Speaking to Australian Prime Minster Trumbull, Trump said, “We have a failing healthcare. I shouldn’t say this to our great gentleman and my friend from Australia, because you have better healthcare than we do.” A day later Trump repeated his praise for the Australian healthcare system, “Of course the Australians have better healthcare than we do – everybody does,” he wrote on Twitter. “Obamacare is dead! But our healthcare will soon be great.”1 Of course in a rare moment of speaking the truth Trump is right about both assertions. Everyone in the developed world has better healthcare than us and at a shocking fraction of the cost.
Trump told Malcolm Turnbull: ‘We have a failing healthcare. I shouldn’t say this to our great gentleman and my friend from Australia, because you have better healthcare than we do.’ Photograph: Jonathan Ernst/Reuters
Does Trump know Australia spends $5,495 per person per year vs our $9,990 (yep 66% more!!) for healthcare that ranks in the top ten in the world? Our rank?? 42nd for life span and 54th for infant mortality (see 2015 CIA World Factbook on this). Exactly how the Republican healthcare bill will improve on this performance is unknown. They passed it through Congress without even waiting for the Congressional Budget Office to grade it for cost and effectiveness. Better to vote out of religious fervor than be bothered by how many millions would be thrown off health insurance.
BTW – Australia is not an outlier in spending and results . All of our developed world competitors have a similar showing.
The May 3rd post “Unbelievable” on our favorite local blog GossipsOfRivertown.blogspot.com caught our attention. This F.H.Stickles concrete truck dumping waste concrete next to a stream running into the Hudson River is a local demonstration of one of the central laws of capitalism.
Every company seeks to get someone else to pay for as many of its costs of doing business as possible. The laws of capitalism require this. If all of Stickles’ competitors are similarly avoiding the costs of disposing of their waste concrete they must do likewise. Otherwise their cost of doing business would be higher. In the short term their profits will be lower. In the longer term they will be forced out of business because they will have to charge higher prices. This is so regardless of the moral values or sense of community of the owners of F.H.Stickles. This how capitalism works.
Carole Osterink reported in her post “Unbelievable” on May 3rd about the dumping of waste concrete by F.H.Stickles Concrete on a site off north 2nd Street adjacent to a small stream that drains into the Hudson River perhaps a hundred yards away.
This practice is in violation of state and Federal regulations of concrete washouts of concrete trucks and other equipment used to deliver concrete at constructions sites. A quick internet search found EPA guidelines as well as NYS regulations about the handling of this hazardous waste.
The recent incident in which United Airlines used the Chicago Police Department to enforce its corporate policies has already roused plenty of comments. Many have focused on the clumsiness, even callousness of the policy and its later justifications by senior managers. This is missing a more telling point about airline travel today.
In the US four airlines control over 80%1 of the seats and in many regional markets the competition veers towards a state of monopoly. There is simply no effective competitive controls on what the airlines can charge and under what conditions. Continue reading →
Jacob S. Hacker, Yale professor and author of many books and article critiquing the American political system, economy, and the fate of the poor and middle classes, reviewed a new book, AN AMERICAN SICKNESS: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal (NY: Penguin Press, 2017). Most of the review takes up the question of why healthcare is not like other commodities and does not fit into the “let the market solve the problem” ideology of the last 40 years. If you are unpersuaded now, this is useful territory. towards the end of the review Hacker turns to our developed country competitors’ approaches to healthcare.
“The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. ….. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.”
This is a great summary statement. Using a variety of tools and institutional arrangements every other government controls prices and healthcare budgets. They do not allow a one-sided market to focus on delivering as many procedures and prescriptions as possible without any systematic focus on health. My criticism is that Hacker should have provided two further data points to put the outrage of American healthcare in its true global setting: US healthcare spending compared to other developed countries and health outcomes relative to other developed countries. As the chart below demonstrates, the US spends more than 25% more than our closest competitor, Switzerland, and twice as much as most including japan, France, Australia and Canada. The health outcomes are woeful. We rank 42 in the world for longevity and 56th for infant mortality. ((see https://www.cia.gov/library/publications/resources/the-world-factbook/)) These facts need to be front and center in our thinking about healthcare. The developed world is filled with universal healthcare systems with many different structures and approaches, all with several decades of experience at delivering better healthcare at much less expense. The only question is how will poor and middle class people in the united states gain enough political power to end this great rip-off??
The title of this short book, only 130 pages, Building the New American Economy: smart, fair, & sustainable by Jeffrey D. Sachs with a foreword by Bernie Sanders (Columbia University Press, 2017) is unfortunately misleading. There is much here about the new economy. The misleading part is that there is very little about its construction, the building of the new economy.
Sachs covers many important issues in a thorough, efficient fashion. If you need a primer or a tune up about the economy this is a good place to start. These include: investment in our society, infrastructure, Federal budget, income inequality, healthcare, energy, military and the empire (not his phrase), and innovation. If you have been reading my postings over the last 5 or so years much of this will seem a bit deja vu. Continue reading →
A central dogma of American politics and culture is the rule of law. The ever present blind scales of justice are trotted out with such regularity that the briefest glimpse serves to remind us that we live in a country with a uniquely fair and just system of law. Of course, if you have ever had the slightest encounter with the reality of this system you will already know that it is only those with money for whom this system produces any justice, and for them more money assures more justice.
I’ve been looking through Paul Krugman’s textbook Macroeconomics (Krugman and Wells, 4th edition, 2015) and came on Principle #2 – “The opportunity cost of an item—what you must give up in order to get it—is its true cost….The concept of opportunity cost is crucial to understanding individual choice because, in the end, all costs are opportunity costs. That’s because every choice you make means forgoing some other alternative.”
In this standard economics model, a central feature of capitalism gets swept under the rug or simply not mentioned, external costs. Many of the total costs of capitalist products are hidden from the pricing system, yet we all live with the consequences of the fact that capitalist markets require producers to socialize (externalize) as many costs as possible. Much of the history of the capitalist era is a struggle over who pays for these external costs. The capitalists wanted to continue to have someone else pay. Others began to push back. Continue reading →
Dan Udell videotaped a presentation on the US healthcare system by Rob Bujan on 3/25/17. I could not attend so I watched Dan’s YouTube video –
The discussions towards the end of this presentation (about minute 50) concerning single-payer systems would have been more vigorous and perhaps useful with a little international context. We live in a world where every other developed country has universal healthcare and has had for decades. So, there is plenty of experience with a range of different structures to deliver healthcare to every person as a right. Continue reading →
Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to other pieces of legislation frequently calling for comprehensive knowledge of the topic to even begin understanding its implications.
The site also spends a lot of time bad-mouthing Obamacare. I get it. Republicans don’t like Obamacare. The question is how will they improve upon it??