Friday, June 30, 2017

This is First Chapter of my new book:   Multiple Payer Care In, Single Payer Out
Who Shall Pay?  For What?  Who Shall Deliver Care?

Chapter One

Notes on Donald Trump’s Rise to the Presidency

Before I get into the role of money in Trump’s election,   let me set the stage by talking about what events in the days   immediately before and after his  election.  I believe the election outcome rested heavily on health care events. 
On November 1, I began jotting down notes on Trump’s improbable rise to the presidency.   On that day, health plans announced  average premium rises of 25% and unaffordable deductibles, and insurers  began  to abandon ObamaCare markets . 

Here are my notes at the time.

November 1 - The Presidential election is one week away.  Polls project Hillary Clinton as a sure winner.  Newspapers universally endorse her, as do Wall Street bigwigs and hedge phone managers. The mainstream media has kowtowed to Clinton.  Foreign governments, anticipating her ascension, have given $140 million to the Clinton Foundation, and hundreds of thousands of dollars to speeches by her husband. 
 
The mainstream media, in particular the New York Times and the Washington Post , portray  Trump as a demagogue,  a bigot, a fascist, a homophobe, a misogynist, a white supremacist, and as intellectually and psychologically unfit to be the nation’s leader.

“On the positive side, Hilary Clinton vows to continue Obama policies.  In health care, his policies have   million from the uninsured into the exchanges and 14 million into Medicare. “

“But the economy is sluggish with a 2% growth rate over 8 years, and middle American workers in fly-over country feel forgotten and neglected with frozen wages.  Many consider themselves victims of broken health care promises that you can keep your doctor and health plans and your premiums will decline.”
“Like many physicians. I have come to believe ObamaCare is unworkable and unaffordable.  It unfairly blames fee-for-service doctors as one of the a principle cause of health care inflation.  

The truth is we have a health system that reflexes the desires  our pluralistic society.  It is a society  that wants a mix of government and private care with access to high technology.”

November 2 – Today  I would like to make these points – universal care is a noble, desirable goal but a one-size- fits-all system is a pipe dream;   government cannot effectively manage care retrospectively from Washington, data along cannot replace physicians’ experiences or intuitive diagnostic and treatment skills,  universal access is difficult because physicians have the options of not accepting Medicare, Medicaid and ObamaCare patients,  and President Obama et all made the critical mistake of ACA passage without a single GOP vote.   Instead he chose to seek standardization om s pluralistic diverse nation,   mismanaging ACA implementation with over 300 software glitches in healthcare.gov, misunderstanding the nature of insurance risk      and how to compensate for risk shortfalls,  and failing to comprehend that America is a center-right capitalistic society favoring choice and entrepreneurialism over self-righteous moralistic government control.  America has embraced the computer revolution but wants high touch combined with high tech. and minimal intrusion into the privacy and confidentiality of the patient-physician relationship.  Government intervention, in short, has its limits.”

November 3 - This week Bill Clinton observed ObamaCare is a “crazy system” with 25 million more insured but accompanied by a doubling of premiums for the rest of Americans.  Mark Dayton, governor of Minnesota, noted, after projected premiums increases of 50% to 67% in his state, stated “The Affordable Care Act is no longer affordable.”   As Samuel Johnson (1707-1784) ruefully concluded, “The Road to Hell is paved with good intentions.”

November 4 -   Candidate Trump keeps saying the election is “rigged” in favor of the media, academic, and bicoastal elite.  I disagree.  The election is not rigged.  The media-academic- political- establishment elite have simply reached a unanimous conclusion -  HillaryCare and the safest harbor for the status quo, and Donald Trump is too much of dangerous gamble.

November 5 -  How dangerous is Trump?   Well, according to the New York Times editorial board, very dangerous.   He has a ‘history of coded race-baiting in lockstep with the alt-right, the Ku-Klux Klan, racists and misogynists. It is simply Clinton-hatred that supports a candidate who also stands for torture, hatred of women, immigrants, refugees, people of color, people with disabilities.  A sexual predator, a business fraud, and a liar who runs on the promise to destroy millions of immigrants and jail his opponents.”
The millions who support Trump and attend his rallies don’t recognize the Devil described by the Times.   They are more concerned by the lack of good-paying jobs, the slowest economic recovery since World War II, the doubling of health care premiums,  the highest business income taxes in the World.  Double taxation, by U.S. government and government where U.S. companies have headquartered their companies,   leaves $3 trillion parked abroad, and a Democratic candidate and a bicoastal elite  that dismisses them as “deplorables.”

November 7 – One day to go and Hillary Clinton still heavily favored.  She is resting,  preserving her energy, before her anticipated election.   Measnwhile,  Trump is holding multiple rallies amidst signs that blacks, Hispanics, and millennials  might not turn out in requisite numbers, and that people who have never voted before may turn up at the polls to volt for Trump.
November 9 – It’s all over, and Trump won the electoral college by 305-220, mainly by capturing key Midwest states, Pennsylvania, North Carolina, Florida, and other Southern,  Southwestern, and Midwestrern states in middle America.
It’s too early for an autopsy,  but in my opinion, these factors were important.

·        Americans in these states and rural America were sick and tired  of  being told how good things were, and of being labelled as white supremacists, bigots,  homophobes,  misogynists, and of being forced to buy insurance they felt they did not need, of being relegated to part-time work.

·        Americans are a proud patriotic people.  They were weary of being told they no longer lived in an exceptional nation,  that they should apologize for being advocates of right of center capitalism and personal responsibility, that the future resided in becoming  a European-like social welfare state, and that globalism would inevitably supplant their national culture.


·        Hillary Clinton had no message other than “It’s my turn,” or
“It’s time for a woman president,”  or “I will extend President Obama’s policies.”  These messages had no resonance among voters looking for change and economic growth that improved their circumstances.

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