Health Care Reality

I have stated repeatedly that the number one reason why Hillary lost the electoral college vote was because she continued to defend Obamacare (ACA) even as it continued to fail the fly-over states. Many of you seem to think Health Care Coverage is not the number one political issue of our time, yet it is.

First understand how bad Obamacare actually got for many people. In at least 5 states there were only one carrier in the ACA health exchanges, while healthcare insurance prices soared in those states as you would expect with such a monopoly. Alabama's health insurance prices became more expensive than California's. Some of that was state-level self-inflicted wounds by conservative states rejecting the Obamacare Medicaid expansion, but just as the public option would have been required to make the ACA/Obamacare work, so allowing for this obstructionism in Obamacare's design was also a fatal flaw.

Various polls have shown that when the policy is explained to the person being asked, we in the USA strongly prefer a "single payer" system for health care to any alternative. The problem is now the name "single payer" because of the specific disaster mentioned above with health insurance monopolies created in Obamacare exchanges. The plain American English for what we mean by "single payer" (which is not private health insurance monopolies) is "Medicare for All," as espoused by Bearnie Sander's platform. There was a very significant anti-establishment overlap between Trump voters and Sanders voters, but once Hillary got her party's nomination, she guaranteed "Medicare for All" would not be on the agenda, and voters desperate for change on this one most important issue had little choice but to vote for Trump.

Before  Obamacare, we Americans were easily frightened by tales from Western Europe and Canada about the failures of single-payer health care coverage. However now that we have seen just how rapidly things can decline, a "European-style health care system" is sounding very good to us. There is one other English speaking country in the Americas, and they are right next door to us. We know the Canadians have a superior health care system to ours, and there isn't any hiding it. 10 years ago you could have pointed to their taxes and convinced us it was too luxurious for the USA, but now that we have seen our health care prices skyrocket in spite of the Obamacare overhaul, "Canadian taxes" are the least of our health insurance expense concerns.

As Americans, we believe in freedom, so that employer based health insurance is a very poor cultural match for us:

1. From an employer's perspective, an entrepreneur or manager shouldn't have to sweat how to cover employee health insurance. This is not a natural part of the wages vs. hours formula, and when health care insurance prices go up for exactly the same or worse coverage, your employees do not appreciate what you are paying for them because they aren't paying for it, except for in lower and less frequent raises. Employer-based health insurance impedes our ability as Americans to complete fairly in business.
2. From an employee's perspective, the threat of losing employment means loosing access to your doctor. For anyone with a significant health condition OR at risk for a serious health care condition (basically all of us,) this is very like threatening our lives. In other words, employer-based health care for the employee is strikingly similar to guns-pointed-at-our-heads slavery.

I also often say "do not tell me about political parties. Instead give me Libertarians and Socialists, so we can have a grown up conversation about meaningful policies." In an era were most jobs are rapidly being replaced my automation, the most important question voters should be asking themselves (besides perhaps issues around maintaining their rights to vote in the first place,) is "what should be paid for by taxes, and what shouldn't be paid for by taxes." We get so caught up in political bike shed issues, that this critical question is rarely debated:

• Roads should be paid for by taxes, because they are too expensive for any of us individually to build and maintain, but we all need those roads. See also military, court system, government, etc.
• Chocolate should not be paid for by taxes, because it is inexpensive enough for anyone who wants it to get it, and even in the case of extraordinarily expensive chocolate, we do not depend on chocolate to survive. See also piano lessons, watermelons, entertainment, etc.

In the days of the traveling door-to-door doctor (think 1800's,) health care coverage was far more affordable and far less effective at extending our survival. Now in 2017 health care is like roads, incredibly expensive and critical to survival in our society. Health care should be paid for by taxes and have have nothing to do with our decisions regarding business plans or how we spend our days.