, the taste hovering over them of vanilla, strawberry, pasteboard and starched milk, the image upon them of lovers and horsemen, squared with clowns in hueless amber.

“Aestival” means of, or occurring in the summer.

Facebooklinkedinrss

Sunday Cartoon Blogging – January 8, 2017

Congress returned, and immediately shot itself in the foot by being against ethics before they were for them. That made no sense, even to Overlord Donald I, so Congress backed down. Then Congress got down to business: They revived a rule allowing them to reduce the pay of individual government workers, which was why they were building lists of pro-climate change bureaucrats. Now, they are working on the process for dismantling Obamacare. Dr. Pence nailed the GOP theme:

The GOP will try to baffle the people by guaranteeing “Universal Access”, to health care. That does not ensure that anyone actually has insurance:

The big story of the week was the Russian hacking. Trump was briefed on Friday. Wrongo is skeptical that it made any difference to the election result. Trump’s public skepticism that Russia was behind it is also troubling:

Don’t worry about Trump releasing any secret stuff. The hacking report is 50 pages long, so he’s not reading it. He’ll watch the declassified stuff on Fox News and tweet what he thinks:

The Inauguration is coming. It might look like this:

(This cartoon is by Marian Kamensky, Slovakia)

Once in office, here is Trump’s foreign policy:

(This is from Tom Janssen, The Netherlands)

Facebooklinkedinrss

American Exceptionalism Doesn’t Include Your Healthcare

The Republican’s effort to repeal and (maybe) replace the Affordable Care Act (ACA) began today. From NPR:

Opening punches were thrown in what one top Democrat today called “the first big fight” of the new congressional year — the promise by President-elect Donald Trump and GOP lawmakers to repeal and replace the Affordable Care Act.

The Obamacare debate is political and ideological, and it obscures a hard truth about healthcare in America. Historically, we spend more money than any other country on healthcare.

In the late 1990s, the US spent roughly 13% of its GDP on healthcare, compared to about a 9.5% average for all high income countries. However, the difference has steadily increased. Last year, as the ACA continued to roll out, healthcare costs hit 17.5% of GDP, the highest ever. That’s $9,695 per person.

We spend over $3 trillion on healthcare annually, and that rate of spending is expected to accelerate over the next decade. With all the debate about Obamacare, and what should replace it if it is repealed, we are ignoring what healthcare costs in the US, relative to other high income countries. It may surprise you that America doesn’t have better care than other high income countries, if we compare life expectancy to per capita health expenditures:

Source: Visual Capitalist

Americans spend more money, but do not receive similar results to other countries using the basic metric of life expectancy. The chart shows that the divergence started before 1980, and it widens all the way to 2014. While the 2015 statistics are not plotted on this chart, but we know that the healthcare expense in 2015 was 17.5% of GDP, so the divergence is likely to continue to widen.

The conclusion is that while our healthcare spending is considerably higher than in other high income countries, it’s also relatively less effective. If America spent more money and got the same results, we might say that our system is unique, but it produces similar outcomes, so let’s keep it the way it is.

But in fact, Americans on average live shorter lives than people in other high income countries. In fact, life expectancy went down in 2015:

The overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer’s disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide.

We have a broken political system, one that cannot deal with the root cause of our expensive healthcare, or the fact that our healthcare system simply doesn’t produce the results that others can.

Despite the talk by Republicans about Obamacare being socialized medicine, our system is private, with the exception of the health insurance provided by Medicare and Medicaid. Our insurance companies are private, our physicians and providers are private.

By some estimates, the private multi-payer system in the US adds $0.38 for every dollar spent to cover the profits and the discreet management organizations that exist in our multi-payer system. The problem is that there is so much money (over $1 trillion) going to the private players, that they will fight like hell to keep the system as it is.

And they have the lobbying funds available to fight to keep the status quo. Thus, we will continue to deal with excessive costs regardless of no Obamacare, or some jury-rigged GOP Obamacare replacement.

In our Exceptional system, the fact is that even though you pay for health insurance, you are not the actual customer. When you go to the doctor or to the hospital, you are not the actual customer. The Insurance companies are the true customers of the doctors and the hospitals, and for the insurance companies, their shareholders are the true customers.

And before you question the statistics, saying for example, that the US counts infant deaths differently than they do in other countries, the infant death rate in the US is about 0.5% of births, and with about 4 million births in the US that translates into about 20,000 infant deaths. If you remove 20,000 people assigning them a life span of zero, in a country of 320 million people, the overall average life expectancy rises by only 1.81 days (43.4 hours). That is the statistical life span increase assuming we had zero infant deaths. (Please check Wrongo’s math).

Higher infant death rates have virtually no effect on the results shown on the chart.

Remember: Whomever is getting that extra $1 Trillion dollars every year has a trillion reasons why they should keep getting it.

Facebooklinkedinrss