Part the First: The President Fixes Healthcare. Oh, joy! A very long time ago I told myself that, surely, by the time I was eligible for Medicare the United States would have fixed our healthcare system so that job lock and other assorted problems would have vanished. Silly me. I have been eligible for Medicare for several years now but have not had to use it. I thought about job lock when I got my first real job as an independent adult when I was 20 years old. I immediately realized was “locked in” to my job because it came with medical insurance. I liked being a research technician, so that was not particularly troublesome to me. But I did recognize that others were not so fortunate. Then there are the looming dread of unpayable bills and the attendant fear of our healthcare system as a rent-seeking enterprise above all. The list of wrongs in American healthcare is as long as you want to make it. But the artist or writer should be free to do as her muse tells her, without worrying about bankruptcy if an inattentive driver knocks her off her bicycle.
But things, they are a changin’. As covered in StatNews, Trump releases health care plan amid pressure over affordability. I suppose:
President Trump on Thursday released a hodgepodge of health care policies that would create new price-control power over pharmaceutical companies, but that otherwise wouldn’t fundamentally overhaul America’s existing system, as he faces mounting pressure to address the cost of insurance and care.
The proposal, which Trump dubbed “The Great Healthcare Plan,” would not reshape the structure of Medicare, Medicaid, or the health insurance plans people get through their jobs. Hospitals and doctors would not cede pricing power.
From the presidential link a few things jump out. My “favorite” is:
MAXIMIZING PRICE TRANSPARENCY: The Great Healthcare Plan requires any healthcare provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business and ensure insurance companies are complying with price transparency requirements.
- In President Trump’s first term, he issued historic regulations requiring hospitals and insurance companies to post prices in various forms.
- The Biden Administration failed to enforce these requirements and took no actions to help patients access actual prices.
- The Great Healthcare Plan requires all healthcare providers and insurers to answer to their patients up front on the prices they will be charged – restoring accountability, transparency, and rightly giving power back to patients.
What of the provider or insurer who doesn’t accept Medicare or Medicaid? I suppose this means that when I needed minor but essential surgery a year ago I should have been able to shop around for a hospital, prep nurse, surgeon, anesthesiologist, and recovery room nurse to be sure I was “getting the most for my money.” And the insurance company’s money. Or something like that. In any case, this is simply ridiculous. We are not a serious nation.
This is all undoubtedly a reaction to the expiration of subsidies that made the Affordable Care Act more or less affordable, depending on individual circumstances. But:
Trump’s proposals could reshape that debate, although Wall Street analysts don’t foresee sizable changes actually getting enshrined into law.
“We view this new document as a largely political exercise,” Spencer Perlman, director of health care research at Veda Partners, wrote in a note to clients. “We think it is intended to demonstrate that the White House is doing ‘something’ about affordability and healthcare prices, but we believe the policies either stand little chance of being enacted by the current Congress or will have a minimal impact if enacted.”
On the call, officials didn’t clearly answer questions about whether they supported extending the enhanced ACA insurance subsidies.
It’s probably best to listen to Wall Street on this one. There are entirely too many rice bowls in jeopardy for anything drastic to happen. Nothing can or will change until it becomes widely recognized and appreciated that health insurance is a simpleminded category mistake that originated when industrial firms used healthcare as a competitive fringe benefit during the wage-and-price-control era of World War II. Insurance is for things unlikely to happen. So, nothing will fundamentally change under the current Neoliberal Dispensation. Joe Biden was correct about that.
And one final thing that is an aggravation, as they say in these parts. A universal healthcare system that works for everyone is not “free.” It is “no-cost at the point of delivery,” with the patient and physician having final say on the course of action. Big difference. This medical care will be paid for out our taxes, just like public roads and schools. Calling such medical free is a strategic error of the first magnitude that gives the Marketeers too much room to maneuver. This is not a hard concept. Aneurin Bevan instituted the NHS in less than two years, without computers or AI. Medicare appeared almost as fast, after the enabling legislation.
Part the Second. The Air We Breathe Now and in the Future. I am also old enough to remember life before the Clean Air Act and the Environmental Protection Agency. At one point the air in my small coastal industrial city killed the Spanish moss in the live oak trees (note the resurrection ferns growing on the branches of the trees). The Clean Air Act fixed that. From Scientific American: America’s Air Is About to Get Dirtier – And More Dangerous:
For more than five decades, the Clean Air Act has prevented millions of premature deaths, hospitalizations, and lost work and school days. By one official reckoning in 2011, the act’s limits on harmful pollution have benefited the U.S. economy to the tune of $2 trillion by 2020, in contrast with $65 billion in costs to implement regulations.
But now the U.S. Environmental Protection Agency is abruptly changing how it enforces at least parts of the Clean Air Act by not calculating the economic benefits of some regulations. The seemingly inevitable result is that Americans will soon breathe noticeably dirtier air and see worse health outcomes.
“I don’t think anyone wants to go back to … not being able to see anything,” says Camille Pannu, an environmental law expert at Columbia University.
The EPA will no longer consider the dollar value of lives saved or other ill effects averted by placing limits on fine particulate matter with the designation PM2.5 or ozone emissions in at least some cases, the New York Times reported on Monday. Instead the agency will only calculate the cost to industry to enforce the act’s rules.
To get a sense of why this matters, it is important to understand what ozone and PM2.5 do to our body. PM2.5 describes particles that have a diameter smaller than 2.5 microns. They are tiny enough to enter the bloodstream, lodge deeply in the lungs and cross the blood-brain barrier. PM2.5 has been liked to diabetes, obesity, dementia, cancer, low birth weight and asthma. Ozone, a key ingredient of smog, is particularly dangerous for people with asthma and other lung diseases, especially children.
The Clean Air Act was enacted precisely because the health effects of bad air are population-wide and difficult to evaluate. In other words, without estimating costs, even imperfectly, “everything is costly, and nothing is worth regulating,” Pannu says. (emphasis added)
Regulation is evil: The Market takes the measure of all things!. No, actually. This is just another proof that the Market is the measure of all things, except those things the powers that be do not want to acknowledge. Still, in my lived experience, the Clean Air Act and Clean Water Act had measurable impacts on the air and water that surrounded us in The Most Delightful Country of the Universe, with unmeasurable, or perhaps more likely immeasurable, impacts on human health and wellbeing:
A 2016 analysis from the University of Chicago found that people in the U.S. had gained 336 million life-years, a measure of how long people are expected to live in a healthy condition, since amendments to the Clean Air Act were passed in 1970. And in 2011 the EPA estimated that updates to the act made in 1990 would prevent more than 230,000 early deaths, 75,000 cases of bronchitis, 120,000 emergency room visits and 17 million lost workdays by 2020. About 85 percent of these benefits stem from deaths avoided because of reductions in particular (sic – particulate would seem to be the correct term) matter alone.
Even if the estimate is off by a factor of ten, 33.6 million life-years is still a very large number. I suppose they will come for the Clean Water Act next. Oh well, there is always bottled water at hand.
Part the Third: A Reconsideration. War was declared on the Substance Abuse and Mental Health Services Administration three days ago on Tuesday. This was to be expected. What was not expected was what happened Wednesday when we learned that Trump administration reverses course on $1.9 billion in cuts to addiction and mental health grants:
The Trump administration on Wednesday reversed course on major funding cuts to addiction and mental health programs it had issued the day before, according to four sources familiar with the decision.
The about-face would spare, at least temporarily, thousands of organizations that receive funding from the Substance Abuse and Mental Health Services Administration.
While the exact funding cuts enacted on Tuesday remained unclear, the scope was vast. Multiple sources told STAT that the number of overall grants originally canceled could number as high as 2,800, with the total dollars affected as high as $1.9 billion — over one-quarter of the agency’s overall budget.
One high-level SAMHSA source told STAT that the agency’s staff were not aware of the cuts, which were not planned in consultation with agency staff or announced internally.
The reversal came after near-universal condemnation from organizations across the mental health and addiction treatment field, which warned that suddenly zeroing out grants that had already been awarded would lead to layoffs, threaten patient care, or force them to close altogether.
Wednesday evening, 100 members of the House of Representatives, including three Republicans, wrote to the Department of Health and Human Services, the agency that oversees SAMHSA, condemning the cuts and demanding justification for them.
This reversal is a good thing. This support will fund services including opioid treatment, addiction care for people experiencing homelessness, helping adults transition out of prison, and HIV and hepatitis C prevention, among other services for fellow Americans in dire need of help. But since only three Republicans out of the one hundred members of the House of Representatives registered their disapproval of this smashing of SAMHSA, I guess this means that only radical leftist un-Americans have fallen into these conditions:
The attempted cuts were especially notable given that health secretary Robert F. Kennedy Jr., who oversees SAMHSA’s parent agency, is in long-term recovery from addiction to heroin and alcohol, and while running for president in 2024 repeatedly pointed to the addiction and mental health crisis as a top priority.
It’s all good, though, because the current Secretary was able to manage his recovery because he has a will of steel, or family money that covered the costs.
Part the Fourth: A Cabinet for the Next President. By way of necessary digression, an update from Teddy Macker in Front Porch Republic with a list of essential cabinet secretaries and department directors for the world around the corner, including these and others at the link:
- Secretary of Gardens and Small Diversified Farms
- Director of Indiscriminate Mercy
- Secretary of the Fifteen Wolves Left in California
- Director of the Office of Nonaligned Political Correctness
- Director of the Office of Malice Toward None and Charity Toward All
- Secretary of Awareness of the Ineradicable Reality of Sickness, Vulnerability, and Death
- Secretary of Awareness of Chronological Snobbery and the Myth of Progress
A good start…And I cannot help but ask if Vice-President JD “Absolute Immunity” Vance recognizes the source of the title of the fifth leader on the list.
As I write this on his birthday, let us remember the essential American of the twentieth century on his day Monday: The arc of the moral universe is long, but it bends toward justice. The date given at the link for this quotation is March 31, 1968. That was four days before he was assassinated in Memphis, Tennessee, at the age of 39.
See you next week!
China’s plan seems to be to run every other country out of manufacturing, to run a trade surplus with the entire world.
ROW is getting a bit tired of it.
Maybe it’s been linked on NC before but thank you for sharing Front Porch Republic, a gem of the internet. “In Praise of Bibliographies “, “Put a Candle in the Window: Songs About the Light”, “Still Asking Berry’s Question”, etc. This is a rabbit hole I will absolutely enjoy getting lost in for the next few weeks.
Thank you for the link to Front Porch Republic, an absolute gem of the internet. I will enjoy getting lost in this rabbit hole for weeks. Starting with “In Praise of Bibliographies “ and “Winter Companions: Songs About Friendship “.
So will places like California once more be getting their smog back again like the good old days? Read of Heinlein and his wife living in California before the war and then doing war work in Philadelphia. When they came back after the war they noticed the smog in the air from all the war factories and noted how it took twice as long to get a suntan now. Of course they moved out long before California’s smog became infamous worldwide but will people really want those smog days back again.
States can have stricter regulations than the EPA, which establishes a floor, so LA can party on. Houston, though (moreso the Bayou) ……
This is a trap. No one in Washington has a problem with the cost of any military expense. The true cost is resources. We can’t run out of money.
Having people believe we lack money for stuff in a fiat world is a trap. It hasn’t helped get material benefits so far. We need a different tac that educates people on how resource allocation really works.
Perhaps this essay needs a Part Five, if only to clear away one of the most persistent confusions that poisons every discussion of health care, infrastructure, and public purpose: federal taxes do not fund federal spending.
Neither roads, nor schools, nor Medicare are paid for by taxes in the way households pay bills. At the currency-issuing level of government, spending comes first. Federal spending creates the dollars; taxation merely removes some of them afterward.
This distinction matters enormously. The role of taxation at the federal level is not to “pay for” programs but to manage inflation, shape incentives, and withdraw excess purchasing power once spending has entered the economy. Confusing funding with draining is like putting the sink drain in the middle of the kitchen floor. You do not drain water before it reaches the basin, and you do not drain money from the economy before public spending has even reached paycheques and communities.
Which leads directly to where drains should and should not be placed. Taxing wages is perverse: it withdraws income at the very moment federal spending is trying to sustain employment and demand. Broad sales taxes do the same, hitting households regardless of capacity to absorb the loss (and the U.S. is, mercifully, almost alone among advanced economies in not having a federal VAT). If the goal is to manage inflation and excess liquidity, the obvious drains are corporate profits, economic rents, speculative finance, and the financial sector itself – precisely where income accumulates without corresponding increases in real productive capacity.
Seen through this lens, the broader pattern returns us to the same conclusion: policies like the OBBBA are not merely cruel or ideological. They are macro-economically illiterate. They starve the real economy, protect rent extraction, and then feign surprise when healthcare remains unaffordable, air and water protections are dismantled, and social systems fracture. None of this is a mystery. It is the predictable result of forgetting what money is for.
Perhaps this essay needs a Part Five, if only to clear away one of the most persistent confusions that poisons every discussion of health care, infrastructure, and public purpose: federal taxes do not fund federal spending.
Neither roads and schools, nor Medicare are paid for by taxes in the way households pay bills. At the currency-issuing level of government, spending comes first. Federal spending creates the dollars; taxation merely removes some of them afterward.
This distinction matters. The role of taxation at the federal level is not to “pay for” programs but to manage inflation, shape incentives, and drain excess purchasing power once spending has entered the economy. Confusing funding with draining is like putting the sink drain in the middle of the kitchen floor. You do not drain water before it reaches the basin, and you do not drain money from the economy before public spending has even reached paycheques and communities.
Which leads directly to where drains should and should not be placed. Taxing wages (deductions) is perverse: it withdraws income at the very moment federal spending is trying to sustain employment and demand. Broad sales taxes do the same, hitting households regardless of capacity to absorb the loss (and the U.S. is, mercifully, almost alone among advanced economies in not having a federal VAT). If the goal is to manage inflation and excess liquidity, the obvious drains are corporate profits, economic rents, speculative finance, and the financial sector itself, precisely where income accumulates without corresponding increases in real productive capacity.
Seen through this lens, the broader pattern returns us to the same conclusion: policies like the OBBBA are not merely cruel or ideological. They are macro-economically illiterate. They starve the real economy, protect rent extraction, and then feign surprise when healthcare remains unaffordable, air and water protections are dismantled, and social systems fracture. None of this is a mystery. It is the predictable result of forgetting what money is for and how it works.
DFWCom’s comments are a brilliant Part 5 to KLG’s piece. The near universal misunderstanding of money – corrected with a few cogent paragraphs here – seems immune to correction in the minds of most people. And this macroeconomic illiteracy has toxic effects on the vast majority of people around the world, not to mention the planet.
Were the moral arc tied to a better understanding of how federal money actually works, we might see a speedier bend toward justice.