Red pills, blue pills, black pills and white pills. The dissident sphere talks of pills often. Take a pill and you behave a certain way. One pill that is often overlooked is the debt pill. The Zero Hedge crowd pays attention. The folks who know the FED’s decades long zero interest rate policy has locked us into problems if/when rates normalize think of debt. The Medicare and Social Security bankruptcy pills are large. Health care needs to be addressed in any populist conception of the path ahead.
Let us laugh at the Medicare-For-All people. I doubt the lawyers will give up their lawsuit cash cow by approving tort reform. I doubt we save a penny by switching to it, and in any case, if we do not shut borders, Medicare would just go broke. We do not have to wait for immigration effects since it shall go broke by ’26. Like Social Security’s impending bankruptcy, it is not broke but the benefits will be reduced if the government does cut payouts to doctors and clinics for Medicare users. This means premium and tax increases, and since Medicare will pay less for healthcare use, all other users will have to pay more to make up the overall shortfall.
We can fix this very quickly. We can offer the Singapore solution as American Affairs described it. Private insurers cover smaller health care consumption while the government handles catastrophic risk. This makes sense and acts akin to high deductible plans that working Americans have been enduring since Obamacare passed. There is the Australian system which has public and private hospitals and can work. The Swiss also have a fantastic system that due to the cantonal structure fits a bit like our state patchwork within the United States. These are easy fixes because the biggest bad guys of them all are insurance firms, so that is a great first target. The fear of dying in the streets over a catastrophic item is a great fear to alleviate.
This cannot work. I am sorry. It is not that easy. It is not the schemes as the models listed above do work. It is what health care is. It is a product for sick people. What we are talking about for schemes is insurance, which is the spreading of poor health risk by communal sharing of resources. The Americans who turned out for health care in the ’18 midterms are sick, often obese, people who are petrified that their sick care may be altered. They are afraid of change and clinging to the government support that they feel they desperately need. Now add a dash of multiculturalism to this and you see the coming problems: disparate outcome of health care consumption and communal sharing that leans heavily on the dwindling number of productive American citizens.
A populist message would be that a grand bargain should be struck of installing some form public/private health care with an immigration shut down and repatriation of recent arrivals. Catastrophic insurance should be paired with private supplemental products. Public insurance only hospitals and clinics meet minimum specifications but if you want the Cadillac hospitals, you must have the insurance or cash to pay for them. You will need the private supplemental insurance to placate the big insurers who are the ones that crafted Obamacare. The Obamacare Faustian bargain was insurers put Democrats in power to insure their poor underclass with the assumption insurers would manage what was in effect a mandated, nationalized health care system for a nice profit. Insurance firms forgot that they are still a boogeyman for the Democrats and their media. The Democrats are Mephistopheles here because they could always knife insurers in the back to just put in single payer and nationalize them. This new populist arrangement puts the gun to the insurance companies heads and say, “it’s this or elimination for you the moment the left can“.
This is an easy fix but you know where this leads in media news blurbs and academic studies in ’28 or ’32. Markeesha suffered the indignity of sharing a room for her delivery with Esmerelda and Katelinne at a public neonatal unit, while Aidan and Ava enjoyed solitude in a room with a hot tub delivery in the private hospital. Oh golly, the public hospitals have worse doctors (who look like the patients) and shuck, people die. You know this would happen.
It is also the only way to fix things. If you have had a child in the last decade at a new or advanced maternity ward, you have seen the dregs of humanity having a kid and consuming the same services as you. Now Cigna, Aetna and Anthem may cover your expenses and you share the cost by forking over a few thousand, but do you think the Medicaid payments for the same services are close to your private insurance negotiated amount? In some states, the gap is small, but in others, sorry, nowhere close. Ibuprofen cost you $50/pill for a reason.
This is just the easiest of examples of what we need to fix and the media described problems that a rational fix will create. A two tier system has to come. The ignorant do not know it, but it is here now. The rise of concierge doctors is creating a bifurcated primary physician market for consumers. That financial hurdle keeps a lot of the best doctors out of reach already for the lower classes. Doctors are another spot to reform as the medical school slots have not been expanded in over 30 years yet we have grown by tens of millions of patients.
As a nation, we can talk about all of the fixes, tweaks and reforms that could alter costs here or there. We will not grapple with any of the big issues. Different outcomes must be accepted. We have to be honest about the obesity problem and revamp our entire point of view on diet and nutrition. We have to stop the immigration flood and accept that a system forever importing people and providing them free health care is just a government gun enforced Cloward-Piven mechanism. How many people will burn with anger if their parents are denied care so that a Somali’s cousin-wife gets proper care for their inbred child? Newsflash: the underclass already gets what it wants as no one gets denied care in America and if they can’t pay it, it goes to collection agencies which they never pay. A credit score ding? What does that matter in the ghetto?
This is less about the detailed policy pieces but more about the conversation and framing of things. As some red states showed, they had an appetite for expanding medicaid. Those states (Utah, Idaho, Nebraska) all have very high Medicaid to private payment ratios, meaning no drop off for providers who accept Medicaid, and those states are also all very racially homogeneous. It is a bit easier to extend socialism when you feel kinship to those poor souls that need the help.
A broad catastrophic federal solution tied to a large competitive field for private insurers given the flexibility to design products and meet different markets and demographics needs would work. Companies can use technology for product design that would make near individual policies for demographics that they can now track and trace due to big data collection. The devil is not in the policy details or execution of the schemes. Like every other problem in America, the problem is in the clerisy spotting an inequality somewhere. This is why wrapped as a populist package and tied to ending immigration, this can set up a policy framework that works for all Americans.