Scott Adams wrote another interesting post this week, proposing that, because congress has proven incapable of acting to create a better healthcare system, it’s time for the people to step in their place. Here’s how he began:
We the People of the United States elected a populist president to go to Washington DC and make the changes the people want. Sounds good on paper.
Unless the people don’t know what they want.
That’s the situation with health care. The public doesn’t have any majority opinion on what a comprehensive plan should look like. The topic is too complicated and the public is too uninformed. We sent President Trump into battle unarmed. If We the People find a way to tell our president what we want, I have confidence he can help us get it. But if we don’t know what we want, our populist president has nothing to sell. That’s our situation today. We elected the world’s greatest salesman and gave him no product to sell to Congress.
He has a point. Most people want to “fix” healthcare, but the issue is complicated and confusing (perhaps deliberately so), so they can’t really get behind a healthcare plan that goes beyond labels, word-thinking, and confirmation bias. “Free market,” “single payer,” “big government,” “insurance,” etc. all serve to obfuscate the issue more than clarify it, and prevent anything meaningful from getting done. It’s part of why Obamacare became such a terrible mess.
Also, any solution that comes to healthcare is going to have to give people on both the left and the right something that they want. This issue is so personal and so contentious that both sides need to have a way of saving face. They also need to alleviate the risk that this would pose to them through bad branding (like Obamacare turned out to be) and give their opponents some of the credit for getting something done (right now, there is a paralysis in Congress on many issues because neither side wants the other to look good – a hallmark of the late Roman Republic).
So without further adornment, here are a few things that I think can be done on healthcare.
1. To immediately resolve the branding issue, you have to name the bill after both sides somehow. This means that both sides will have to own it entirely so they have an incentive to do something good. This also means that both sides would accept that they will share credit and risk with the other from the get-go. The outcome would thus either be very good or very bad for both sides instead of just one. Maybe you can name it something like the “Bipartiasn Healthcare Reform Act,” or whatever.
2. Start with what President Trump campaigned on. Allow sales of health insurance across state lines to end the monopolies and allow a national marketplace to flourish. This is hugely popular among Republicans (or so they say).
3. Another hallmark of Trump’s campaign was to allow drug imports and permit the government to negotiate on drug purchases for its own programs. This drives down costs and is very popular with Democrats.
4. Those currently with pre-existing conditions should be covered by medicaid, proportionate to the costs of care for the condition that needs to be treated (cancer is probably more expensive than something else). In the words of one commenter at Scott Adams’ blog “no sane insurance company would want to provide coverage to someone who is guaranteed to need it.” This is the chief reason why costs for everyone else have skyrocketed so much. Obviously, this would be a huge victory for the Democratic side of the equation, so you need to balance it out with a win for the Republican side.
5. Block grant medicaid to the states. It’s been a popular Republican policy prescription for a long time. Let the states take care of their own people (subject to some minimal federal guidelines), the people they know best. If a change in the entitlement comes in the new bill, then a change in its administration should also, which would give the Republicans a concurrent win. To make sure the program works as intended, have a sunset provision which forces the issue to be brought up for renewal and debate every 10 years.
6. End the mandatory health minimums from Obamacare. People need to be able to choose their own healthcare plans. I don’t need to pay for ovarian cancer screenings and women don’t need to pay for prostate cancer. This is a huge reason why insurance costs have skyrocketed since Obamacare and it needs to end. Let people buy the plans they want. Also, for those who may develop pre-existing conditions in the future (but too late to get medicaid in most instances from point #4), adopt the rump Obamacare plan of one per state that Ted Cruz and Mike Lee are floating around.
7. Tort reform to make it harder to sue doctors and hospitals for not performing unneeded tests. The only people that don’t benefit from this are trial lawyers and grifters (they’re often the same) and it was inexcusable that this wasn’t part of Obamacare.
8. Legalize marijuana. There is no reason why this harmless drug should be illegal. It also works better and is cheaper than many drugs prescribed for many conditions. I know this second-hand because a friend of mine suffers from fibromyalgia and the marijuana would work better for her condition and cost less than the drugs she’s taking, but she can’t get it. That isn’t healthcare. This would make for a major victory for the more left-leaning part of the country, so conservatives would need something in return.
9. Reduce and streamline FDA regulations to let drugs get to the market faster. If a drug is already approved in another advanced, industrialized area like Europe or Japan, waivers should be granted. President Trump proposed this in his speech to congress earlier this year and it would make for an equally laudable conservative victory that balances the marijuana part of the equation.
10. The biggest part of the solution might be the one that’s getting the least attention, and that’s preventative care. Healthcare, by design, is structured to meet crises that have already happened, but it’s a good idea to manipulate time and go backward to prevent as many of those crises from occurring as possible. In whatever way possible, preventative options should be incentivized.
For instance, America is the most obese nation in the world. This can’t be good for healthcare. While the country has done a very good job of reducing and even stigmatizing smoking, we still have a long way to go with obesity. One option would be to give tax credits for middle and lower income people for gym memberships and maybe even healthy, organic, nutritious food. While the more conservative people my chafe, recall that the government is basically doing the opposite now by subsidizing corn syrup – and those subsidies should be gotten rid of as soon as possible, by the way.
On the flip side of the equation, I’m not against Pigovian taxes on sodas and other junk (I used to be, but saw that the case for these taxes is strong). These taxes would force people to pay for their own unhealthy habits (much like they do now with smoking) and ultimately save programs like medicaid money, which means that people who make healthier choices aren’t subsidizing the ones that don’t. Though obviously, these taxes should be done at the state and local level, not the federal one.
And so there you have it, a relatively bipartisan healthcare plan that lets everyone look good, gives both sides things they want, and shares the risk between them. If you have anything to add, say something below.
Persuading your opponent to your point of view is easier if you make him look good. Read Stumped to learn how to do that.