Of Health Care Villains, Political Will, and Monopsony Power: Thinking Straight about Health Care Reform

greedy doctor

Josh Barro, Democrats Obsess Over Health Insurers When They Should Fight Doctors and Hospitals

Nancy LeTourneau, The Search For a Villain in Health Care Affordability

I highly recommend these articles. Please read them for yourself, but here are some key takeaways.

One. The main reason health care costs so much is because our hospitals, our doctors, and our pharmaceutical companies charge us a whole lot more than comparable institutions charge in other countries.

Two. Private health insurance may add to our costs, but in an amount that is very small in comparison to the effect of high prices charged by hospitals, doctors, and drug companies.

Three. A single payer system could drive down costs, by virtue of monopsony power.

Four. But a single payer/monopsonistic system will drive down costs if and only if there is the political will to resist the powerful lobbying by hospitals, doctors, and drug companies and have the government actually drive down prices significantly.

Otherwise, we would just get a single payer system with the same high prices, paid for in higher taxes.

Five. But if there is that political will—to resist lobbying and drive down prices—then an alternative approach is just to keep the current system but regulate the hell out of provider prices.

Gott Mit Uns

Gott Mit Uns

Ross Douthat, What Are Conservatives Actually Debating? What the strange war over “David French-ism says about the right.

Andrew Sullivan, This Is What a Real Conservative Looks Like in 2019

Nancy LeTourneau, When People Are Certain That God Is On Their Side

The sources listed above provide more insight and clarity about the intra-right “intellectual” controversy about which I wrote two days ago.

Mr. Sohrab Ahmari is a recent convert to Roman Catholicism who, with the zeal of the recently converted, has apparently decided to be more Catholic than the pope. He wants people of faith—that is, folks espousing a certain strain of purported Christianity—to impose a dictatorship on the rest of us.

Now, the world is full of kooks, and Mr. Ahmari’s views would not be important but for the fact that they reflect—and provide a superficial “intellectual” veneer to support—the outlook of a non-trivial portion of our population. These include, BTW, quite a number of my high school classmates of many years ago, as evidenced by their Facebook postings.

Also, I call your attention in particular to the clarifying analysis of Ross Douthat. As he explains, the Ahmari versus French dispute could portend a decision by the religious right to abandon its alliance with the plutocracy, and just take its marbles and go home.

And what a happy event that would be.

Here’s my two cents. For the sake of the discussion, let’s say I’m the kind of person who thinks the most pressing issue of public policy is the necessity to force 13-year old rape victims to bear their rapist’s child, regardless of injury to physical or mental health. Coming in a fairly close second is my God-given right to be really nasty to gays and lesbians. Also of paramount importance: my right to erect “Christian” monuments on public property, and my right to enforce mandatory prayer before public school sports events.

Were I such a person, I would begin by addressing, not the moral rightness of seizing the levers of power and stuffing my views down the throats of everyone else. Instead, I would first ask whether such a course of action is practical. (Why waste mental energy worrying about the morality of a stratagem you could never pull off?)

Having asked myself the question, here is how I would answer: “Self,” I would say, “if the entire United States had the demographic and ideological characteristics of the population of the State of Alabama, then seizing the levers of power and establish a theocracy might work. But, inasmuch as the United States is not much like Alabama, my desired course of action won’t work, and I had best try something else.”

That’s the main point Douthat makes, though he uses a lot more words. And, Douthat cogently adds (in words or substance): if I am going to choose a political champion to advance my theocratic views, then I really need to choose a more attractive, and much cleverer, champion than Donald Trump.

That’s how a logical theocrat would think, but Mr. Ahmari and his ilk are not logical, and that’s not how they think. As Ms. LeTourneau remarks, “Frankly, it is impossible to engage someone like that, because the only response they will accept is capitulation.”

C’est de la Folie, Deuxième Partie

hardest thing

In an earlier post, I took note of Trump’s evident belief that he could fire the FBI director before his inauguration, and before his election, and even before his nomination, as evidence of increasing mental deterioration.

In a post this morning, titled The President’s Mental Deficiencies Have Been Normalized, Nancy LeTourneau addresses the same issue. She writes,

What is perhaps most disturbing about all of this is that we’ve all grown so accustomed to these kinds of things from Trump that it barely registered any attention in the media. That is how this president’s mental deficiencies have been normalized to a dangerous degree.

A Two-Handed Observation

On the one hand, one understands why reporters now feel it’s superfluous to add comments such as, “In making this claim, the President obviously was wearing a tin hat and receiving messages from the Planet Krypton—or was acting on the assumption that his followers have lost all capacity to distinguish between delusion and reality.”

On the other hand, it’s unwise, I think, to miss signs that an already delusional liar is now manifesting signs of yet further mental disintegration.


The photograph above comes from Fort Bend County, Texas. The large elephant in the room is intended to represent both the god Ganesh and the Republican mascot.

Reading the Right Wing Media So You Don’t Have To

I don’t read it either, but, thankfully, Nancy LeTourneau of the Washington Monthly does. In Right Wing Media on the Bannon vs Priebus Power Struggle, she describes how Breitbart and NewsMax—obviously spoon fed by Steve Bannon—are depicting the chaos in the White House as a power struggle between the “GOP establishment” and the True Trumpistas.

In wingnut land, it isn’t the “intelligence community” that is Trump’s enemy, nor is it “the media.” The enemy is the “establishment” in the form of Mike Pence and Reince Pribus. Pence and Pribus are the people responsible for the tragic loss of that great patriot Mike Flynn.

How long will it take the Mad King to figure out that Mike Pence is waiting for hm to screw up so badly, and so undeniably, that Mike Pence becomes president?

Aardvark is taking bets on how long it will take before Trump denounces Pence as a traitor. A month? Two weeks? A couple of days?

Camuccini, Vincenzo, 1771-1844; The Death of Julius Caesar

It’s a Snowy Day in Hell: Jonathan Chait is Wrong, Jennifer Rubin is Right


A Delusional Goofball, Not a Koch Brothers/Paul Ryan Sock Puppet

Aardvark enjoys reading Jonathan Chait, benefits from his insight, and stands in awe of his erudition and progressive fervor. Occasionally, however, Atlas shrugs. Yesterday Chait advised us that The Fight for the Soul of the Reopublican Party Has Been Canceled. After a meandering discussion of Trump’s singular inaugural speech, the role of Andrew Jackson in American history, and other topics, Chait concluded, “Far from being at odds with the agenda of a party allied with entrenched wealth, that populist style [of McCarthy, Wallace, Palin, and Trump] is the best way to lend that agenda mass appeal. We should stop seeing Trumpism as a challenge to the GOP and instead understand it as the party’s natural historical evolution.”

But today Jennifer Rubin—she of the burning passion for Mitt Romney—lets us in on the secret that Trump isn’t opn the same page as Ryan. He’s not even in the same library. Rubin writes,

Ryan may be heartened by hearing, The President wants tax reform. That means nothing. One cannot tell if Congress and Trump are on the same page until Trump knows what he wants, and Ryan will never get a definitive answer until Trump either supports what Congress produces or declares it “stupid” or a “loser.” Trump wants crowds, “wins,” acclaim, respect and adulation; what legislative product he gets matters only insofar as it provides him with emotional sustenance. …

To state the obvious, Ryan’s agenda is not Trump’s agenda. The things that motivate Trump are the wall, massive voter fraud and other shiny objects that his low-information base delights in. Trump devotes time to the things that matter to him, and this week demonstrates amply that trivial, fictional and personal issues matter. If he waves his hand and tells Ryan, Whatever you guys have is good, that’s no sign of agreement, or even interest. Lawmakers should understand that they really have no idea where Trump is on the details that matter.

They will spend months working on issues as Trump heckles from the sidelines, never supporting them when the heat rises. The sooner lawmakers grasp this, the more intelligent choices they can make about prioritizing objectives.

Meanwhile, at the Washington Monthly, Nancy LeTourneau asks, Are Republicans Starting to Recognize Trump’s Mental Instability? Good question.

And Martrin Longman, channeling Aardvark—or, more likely, it’s the other way around—laments,

Whatever this is, it’s not sanity. This isn’t some crazy like a fox cunning aimed at distracting us while Trump steals our lunch. It’s out-and-out racist-drunk-at-the-end-of-the-bar insanity. In fact, Cliff Clavin look reliable in comparison.

The media is treating this with appropriate astonishment. They’re really not sugarcoating it except that they’re not willing, like me, to come out and call this man exactly what he is, which is critically, urgently, unfit for office.

He must go soon.


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