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Healthcare continued …

from Peter Radford

Nothing could possibly give us more insight into the ineptitude and unpreparedness of Trump for high office than his comment yesterday:

It’s an unbelievably complex subject. Nobody knew health care could be so complicated.”


Everyone knew. Everyone.

Except for Trump who has blithely been assuming that his bully-boy attitude could translate easily from his real estate business into the White House. He, like a lot of others in recent years, reacted to the gridlock in Washington by arguing we needed a bold business like period of “action” to solve our national issues. We did not need anymore “talk”. All talk and no action is a criticism Trump levels glibly at anyone who appears to want to reflect before doing or saying anything.

So it is with health care.

During the presidential campaign Trump promised the earth. According to his many statements on the topic no one was going to lose coverage, prices would fall, people could keep their own doctors, and all this would delivered by a private rather than public mechanism. He said he was going to eliminate the dreaded mandate aspect of the Affordable Care Act [aka Obamacare]. This was the crucial part of the three legged stool approach in the ACA that lowered average insurance premium costs. Unfortunately it raised them for healthy people and lowered them for the sick, and it was the subsequent uprising amongst the healthy that so motivated the Republicans. This was, of course, over and above their ideological objection to anything smacking of governmental intrusion into the purity of the free market.  

The Republicans have been calling for the destruction of the ACA ever since it was voted into being. They have been passing legislation calling for its repeal with regularity — all the time knowing that Obama would veto any such attempt.

But here we are: since they control all branches of government the Republicans can now carry through with their threat. Their leadership promised urgent and early repeal to their rabid base of supporters. It was, we were led to believe, their number one priority ranking even higher than their promise to reduce taxes for the rich.

That sound you hear is the silence surround their efforts.

It now transpires that Trump had no idea what he was talking about, and is only just getting an inkling of the difficulties surrounding a health insurance program based on private market delivery. Any such program is riven through with contradictions unless, and this is the pivotal point, legislators are prepared to cut millions of people adrift from health care coverage. If the Republicans were willing to roll back the triumph of the ACA and its extension of coverage to the well over 20 million people who previously had not been covered, they could easily forge ahead. It would be an act of enormous callousness but not wood be consistent with their anti-social pro-individual ideological stance. Under that stance anyone without health care coverage is to blame for their own inadequacy and it is not the proper role of the state to compensate for that inadequacy.

The Republican mantra is, in this sense, straight out of the Hayek and Friedman playbook: “everyone gets what they deserve”; and if you have failed to get health care coverage you must, by definition, deserve not to be covered.

The social democratic mantra is, in contrast: “everyone gets what they deserve” implying a socially cohesive policy stance allowing for the public provision of health care because all citizens deserve it. They are, after all, equally citizens.

The problem currently undermining the Republicans is that their ideology prevents them from caring about their fellow citizens and so providing coverage to everyone. The idea of full coverage is contradicted by the need to prevent state coercion. Since the latter is needed to ensure the former the whole idea of full coverage through a private market collapses. It cannot be done.

Apparently neither Trump nor his key advisors had thought this through. Hence his ridiculous claim that nobody realized how complex health care policy making is.

Everyone knew.

Except Trump: What an amateur.

  1. J Ruivo
    March 1, 2017 at 9:55 pm

    His “nobody knew” lie is a direct insult to everyone engaged in the issue and the public at large. The constant and unending lying is infuriating.

    And your analysis of the incompatibilities between the Republican stance and what was promised is spot on.

  2. patrick newman
    March 2, 2017 at 11:44 am

    Whatever Trump does about replacing ACA you can be sure it wont be driven by compassion. The fact that roughly 17% of GDP is spent on American healthcare – about double that of the UK – appears to be of little concern to Trump and and his newly acquired Republican acolytes!

  3. March 2, 2017 at 12:50 pm

    The foundation of the dispute is revealed in a simple statement by Speaker Paul Ryan in the Washington Post. Ryan was obviously upset after being hammered repeatedly about the Republicans’ intentions regarding the ACA. He summed his anger by saying that with the ACA Americans aren’t free, and that freedom is the first objective. For Ryan and a lot of Republicans there is no acceptable level of government “coercion.” Hayek uses the phrase “without restraint” to describe the kind of freedom he supports. This is, of course ridiculous, since life is always restrained. The real issue in healthcare and most other areas is not how to remove restraints but rather how to pick the restraints that address problems successfully with the fewest side effects. This is hard work. Something Ryan and most Republicans have never experienced.

    • March 3, 2017 at 12:05 am

      In Hayek’s ‘ideal’ world, the rationality of individuals creates personal self-restraint. Ironically, however, he requires, er, coercive law merely to uphold contracts.

      Freedom without social restraints on that freedom can be found in Somalia … an ideal libertarian ‘state’ without a state.

      • March 3, 2017 at 12:23 pm

        Or, in the words of the song “Me and Bobby McGee”: Freedom’s just another word for nothin’ left to lose
        Nothin’, don’t mean nothin’ hon’ if it ain’t free, no no

  4. March 2, 2017 at 2:13 pm

    “The problem currently undermining the Republicans is that their ideology prevents them from caring about their fellow citizens and so providing coverage to everyone.”
    The problem is that Pres. Trump does not realize…the established Republican ideology
    is directly opposed to…’Give The Power Back To The People’.
    Trump must Drain The Swamp of those who would seek their own political agenda.
    They must be informed “Do Your Job”, Nov. 2018 and Nov. 2020 are not that far away.

  5. Grayce
    March 2, 2017 at 5:40 pm

    To engage the more bookish background of economic philosophy, and replace the rhetorical and ideological argument that “we believe it because it is ‘a conservative principle'” (to quote Rand Paul), one could read a short passage from E. F. Schumacher in his book, “A Guide for the Perplexed.” He points out that opposing forces at the gut-level are usually reconciled by a higher order.
    The present controversy can be overlaid on one of his examples: justice v. mercy. Perfect justice (Republican, Conservative) would allow the strong to prevail over the weak, and an eye for an eye, or getting what you deserve, would rule. On the other hand, perfect mercy (Democrat, Sanders, Liberal) would divide everything in equal shares with or without effort, eventually displacing the incentive to work harder or try to improve one’s own lot.
    Schumacher proposed that a third corner be considered: wisdom. In that scenario, an injustice occurs when the strong can overpower the weak, well, without mercy, and wisdom knows the difference. Likewise, perfect mercy is tempered with practicality, and wisdom knows when to apply the difference.
    So, considering that ideology can operate as a “mind-forged manacle” (William Blake) that removes wisdom from the picture, and a bleeding heart can operate as “blinders” that remove wisdom from the picture, who or what stands for wisdom?
    One area to look for an answer is in an expectation of the “nonpartisan” judgment of legislators, executives and justices; to not advocate for “bi-partisan” anything; to interpret the oath of public office to mean that party hats are not allowed inside the House (or Senate).
    We, the people, are getting what we deserve. We follow politics like a sport. We choose sides and maintain our identity even after the game (election). We fight during the term of office over every opinion poll. We oppose policies based on the person sponsoring them. We lazily or unknowingly allow a party to set our personal agenda. We like “clubbiness” with fellow party people, lobbies, and special interests. We do not make an effort to teach our children how to separate slogans from analytical conclusions.
    We, the people, honor business economics over social economics and abdicate to people with visible success in material accumulation. We give voice to legal fictions and choose money as voice, whether as contributions or as the “public purpose” of eminent domain. We collectively choose leaders who promise to give us more and take less back in determining our fair share of anything.
    So, where is wisdom today. Who has it? Who claims it? Who has witnessed it? Nelson Mandela? Pope Francis? Donald Trump? Kanye West? Joe the Plumber? Meryl Streep? Neil Gorsuch? And, is nonpartisan service possible in the modern world?

    • March 2, 2017 at 7:22 pm

      Great Quote,”So, where is wisdom today. Who has it? Who claims it? Who has witnessed it? Nelson Mandela? Pope Francis? Donald Trump? Kanye West? Joe the Plumber? Meryl Streep? Neil Gorsuch? And, is nonpartisan service possible in the modern world?”

      ***** “Believe nothing merely because you have been told it…But whatsoever, after due examination and analysis,you find to be kind, conducive to the good, the benefit,the welfare of all beings – that doctrine believe and cling to,and take it as your guide.”- Buddha[Gautama Siddharta] (563 – 483 BC), Hindu Prince, founder of Buddhism

      A HISTORIC CHANGE For The Betterment of The People.
      Allow everyone to achieve “The American Dream” and to retain their “Fair Share”

      Yes,”It’s a very exciting time for America.”
      Give the power back to the People
      Their voices represent a bright new future for our great nation full of more opportunities for everyone, not just a select few.
      Together, we can create a movement that continues to gain momentum.
      Together, we are making history. Together, we are bringing back the American Dream.
      The time is now, Together, we will Make America Great Again!”

      The U S Constitution has structured this union
      so that the Chief Executive Officer, CEO (The President)
      is responsible to its Board of Directors, BOD (The Congress)
      and with its Chief Compliance Office, CCO (The U.S. Supreme Court)
      shall work together “…to form a more perfect Union , establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity,…”

    • March 3, 2017 at 12:43 pm

      I wrote an op-ed a few months ago arguing that the push to get rid of the politicians is both counter productive and its pursuit is the root of many of current problems. Politics is the practical art of the possible. Practiced correctly it involves justice. mercy, wisdom, and practicality about what can be done and what cannot be done. It is messy, often involves detailed compromises, and per the old saying, leaves everyone involved dissatisfied. That Trump never understood politics or how to practice it made him a poor businessman. He could only fall back on lies, deception, and an endless assortment of huckster tricks. Why would anyone expect this to change when he became President?

  6. Jeff Z
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