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Tuesday, 17 November 2020

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SoD,

Socialism in the US takes the forms of subsidies for various industries, highways, the income tax homestead and mortgage exemptions, Medicare, Tricare, Social Security, Medicaid, child tax credits, and a bunch of other stuff that no one even thinks of as socialism any more. We're not killing people en masse for construction materials. Christ, you are such a drama queen.

Missing word - YET.

"Yet" is the key word. When all the goodies can no longer be paid for, then the rubber meets the road aka what Mrs Thatcher said. Then people get angry and things begin to spin out of control very fast. Add that to the increasing interest payments on the debt load and then it's off to the races.

“We disrupt the Western-prescribed nuclear family structure requirement by supporting each other as extended families and ‘villages’ that collectively care for one another, especially our children, to the degree that mothers, parents, and children are comfortable.”

And that's just BLM. Who knows the unnatural inhuman horrors in the manifesto of Antifa?

Ask your Venezuelan and Cuban Latinos Bob, are they all "such drama queens"? Oh, I forgot, you already did, and they voted for the Don.

SoD

People are already unhappy because they're not getting stuff like wage increases, a reasonable social safety net including reasonably priced health care and education, respect from people lying to and fleecing them, and so on.

I've asked all our Venezuelans and Cubans, and they don't all know the difference between an authoritarian government and a democracy that includes some elements of socialism. You have to admit it's really confusing. Most of the younger ones seem to have caught on, though.

The US healthcare market is a cartel, the antithesis of a functioning market. In many ways it emulates the NHS, certainly in cost (extortionate) and value for money (poor).

The cartel needs to be split into a thousand new pieces and competition restarted: The "Operational Olympics" reborn. Nobody loses when a company is split, it's not expropriation: if I take a $10 share from your wallet and put ten $1 shares in your purse I haven't robbed you, I've merely given you change. But the benefit to all of ten CEO's now competing versus one monopoly running the industry like a Socialist state is huge.

Open the borders for healthcare with zero tariffs and quotas, add freedom of movement of capital and labour for healthcare workers. A Single Market in healthcare with the rest of the world. The price goes down as the supply goes up. But a Single Market can be improved upon ...

... Open the borders to all the healthcare standards and rules and regulations of the developed world. Let the standards bodies of the world compete for the attention of the American people; if they're responsible enough to choose the executive and legislative that enact the rules and regs, then they're responsible enough to choose the rules and regs themselves. Capital and operators will pour in from the Anglo-Saxon world, Europe, and South East Asia as healthcare organisations extend their delivery into the US market with their existing standards and regulations, the bureaucratic friction removed. Move over Single Market, and thanks Maggie for the ride, but now it's time for the Multi Market.

The price, quality, and value for money of healthcare in the US would all improve hugely from the low base - just as would happen in Blighty if we ditched the NHS. Throw a dollop of Social Buying Power to each citizen - vouchers, or negative income tax, hat tip to Milton Friedman - and you're done.

The job of the state is to be like a gardener of the independent sector, pruning, splitting and dividing, tending; it shouldn't try to be the garden itself.

The duty to not harm someone by your inaction (John Stuart Mill), like leaving someone without healthcare who can't afford it, is met by the citizen's tax going straight to all citizens as Social Buying Power: A state bypass, no money goes near the swamp with vouchers and negative income tax. So it's also the least grumble inducing system for the tax payer, "No money was harmed in the operation of this system because no pols were involved - it's the same supply side you choose to go to as a middle or high income earner with your own cash."

We'll never do this in Blighty. You're the last hope of the old free world, Uncle Sam.

SoD

Bob, there's (hopefully) a world of difference between the embryonic forms of socialism encountered in the US of A and the full-fat Marxist Leninist variant.

SoD,

A form of that experiment is taking place now with the further pushing of Medicare Advantage. The disadvantage to breaking healthcare into thousands of pieces is complexity. Every insurance company and health care network has a plan. The network size and services offered by each vary widely. The drug coverage is a game of "find the pea under the walnut shell". Each plan covers some drugs and not others and most shift every year. All plans have restrictions concerning where treatment can be sought under various conditions. The wife and I looked into one that demanded we inform them whenever we leave town in case we have an accident and have to be treated outside our network. And of course each plan has its own set of paperwork requirements that add to complexity and cost.

Around 30 years ago my mother-in-law got a Medicare Advantage plan thinking it would save her money on prescriptions. It did save a small amount. However, she developed breathing problems and a few weeks after contacting her primary doctor's office was diagnosed with lung cancer. She couldn't see a doctor in her network again in a timely manner. Her sons and daughters finally got her into a hospital through the emergency room after several days of Kafkaesque contacts with the health network. She died less than two weeks later.

Health care insurance can't be trusted to private industry any more than armed services or prisons, though we've tried those too with poor results. There's a reason the US is the last holdout for healthcare privatization. We had a great economic advantage following the world wars that allowed us to waste huge sums of money experimenting with a private system that, by the way, was designed in part to hire scientists and engineers away from Europe. We no longer have that economic advantage and the private system has failed. We pay more than twice as much per capita as the rest of the advanced world for service that fails a large percentage of the population.

Richard,

There's a huge difference, but it's usually easy for politicians to scare people by confusing the two.

The missing piece, Bob, and I missed it out in the above, is an SLA (Service Level Agreement) defined by the state. It's the list of services, procedures, drugs, treatments and timescales, that the insurer is required to deliver if the vouchers received from the citizen customer and presented to the state by the insurer for exchange into cash are to be honoured. It's the supply-side contract that must be delivered in exchange for the citizen's tax funded Social Buying power.

In Blighty we have an organisation called NICE which defines the SLA for the NHS. The NHS fails to deliver to the SLA systematically and has done for 75 years, hence £4bn negligence and legal costs per annum. The NHS doesn't care, we wait weeks to see a GP, months to see a consultant, and years to have an operation; incompetence, criminal negligence, and downright abuse abound.

Why? Because there's no competition at source. The citizen customer cannot change their healthcare provider from month to month, like they can their car insurance, broadband package, gas, electricity, water, etc., because there's only one NHS to take your £2500 per annum.

Don't worry about healthcare networks not having full coverage, they can do it. The myriad of individual clinics are the neurones in a neural network of offerings, the insurance commissioning team will get their heads round it if they have to in order to meet the SLA. My insurer in the UK, BUPA, does it ok. Open the border doors and let the globalised market for healthcare in and the neural network will spin up and make a market like a good 'un.

I remember there was an enterprising Indian guy who set up an offshore cruise liner off the coast of America offering heart bypass surgery for Americans needing it, but who couldn't afford it. $5,000 versus $50,000 on the mainland, if I remember rightly, something like that. Let the guy operate on the mainland in competition and save even more cost, FFS, you might get heart ops for even less than $5,000!

Norway is much smaller than the US but they manage to have 14 different independent companies offering the full range of the SLA. Likewise most of the South East Asian countries. Many of them even have a single payer system i.e. one insurer and service commissioner, and they still make that work. Not optimal, IMHO, split the operation at all levels of the supply chain and make them compete. A neural network has a broad number of neurones in each layer, it doesn't work well with a choke point of one neurone at any level, including the first.

The problem with the US and Blighty is the politics (of course). In the US you have a party of business suspicious of the state, and a party of workers suspicious of business. This will lead you to either no solution (party of business wins) or a horrible NHS solution (party of the workers wins).

In Blighty the party of workers won in 1948 and we've been suffering with the NHS ever since. Both parties in Blighty are Socialist now. We're kinda just one step ahead of you down the bone road.

The "third way", as Tony Blair's famously coined phrase goes, saw improvements in the NHS by commissioning the services more from the market, but it wasn't enough. Blair left the front-end commissioning role itself with the old state socialist monopoly model for the political reason that the Labour party would have strung him up for finishing the job and ditching the socialist model completely.

A third way party based on Funded Libertarianism (of which the above healthcare discourse is a specific example) is the only way forward. But I don't see it in the US or Blighty. We're locked in socialism, and you're tinkering with Naive Libertarianism while hovering on the abyss of Socialism.

Sighs all round really.

SoD

Bob, a national health service could be cheap if you exclude nip and tuck sex changes etc. Just stick to the basics.

In the US you have a party of business suspicious of the state, and a party of workers suspicious of business.

If only that were true on the national level. We have one party that's a marketing arm of business. They keep the bulk of their voters in line with cultural issues like unrestricted gun ownership and very restricted personal freedoms.

The other party is just as corporate and plutocratic but strings their voters along with identity politics. They use to be a workers' party that promoted personal freedoms, but Bill Clinton and Barack Obama blew that up. Even if he tries, it's doubtful Biden will be able to return the party to the pre-Clinton platform.

Our Medicare system works very well, though it's not without problems mostly caused by politics. There's no way I'm voluntarily giving it up for a Medicare Advantage plan. I buy certain medications from Canada, where those particular ones cost about 30% as much. My doctors have always been willing to send prescriptions to Canadian pharmacies. Many Americans also go to Canada or Mexico for medical treatments or procedures, where they cost significantly less even without insurance.

I can't comment on how a single-payer system would work here, since we're not likely to see one soon and we're not even very far into moving towards one. At this point around 65% of American adults favor a single payer system.

Glesga,

Fine by me. I'm way too manly to make a passable woman.

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