The View from Right Field

#MedicareForAll – How It Will Really Work

While New Zealand has been in the news for other reasons lately, a hearing before the health select committee of the New Zealand Parliament last week should be of interest to those who think “Medicare for All,” or some other form of government-run single-payer health plan, is the answer to our problems with health care.

At the hearing, women with advanced breast cancer asked for pressure to be brought on Pharmac, the government-run drug-buying agency, to fully fund two additional drugs for breast cancer, Kadcyla and Palbociclib (also known as Ibrance).

The pleas of the women were very moving.  One of the women said that Ibrance was a “game-changer” in other countries for conditions like hers.  She asked why women in New Zealand had to travel to Malaysia or move to England or Australia to get access to cheaper life-extending drugs.  Another woman said that she was alive only because she had paid for the drug herself.  “This would … be impossible if I had to rely on Pharmac.” 

Obamacare’s Elusive 60th Vote

Democrats complained a lot about the way Republicans passed the tax bill.  Megan McArdle explained¹:

“Last week, as you may have noticed, Republicans passed a tax bill.  As you may also have noticed, Democrats were aghast.  Passing a bill like that on straight party lines!  Using a parliamentary maneuver to push through something that could never have survived a filibuster!  How could Republicans be so brazen, so immoral, so fiscally irresponsible?

Those of us who remembered saying many of the same things during the passage of Obamacare had to beg them to stop.  I mean, we could have been seriously hurt, laughing that hard.”

In addition to the things Ms. McArdle mentioned, there were complaints about how Senators Bob Corker and Mario Rubio agreed to vote for the bill at the last minute.  Democrats complained Senator Corker had abandoned his concerns about the deficit, and Senator Rubio was bought off by a last-minute change to the family tax credit.  Of course, in making those complaints, the Democrats forgot about the Cornhusker Kickback and the Louisiana Purchase that got Senators Ben Nelson (of Nebraska) and Mary Landrieu (of Louisiana) to vote for Obamacare.

What Goes Around Comes Around: The Obamacare Version.

Donald Trump couldn’t get Congress to do what he wanted on Obamacare, so he has issued an executive order to try to accomplish much the same thing.  Hmmm.  I wonder where he got the idea to do that?

Medicare for All (Or At Least More): Will It Mean Political Campaigns Based on More Knee Replacements?

Democratic Representative John Conyers, Jr., from Michigan has introduced a bill that would allow anybody, of any age, to buy into Medicare.  The theory is “everyone loves Medicare,” so why not let people buy into it if they want to.  Last year Hillary Clinton proposed letting people over 55 buy into Medicare.

Megan McArdle explained the problems with this idea.  Among others, there was this:

“If we followed Clinton’s plan, and lowered the Medicare eligibility age, one effect would be to take some pressure off Obamacare’s exchanges, by moving the sicker and older patients out of the pool.  But that cost has to go somewhere, and where it’s likely to end up is in hospitals, as their patient load shifts dramatically toward lower-reimbursed Medicare patients.

If Great Britain’s NHS Is So Good, Why Are There Ads for Private Healthcare?

Supporters of single-payer healthcare in the United States often point to Britain’s National Health Service as a model of what we should have.  There are many reasons why that is not so, but today I just want to ask one question.

When we were in England last month, I noticed ads in the newspapers for private health insurance.  Here is one from the May 5, 2017 Evening Standard in London:

My question is as stated in the title of this post: If the NHS is so good, why are there ads for private health insurance?

The CBO and the “Give-Me-a-Number-I-Gotta-Have-a-Number” School of Decision Making

The Congressional Budget Office has issued its numbers for the Republican substitute for Obamacare – and the numbers don’t look good.  The Wall Street Journal editorial page has gone into some of the problems with the CBO’s numbers.¹  A lot of the problems relate to the strictures within which the CBO has to operate.  The CBO only looks at the next ten years.²  They have to assume programs will sort of actually work like they say they will work.  They can’t ignore provisions that are obviously never going to come into effect because Congress will change them.³

All of which reminds me of an executive where I used to work.  He would say to this one guy, “I need a number.”  The employee would give all kinds of good reasons why he couldn’t give him a good number.  He hadn’t inspected the property.  He hadn’t looked at the local market.  And so on and so on.  But the executive, who was actually the Executive Vice President, would yell, “I don’t care.  I need a number.  Give me a number.”  The employee would eventually give him a number.  And the Executive Vice President, even though he knew that the number was not based on good information and that he only got the number by yelling at the employee, would use the number in making his decision.

Whither Obamacare: Will It Go Away Even Without the Republicans?

With Republicans controlling both houses of Congress and Donald Trump winning in November, those who dislike Obamacare wanted it repealed – now.  Doing so, however, is taking longer than some people would like because Republicans in Congress don’t agree on what should replace it.  Still, it has only been a month and a half since President Trump took office, so I’m not sure people should be panicking yet.  After all, look how long it took President Obama and the Democrats to get Obamacare passed and implemented (assuming it is fully implemented even now).

One of the interesting things about the debate over Obamacare is that approval ratings for the ACA seem to have increased in the last few months.  As the title of a post by David Post at “The Volokh Conspiracy” says: “You don’t miss your water till the well runs dry” (following, I assume, on a song by William Bell).  This may be because Obamacare is now being compared against other plans, or at least features of other possible plans, as opposed to being looked at by itself.  Also, there is a lot of talk about how people who have insurance under Obamacare might lose it under one or more of the Republican plans. 

Do We Have a Dysfunctional Congress – Or a Dysfunctional President?

As the presidential campaign heads into the fall, I assume President Obama will be out campaigning for Hillary Clinton and other Democrats.  And I assume he will spend a lot of time complaining about the “dysfunctional Congress” that he has had to deal with and that has frustrated his efforts.  Except, I am not sure it is only Congress that is dysfunctional.  It might be the President, too.

President Obama likes to say he was elected twice by the American people to deal with our problems.  It is certainly true he was elected twice.  And the first time he was elected, a Democratic Congress was elected, too.  The problem for him was it didn’t last long.

A Tale of a Seagull and the Affordable Care Act

We were at our condo in South Haven last week.  While walking on the beach, we saw a seagull hopping on one leg.  It must have hurt its other leg.  Later, as we walked back the way we came, we saw the bird again.  He/she/it was in a group with other seagulls and still hopping around on one leg.

We felt sorry for the little bird.  But then I realized everything would be okay.  After all, I have heard many people say that Obamacare is for the birds.  So I knew the little seagull would be fine.

Is “No Boots on the Ground” in Iraq the New “If You Like Your Doctor, You Can Keep Your Doctor”?

In 2009 and 2010, President Obama famously (or was it “infamously”) said that under his new healthcare plan, “If you like your doctor, you can keep your doctor.”  Obviously, it wasn’t true.  It is pretty clear that President Obama either knew or should have known this statement wasn’t true when he said it, which is pretty much the definition of lying.  The President, however, wouldn’t admit it.  Here, for example, is one of his attempts to explain what he really meant when he said it.

Which brings up the question of President Obama’s pledge that there would be “no boots on the ground” in Iraq.  Now that we have troops undertaking combat missions in Iraq – and people dying, what about this pledge?  Was it a lie, too, like “If you like your doctor, you can keep your doctor”?  I don’t think so, though I am not sure if it helps all that much. 

I think President Obama really didn’t want to send combat troops back to Iraq and he was not planning on doing it.  What happened, however, was that the situation in Iraq kept getting worse and worse.  Eventually, he had to send combat troops.