Donald Trump: A Man For Our Times

If you can get past the snark, the insufferable Paul Krugman is, unbeknownst to himself, actually groping his way to an important point, even if he never gets there:  it is depressingly clear the Republicans are "A Party Not Ready to Govern".  Why?

Consider Obamacare.  For seven years the Republicans have been chanting "repeal and replace."  So how, exactly, should they go about doing that?

I imagine that early on they would have formed a working group.  That group would have consulted with think tanks, economists, lawyers, and actuaries.  Seven years is enough time to put together a serious plan.  Likely, they would have written pro-forma legislation.  And, over seven years, Republican leadership would have had time to educate, inform, cajole, and sometimes threaten their membership to get on board with the plan, for when the time came.

Amazingly, they did none of that, and that requires---nay, demands---an explanation.  I, of course, have no such explanation, but I do have an hypothesis.  To paraphrase The Three Stooges, "Hypothesis means I'm guessing and I have a college degree."

Like most of us, I suspect the Republicans are surprised to even be in power.  But even if they did not expect to be in power, they should have had blueprints for their idea of the ideal health care system.  In this way, they would have had some plan of action for influencing the development of Obamacare.

The Republicans have nothing.  Krugman implies they have nothing because they are idiots.  He writes, "they have no idea how to turn their slogans into actual legislation, because they've never bothered to understand how anything important works."

That is just a stupid remark.  I think the Republicans do not have a plan of action on health care because they never intended to repeal and replace Obamacare.  I think they like Obamacare just fine.  In the matter of health care, the Republicans and the Democrats are as one.

Does that seem unlikely?  It should not.  We have exactly the same thing regarding immigration.  Year after year, at least since the presidency of Ronald Reagan, the American people wanted the borders controlled and immigration reduced.  Year after year the Republicans would promise.  And, year after year, nothing would get done.  At some point, you have to conclude that the Republicans are happy with things just the way they are---just as happy as the Democrats.  As with Obamacare so with open borders, the Republicans and the Democrats are as one.

Oh, you still don't believe me? Then take it from "Jeb!" Bush, 

many who illegally come to the United States do so out of an "act of love"

Don't you just want to punch him in the mouth? I think a lot of Americans finally caught on to the evident fact that there is no important difference between Republicans and Democrats, and that is why Donald Trump swept the field during the Republican primary elections.
Furthermore, this explains why so many Republicans share "Trump derangement syndrome" with Democrats.  They like things just the way they are, and they hate Donald Trump for upsetting the apple cart.  The election of Donald Trump is as much a defeat for the Republicans as for the Democrats.

The failure of the recent effort to repeal and replace Obamacare merely confirms my conviction that Donald Trump is "A man for our times."  We have an apple cart that needs overturning in the worst way, somebody has to do it, and it looks more and more like Trump is our guy.

The Ayatollah of Health Care

I know health care is a hideously complicated subject, and it is more than likely I am talking doggy doodoo, but here is what I think I know.

There was never any chance, whatever, that Obamacare was going to reduce costs, and everybody knew it at the time.  Except, possibly, Barack, who does not care about cost.  Cost was never an issue for him.

Barack wants to lead a revolution, nationalized health care is a means to an end, and he channels the late Ruhollah Khomeini, master of the 1979 Muslim revolution in Iran.  It was once explained to Khomeini that certain of his plans would have adverse economic consequences, to which he famously replied, "This revolution is not about the price of watermelon."  As with Khomeini, so with Barack.

Oh, the old American health care system certainly could have benefited with some tweaking, here and there.  Maybe a lot of tweaking.  But nothing more than tweaking.  Certainly, there were some inefficiencies and some fraud, but there never were massive inefficiencies, or massive frauds, and rising costs were not due to the rising costs of established medicines and procedures.

It is not as if we are paying more for aspirin, for example.  To the contrary, we are paying much less.  Consider aspirin prices in Morris County, NJ.  In 1932, aspirin cost 1¢ per pill.  Prices varied over time, and in 2012 aspirin cost 3¢ per pill.  Nominal prices.  In real dollars (2011), aspirin cost 16¢ per pill in 1932 and just under 6¢ per pill in 2012.  A 62.5% drop in the cost of aspirin in the 80 yr span.

And that's how it is with all old, established medicines.  The "problem", especially over the last 30 years or so, is that pharmaceutical companies have developed a wide range of miracle drugs, real life savers.  It may well be true that Big Pharma extorts obscene profits, but it is also true that it can cost half a billion dollars to bring a new drug to market.  There is no way around the evident fact that, these days, we are buying aspirin and a whole lot of, very expensive, new life saving medications.  In other words, we are buying more health care and we have to pay for it.

The same with medical procedures.  Before 1967, nobody was buying a heart transplant because no such thing existed.  The first heart was transplanted in December, 1967, it then took a while for the expertise to spread, and these days there are about 2,000 transplants a year, in the U.S. alone.  Should I mention this is an expensive procedure?  Well, the more heart transplants (and other daring, new, and very expensive procedures) we buy, the more we have to pay.  It's really that simple.

There is also a well known allocation problem in health care.  It is a strange but true fact that fully 30% of all Medicare expenditures are made in the last year of life.  As the population ages, this will get worse.  Does this enormous expense really make sense?  Almost certainly not.  Now, you explain to your neighbor that he cannot spend money on his beloved, dying mother.  See the problem?  The problem is that we have to pay for what we want.

In other words, unless Obama was going to withhold new medicines, or withhold new procedures, or withhold some significant amount of care from the elderly, there was no chance he was going to reduce costs.  To the contrary, as he put more people on the health insurance rolls, costs had to go up.

And so they have.