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Trumponomics Will Fail and So Will Repeal/Replace
Actually any economic policy we have will fail. Treasury Secretary Mnuchin has stated that Social Security and Medicare won’t be touched now but that the regulatory reform and tax cuts will stimulate business, thereby helping with our debt long term. The surge is supposed to make all the Mnuchinkins happy in Lollipop Land.
I am positive that Trumponomics will be massively better than whatever the socialist party would have given us so I do expect short term gain but also the usual avoidance of needed pain. No one meaningful is willing to take one on the chin so our enormous economic mess will be another four years down the road until someone discusses fixing it.
This may seem simple to the Ivy economists, but I know I’m right. Without massive entitlement reform (SS) or removal (Medicare/Medicaid), we are economically doomed.
Repeal and Replace is going to fail too. Only by destroying the entire pricing structure of medicine and letting the free markets sort it out will that problem ever be fixed. The medical insurance industry needs to be destroyed too and started over. Too much dysfunction to overcome. A national health system with all its massive problems (free market on the side) would be better than what we have now if the pricing structure is obliterated.
This may seem simple to the Atul Gawandes and Avik Roys of the world, but I know I’m right. The system is beyond reform unless the entire pricing structure and medical insurance system is scrapped.
What should be done? Simpson-Bowles on steroids.
National televised hearings on our economic mess with direct discussion about the fiscal insanity of runaway entitlements.
National televised discussions on medicine from every perspective. We need to educate our country about the most critical domestic problems instead of letting the GOP, the Democrats, and everyone else hide the unpleasant truths.
Published in Economics, Healthcare
The medical insurance industry needs to be destroyed too and started over. Too much dysfunction to overcome
And they’d deserve it for getting into bed with Obama. A pox on all their houses.
I did a spit-take reading this and I wasn’t even drinking anything. I’ll never be able to watch this movie the same again.
Deliberate or typo? I’m hoping it was deliberate, though perhaps you should have said “Simpson-Bowels on ex-lax.”
Is there a model out there that you think would both work to accomplish this and that is palatable to the electorate?
This problem didn’t start with Obamacare, this problem started back in the 50s with the special tax treatment of health benefits.
I was thinking Doc was implying that the solution would be a pretty crappy situation. So to speak.
I wish I could blame it on something other than error. Maybe tie it in with prednisone therapy for inflammatory bowel disease somehow.
Everything will fail because there is no agreement on what success means. Nor enough common destiny for there to be a common success.
Maybe Switzerland. Taiwan, Japan, Australia, and a few other countries make it work for much less but the expectations of the citizenry are less. Anything will work better if we destroy the pricing structure. What will happen instead are some tweaks with insurance lobbyist approval except maybe the state line competition issue which will hopefully be gone.
Yeah, Alan Simpson and Erskine Bowles would probably concur with this completely. :-)
Nothing started with Obamacare but the president’s people, Reid and Pelosi, got in bed with every special interest which added massive accelerant to an already burning structure. It’s a Gordian knot of dysfunction impossible to undo.
I wouldn’t use the Australian model – the bifurcated payment system of public/private care still preserves some perverse price incentives. The Taiwan system is just straight up socialized medicine based on my experiences with it – there are a lot of perverse incentives for doctors to order treatment just for the sake of treatment. Have you taken a look at the Singapore model?
Of course, but if we think only in terms of Obamacare we’re not going to solve the actual problem. The problem runs much deeper.
I didn’t SAY that. I meant only that the insurance companies colluded with Obama and made everything even worse.
I wouldn’t like those either for multiple reasons. Yes I’ve reviewed Singapore.
The key to a national system is to have free markets outside the system direct the pricing costs rather than pricing from inside the system. Problematic.
I’d rather return to free county hospitals and a private system for anyone who can afford it, which should be most people. The only insurance I’d like to see stay is catastrophic care. HSA’s obviously can have a role too.
Where’s the graft in that?
Good point. My dream has lobbyists who bribe and those politicians who accept bribes being wood chipped but that’s such a slippery slope. It’s slippery because I put exit pipe on the edge of a slope so the red wet shredded bits cover it. Super slippery slope.
This is a truth.
Thoughts on that model? It happens to be one of those I find most likely to succeed in driving down costs.
Mandatory HSA like account seem worthy but problematic because of the mandate. I suppose the same with government price controls. I was looking in to a position at Raffles hospital there at some point in the past. The country is proud of their efficiency.
Dr. Jay,
Absolutely only the free market can sort this out. It must be torn down, burned up hacked to death. Massive, special interest dominated, bureaucratic politically sensitive, completely non comprehensible programs cannot be reformed. I’m not sure we can wait too long as we’ll need to cut lots of fat and deregulate massively to get the economy ready to handle entitlement reform but only SS can wait. Not health care.
Jaime L
Don’t you think the population will widely support real change once it’s done and working. They will Never support a priori reform presented in big pieces in all its complexity. The Democrats and their media will destroy anything complex enough to be lied about. Get it right. Get it really simple, and sell the hell out of it. it can be done.
My ideal system would be free markets, free to cheap county hospitals/clinics, a healthier population with realistic expectations and no tort lawyers ;-)
Really, it will continue to be screwed until we peel back to the root of problematic pricing in the modern medical era: malpractice litigation. With Bill Paxton recently gone, this is difficult to broach — but I see a huge drop in insurance costs if people and their families agreed that the 20 – 40% chance of things going terrible or worse includes them. I have no idea how to monitor physician malpractice, but restoring that confidence and trust would be a huge, if currently under-appreciated boon.
Burn it all down.
Or, you know, this.
Ha!
I see the mandatory HSA system no different than previous conservative proposals to eliminate Social Security – as long as the accounts and funds are under the control of the people I see no problem.
Doc, I saw an article in the WSJ today about “Direct Patient Care” – an offshoot of the concierge option. They profiled a PCP in Boston, among others. They see it as up-and-coming, but the PCP interviewed fears a shortage of doctors in general medicine will hamper wider use of this sort of model. Your thoughts?