Thursday, September 21, 2017

Ross Perot's approach is what we need to break the muddle over health care reform

Won't someone please inject some
facts and figures into the health care debate? 

The more the debate trudges on in Washington over health care reform, also known as the campaign to repeal Obamacare, the less I understand even the basic contours of the ruckus. 

So confused am I that I woke up this morning thinking about Ross Perot, the short and very wealthy Texan with a squeaky voice who ran for president in 1992 on the promise of bringing businesslike rigor to the perennially chaotic federal government. The "Straight Talk Express" Perot called his campaign and John McCain borrowed the phrase in his 2000 presidential run.

Perot went on television, on his own dime if I recall correctly, armed with colorful bar graphs, pie charts and other teaching aids, plus a short pointing stick, to buttress his arguments. 

Now, lookee here people.  
Perhaps at this baffling juncture in the health care debate we need Perot's didactic style of politics to bring together both parties and have them explain to the American people just what the heck is going on. Three years after his failed campaign Perot even wrote a little-noticed book on health care reform.  Maybe there's something in it we should reprise.  

These televised teach-ins could be conducted by Rep. Paul Ryan, or perhaps Sen. Rand Paul—both devout followers of Ayn Rand's catechism of minimalist government—or some other prominent Republican leader, and televised nationwide to probably a limited but curious and motivated segment of the American public. 

President Trump definitely would not be qualified—even Republicans would admit as much—because other than continually calling Obamacare a "dee-saster," he doesn't seem to have a clue about what's specifically wrong with the program or how to fix it. You're fired. 

Democrats would be expected to put on their own health care reform show too, presenters yet to be determined.   

My assumptions are that there is something seriously flawed with the U.S. medical system that cries for urgent attention: It's monstrously expensive, more so than comparably developed countries. Worse still, it leaves out millions of Americans (twenty, twenty-five million?) with no access to basic health care. Lots of money for not-so-great results. 

Sorry, Fox News, shunting sick but uninsured people to the nearest emergency room is not anyone's idea of cost-effective or rational health care. 

The cynic in me must confess that I, soon to be seventy years old, don't have a dog directly in this race. Basic Medicare, plus some add-ons, pretty much covers my health care expenses, and Stew and I have enough resources to cover other costs here in Mexico or back in the U.S.

Yet I cannot write off the plight of millions of mom-and-pop-and-three-kids American families squeaking by on minimum wage or thereabouts, and trying to find health insurance that won't kill them with high premiums or deductibles, or critical exclusions in coverage. That doesn't seem fair. 

So here is what I would like to know:

1. What exactly is wrong with Obamacare? Republicans talk about it as if it were some dreaded fungus about to eat America's brain. Obama being a Democrat and black, and an all-purpose voodoo doll for Republicans, hasn't made an objective debate any easier. 

Still, I don't honestly understand what's wrong, perhaps because I've never fully understood how it works. 

Obamacare's elimination of pre-existing conditions clauses sounds like a good idea, though I can appreciate how it exposes insurers to more risk and potential expenses. But that's what insurance pools and actuarial tables are for, no?

In fact, when we retired but were not old enough to qualify for Medicare, Stew and I took a stab at buying individual policies in the much-vaunted "free market" and what we found were not only sky-high premiums but explicit exclusions of anything that might actually afflict us. 

I had a retina operation: So insurance policies wouldn't cover anything related to my eyes. And so on to the point the policies didn't seem to cover much of anything other than getting run over by an eighteen-wheeler.

Obamacare is expensive alright, and someone has to pay for it. Obama tried to cover the cost by taxing the very rich and requiring individuals to buy health insurance or pay a penalty. Taxes of any kind, particularly on the wealthy, are a mortal sin for Republicans, but what else is there? I'm listening. 

Time for Ryan, McConnell or Rand to have their Ross Perot moment and pull out their pie charts—or maybe flashy PowerPoint presentations—and explain why Obamacare is the worst, followed by the better ideas they have to replace it. 

Or if they believe in leaving health care up to the push and pull of the free market, I'd like to hear how that's going to work too. We need specifics rather than sermonettes about the horrors of big government. 

Cost-containment in health care must be part of the discussion. How's that's going to happen without some sort of government intervention? I want to hear how we're going to manage the clash of insurance companies, drug companies, hospital chains and other special-interest icebergs out to protect their profit margins. 

In fact, we have scant details about a Republican grand vision for health care for America. We hear rumors about obscure and contradictory legislative maneuvers, and last-minute fixes taking place but without the benefit of open hearings or public debate. It sounds like bubble, bubble, toil and trouble rather than an honest plan.

Democrats should get their show together too. How do we control federal budget deficits while adding another hefty line item to the expense side? What is wrong with Obamacare and how do you propose to fix it? And what about all those lobbyists for the medical-industrial complex banging at your door? 

So far Democrats have adopted the old tactic of standing on the sidelines watching the Republicans shoot each other. Recent talk about a single-payer system also sounds like fodder for a college bull session over pizza and beer, not a realistic plan. 

Who would present the Democratic vision? Please, no Nancy Pelosi, Dick Schumer or, God forbid, Hillary Clinton. There's got to be a new player in the Democratic bullpen. Looking for new faces and ideas itself would be a healthy exercise for Democrats.

Ross? Nah. He's 87 years old and happy somewhere in Texas counting his money.



  1. "Obama being a Democrat and black..."

    Obama is not black. He is mulatto, half black, half white.

    "I've never fully understood how it (Obamacare) works."

    Me either. Does anyone understand how it works? Premiums shot up. Everyone understands that part.

    Kudos to you for a pretty sensible look at the situation. As for me, I'm delighted I'll be getting my healthcare in Mexico forevermore.

    1. OK, so Obama is technically mulatto though that's not a designation much used in the U.S.

      Now you owe the readers an explanation of what sort of health insurance you have in Mexico. Mexican Social Security? Seguro Popular? The grace of God and your good looks?

    2. Mulatto is a perfectly good English word. People don't use it because it's not PC, plus people want to think he's black. Makes them all tingly inside. But Obama is no more black than white. He just "identifies" as black. Chortle.

      As for health insurance here, we signed onto Seguro Popular about four years ago because it's free, and having it makes my wife feel a little better. Can't imagine we'd ever use it, short of being dead broke. No, we just pay as we go. Works fine.

    3. To expand a bit: We could also subscribe to IMSS, as can you. It's not free. The annual subscription is reasonable if a tad pricey for someone over 70, which I am and you will be soon. I forget how much it is, but it's way less than you'd pay above the border. Reasonable enough. The annual price depends on one's age.

      The first year I lived here, being as obsessed with medical insurance as your typical Gringo, I purchased IMSS coverage, but I let it lapse after a year when I realized I did not want to mess with IMSS clinics and that private care was excellent and inexpensive.

      I read just recently that a survey in Mexico indicates that a huge percentage of people who use IMSS are happy with it, so IMSS is getting its act together, which is good. I am sure that service still varies considerably from one facility to another.

      But we wing it, living like most of the middle class here, I suspect. I would not dream of going to the U.S. for medical care. No need.

    4. I've heard that quality of care at IMSS can range from first-rate, mostly in the larger cities, to dicey in smaller towns. What you're doing is self-insurance, which depends on one's risk tolerance (neurosis about health care costs). Gringos around here go to private hospitals which are far cheaper than US counterparts but still can get pretty expensive for a "major" event like a heart attack or stroke. I've heard the bills can easily reach ten or twenty grand pretty quick. So you have to figure out what works for you. The suspicions you expressed before about medical operators and greedy doctors in San Miguel pouncing on gringos and rich Mexicans with credit cards.


  2. The sad truth is that there is no answer. People who work and pay taxes have to buy expensive insurance that has such high deductibles that it is basically worthless. People seem to prefer to pay the penalty rather that buy the insurance. I cannot blame them.
    Obamacare seems to work for those that do not work. Sadly, that seems to be a huge part of the population now.
    There is no answer.

    Robert Gill
    Phoenix, Arizona

    1. "Obamacare seems to work for those that do not work."

      That was the objective from the get-go. If you look at it that way, Obamacare is a roaring success. It's medical welfare.

    2. Robert: It's not such an intractable problem; other First World countries have found a bunch of different solutions and ways to handle health care costs. The question I have is whether Obamacare is so worthless it's the equivalent of having no insurance at all.


    3. Felipe: C'mon. This is another one of your Zapatisms. Obamacare was aimed not at the freeloaders but at the working poor, those folks working for ten bucks an hour at places that do not provide health insurance. There are millions of those marginal jobs in the service and retail sectors: janitors, shelf stockers, rent-a-cops and so on.

      The math is not difficult: Ten bucks an hour is about $20,000 a year, minus fifteen to twenty percent off the top for taxes of all sorts. So if you have a mortgage and two or three kids there is no way you'd be able to afford $700 or so for any health insurance. Those folks at the fringes make up the bulk of the medically indigent or uninsured.

      And it's those angry white folks who feel squeezed from all sides and who supposedly voted for your man, the Donald.


    4. Well, them too, of course. But if you're earning $20,000 a year, you have no business with a mortgage and three kids, eh? And it's not just "angry white folks" who feel squeezed in the U.S. Lots of upstanding, responsible brown and black folks are getting squeezed too. Brown and black folks are not always deadbeats by a long shot, and I am appalled -- appalled! -- that you would suggest that.

  3. I am afraid that we have become used to a life style that we no longer can afford. There are not enough rich folks to bleed, and we can no longer rob from the future with debt. Other nations will not buy our debt, and they are off loading it now.
    The sad truth is that some people will die.
    We voted for Mr. Trump not because we are racist, or that we hate the poor, but because we were and still are very desperate. A nation cannot exist on welfare and food stamps. Someone must do the work and pay the taxes.
    It is better to buy something used in the second hand store than to buy something new that was made in China.

    Robert Gill
    Phoenix, Arizona

    1. Robert, with the radical and continuing drift of income toward the one percenters, and away from the middle and lower classes, I can appreciate your despair and that of many other Americans. But there are answers I am sure, and I don't think we're about to run out of rich people who should be paying more of their fair share instead of stashing their money offshore. I remain hopeful.


  4. Well, I've been on something of a comment strike here because I put a lot of effort into comments that you often don't answer or acknowledge.

    But I'll assume you want some genuine debate or commentary, so here it goes.

    The problem with Obamacare is that it caused massive premium increases among people who had been in the individual market. And it also required them to buy higher levels of coverage than what they had previously deemed appropriate for their situation. So using an automotive analogy, not only did cars get a lot more expensive in some places, but people were forced to drive something bigger than what they wanted. Furthermore, Obamacare is driving high federal costs for the subsidies pressuring an already-stretched budget. Oh, and people like myself who are too wealthy for the subsidies, but older (mid-50's) and healthy, are paying through the nose for the poor, donut-addicted, couch-potatoes of the world, something we resent.

    As for the problem, I'll let you in on a secret that no one in Washington knows. Neither Obamacare, nor any other insurance scheme is the real problem. The real problem is that in the USA, healthcare costs too much. We spend 17% of GDP (and the largest GDP at that) on healthcare while the OECD average is 10%. If you could get us to a 10% spend on healthcare, that'd mean a 40% cut in healthcare costs. If that happened, no one would be complaining about Obamacare, and most of these problems would simply go away. Sure, it'd still be real money, but it wouldn't be so life-drainingly expensive.

    You also write, "Cost-containment in health care must be part of the discussion. How's that's going to happen without some sort of government intervention?

    I would argue that government intervention is the source of the problem and thata free market in healthcare would go a LONG way toward controlling costs. Right now there appears to be no incentive on anyone's part to reduce costs. Insurance companies (who should be interested) appear to have no incentive. (Based on personal experience too tedious to write up here.) The medical-industrial complex has every incentive to increase costs too, with lawyers constantly nipping at their heels. And there's no free-market competition to reduce these costs. The gov't has already regulated medicine to an extreme level, so it seems pretty insane to expect gov't to somehow now solve the problem.

    I'd argue for putting some economic incentives into the system, like forcing insurance companies to share cost savings with patients who shop around. We need more doctors and mid-level practitioners, and we need their education system to work with a broader group of folks than the top 0.00001%. Not every medical practitioner needs to be brilliant, merely competent. We also need to eliminate the gov't practise of granting monopoly status on older drugs and then allowing the manufacturers to crank the prices up to insane levels. That's a direct outcome of gov't regulation, and it's killing consumers.

    As for taxes, the only people who really pay them (and I refer to the bulk of the taxes collected) are the top 10%. So yeah, taxes need to go up for a bunch of reasons, but there are limits on how fair it is to make the top 10% pay for everything. Frankly, I'm all for low taxes, but I balk at simply borrowing the difference. Low taxes are only sustainable if gov't spending is low. And in the USA it's anything but low.

    Anyway, there are some solutions out there. But they focus on the supply side and actual practise. If the congress remains focused on insurance schemes, it will not solve the problem.


    Kim G
    Redding, CA
    Where we remain astonished at the sheer volume of paperwork that has to be done to treat my mother's cancer.

    1. P.S. On Obamacare, I didn't even mention the so-called "death spiral," which it's in now. This is where premia for policies become so expensive that healthy folks like myself stop buying insurance. And then the insured pool becomes that much more expensive, causing premia to rise yet again.

      You should also ask yourself if it's really reasonable to allow preexisting conditions forever. At first, I think it made sense as a transitional step. Now I think the gov't should announce a deadline. If you insure before that deadline, then all your preexisting conditions will be covered. After that deadline, they won't be covered. Any universal scheme needs that to function. Otherwise people can free-ride until something happens and then buy insurance. It's the same with flood insurance. You can't let people buy policies as the hurricane approaches. If you do, then the whole concept of pooled risk simply doesn't work.

      What say you? I see you haven't replied to my initial comment. Thoughts? What would you do to make the US system workable?

    2. Whew. Despite your vehemence there is a surprising amount of common ground between what you and I wrote.

      But first let me state perhaps a fundamental point of disagreement. I believe—and apparently so does a growing majority of people in the U.S. who, alas, are now supporting keeping Obamacare—that basic health care is a right not an frill. That is the foundation of the wide variety of health care systems that exist through the developed world.

      It is only in the U.S. where you find an implicit plutocratic, let-them-eat-cake attitude to basic health care. There are lots of people, millions of people, who DO work but don't earn enough to pay for adequate health care for themselves and their families. Or people who have lost their jobs, or have migrated down to lower-paying jobs after getting laid off by the collapse of the manufacturing sectors. Or people who are disabled, gravely sick (AIDS?) or otherwise unable to pay for medical attention or buy insurance. Or are old and very sick, like your mom.

      Shame of you for dismissing them all so contemptuously as "donut eaters" and "couch potatoes" as part of your "free markets" anti-government anything jihad.

      And the reason these folks can't afford health insurance is, as you correctly note, the enormous financial burden of the U.S. health care system, caused because the driving force behind it is not good health care but profiteering by all the members of the medical-industrial complex.

      Drug companies: I just bought 20 tablets of Amoxicillin for a sinus infection in Mexico for which I paid $11. The identical medication at a Walgreens in San Antonio was $79. Why does Walgreen and the drug companies charge so much in the U.S.? Because they can: Drug pricing and marketing is totally unregulated.

      Indeed, the prescription drug Medicare coverage-giveaway passed by the second Bush administration PROHIBITS the government from any price negotiation with Pharma.

      And so are the fees doctors and other providers charge because sick consumers are not in any position to exercise your vaunted private-market options. If your wife goes into labor prematurely, are you going to shop around for the most economical gynecologist or cut-rate hospital? Or postpone care because if you kid is diagnosed with some chronic disease, until you can raise the cash? Or "save" on prenatal care by not getting regular checkups?

      Health care is by its nature, as opposed to buying tires or underwear, not very susceptible to price controls by competition and consumer haggling.

      I have no idea how Obamacare works and I have no interest in investigating it. Except I think it should be reformed, tweaked or adjusted, just like Social Security was for years after it was enacted, rather than abandoned. The death spiral Obamacare may be experiencing is a self-fulfilling prophecy by right-wing ideologues hell-bent in making it crash.

      Is your mom on Medicare? I suspect she is, as were my late mom and dad. And when you go to bed at night, buddy, thank God for Medicare and Social Security. If you had to pay for all her medical care, or I had had to pay for my parents', we would both be broke or seriously less well-off.

      So don't complain too much about the paperwork caused by Medicare. That somehow remind me of a bumper sticker I saw once, "If you think education is expensive, try ignorance."

      That's it. I'm tired of writing.


    3. My apologies to readers for the typos in the preceding manifesto. Need to hire Felipe to do some copy editing.

  5. Well put, Kim. Lest anyone think you're just another of those right-wing white men, let us point out that you voted for Obama twice. You have, however, come to your senses. Kudos.

    I'm not sure if Al can wrap his mind around a gay guy who voted for Trump.

  6. Medical care is expensive, and in the US it is very expensive. That so many insurance companies have withdrawn from the market indicates to me that they cannot make money under Obamacare.

    So what is the answer? Do we pay high premiums for worthless insurance? Do we let people die? Who is going to make these decisions? This is really scary.

    Robert Gill
    Phoenix, AZ


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