Big Government

A Modest Proposal

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New ‘Medicare for All’ Bill Would Kick 181 Million Off Private Insurance

Now might be a good time for new federal legislation requiring all members of Congress to use only Medicaid for their own non-emergency medical care. The plan’s features could include:

-Doctors assigned randomly from a list of the Medicaid providers in each member’s district.

-Penalties (fines? misdemeanor/felony? the posting of the member’s name in an online ledger?) for going outside of this system for treatment without prior approval.

-Prior approval to require a unanimous vote by a panel of citizens selected randomly from a list of the registered voters in each member’s district.

Of course this legislation would have no chance of passage. Its purpose would be to make Congressional single-payer advocates explain why they should be exempt from it, and then why the rest of us should be be subjected to their hare-brained socialized-medicine schemes.

Make them live by their own rules, as a great man once said.

Seth Barrett Tillman: Today’s Question On CONLAWPROF: Where Would You Put Trump?

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Professor ZZZ asks: “Trump is not Stalin but in the history of national (federal) political figures in this country, I’m wondering … where [would] you put Trump? … Having a POTUS so publicly awful along those lines lowers the horrible bar so dramatically that we will pay for years to come. Not being Stalin but being Roy Cohn is a hell of a legacy.”
 
Tillman responded:
 
[. . .]
 
Trump is ahead of Woodrow Wilson: World War I, and! his resegregation of the federal civil service. I grant you that being ahead of Wilson is not saying much…but then, the nation survived Wilson, and no one today thinks of Wilson as having lowered the bar vis-a-vis future presidents. Professor ZZZ seems to be worried about this. He wrote: “Having a POTUS so publicly awful along those lines lowers the horrible bar so dramatically that we will pay for years to come.” Really?—Will we pay for it in years to come, or is this just a shabby slippery slope-type argument?
 
I cannot say I see much sense in Professor ZZZ’s references to Roy Cohn. Roy Cohn’s permanent claim to fame is his association with McCarthy and aggressive anticommunism. Trump, by contrast, has been criticized for being too close to Putin. It is not exactly the same; actually, the two are not alike at all.
 
If words and pretty speeches are the measure of a president, then Trump comes up short. The question is whether that is the correct standard for measuring presidents in a dangerous world.

Read the whole thing.

Seth’s last line is a good summary of the general flaw with many anti-Trump arguments. However, Seth doesn’t go far enough with specific examples:

-Trump didn’t withdraw US forces precipitately from an overseas conflict, leaving the worst of our enemies to fill the resulting power vacuum as Obama did in Iraq.

-Trump didn’t reverse longstanding US policy, deprecating alliances with pro-American countries, in a foolish and futile effort to buy the love of the Iranian mullahs as Obama did.

-Trump didn’t let himself get played by the North Korean dictatorship as Clinton, both Bushes and Obama did.

-Trump didn’t use the IRS to harass his political opponents – as Nixon threatened to do, as the Clintons did to right-wing activist organizations, and as Obama did to organizations and individuals who were active in the Tea Party movement.

-Trump didn’t use the FBI and CIA to spy on his Democratic rivals’ election campaigns as Obama seems to have done to Trump’s 2016 presidential campaign.

I can think of numerous other examples of unwise or malicious actions taken by previous presidents that Trump hasn’t done. Feel free to add additional examples in the comments.

Some thoughts on what health care reform could look like.

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I have previously posted some articles on the French healthcare system, which is the best in Europe.

Here is an article on the French system.

The French citizen or resident joins Caisse Nationale d’Assurance Maladie deTravailleurs Salariés (CNAMTS)—health insurance organisation for salaried workers. That covers about 80% of the population now and it pays 80% (often more like 70%) of a fee schedule for the doctor visit although specialists are allowed to charge more. French doctors are divided for payment and fee schedule purposes into three “sectors” after 1980. Sector 1 doctors agreed to abide by the fee schedule established in 1960, modified for inflation and technological changes. They are mostly primary care doctors although some had waivers from the fee schedule prior to 1971 because they were more experienced or had great reputations. Few are still practicing. Sector 2 doctors could set their own fees but reimbursement was still determined by the fee schedule. These two categories correspond roughly to Medicare assignment in the US. If you accept assignment, you agree to accept Medicare payment as the full payment (or 80% of it plus the Medi-Gap payment).

The French have private insurance that acts like US “Medi-Gap” polices but for all.

It seems unlikely to me that Democrats would accept a health plan that allowed balance billing, which is the only way to control costs, short of pure rationing. The French basically provide a fee schedule that is the same for everyone but which allows doctors to charge more if the patient is willing to pay. For example, I called the office of a new internist last week to schedule an appointment. The clerk required that I submit all my insurance information, not my health status, and the doctor would decide if he would see me. If he is that busy, perhaps he could justify charging more.

Here is another article from that series explaining the French system.

French primary care physicians are paid less than American but medical school in France does not require a college degree and is free. I suspect that system might be more attractive in the US than many realize.

Unfortunately, such a radical reform is unlikely. There are other options under consideration.

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Russia to healthcare in one day. What now ?

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Last Friday, the Mueller report was submitted to the DOJ. Monday, left wing media saw ratings collapse.

What next ? Why Healthcare, of course.

Obamacare, which is a form of expanded Medicaid, costs too much and provides too little care (high deductibles) unless you are a Medicaid recipient. It was designed to shift costs to the insured from the poor. It also was a gift to certain sectors of the healthcare industry. Ted Kennedy criticized healthcare as a “cottage industry” with lots of independent doctors doing their own thing as small businesspeople. That is why doctors have traditionally been conservative. Obamacare changed that. Healthcare is now an industry with doctors mostly on salary and controlled by administrators.

I talked to a young ophthalmologist last week, who had treated a mild eye disorder. He told me he moved to Tucson to work at U of Arizona medical center, which used to be called “UMC” by everybody in Arizona. He explained that the UMC administrators had gotten deeply into debt installing a new “Electronic Health Record” system and sold the UMC to Banner Health. This is a chain that runs the former UMC and has seen an exodus of university faculty physicians. Even my barber noticed. He told me several weeks ago that his surgeon, who had operated on him, got tired of constantly being told he only had 15 minutes to see each patient and left for the VA. The ophthalmologist was disappointed as he had looked forward to working at the academic center.

Traditionally, administrators hated doctors. We made their lives more difficult by advocating for patients. I once told an administrator that if the hospital did not reduce the markup on pacemakers, I would testify for the patient if they sued him for the balance of the bill. They didn’t like it but knew I could go elsewhere,and take my patients there. If I had been an employee, I would not have that choice. Several years ago, I explained how we started a trauma center in our hospital. Since then, the hospital has been sold to a non-profit run by nuns. The surgical group that ran the trauma center for 35 years was fired two years ago. They had declined to sell the group to the hospital. They were replaced by six female surgeons no one had ever heard of and who had never applied for privileges at the hospital or been evaluated by the Surgery Department. No one knew anything about them except one member of this new group had applied for a job at the trauma group and been turned down.

There were a few comments about some less satisfactory results on trauma cases but that has quickly gotten quiet.

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The 737 MAX and the Death of MIL-STD-499A SYSTEM ENGINEERING MANAGEMENT

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One of the life experiences that comes with being a three decade veteran of military procurement is you have been around long enough to know where all the important bodies are buried — case in point, the Boeing 737 MAX.   What we are seeing in the two recent 737 MAX crashes is the the 20 year accumulation of professional toxic waste and decay in Boeing management that came with the first Clinton Administration’s cancellation of MIL-STD-499A SYSTEM ENGINEERING MANAGEMENT.

737 MAX Jetliner in South West Airline Colors.

I was e-mailed a link today to this Daily Kos post on the 737 MAX :

Did Boeing ignore basic SW engineering principles?
Thursday March 21, 2019 · 8:34 AM CDT

and this passage just jumped out:

A few software engineering principles:

  • Software engineering 101: validate your inputs.
  • Software engineering 201: when something goes wrong, provide useful data to the human.
  • Software engineering 301: for life-critical decisions, avoid single point of failure.

Until today, I had thought that aviation was *good* at software engineering. But my faith is shaken by the New York Times description today of what went wrong with the Boeing 737 MAX.

The above passes my professional “Bozo Test” of whether the poster knows what he is taking about regards software development.   He does.

This is where that “military procurement life experience” I mentioned comes in.   The timing of the development of the 737 MAX MCAS software was roughly 20 years after the Clinton Administration cancelled the majority of Mil-Specs in the mid-1990’s and in particular the one for system engineering management.

See:

MIL-STD-499A (NOTICE 1), MILITARY STANDARD: SYSTEM ENGINEERING MANAGEMENT (27 FEB 1995) [NO S/S DOCUMENT]., MIL-STD-499A (USAF), dated 1 May 1974, is hereby canceled without replacement.

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