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  • Obamacare – The COVID-19 Virus of U.S. Healthcare Insurance

    Posted by Kevin Villani on September 30th, 2020 (All posts by )

    It tricks its way in and infects the vital organs.

    Obamacare promised to reduce the cost and improve the availability of health care services in the U.S. without reducing the quality, generally considered the world’s best. By traditional metrics, e.g., the health of the American public, the cost, and the share of national resources devoted to healthcare, Obamacare is a total bust. As with any government program targeted to a single metric, a higher percentage of the population has insurance, whatever the cost or coverage, but even that has been declining since the enforcement mechanism, a grossly excessive individual mandate, was eliminated.

    Obamacare made some households feel more financially secure, others less so. But it’s an illusion from a broader perspective as federal, state, and local finances are virtually all unsustainable. The federal government spent about $1.5 trillion on health care in 2019 and states about $300 billion. Handing out stacks of newly printed $100 bills to assist households with medical bills would have been a much cheaper and simpler solution.

    The current Rube Goldberg monstrosity reflects the attempt to achieve the universal coverage and uniform quality of national health systems while maintaining private medical services and private health insurers under the misleading banner of “insuring the uninsured.” Many analysts believed Obamacare was purposely designed as a Rube Goldberg contraption intended to end with a “bang,” paving the way for “single payer” or “Medicare for all” – the current progressive goal. But like virtually all failed government programs, Obamacare whimpers on.

    To repeal and replace would admit the obvious. But the “single payer” and “Medicare for all” proposals aren’t an actuarial insurance fix, merely a progressive federal tax. Their perceived merit is eliminating insurance company administrative costs (and administration), profits and actuarial premiums with political premiums – payroll taxes that contribute to total Treasury tax revenue. Politicizing the premiums will further politicize provider payments, two steps toward nationalized healthcare, the likely goal of many proponents.

    Socialized national healthcare may be preferable to it. But politicians deny and mis-represent the European national healthcare systems’ inferior medical performance and deny the totalitarian necessity even while issuing multiple mandates and threats under Obamacare. The original separation of the private and public healthcare systems in the U.S. – the original “public option” – is another, arguably better option.

    The Winding Road to the Obamacare Dead End

    In a competitive market economy health expenses would largely be paid from personal precautionary savings or medical insurance, the premiums sufficient to cover actuarial claims according to the “law of large numbers” for unpredictable claims, with insurance reserves for worse than predicted experience, e.g., due to a pandemic. All insurance requires a degree of “assurance” to mitigate avoidable claims, a “moral hazard that the insured will take greater risks.

    The U.S. health insurance industry in the early twentieth century followed the path of the savings bank industry of the prior century. Individual not for profit (mutual) firms (Blue Cross and Blue Shield) started appearing during the Great Depression for employees (initially teachers). The big expansion came when during WW II, FDR, no stranger to fascist business methods, capped wages but not benefits creating a loophole for un-taxed employer health insurance benefits that persists today, an advantage over individual plans paid mostly with after tax income.

    Health care needs of the poor were addressed by a variety of public, civic and religious institutions. During the first half of the 20th century, driven largely by public health concerns, municipal hospitals provided health services but with independent fee for service doctors, whereas housing policies followed the fascist Wehrmacht model, paying private developers and builders to construct public rental housing.

    Public healthcare, like public housing, was definitely below average. But the World Health Organization (WHO) Constitution of 1946 declared “enjoyment of the highest attainable standard of health”—defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”—“is one of the fundamental rights of every human being,” reaffirmed in the 2020 Democratic Party Platform.

    Similarly, in market economies housing structures are considered a capital investment financed with debt or equity, owned or rented. But the United Nations identifies adequate affordable housing and secure tenure as a “fundamental human right.”These assertions followed the destruction of WW II and rise of European “democratic socialism,” but were foreshadowed by FDR’s New Deal policies during the Great Depression and his Second Bill of Rights in 1944.

    European national Healthcare systems reflected this uniformity, with one standard for all under Britain’s system, whereas the French system allowed about 10% of the population to opt for higher quality care with private insurance.

    The U.S. went in the opposite direction in the 1950s and 1960s. Federal expenditures for housing and health services were increasingly directly subsidized with federal progressive taxation, less intrusive to the private sector than prior methods or European systems, albeit more so than subsidizing income directly. The advent of federal Medicaid and Medicare subsidized insurance led to the decline of public hospitals (as did the movie “One Flew Over the Cuckoo’s Nest.” ) But the Budget Act of 1974 making expenditures more transparent shifted lobbying efforts to less transparent tax subsidies and to regulation by the Administrative State.

    So progressives targeted finance and insurance, where the subsidies are often opaque. The objective became achieving a socialist incidence of both cost and delivery of health services by subsidizing and manipulating the private insurance market. The problem with FDR’s freely granting of multiple “rights” including healthcare and housing during this “fireside chat” was that they were not his to dispense. Progressive “rights” are nothing more than meretricious socialist promises implemented with a totalitarian stick that violate the unalienable rights in America’s Declaration of Independence that are the cornerstone of a market system, the reason for multiple conflicting and confused Supreme Court decisions regarding Obamacare.

    The Clinton Administration first proposed Hillarycare, the precursor to Obamacare, in 1993. When that failed, it turned to housing, where it was too successful. These latent New Deal viruses later turned deadly. Some three and a half years ago I argued that the two legislative centerpieces of the Obama Administration, the “Dodd-Frank Act” (the Wall Street Bank Bailout) and the “Affordable Care Act” (Obamacare) had the same fatal flaw. Politicians basically intervened in finance and insurance markets to provide equality of home ownership and medical care across all incomes without transparently paying the price. The effects spread like a deadly virus, distorting all the incentives, checks and balances that kept the private system afloat, replaced by universal one-size-fits-all mandates. The sub-prime lending debacle, like the Wehrmacht, lasted a decade, the current age of Obamacare (see Appendix).

    The Building of a Rube Goldberg Contraption: Doubling Down on “Pre-Existing Distortions”

    About three quarters of the uninsured are U.S Citizens, mostly low income employed by small businesses with no healthcare plan. If they do not get their healthcare from public, civic, or religious institutions, they generally underpay hospital bills (by almost $100 billion in 2013), made up mostly from public sources. So subsidizing insurance premiums to an affordable level could in theory raise their level of care with no additional public expense.

    Obamacare expanded Medicaid to cover those with earned income up to 138% of the poverty line ($24,000 for a family of 2, not counting the value of any other subsidies), providing subsidies (mis- labeled “refundable” tax credits) to lower middle income households above this threshold for private insurance premiums on individual plans purchased through the Health Insurance Marketplace. The problem is that premiums for individual plans were already seriously inflated due to pre-existing distortions in medical insurance that were made worse by Obamacare.

    This employer tax distortion was relatively benign until labor unions bargained for “Cadillac” insurance plans that arguably pay for procedures where costs far outweigh the medical benefits. The focus changed to getting insurance companies to cut coverage, but rather than eliminating the tax free benefit Obamacare proposed a Cadillac excise tax, never implemented due to ongoing political opposition.

    Tying benefits to the employer has had an effect similar to that of state enterprises in the formerly socialist centrally planned countries. When leaving a job, even if you stay with your current provider as an individual or with a new employer, you are considered a new customer to that plan subject to a “pre-existing conditions test.” This legal glitch morphed into insuring the self-(un) insured after they became ill. Paying for pre-existing conditions isn’t insurance, it’s a cost of health care. Shifting this cost from the self insured who have exhausted or do not want to use personal resources and from government assistance programs to insurers created a massive unmanageable moral hazard. People would simply wait until they had claims to join and pay the premium.

    In true Wehrmacht fashion, the federal government negotiates below cost arrangements with medical providers for its Medicare and Medicaid insurance, one way to limit quality that also invites massive fraud to make up part of the difference. This means providers have to charge employee insurers about two and a half times the Medicare allowance to make up the rest.

    Nevertheless, the premium for employer plans (including contributions of employer and employee) are generally less than for individual plans, even before considering personal income tax differences. Over 90% of large companies (with over 5000 employees) self insure, and over 80% of all participants are in totally self insured (46%) or partially self insured (37%) employer plans. In addition to greater flexibility with insurance (e.g., the use of stop loss insurance) and benefits, self insurance has the regulatory advantage of avoiding state regulation (which includes coverage mandates, taxes and capital requirements) in favor of less restrictive ERISA requirements.

    Rather than eliminate all these tax and regulatory distortions affecting employer plans, Obamacare doubled down, requiring businesses with 50 or more employees to provide health insurance. Too small to self-insure, this led to a significant decline in small business formation.

    Obamacare could have reduced costs of malpractice risk estimated at over $50 billion annually at the time, untouched in deference to a major political constituency. Rather than limit excessive care, Obamacare focused on expanding mandatory coverage (e.g., maternity, abortion) to some favored political constituencies.

    Hospitals historically over-charged the uninsured in response to the high rate of charge-offs and insurers typically actuarially over-priced individual plans for healthy individuals to compensate for discounts to public and private employer plans. But Obamacare mandates caused premiums for individual policies to skyrocket to multiples that actuarially necessary to cover their risk. Paying the “tax” penalty for the “individual mandate” until filing a claim for a pre-existing condition was the better choice.

    Progressive politicians wailed about excessive profits in the health insurance industry, but U.S. healthcare insurers had a somewhat lower return on equity (ROE) than other lines of insurance, probably partly related to the competition from mutual insurers. Fearing a massive actuarial loss implied by Obamacare mandates, the insurance companies resisted until they got the promised quid pro quo of administrative fees for Medicare and a promise of a bail-out should that prove insufficient, which it received in 2020.

    Obamacare coverage mandates pressured for profit insurers and providers to achieve greater efficiency through consolidation. The insurance industry consolidation paralleled that of the banking industry, resulting in a similar monopsony too-big-too-fail relationship with the federal government. As with community banks, consolidation also contributed to the disappearance of many not for profit community and religious hospitals into for profit too-big-too-fail hospital chains.

    As with mortgage finance, health care consolidation provided greater efficiency, but commissioned brokers stand between the consumers, the insurers and health care providers, creating huge incentive conflicts and moral hazard. What could go wrong?

    All these crony capitalist price distortions left medical insurer ROE about where it started. The after tax return to investors for hospitals shows: “Urban locations generate a 12% return to equity holders, while rural locations generate a 5% return.” But the resulting opaque pricing structure is more distorted than it initially was and likely more than that of the Wehrmacht before it collapsed.

    Obamacare’s earned epithet: “Here’s another nice mess you’ve gotten me into”

    Back to the Future

    The Constitution clearly left such issues as public health and housing to the states, which were much closer to the needs and more accountable for the cost. Progressive reforms started at the end of the 19th century from the bottom up, at cities and states. But by the time of the Great Depression, it was competing with other national ideologies that were imposed from the top down.

    But Obamacare is purportedly modeled after Romneycare, a “Republican” plan in a heavily blue state. There are scale economies in government programs. Massachusetts ranks 15th in population, the middle of the pack among European states. Smaller states could easily form regional plans to achieve scale economies. Competition among states and trial and error would be self-correcting, unlike any national plan.

    The only “advantage” the federal government has over states is even less fiscal accountability due to a presumed constitutionally privileged monopoly on printing money, which it has been doing to meet Social Security obligations for a decade and will soon have to do for Medicaid/Medicare as well. This too will end, probably with a bang. States have more pressure to face economic reality sooner, and many may have already reached the limit of unfunded liabilities. The federal government faces an enormous moral hazard in bailing out profligate states, especially opaquely as was tried with the CARES Act. Obamacare tried to entice states to expand Medicaid by front-loading federal subsidies that bottomed out at an overly generous 90%. But states outsmarted the feds by shifting their existing medical insurance liabilities to Obamacare, another reason for states to run their own plans.

    Romneycare quickly learned that most of those who signed up already had insurance. Getting all the uninsured low income (above the medical threshold) to sign up was extremely difficult unless mandated. Any premium represents a bigger sacrifice for low income, although people with less had accumulated precautionary savings in prior generations. The existence of a safety net however uncertain created a moral hazard discouraging plan participation.

    What if, instead of the complex Medicaid and Obamacare insurance, states and municipalities look back to their original approach. They may find it most effective to contract with existing non-profit HMOs or sponsor new ones that cater to the poor, or work through their municipalities to do the same. Copayment based on income would be set to discourage any substitution from employer plans, while providing a safety net for the uninsured. Limiting the federal role to simple block grants or matching grants would undoubtedly cost less than the current Medicare and Obamacare does, while the level of benefit would reflect state resources.

    Reminiscences

    As captain of the BC High debate team in 1964, I argued against that year’s debate topic:”• 1964 – Resolved: That Social Security benefits should be extended to include complete medical care.”My debate adviser and uncle, Fred Maloof, a general practitioner at the nation’s first municipal hospital Boston City Hospital (1864) and, following in the footsteps of Paul Revere as Boston Public Health Deputy Commissioner, spent a lifetime assisting the less fortunate with healthcare. But as a WW II Navy Captain he also understood the dangers of the various socialist ideologies. I lost that debate: Medicare was signed by LBJ the next year, and I’m now a card carrying member.

    My first hospital stay was in a 4 bed ward that looked a lot like my subsequent college dorm. But US real per person GDP has tripled since 1964 (in spite of the tremendous growth of government). Just as dorms became luxury student housing as federal money poured into college education, non profit Kaiser Permanente now offers Medicare members Platinum hospitals with all private rooms.

    Boston City Hospital is now part of Boston Medical Center. National improvements in healthcare since 1964 with “federal government help” are truly astounding. But just think how much more could have been achieved without it.

    Kevin Villani

    Kevin Villani, chief economist at Freddie Mac from 1982 to 1985, has held senior government positions, has been affiliated with nine universities, and served as CFO and director of several companies. He recently published Occupy Pennsylvania Avenue on the political origins of the sub-prime lending bubble and aftermath.

    Appendix: The Pennsylvania Avenue Sub-prime Lending Debacle: Prequel to the Obamacare Dirge

    Progressive market incentive distortions and mandates directed millions of mortgage loans to households that didn’t meet traditional underwriting criteria, resulting in trillions of dollars in credit losses and a sharp global recession. Progressives then spent tens of millions of taxpayer dollars on the Financial Crisis Inquiry Commission Chaired by Democratic operative Phil Angelides to deny the obvious causality, with a final Report that no Republican member would sign.

    One of my favorite economist colleagues Marvin Phaup posed the question whether the federally insured mortgage lending industry would “go out with a bang or a whimper” some four decades ago. That deposit-funded system and its successor capital market system both went out with a bang, but the reason why isn’t obvious. The systems of the 1980s and 2000s were both nominally private but totally politicized. Their regulators forced them to recognize hypothetical mark-to-market accounting losses (arguably some illusory losses in the 1980s) that forced their closure.

    The U.S. Banking system could often have been declared technically insolvent by that method, especially in the 1980s. Instead, the Fed and federal deposit insurance regulators colluded to let banks defer loss recognition until subsequent profits and implicit opaque tax and regulatory subsidies restored their solvency. Bureaucrats, like their political masters, don’t admit systemic failure on their watch.

    The transparent recognition of losses served the Fed’s purpose of forcing most depository institutions under its umbrella. Politicians were put in the dock, but as experienced masters of illusion blamed “greedy” managers in the former and Wall Street and market capitalism in the latter. In the last half century over five thousand savings banks and savings and loans – almost all – have disappeared, some merged with banks. Today there are only about a sixth as many deposit institutions, with a greater concentration in the top five banks. The post 2008 Bernanke bailout also put the investment banks under the Fed’s protective cover for commercial banks.

    The two government sponsored mortgage oligopolies that controlled about half the mortgage market when they went bust in 2008, Fannie Mae and Freddie Mac, went into government conservatorship with a whimper, where they remain doing essentially the same thing they always did subject to the same progressive regulations.

    The nationwide oligopoly structure produced a wide separation between the borrower and ultimate source of funds, with commissioned brokers in the middle. This created huge incentive conflicts and what insurers call “moral hazard” that mis-priced risks leading to risky behavior, a primary cause of the prior sub prime lending debacle. By preventing the occasional “bang” due to flaws in the system Dodd-Frank made the entire financial system more prone to systemic failure.

    Taxpayers paid the bill opaquely, but the burden fell transparently on the millions of lower income households induced to buy homes that were subsequently foreclosed, leading to eviction and in some cases homelessness. Politicians again blamed the bankers.

     

    17 Responses to “Obamacare – The COVID-19 Virus of U.S. Healthcare Insurance”

    1. Kirk Says:

      Regardless of how you feel about “free” public health care, the essential problem is that you’re simply not going to fix a problematic situation that has grown up like some kind of bizarre free-form colony organism with one piece of God-like legislation. Ain’t. Happening.

      Assuming that you really do want to “fix” health care in this country, what you need to do is either start from zero by tearing it all out and beginning from nothing, or you need to slowly try to unwind and rework a literal century of government meddling and market distortions. Obamacare was neither of those things, and it simply could not work, is not working, and will only create more grief on down the line.

      Friend of mine is in the medical administration field. Her belief is that roughly seventy-five cents of every health care dollar goes towards overhead and administration. If you’re lucky. This is not a situation that anyone receiving health care should be willing to tolerate, although it is making a lot of administrative drones a good deal of money. The trick, of course, is figuring out what the precise right amount of “overhead” is necessary, and cutting out the rest of it.

    2. OBloodyHell Says:

      Eliminate the $#!$%#$# idiotic employer tax benefit, and let people get their own insurance — require it, even, with suitable subsidization at a minimum allowed level (i.e., not less than 5k or 10k deductible with an accident waiver, perhaps). Offer a tax write off at some percent level for money spent towards plans, up to a reasonable minimum…

      The notion that I have to have a new insurer every time I switch jobs (once an unusual thing but no longer unusual in the current job market, and it ain’t gonna change back anytime soon) and have to wait 60-90 day or more after a new job for the insurance to “kick in” are both utterly ludicrous. Insurance should be tied to the person, for blatantly obvious reasons.

      Encourage employers, freed of the burden of paying for insurance, to offer a voucher to the workers towards their insurance, instead. Said voucher applicable to anyone’s insurance plan — either new or old.

      THEN encourage the formation of collectives, allowing similar groups (i.e., people with heart conditions, parents covering their teens, 40-somethings, diabetics) to form into small statistical universes which the actuaries can work off of.

      There’s no need for things to be this complicated, not even for the benefit of existing special-interest groups. Most of them could easily carve out a niche for themselves — for example, union workers could form one of these collectives which allowed them to retain most of the same benefits, if they aren’t absolutely ripping employers off, since they could bargain for the employer to provide suitably decent vouchers to all union employees.

    3. Brian Says:

      The fact is that people don’t want health insurance. They want to not have to stress about paying their health bills. It’s crazy, but I guarantee you that people would rather their employer give them “free” health insurance that had colossal premiums that they never see, if it had a zero deductible so they didn’t have to pay anything when they went to the doctor, even if their annual costs were nowhere near the premiums.
      That’s the sad fact, and all the conservative free-market talk that doesn’t acknowledge that reality, thanks to decades of propaganda from the left, is just wasted breath. We were completely right about the effect Obamacare would have on premiums, on existing plans, etc., but what has that got us?

    4. Mike K Says:

      First, it is important that insurance companies HATE health insurance. It is a money loser from a to z. What they do like is acting as “Administrative Service Organizations” to process claims for employers who are self insuring or for Uncle Sam with Obamacare.

      In the old days, that I just barely remember, actuaries calculated risks and insured these unusual events, like strokes and heart attacks. Most of these plans paid “indemnity style,” which mean they might pay $600 for appendicitis. The rest of the bill, if any, was the responsibility of the insured. This was a bit like fire insurance. If you wanted higher coverage, you paid for it.

      The only way we will get out of this mess is to go back to something like that. That would include cash prices by providers, openly displayed. Right now, prices are trade secrets.

    5. Gavin Longmuir Says:

      Kirk: “… what you need to do is either start from zero by tearing it all out and beginning from nothing, or you need to slowly try to unwind and rework a literal century of government meddling and market distortions.”

      Kirk, as usual, is right. Those are the viable options. Sadly, the Political Class is following a third non-viable option — slapping on additional rules, regulations, and charges to try to fix the problems they have already created through their meddling (no matter how well-intentioned).

      The challenge with slowly unwinding the mess is that it would depend on first achieving a broad consensus in the mass of the population about moving in that direction — and that is not going to happen! Face it — the Political Class is dominated by lawyers, and count the number of adverts you see every day for lawyers seeking clients to sue hospitals, insurance companies, and pharmaceutical manufacturers. The present system does not deliver good health care for all — but it does provide a very good living for the ambulance chasers.

      That puts us in the unfortunate position of having to wait for the entire edifice to collapse, and then start again from zero. We seem to be living in an echo of the 1930s, when anyone who cared to look could see the warning signs about the disaster that would some day strike — but the Political Class looked the other way. We don’t know when the system is going to break, but we do know that it WILL happen, and it will be very painful for us all when it does.

    6. Anonymous Says:

      My head is going to explode.

      There may be some things we can reasonably do to reduce the inefficiencies in the thorn ball of healthcare law and institutions, but a comprehensive solution is currently beyond reach. A major financial collapse might change the urge, but likely result in more, not less market intervention.

      The lower hanging fruit might be tort reform, cross state line competition, healthcare savings accounts, and medical expense cooperatives. I’m still trying to understand what might happen if SCOTUS kills the rest of Obamacare.

      Death6

    7. PenGun Says:

      “Regardless of how you feel about “free” public health care” TANSTAAFL

      Still it comes down to how a society wants to spend its money. In Canada we have Universal Health care provided by the federal government. It is administered by the Provinces. There are payments that all working people pay into that system and its a universal single payer system. Works quite well. It may be one of the reasons our C19 outcome is so different from yours though.

    8. Brian Says:

      There was a brief moment where meaningful conversation could be had about what the heck was going on with the Wuhan virus. Even Penny had contributions to make. He was the first place I heard of hydroxychloroquinine, zinc, etc. That was from late January through February. Since then it’s all devolved into garbage, and Penny has gone back to being a boring troll. Oh well, what a missed opportunity.

    9. PenGun Says:

      Brian. I know quite a bit about the C19 virus and am happy to share, but here I just get insulted. Not a problem, I expect this from the group here. It is true though that your rather pitiful health care service, with emphasis on the ‘service’ part, has contributed nearly as much as American intransigence. to your death toll.

    10. Brian Says:

      Yawn. Yet apparently Quebec has a worse health care system than any but the very worst hit US states. Funny that. Must be due to all that systemic anti-French bigotry…

    11. Dr. Sherif Khattab Says:

      Thank you Mr. Villani.
      After several years of studying the macro and multiples more living in the realm of healthcare payment sources, it is COMPLEXITY
      that remains as the root cause of evil for our healthcare system. Until that is treated, many efforts will die on the vine. Agree with you that parallels can be drawn. In fact it is surprising no one is headlining this fact. Maybe it is time to do exactly that. These disastrous consequences can still be avoided. However, expecting solutions for complexity to come from the people who created it is excessively hopeful. It may be comforting but still not wise.

    12. vipes Says:

      I agree with most every comment here. The issue though is too much money and bureaucracy. ACA/Obamacare was never going to fix it. Medicare for all will never fix it. Taking on the healthcare systems and insurance industry is like getting the Pentagon to do an audit. Nice idea but won’t happen like some would expect as in the private sector. Just too much money and bureaucracy. And simply ginormous in scope.

      Here is an ad hoc perhaps out of place personal story of ACA and Medicaid…

      I was ‘furloughed’ due to business impacts from COVID-19 back in late April. I won’t bore you with details on how that was BS and the company is sinking like a rock.

      I applied for an ACA plan thereafter as I did several years previously when laid off. Heck, I’ll use any applicable tax break even if I didn’t vote for it. So why not Obamacare?

      This time though, the ACA process denied me for not having enough income to pay for a plan. What? I would pay for it on time, every time like I did previously. I appealed. They denied again. I cannot do anything further. Was explained my state Medicare program would pick me up. Great. Wonderful.

      I applied for my state Medicare plan. Denied. We made too much. What? Yes my wife works full time. But it’s retail and not a big, fat paycheck. Also missed out on the window to get her insurance due to ‘major life changes’ since we had been looking at the ACA as our option. Contributing to the part of we ‘make too much’ I believe is the additional $600 per week in unemployment benefits the Feds were doling out at the time. I didn’t ask for it but now paying the price thanks to the Feds helping. I appealed and denied again.

      We are doing fine. But the notion the ‘government’ is there as a safety net is baloney.

      I am from the Government and I am here to help. Still the scariest words to hear.

    13. Mike K Says:

      PenGun is an instant expert on most topics.

      I have explained my proposed model for a real reform of healthcare in this country. There are a series of posts that are ten years old and still valid on the side bar. It is the French system, as designed. France has such a bad unemployment problem that the system is heavily stressed but the concept is still good. It uses a market mechanism for private care and is thus anathema to Democrats and leftists like you-know-who.

    14. PenGun Says:

      “PenGun is an instant expert on most topics.”

      LOL. I’m old and have had an interest in this Universe since I was young. “Run and find out” has been my motto since I read the Jungle Books. I was sent away young to school, and was not happy being bullied by the local bullies, so I loved Rikki Tikki Tavi and his attitude. He was my hero.

      So knowing about stuff is my hobby now. ;)

      Brian, I’m sorry for making you tired. If you look you will find the worse hit provinces are the ones that did not close down well, and acted pretty well like the US, with Ontario and Quebec being the worse hit. We have pretty well the same health care system across the entire country and BC for instance has done quite well, comparatively speaking. The surges everywhere are the result of people regrouping after isolating, its that simple. Way too soon. As I said elsewhere, this is physics in action.

      I must extend my hope for a speedy recovery of The Donald. I was worried about Boris and he came close to not making it. Its a danger to all people who have to deal with people face to face, as politicians have to. I hope this makes some people reconsider their cavalier attitude to distancing, masks etc.

    15. Mike K Says:

      Just came across this at another site.

      A taste of it.

      First of all, primary care is easily available in Canada. Thereafter, specialty care is a real challenge. I will never forget having to call every day to a cardiologist’s office to try to get a patient of mine bumped up the list to get an angiogram because he was having chest pain just getting to the bathroom. Somewhere about the time I learned the names of the receptionist’s goldfish, I finally got him an appointment. He could easily have died waiting in line – something bureaucrats don’t mind in big systems. I saw that both in Canada and in Saudi Arabia (for the non-VIPs) – the line meant health care was available … eventually, if you survived.

      My impression, too.

    16. miguel cervantes Says:

      obamacare was designed to fail, to lead to single payer, this was admitted by jacob hooker, jan schakowski, barney frank (who was a witch doctor of subprime)

    17. tomw Says:

      Many parts of Canada have such low population density that they match that of Montana, the Dakotas, etc. I suspect that the infection rate approximates population density to a degree, which therefor infers that Canada overall should have lower incidence of infection, and likely less casualties.
      Dunno where to find the appropriate information to even attempt to interpret.

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