The Donelson Files

 

The starting point for a discussion of a national health care system should be setting our goals.

American health care should be:

1. High quality, state-of-the-art
2. Available to all
3. Affordable
4. Abundant
5. Well-funded 

What are the principal obstacles to these goals

A. The shortage of medical personnel. This shortage has two facets:

Not enough medical professionals are produced in the first place, and too many drop out before their time.There are whole areas of inner cities and rural America, for example, which have no physicians at all. Why? Because our medical schools do not graduate enough doctors to serve the population of the United States. Why not? Lack of intelligent students? Lack of students who are motivated to give their lives in service to their fellow man? Not at all.

The reason is lack of money! Medical education is so lengthy and so costly in this country that very few students can afford to go to medical school. This situation has created a national crisis.

One very good use of taxpayer funds would be to offer medical and nursing school students free tuition, open to all qualified applicants. We do it for the military, why not for doctors and nurses? The cost would be miniscule compared to the Department of Defense or agricultural subsidies.

This policy would have a massive return on public investment. More doctors would increase coverage of the population (perhaps there should be a requirement for a graduate M.D. and R.N. to spend two years in a “no-doctor zone”). More doctors would increase competition for the patient dollar. More could devote themselves to research. New people, new ideas, new openness to change. The quality of care would go up, and the cost would go down – a mantra we have been hearing a lot lately. This program would also assure continuing support for U.S. medical technology which is already the envy of the world.

B. Inadequate funding

So how do we provide for adequate funding? Where does the $3 trillion we now spend go? The money flow starts with the employers who pay the insurance companies out of profits. It then goes mainly to the vast bureaucracies in the insurance companies which distribute the money, the government which oversees the money, and the hospitals and practitioners who must respond to the companies and the government. Only about one-third of the $1 trillion spent on healthcare gets to the practitioners. So how can this labyrinth be simplified?

1)  First, take the employers out of the picture. The added financial and personnel burdens on businesses of paying and accounting for employee health care is a double disaster. It is a drag on the efficiency of the economic system by vastly increasing the cost of starting and staying in a business, and on the healthcare system by removing from individuals the responsibility of seeing to their own health needs.

2)  Next, reduce the role of insurance companies. They are not chartered or ordained by God to be judging the value or disvalue of medical procedures. They are supposed to know about money, not cancer! The decisions about medical care and the balancing for costs versus therapies should be in the hands of the patients where they belong. When the ultimate decisions of life and death have been left with the patient, we will have come a long way toward patient-centered medicine. Face it, there is no way for the patient to become the main arbiter of his or her fate unless the patient is the source of the money which runs the system.

3)  This free market system would be much better and much cheaper. The individual works for the money; the individual chooses the doctor, makes the final decision as to spending the money, and pays the doctor, hospital, physical therapist, and pharmacist. So where does the individual get the money? From his or her own health savings account with enhanced income from fewer deductions, also from voluntary insurance or cooperative membership, or from family, friends or philanthropic sources. Since the money is the patient’s own, the patient is far more likely to become very cost-conscious – unlike today’s insured patient, who is always spending someone else’s money

C. Insurance Companies and Government

A patient-centered system also reduces the role of federal and state governments (46.9% of health expenditures, NCHS, 2016). The patient doesn’t need the insurance company or the government. If both the government and the insurance companies were completely eliminated from the system, about two-thirds of the cost of American health care would be gone. Of course, there will always be some need for both, so assume that half of that cost would be gone. At today’s rates, that would be about $1.5 trillion. This is a gross number, but it shows the potential.

1) There is still a place for insurance companies in this system, although dramatically reduced. The most obvious place is for catastrophic insurance. A safety net for when something very expensive happens to someone in the family – or the church, or the credit union, or whatever assembly of people the individual chooses to participate with. And this brings us to the role of governments.

2) The first federal government act should be to lift all interstate commerce restrictions on insurance companies, so that they are free and invited to offer policies in any or all the states they wish without the necessity of creating a separate bureaucracy for every state they enter.

3) The second federal reform should be the creation of a program for financial aid to qualified students in the medical professions. My suggestion would be a free education in exchange for a period of service in underserved areas of practice as determined by a federal government body, such as, CDC or NIH or HHS.

4) A third federal reform which would dramatically reduce national health care costs is tort reform. Everyone makes mistakes, including medical practitioners and hospitals. It is the federal government’s role to protect both the treatment sector and the patient. But the current practice of unlimited liability has led to “defensive medicine,” that is, exhaustive tests and treatments used far beyond medical purposes. These extras are done to provide a defense against the inevitable lawsuit in case anything goes wrong. This uber caution has become a major cost driver in American medicine. Congress should set reasonable and realistic limits on the monies which can be given to the victims of everything from malfeasance to honest mistakes. No more windfalls for injury lawyers.

D Universal Coverage

The larger issue is care for the poor and the other underserved members of our nation. The concept of universal care is a noble and worthwhile goal. But socialized medicine is not the only or even the best way to achieve universal care. We have government programs to feed the hungry; to provide health care for the elderly; to protect the innocent. We can provide health care access to the poor and the underserved, whether because of poverty or location. We can also do better than the COBRA coverage for those who lose their jobs, or those who are excluded because of pre-existing conditions.

It is very tempting to design a system in which no government plays a major role. However, the most efficient way to care for the poor would seem to be a State-run program which levies a small per capita fee on each pool of insured to be placed in a designated fund, administered by the State, for the benefit of qualified citizens. A model for such a program might be the Medicaid programs in each State. Another model is the Uninsured Driver programs administered by the states.\

E. Medicare

We have now discussed the entire healthcare cycle without mentioning Medicare. There is a moral and legal mandate involved in Medicare which does not exist elsewhere. Medicare works reasonably well as a medical insurance system for those who contributed to it all their working lives. The most prudent and honorable way to approach Medicare would seem to be to leave it alone for those to whom commitments were made, even while moving the system slowly toward a patient-centered system for those just starting out, with free choices developed for those in mid-career. The pressure of the free market system we have been describing here will undoubtedly alter and reform Medicare as the new system matures in due course.

So here is what a free market system might look like. It would fulfill all our goals for an American system that is:

1. State-of-the-art;
2. Available to all in need;
3. Affordable;
4. Abundant; and
5. Well-financed.

To get there, we need to:

1. increase the supply of medical practitioners,
2. create a patient-centered system by letting the patient spend his or her own money on healthcare;
3. create state-sponsored safety nets for the poor and underserved. 

These proposals, of course, seem radical today, even in America’s free market culture. But sometimes the most obvious solution is indeed the best. The fact is that the employer-based system we have today was initiated because the elite of another day considered average Americans too irresponsible to handle their own health and welfare. Not true today.

(Larry Fedewa, Ph.D. is a conservative commentator on social and political issues. Former international technology executive, business owner and college president, he lives on an Arabian horse farm near Washington, D.C.  He granted permission to use this article and we are appreciative.  He will contribute to the websites and is presently working on a his own radio show/podcast)

Many of us remember where we were on 9/11 and while we remember the collapse of the twin tower, we should note that New Yorkers have rebuilt their city in wake of the attack.  Where the twin towers existed, stands One World Tower, orignally called the Freedom tower and around the area, the 9/11 museum and memorial reminds of that day.  Other buildings being constructed or are completed include 7 World Tower, 4 World Tower and 3 World towers.  Out of the ashes of the old, arises the new.

.

John McCain Legacy for me is a mixed bag, a Senator who served his country first as a soldier who sacrifice much for his country and finally in Congress, first as congressman before moving to the Senate.  The first time I saw John McCain was in 1993 when he appeared at a health care conference opposing what was then Hillary care. Ms. Clinton appeared briefly in the morning, made her statement and left without taking questions from the media or anyone and leaving the heavy lifting to others to defend her position during the rest of the conference.  I covered the event for KC Jones, a conservative newspaper and had a chance to interview people from both sides including McCain.  When John McCain voted against the skinny repeal proposed by his friend, Lindsey Graham, I remember the McCain of 1993 and wonder if maybe Senator McCain of 2017 might wanted to reread his own speeches on health care reform. He betrayed his own voters who he promised in 2016 that he would lead the fight to repeal Obamacare and his past beliefs.  This vote represented for many of us the most frustrating aspect of John McCain career, a man whose often voted conservative most of his career but in many crucial moments over the years, become the Maverick by not just compromising on his beliefs but abandoning them.

It is the Maverick McCain that helped open the door for the National Populist movement that he would spend the last years of his life fighting. In 2000, the McCain express opposed George Bush run to the White House and his campaign was based on a premise that many voters were no longer satisfied with both political parties. He often moved to populist points starting with campaign reform and later opposing Bush Tax cuts from a populist position that mirrored Bernie Sanders and in some respect, Donald Trump.  The 2008 McCain ran a more traditional conservative campaign but his selection of Sarah Palin, who was a Maverick in her right opposing the Republican establishment in Alaska showed that he had not abandoned the populist and anti-establishment route. Throughout the Obama years, he was a leader in opposition to a good portion of the Obama agenda including foreign affairs.

McCain legacy will be the last of what I would call the Wilsonian internationalist who believed in the goodness of America to influence the world as Coco Konski and I discussed his legacy on our podcast,. What is often forgotten, McCain ran on a platform of a muscular foreign policy and American Greatness, influenced by the staff of Weekly Standard in 2000 and it was George W. Bush who ran on a platform of “more modest Foreign policy,” similar to the Trump campaign strategy 16 years later. The American Greatness did evolve into a more Nationalistic view of America that Trump took advantage of.  Trump ran on the more modest foreign policy but he also ran on the greatness of America with the idea of Making America Greater.  After the 2000 election, while McCain still held Bush’s tactics in the 2000 primary against him, both men found common grounds after 9/11 as Bush sided with McCain view of foreign policy.  Bush adopted the Freedom agenda of McCain and we spent the next decade importing Democratic procedure to the Middle East where so far, they have not taken much root.  We can argue the mistakes made in the Middle East and whether the pro-democracy agenda was doomed from the beginning or had a chance for success, sabotage by poor execution and Obama retreat from Iraq. That is a debate for another time.

The Freedom agenda also led to bad judgment including supporting the rise of Muslim Brotherhood in Egypt and deposing Muammar Gaddafi in Libya.  David Goldman describe Egypt plight before the military finally disposed of the Brotherhood, “In 2012, Senator McCain backed the installation of a Muslim Brotherhood government in Egypt…In July 2013, more than 30 million Egyptians – a majority of the adult population – demonstrated against the country’s Muslim Brotherhood government. Under General Abdel Fattah al-Sisi, Egypt’s military took control of the country, which was nearly out of food. Al-Sisi saved Egypt from starvation and chaos…Senator McCain sadly denounced the military takeover as a violation of the democratic process. Technically speaking it was a coup against an elected government, although under emergency conditions and with massive and visible popular support. So beguiled was McCain with the prospect of a democratic Islamic regime that he never accepted that his illusion had vanished.”  The irony is that Egypt under the Muslim Brotherhood was seeing the fabric of Democracy already being throttled plus the country was about to enter into chaos and massive starvation.  In the case of Libya, there was no game plan for a post Gaddafi and it became a terrorist playground.

Goldman noted the difference between McCain and Trump when he noted, “The bright line in American policy divides the utopians who believe that America’s mission is to bring free markets and liberal democracies to the benighted, backward nations of the world, and realists like Trump…Senator McCain threw his support to the Muslim Brotherhood in Egypt in the expectation that it would become a vehicle for Muslim democracy; Donald Trump proposed to insulate America from the problems of the Muslim world.”

The modest foreign policy promised by Bush in 2000 is the basis of Trump’s policy in 2018 and America rejected the more internationalist view of McCain for a more realistic policy that accept the limits to American foreign policy and constructing policy toward a identifying and defending America’s national interest. As I noted in my book, “The Rise of National Populism and Democratic Socialism What our response should be”, Trump foreign policy would be “Donald Trump s bringing back realpolitik, in which our country’s foreign policy will be based on America’s national interest. Idealism will no longer be a reason to send young Americans into combat, but defending our national interest will.”  This approach is not isolationist but a more realistic approach to a world that is now multipolar with different blocs and Nations defending their national interest first, world predicted by the late Herman Kahn in his book, The Coming Boom. I observed in my book, “In 1982, Herman Kahn wrote The Coming Boom, in which he foresaw the economic prosperity of the Reagan years and a new world order that included the rise of regional powers and new challenges to the bipolar power struggle between the United States and the U.S.S.R.  Kahn thought that a multipolar world would eventually stabilize but the era before stabilization could be chaotic.  Kahn’s predictions proved to be accurate.”  McCain worldview has now been overtaken by events and the desire from the American people for a more modest foreign policy.  The world of John McCain internationalism has passed and he, like many within the foreign policy right including William Kristol, fail to realize the changes in the world.  McCain defended those institution that kept the peace just as NATO, Trump is asking the question if these institution serves our national interest.

McCain was a man in full, not a perfect man or the master of the United States Senate and often times, his own view disagreed with his Party. In many cases it was his Party that was right and not McCain. His support for carbon tax to save the planet has been rejected by his Party and with good reason and the one bill that bears his name, McCain-Feingold was declared unconstitutional by the Supreme Court for the simple reason that it interfered with freedom of speech.

McCain was not perfect and there were times he could hold grudges that last a long time and mistakes were made. McCain would be first to admit that he should have supported Martin Luther King Holiday in 1987 and his refusal to allow Sarah Palin to come to his funeral was more than a mistake since Ms. Palin had stayed loyal to McCain, never uttered a bad word about him and even campaigned for him after 2008.  As Sarah Palin noted not once did McCain ever said to her that it was mistake to place her on the ticket in 2008 only to find out that he would declare this in his last book not yet published.  For many politicians, loyalty is a one way street and John McCain is not the first politician nor will he be the last to throw some of his own past supporters under the bus if need be.  Every politician at some time has but unlike former campaign staffer, Steve Schmidt and Nicole Wallace, who profited from their own disloyalty, Palin stayed loyal.  National Review John Fund summarize John McCain, “But John McCain was enough of a genuine American hero that he need not be placed on a pedestal and treated like a plaster saint. He was throughout his career what is called “a man in full,” a leader defined by his bold moves, bold personality, and bold accomplishments. He also deserves to be described in our farewells as a man in full, with all of his contradictions, inconsistencies, and expedient behavior…By holding up him up as a paragon of virtue, the media failed last week in their job of telling John McCain’s story in full. I suspect their credibility took another hit with many Americans as a result, a credibility that is already so low that someone like Donald Trump has been able to exploit it.”

McCain served his country and suffered as a result and many of the same people who praised him during his funeral were perfectly willing to call him a fascist, a racist and everything in between when he oppose their agenda and it suited them in his 2008 presidential run against Obama.  McCain was not the perfect vehicle and over the last half of his legislative career, he often abandoned principle to reach across aisle and like many of his generation, he failed to see causes of the present rise of Populism, a movement that he himself help start two decades earlier.  There is much to praise about McCain heroism and much to criticize record wise as a legislator.  History and Historians will make their own judgement years from now and I will let others decide if working across the aisle as Man putting country before Party or simply fool errands that did little to advance the causes he believed in.  I remembered the McCain who took a stand to defend free market reforms in health care in 1993, ran on those platforms in 2008, campaign on them in his 2016 Senate race only to desert them in 2017. This sums up the contradictions of McCain the Senator.

 

 

 

Another way to look at the Trump phenomena is to understand his populist base is for real and for many Republicans, their future is tied to the success of their ability to combined conservatism with a populist edge.  As I noted in my book, The Rise of National Populism and Democratic Socialism, conservatism Trump populism is compatible with Trump populism as Trump based his individual tax plan on the Rubio proposals from the 2016 election including tax rates. (Trump did add an additional 37% tax rates on the wealthy but he added many tax breaks that benefits the Middle Class, similar to what Rubio proposed.)  The corporate tax plan proposal begin at 15%, similar to Cruz’s 16% rate and ended up at 21%.

Trump own view of immigration is a combinations of amnesty for many of them here illegally now combined with restricting future immigration levels, border security, vista reform and moving toward a more merit base system, most of which is supported by majority of Americans and this is where most Republicans are.  For many Americans, they no longer believe that immigration is a boon to their economic prospect and while many in the political class wants increase immigration levels and amnesty for illegals but little in the regard for border security or change in our present immigration levels.  Immigration increases GNP overall but it also impacts those at the bottom of the economic skills as lower income and Middle Class compete with both legal and illegal immigrants. What we see is that overall economy goes up while those at the bottom of the economic ladder see their overall income go down.

The political class, in particular the left, biggest failure has been in foreign policy.  While we debate the wisdom of the second Iraq war, we can positively say that America was safer in 2009 than in January of 2017.  Isis rose in the ashes of Obama pulling out early, only to force Obama to begin putting America troops back, and his policy in Syria has led to the death of at least 500,000 million civilian and a weakening of our position in the Middle East. The Iranian deal allowed Iran free reign throughout the region and the deal will allow Iran to produce a nuclear weapons.  Russian essentially annexed half of Ukraine and added Crimea.

China has essentially used the WTO to its benefit while applying its mercantilism theory to gain the upper hand in its own quest to turn the Middle Kingdom into the center of the universe in place of the United States.  Many of the post-World War II era institution that kept the peace are fraying and Trump is asking the right questions.  What is the role of NATO today? How do we get our Allies pay more of their defense? What should our relations be with Russia and is Russia a greater threat or is China over the long run?  How do we liberalize trade while dealing with various inequality that exist within the United States?  We could go on but Trump own view is that American interest comes first and while I question his views on trade, it would be ironic that Trump may end up be a more free trader after being elected to be the most protectionist.

For the Republicans, a new coalition is within reach that includes a portion of the minority whose economic interest no longer served by Democratic policy, blue collar workers and the Middle Class, and need to get some of those suburban whites who deserted Trump.  The Democratic Party has moved to the left and within the Democratic Socialism movement, many Trump voters understand the when it comes to Democratic Socialism movement, the Democracy is expendable when it comes to push socialism and as Trump voters see their own views censored on many of the social media sites, they understand that what stands between them and the political class is Donald Trump.