re: #3 Obdicut

Good luck with that, Boehner.

I think Obamacare has got to go too. Eventually, we’ll want to replace it with single-payer.

But just getting rid of it? Dumb.

As I’ve been saying, Obamacare has provisions that, once they’re put into force, will in my opinion set the private health care system to circling the drain.

Now partisans of single-payer system, if they too foresee this, would have every incentive to hotly deny it. Then, when it comes to pass anyhow, the case for single payer will be overwhelming. There will be no alternative. Nothing to which we could go back, even if we wanted to.

Any bets on whether Obamacare will prove to be feasible as now written, and will not have to be replaced by single payer?

Getting rid of Obamacare and simply going back to the status quo ante, which was itself in deep trouble, isn’t much of an option. If the public decides it doesn’t want the federal government to have the final say over which states and cities get to have the cutting-edge hospitals and which have, well, much less, or if it wants market-driven medical innovation to continue, there will have to be some serious ground-up thought about what system we do want. I’d want insurance to be completely portable, and not tied in any way to employment. Losing your job shouldn’t mean losing your health coverage, and then finding that your “preexisting condition”, which didn’t exist when you first got covered, was suddenly excluded. I’d want malpractice awards capped, and I’d want judges and juries hearing those cases to know a little something about medical science and statistics. I’d want an end to forum shopping.

I’d want provisions for the poor to have some default insurance, that covered everything that wasn’t in some sense a luxury or optional or hugely expensive. It should include preventive medicine such as dental care, inoculations, screening for metabolic syndrome, etc. But not aromatherapy, or chiropractic treatment, or plastic surgery for the ordinary consequences of aging. It shouldn’t be so comprehensive and gilt-edged as to cause working folk to wish they, too, could be poor so they could have it themselves. (The “moral hazard” problem that sinks so many well-intentioned schemes.)

I’d want the system now in place for reporting of near-accidents to the aviation authorities copied to the health care system. Mishaps, difficulties with MRSA control, and on and on, would be reported on a no-fault basis to an authority (yes, government) which would then set standards with a view to keeping down the future incidence of such problems. Failure to observe the standards would be a yes-fault thing.

I’d want a lot of experts to think things through and come up with more ideas—-these here are just to get the ball rolling. It isn’t that Obamacare has got to go because it’s ideologically unacceptable—-it’s that it’s the kind of law that torpedoes itself. In this, I think it resembles California’s system for regulating utilities in the Gray Davis era. The regulations were so game-able, they got gamed, and provision of “electricity care” to CA pretty much fell apart.