Saturday, April 1, 2017

Understanding the Ryancare Play

When it comes to health care reform, there most certainly is a right thing to do.  But those guys in Washington are clearly launched in a very direction.  So what's that about?
Ryancare was fundamentally flawed because it accepted the basic leftist premise that government should be responsible for individual health care.  This is wrong, both morally and practically – morally because nationalized health care corrupts everyone it touches, and practically because it's ridiculously expensive.
The Canadian situation is typical in its illustration of the moral issue.  Canadians are under enormous and unrelenting media and government pressure to praise the national health care emperor's shining halo and glorious clothes when, in reality, the system is terribly expensive and often ineffective; disenfranchises millions; and can, at best, be said to work most of the time for most of the people.
  1. Services are rationed, with the average waiting time between initial diagnosis and non-emergency treatment now in excess of 140 days, with almost a million Canadians on waiting lists.
Since paying for services directly is, except in relatively limited circumstances, illegal, someone who needs a service is, by law, unable to buy that service in Canada until the system gets around to providing it.  Since many of the rationed services are tests or specialist judgments based on tests, and the system won't take action on issues that can be seen as related to those tests or judgments pending their outcome, placing those affected on waiting lists effectively suspends their access to the services they need just when they need those services most.
  1. The system works well for routine, easily scheduled, and widely understood services but essentially abandons those with ambiguous (or under-funded) problems until they recover naturally.  The problem morphs into something easily recognizable and funded within the system, or these people die.
Bureaucracy can neither tolerate nor accommodate TV's Dr. House: quality of care is de facto determined by the extent to which the problem is familiar to the first gatekeeper (usually an emergency or family physician) the patient encounters.  Thus, a friend who, forty-plus years ago, spent six years jumping out of airplanes is now feeling the consequences in his neck and upper back, but his MRI, ordered by a family physician in October of last year, isn't scheduled until August of this year – and, because I'm fairly sure the microfractures and membrane tears that are now starting to bother him won't be obvious to a bored tech babysitting a one-tesla unit, he's very likely to find himself expeditiously, efficiently, and very compassionately abandoned to over-the-counter painkillers.
  1. People who are neither rich nor politically visible but think they are the victims of malpractice have no practical access to either legal recourse or the information they need to determine whether the system served them properly or not.
  2. Health care costs are largely hidden within the general tax system.  Thus, free health care for roughly thirty-six million Canadians costs each of them about $4,700 (USD) per year – mostly collected through taxes and increases in the public debt.  Thus, gasoline produced in Alberta costs people working at the refineries in Fort Saskatchewan more than twice what it does after it's shipped to Montana.  This year's increase in Alberta's public debt is budgeted at around $1,850 (USD).  And most Canadians pay a 15% retail sales tax on just about everything.
Basically, "free" health care for a Canadian family of five costs that family an average of about $23,600 per year.
Trump and his advisers may not know how misleading advocacy claims (and the OECD numbers) on nationalized health care quality and cost really are, but they have been dealing with the VA example and its problems since the campaign began, including uncontrolled cost escalation, lengthening waiting lists, increasingly inadequate care, depersonalized treatment, and the suppression or distortion of both cost and quality information.  These are typical of nationalized health care everywhere.  As a result, it's difficult to believe that Trump's people would want to go along with the policy ideas and key assumptions built into the Ryancare proposal.
Less rationally, Ryan is the GOPe leader
And yet an administration that both has to know better and has personal reasons to oppose anything Ryan seems to have pulled out all the stops in support of Ryan's plans.  Why?
My theory is that what Trump did made Trump look like an apolitical team player willing to work with his political enemies for the public good, left Ryan walking roadkill run over by the bus he aimed at conservatives, and is the first major step, something akin to firing a flare over a swamp at night, in a plan to rebuild the Democratic Party by making its hypocrisies obvious to everyone.
In this view, the long-term effect of the Ryancare debacle will turn out to be the light it shines on the Washington elite, because the GOPe has just shown itself to represent the values most Democrat voters think their party stands for, the Freedom Caucus and their colleagues have shown themselves to be mostly genuine republicans, and the cabal in control of the Democratic Party has shown itself to be little more than a gathering of convenience for America haters-ranging from simple crazies like Maxine Waters to the man who would be Kalif and various servants to the über-rich – like Schumer and the Clintons.
It will take further increases in acrimony, leftist violence, judicial abuse, and the operation of uninformed rhetoric for Trump and his political operatives to fully separate those in control of the Democratic Party and its media from their audience, but we're already seeing unease among the grassroots and a market pullback as the über-rich start to understand that Trump is for real – and once the traditional balance between the elites and the middle-American Democrat voter reasserts itself, nothing will stop them until people like John Brennan are in jail, Obama is discredited, the Democratic Party once again welcomes people like Joe Liebermann, and America can safely be American again.


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