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Testing …. Welcome to J&T’s first-ever Internet Town Hall meeting. If you were around last fall, you might have seen our live-blog of the final presidential debate. We are going to use the same basic format.

This is an experiment, so bear with us. Feel free to chime in – PLEASE chime in, we need all the help we can get – and follow along for the next hour or so as we discuss single-payer healthcare. I’ll post a short op-ed I wrote last week in the first comment; you can respond to that, make up your own thing, or tell us a knock-knock joke. Anything goes. Well, except for trolling; we’ll delete personal insults and unsupported accusations. This is a nice neighborhood.

But it’s going to be pretty loose, and we expect it to wander all over the place. I’ll post my op/ed from last week at the top, then we’ll see where the conversation goes:

There are two expandable single-payer healthcare models in place in the United States: Medicare and the Veteran’s Health Administration. Medicare expansion seems to get all the attention, but is it our best option? The VHA has features in place that might make it more desirable as our national healthcare model.

Medicare expansion would still leave the neediest health care patients with large bills to pay. In 2011, according to the AARP Public Policy Institute, the majority of Medicare users spent at least 18 percent of their income on medical expenses, premiums and deductibles.

Many of those bills wound up in collections or written off – effectively charged back to taxpayers. The VHA system’s benefits are based on previous service; VHA medical bills are, in effect, paid in advance. A single-payer plan based on the VHA model would not have to deal with a consumer debt variable; the cost could be calculated up front.

The VHA’s notorious system bugs will have to be worked out, but most of them can be eliminated through proper funding and management. Citizens can earn a lifetime of good quality healthcare through national service, gaining peace of mind – and perhaps a little national pride in the bargain.

C (Chris Early): Sounds good to me. The status-quo folks will point to the VA’s sketchy management history and say any new program either can’t or won’t be run any better. There needs to be an answer for that.

T: You got straight to the 64 dollar question on the VA, Chris. Most of the VA issues are management and support-related, I think – not systemic flaws. The last time I was in the VA hospital it was like the Zombie Apocalypse – except all the zombies had walkers and wore ballcaps with military unit insignia.

J: I would disagree with the status-quo folks on Medicare; Medicare is the most efficiently-administered healthcare delivery system in the country, by a mile. So the government can, and does, do healthcare well. I would echo Terry’s comment that the VA’s problems aren’t built-in; they’re due to chronic understaffing and mismanagement at the individual level.

T: I like the idea of expanding the VA as opposed to Medicare for a uniquely American reason: It’s a patriotic organization. If we combine healthcare and national service under a single umbrella, it won’t feel like socialism, it’ll feel like patriotism. If it works, it will be patriotism.

J: I think that offering VHA healthcare in exchange for national service is an outstanding idea; it wouldn’t be limited to the young and fit, either. Anyone would be eligible to perform service; we could have people act as childcare workers, elder care workers, infrastructure builders… on and on.

T: I especially like the idea of using a combination of healthcare coverage and training opportunities to solve our massive human care issues. We need people to take care of the old and the young, and we need them to be properly trained. And one of the beauties of a strong internal system is that a large portion of the cost is reinvested. We pay our own people, and they have money to contribute to the economy. It’s a jobs bill AND a healthcare bill.

J: I think we can all agree that the current system is severely broken; Americans pay, by far, the most in the world for their healthcare in both absolute and per-capita terms. There are a lot of proposals out there to fix the system, but none of them address the fundamental problem, which is the tremendous inefficiency of the current healthcare system.

T: John, you are in the business – what are the biggest abuses you see?

J: I’d say the biggest inefficiency is the gatekeeper system of healthcare; I spend probably half my days dealing with issues related to authorizations, or not having authorizations, etc. The hospital group I service has an entire department devoted to dealing with these issues; that’s money being devoted to administration that could be devoted to patient care..

T: I know we struggle with that … I think our administrative load is something like 22 percent, compared to most of the single-payer countries, who only spend 3-5 percent of their medical budgets on paper clips and gummy notes.

J: This is kind of weird for me… I’m advocating for the elimination of my own job, but I would be superfluous in a single-payer system.

I (Ida, John’s wife): Hey, who gets free gummy notes? Not John. I have to buy them for him right along with pens.

J: And don’t forget insurance-carrier profit; that typically runs at about 9 percent of gross revenue. If our proposed single-payer plan was organized as a nonprofit, we could save about 30 percent of current healthcare expenditures… that’d bring us in line with the rest of the civilized world on a per-capita basis.

T: OK, John, in English?

J: Currently, the US pays about $8,200 per person per year for healthcare. The second-most expensive healthcare system in the world is Norway’s; they pay about $5,300 per person per year. If the US reduced expenses by 30 percent, we’d be down around $5,700 a year… still the highest but not hugely so.

T: And how much of that is insurance company profit? Nine percent, you say?

J: About that, yes.

T: How much money, you figure, are insurance companies saving by hiring underwriters to cherry-pick their clients?

J: The savings are probably pretty considerable, although it’d be hard to quantify. Also, you have to consider the effect of interest; if an insurer can delay payment on a claim by 30 days, that’s 30 days’ use of that money they get for free, and 30 days’ interest (or investment income) they get. That’s not much on your $80 ingrown toenail, but multiply it by 13 million policyholders (an Aetna-sized company) and you’ll see it ain’t chump change.

D (David Willoughby): I remember when insurance was actually affordable; it covered everything from child birth to major surgery, without much out of pocket cost. Now the same coverage is either exponentially more expensive, or nonexistent. I came up with a simple and effective solution. Open up free trade across state lines, saturate the market, let the smaller guys play too, then prices are bound to go down. I’m not too keen on AHCA as they call it now, but they hit a valid point here, mutual companies make sense. Not a one size fits all plan that works for some and sends other to the poor house.

T: John wrote an article about mutual insurance … lemme find the link.

J – Mutual Attraction

Back in the good ol’ days, the ’50’s, when Ike was in the White House and Ward and June were on your seven-inch Philco TV, most health insurance companies were what is known as mutual insurance companies.

That doesn’t mean they insured each other; in this context, it means that the companies were owned by their policyholders. Every policyholder had a “share” in the company, and had a vote in the company’s planning and decision-making. The company’s profits were either paid to the policyholders as dividends or retained as reserves against future claims.

This model worked very well for a long time, and it still works well today; many of the largest life insurance carriers (Northwestern Mutual, Mass Mutual) are still mutual companies.

However, sometime back in the ’90s, it became apparent to the executives running health insurance companies that there was more money to be made if those pesky policyholders were cut out of the loop, and the executives were allowed to make decisions based on profitability, rather than on the benefit to the company (and those pesky policyholders) as a whole. So the executives sold the policyholders on the idea of demutualization, and there was a wave of these transactions.

There are a few holdouts; Mutual of Omaha is probably the best-known mutual health insurer, thanks to Marlin Perkins as well as their insurance business.

The mutual model should be revived in the health-insurance field. Imagine the possibilities of a government-backed mutual insurance company, something like Fannie Mae or Freddie Mac are for mortgages. We could have relatively inexpensive basic health insurance, with riders you could add to cover things like infertility treatment, weight-loss surgery, plastic surgery-a completely a la carte health insurance system. The possibilities are endless.

D: I was reading that on your page earlier. And it makes sense, question is, how come common folk get it But not those that can make the change? It baffles me at times. I understand its corporate greed, but there has to be a way.

T: Well, one of the biggest hurdles a single-payer plan has to face is that in America, once businesses get a chance to profit, they feel like they are entitled profit forever. Corporate Welfare.

D: I get that – I want to make as much money as I can as well. But at what cost?

T: There is a documentary on YouTube that runs about 45 minutes, called “Sick around the World” … T.R. Reid travels to several countries with centralized healthcare systems and shows us how they work. Most of them turned healthcare insurance into a nonprofit business model, and it seems to work fine. Some of the insurance companies make more than they did before.

J: After watching that doc, you’ll wonder “why can’t we do that here?” The short answer is “lack of political will.”

T: Desperation can change political will; yesterday’s dogma is today’s dirty diaper.

D: That makes sense, if a 21-year-old, fresh into the work force, pays his insurance premiums and rarely uses his coverage, that’s money in the bank, and there is still plenty to pay providers for the serious stuff.

T: That’s the key, Dave. We need to get everyone involved, and get them in young. That way even catastrophic healthcare can be paid for without putting anyone in the poor house. John has been working on the math … what’s the latest on the healthcare nut, John?

J: We’ve calculated the lifetime nut at around $250,000. That sounds like a lot of money, but it’s actually only about $300 a month over a 40-year working lifetime; and it could potentially be less, depending on interest rates.

D: That’s exactly right John, about the political will. Whether it be partisan politics getting in the way, or special interest groups lobbying, it all becomes political, both side want to be the hero, but don’t want to lose the money and power. Don’t HSA accounts work the same way in a sense?

J: Most HSA’s are hybrids; they have a really cheap high-deductible insurance element, and a savings element. So you might pay, say, $200 a month to your employer; $20 of that might go to pay your cheap insurance premium, and the other $180 would go into your HSA. That money accumulates over time, and you can use it to pay towards your high deductible. The beauty of the HSA is that the money carries over year to year, so if you don’t get sick during a year, all the money you put into the HSA carries over to help you pay your deductible the next year. It’s actually a really good system for someone who doesn’t go to the doctor a lot.

D: Thanks for the information on HSA, John. But this administration isn’t any better; its like putting a Band-Aid over a huge crack in the dam. Sooner or later, it’s going to burst and they’ll say, “nobody saw it coming.”

T: This administration hasn’t had much time yet, to be fair … but the schism in the GOP makes it impossible to get anything through that smells even mildly political.

D: Partisan politics is killing and dividing this country, I’m afraid almost irreparably.

T: Oh, it’s a pendulum thing, Dave. We’ve been through worse. You never know which one’s going to kill us. It might help to stop electing incompetent boobs like Trump … but in some ways Trump is doing the system a favor. By the time he’s done – assuming he doesn’t break the system, and I don’t think he will –  by the time he’s done, we’ll be so shell-shocked by his term that we’ll run back into each other’s arms and apologize.

D: My only problem with centralized healthcare is more government, which really doesn’t thrill me. Less government, more of the people governing ourselves, I do understand that’s like trying to herd cats, but it is achievable. I doubt Trump will break the system, bend the hell out of it, but the same affect.

T: Did you read my article, “Why Single-Payer Healthcare”? I address that. I don’t want to build another bureaucracy, but the system is unbelievably overburdened as it is. A centralized system actually shrink the government.

J: There’d actually be less administration under a single-payer plan; you wouldn’t need armies of billers and coders and ancillary paper-pushers. The single-payer would also run the show as far as reimbursement; when you’re the only game in town payment-wise, you don’t negotiate; you dictate.

It would put me out of work. You guys hiring?

T: We spend 22 percent of $2.6 trillion every year on administration. Taiwan, by contrast, spends about 2 percent of their overall budget on administration. That’s a big number – big enough by itself to pay the entire catastrophic healthcare nut. The top 1 percent of Americans cost a little over a half-trillion dollars in 2009. That’s about what the difference in administration would be.

D: It’s a huge number, I believe big pharma should be put in check as well. Their profit margin is incredibly high, to the point that it’s stupid.

J: Oh, I agree fully. Granted, pharma R&D is tremendously expensive, but there should be much shorter limits on patents. Currently, drug patents last for 10 years; during that time, no one else can make the drug (no generics) and the patent holder can charge whatever they want. Patents should be limited to three years; that should be long enough to recoup the cost of R&D and make a few bucks. After that, let the generics in.

T: Why not just cut the developers in for a piece of the generics? Then they can go play golf or chase hookers while the money pours in. Tie it to licensing.

J: Oh, the developer can still sell it. It’s just that after the patent period they have competition. And that competition usually drops the price by 80 or 90 percent.

T: They should get a piece of the competition – but we can’t be a free market only when it’s convenient for the money men.

D: Case in point – a Xarelto starter kit costs $800; even with insurance I come out of pocket about $350 – that’s a big hit.

T: What is Xarelto, Dave?

D: It’s a blood thinner, it helps control my A fib, and prevents clotting in the arteries.

T: How about they get, say, half of whatever the competition sells for a set period of time? The percentage can be negotiated up or down to regulate the market – balance price fairness with developmental expense fairness.

D: But that would be too easy, and would cut into the country club memberships, the mansions and yachts.

J: I agree, Terry. The developer should (and probably does) get licensing from the generic manufacturers. There’d need to be transparency about R&D though. The drug makers might push back on that.

T: That’s a hefty copay on Xarelto- nearly half.

J: And when it goes off patent it’ll cost about $80.

D: I asked about a generic but none are available.

J: It goes off patent in 2020. So no generics till then.

T: Have you checked Canada, Dave?

D: Not there but Mexico.

T: Is the box light enough to toss over a wall?

D: Maybe a year’s supply. But there are already drug cartel tunnels so we’re good there.

J: Running Xarelto through the tunnels… that’s a new twist.

D: I’m in, maybe we buy it on the cheap there – sell it at a 35% markup.

J: The problem with overseas drugs is quality; a lot of the stuff out there doesn’t meet FDA standards. If there were international standards, that’d go a long way.

D: International standards would take cooperation on many fronts, that puts us right back at the beginning.

J: Well, if I were you, I’d want to be sure that my five-milligram Xarelto pill actually contained five milligrams, and not two. Or forty.

J: This same story plays out over and over again. When Gemzar – an anticancer drug – went generic a few years ago, the price went from $600 a shot to $60 a shot almost overnight. Obviously it doesn’t cost $600 to make, or they’d still be charging it. Price gouging pure and simple; they charge more because they CAN, that’s all.

D: R&D can get pricey but for the cost, you’d think that fixing one problem wouldn’t cause 6 or 7 others.

J: Yeah… your cancer is treated, but you’re at risk for heart disease, stroke, high blood pressure, leprosy, hairy palms, giant eyeball, explosive diarrhea, typhoid, rickets, and purple flatulence.

T: The entire medical cost system is riddled with principle agent syndrome … that’s where the buyer isn’t the same person as the user. Any industry that relies heavily on insurance deals with it all the time. If the costs are not controlled closely by the user, eventually they will grow out of control, like weeds that never experience the taste of a lawn mower.

J: I know we’re all in favor of less government, but price controls on pharmaceuticals are probably overdue.

T: I honestly think smaller government would be more cost-friendly. Every layer of bureaucracy lies on top of the truth like an opaque sheet, obscuring the view. Vermin operate in the dark.

D: That I am in full agreement with. It kills me to see elderly either get the meds they need or a nutritional meal.

T: We don’t need a million agencies to keep costs down – we just need to enable users to keep a closer eye on their costs. In a single-payer system, costs are easy to keep track of. It’s one freakin’ agency.

D: If the populace only knew, and have 2 tugs of a goats dangle down, maybe it would be plausible.

D: But the point is still the same. People like my mother, that worked their while life, get put in situations that are near impossible.

T: If we get our way, Dave, there will never be another unpaid medical bill. It will all be paid for – at no cost to the government. If all hands lift, the burden won’t be so heavy.

Slack Chat – Handicapping the Race to Leavenworth

T: All right, John – If you could choose which beltway regulars we get to lance from our consciousness like festering boils, who would they be? Give me your mountain.

J: I would say the Giant Cheeto, Kellyanne Conway, Sean Spicer and Adolph Bannon.

Conway because she has demonstrated impressive incompetence, such that even the ordinary incompetents populating the White House feel the need to isolate her from the public as much as possible… Spicer because he’s just annoying, and Bannon because he’s dangerous… he’s been largely shunted off to the side but he does still represent the flannel wing of the GOP, and he still has leverage with Trump, although it has been somewhat diminished recently.

T: My mountain shares two names with yours (Trump and Bannon). I wouldn’t dump Conway; I think she’s harmless, and it’s always nice to know somebody who looks like the “My Name is Earl” daytime hooker has a decent job. I wouldn’t dump Spicer, either. I could argue that both of them perform a vital public service. Spicer is a hateful little troll who serves as an iconic target for the Trump resistance, and Conway is such an obvious schmoo that her mere presence in the White House lends the place a little un-class, un-credibility and un-dignity.

Bannon I’ll grant you, and Trump. Both are too dangerous to be anywhere near the launch codes.

J: Do you think Trump needs any more lightning rods? How in the hell is lightning going to get past his giant, reverse-polarity head?

T: Well, to me there ain’t no such thing as too much negative force in a resistance field. We’ll take all the lightning rods we can get. Just plant ‘em in the White House rose garden.

J: All right then, who would be on your Mount Lanceboil?

T: My other two are Mitch McConnell and Jeff Sessions.

McConnell is actively suppressing the Russian investigation, and he was already a political mud pie in my mind for treating the Supreme Court like a dammed football.

Plus Paul Provenza sat next to him at one of the White House correspondents’ dinners. He said he’s a humorless prick.

J: There seems to be a concentration of humorless pricks in the administration.

T: Sessions … He’s funny-looking enough to fit in with the Spicer/Priebus/Conway group, but he is a Sheldon Adelson tool. If left to his own devices, he would take marijuana away from even medical users, and he’ll outlaw any gambling that isn’t a state lottery or in a brick and mortar casino. Preferably one of Adelson’s casinos.

J: I could agree with Sessions, he’s in a much more dangerous position than McConnell… or Conway, for that matter. A few months ago I would have argued for Priebus to be on the mountain, but he has been pretty effectively neutered.

T: I wouldn’t dismiss Priebus out of hand. He’s the GOP’s Neidermeyer.

J: Priebus still has influence, but he represents the establishment wing, which has fallen out of favor now that it has been shown that it doesn’t have the power to jam through legislation.

T: He was in the middle of the intrigue that led to the firing of FBI director Comey.

J: There was a lot of intrigue around that; a lot of people wanted Comey out.

T: Yes, there are a lot of people on both sides of the aisle who weren’t all that torn up to see him go over the side. All the angst was about who did the pushing.

J: I think it was just a matter of time before he got fired, but I was definitely surprised at the timing; I thought they would wait until the Russia business died down somewhat before they gave him the ax.

T: McConnell is going to have to appoint a special prosecutor now – Comey’s ouster could be the best thing that happened to the Russia investigation.

J: I agree; I think public opinion has been building toward an independent investigation – and Trump just threw a whole can of gasoline on that fire.

J: Did you see this? Michael Flynn was subpoenaed today – something about providing documents relating to his Russian contacts.

T: Nice mug shot there – you can always tell if you are on the media’s shit list by your picture. If you look freshly coiffed, as if you just got out of a makeup chair, you are on the good list. If you look like a hungover serial killer …

But Flynn always looks like a hungover serial killer.

*******

T: Speaking of future prison wives, I have a another question: Who is going to jail? If we stipulate that there is some fire to go with all this smoke – that laws were broken, at a Watergate level – what are the odds these people go to jail?

J: I’ll put Flynn at 10-1 he goes to jail, 2-1 he cuts some kind of immunity deal in return for testifying against the rest of the crew. Roger Stone, I’d say 5-1; he revels in his “dirty trickster” persona, and I think it’s going to come back to haunt him. Carter Page I’ll venture 20-1; he’s a big talker but he seems to be peripheral to the case… a wannabe Russian made man.

T: I would put Flynn’s jail odds a lot higher … I’d say 5/2 for jail, 3/5 for either jail or a deal, and 6/5 for the deal. Flynn has been on the US shit list before, and his current crime is clearly in the room with treason, if not actually sitting in treason’s lap and licking treason’s ear.

Let’s be more systematic, though. Stipulating that some people are going to jail, how would you set the odds?

J:  Here’s my list:

  • Trump 5/1; he knows how to keep his hands clean but he could well get pulled in as an unindicted coconspirator, like Nixon was.
  • Pence 5/1 Possible perjury case, but it’s iffy… depends on the zeal of the prosecutor.
  • Michael Flynn 3/5, although my guess is he’d flip rather than go to jail.
  • Carter Page 10/1, big talker but all hat and no cattle.
  • Paul Manafort even money, he was probably the bagman.
  • Roger Stone even money, dirty trickster extraordinaire.
  • Kellyanne Conway 20/1, nothing but a talking head – she sounds like Georgette from Mary Tyler Moore if Georgette moved to D.C. and spent 20 years smoking crack with Marion Barry. Even in this crowd of clowns she’s hard to look at.
  • Steven Bannon 5/1 for something related to national security disclosures.
  • Mitch McConnell 20/1 just for assholery.
  • Paul Ryan 20/1 more assholery.
  • Chaffetz 20/1 still more assholery.
  • Nunez 5/1 for obstruction of justice.
  • Sessions 20/1 yet more assholery.
  • Comey 20/1 the fall guy, would be tough to make a perjury case against him but an eager-beaver prosecutor might try.

T: Here’s mine:

  • Trump – 7/1; I honestly don’t think he’s directly involved, but he might be too stupid to get out of the way.
  • Pence – 5/1; Flynn might toss him under the bus for the phone call, and there is no obvious reason to believe Pence was naive enough to believe some lying jackass like Flynn. He was gullible – or he lied. Neither possibility is ennobling.
  • Michael Flynn 2/5; he could cut a deal, but that’s the only thing keeping him out from under some rough trick named Jim. Or on top – Flynn strikes me as more of a top.
  • Carter Page – 8/5; if anyone is likely to wind up dead in a dumpster before this is over, it’s this guy. I agree that he’s a wannabe, but I disagree about what that means. The wannabes are always the most willing to commit any atrocity that will grease their way into the group. Page is as wannabe as they get, and every bit as soft, doughy, creepy and stupid as Trump.
  • Paul Manafort – 9/5; I think his crimes might have been out of federal jurisdiction, or he would be 2/5 like Flynn.
  • Roger Stone – 2/1; he’s in it down to his tonsils – he may have replaced Manafort as the primary contact. If Page winds up in a dumpster, check for Stone’s prints.
  • Kellyanne Conway – 50/1; it’s just a flyer bet. I would be shocked if she was directly involved, but she could have been privy to crimes. She is so above her depth in this mess that she makes Carter Page look like a savvy insider.
  • Steven Bannon – 12/1; he’s more dangerous to the country now than the rest of them combined, but I think he’s clean as far as the Russia deal. He wasn’t involved when the hacking occurred, and his role in the race seemed more akin to propaganda than espionage.
  • Mitch McConnell – 4/1; he acts guilty, and I want to know why. I doubt he was in on Russia, but he may be guilty of obstruction of justice as part of the cover-up, assuming there actually is a cover-up.
  • Paul Ryan – 500/1; I would be shocked if he was involved in any of this mess. He’s as dumb as a tongueless parrot, but I think he’s basically an honest guy.
  • Chaffetz – 9/2; there is no in-between with Chaffetz. His resignation means he’s clean – or he’s filthy.
  • Nunez 5/1; I am amazed by … how can I say this nicely? – by how god dammed stupid some of these guys are. Nunez butchered his 15 minutes of fame worse than Ken Bone, that fat guy in the red sweater at the debate who forgot to delete his browser history.
  • Sessions – 99/1; he’s a pro. I don’t much like him – he’s a little too southern beltway for my tastes, and he’s a freedom fighter (he fights freedom) – but I am sure he would never commit treason. On purpose, anyway.
  • Comey – 40/1; he could still wind up getting caught in the net, but as the FBI director he’s one of the few names on this list who was thoroughly vetted prior to joining the beltway klatch.

T: Neither one of us thinks Trump is guilty of overt criminal acts, but he is the top chop so he’s susceptible. Witches die in witch hunts.

J: I don’t think Trump is guilty. I think he knew what was happening but was smart enough to keep it all at arm’s length, or further… they’d never be able to prove anything.

T: How many people went to jail for Watergate?

J: It was a lot… all the burglars, most of Nixon’s top aids.

Wikipedia says 40 indictments, eight of Nixon’s top aides plus the burglars, so 13.

T: What are the odds that this turns out to be a Watergate-level investigation, with eight or so main players eating tossed salads and calling some Aryan Nations thug daddy?

J: I’d say right now about even money that we end up with criminal investigations coming from this.

T: I think a full blown mess is probably more like 5/1, maybe even higher. Deep down, I don’t believe Trump and his advisers were in bed with the Russians. Well, maybe in bed together, but not conjugating their verbs, so to speak.

J: I don’t really, in my heart, believe that the Russians influenced the election. They tried, but I doubt they actually had much if any influence.

T: Attempted treason is still treason, though.

J: Yep, no mitigation for sucking at it.

J&T’s Awesome, Incredible Healthcare Plan-Plan … to plan how to plan the … well, we have some ideas. Plans.

This plan (sorry) is designed to cover all Americans, from cradle to grave, soup to nuts, whatever you want to call it. This is a work in progress at this point; stay tuned for future updates.

Level One Coverage

Services designated as Level One are required as part of base plans.

Men Aged 26-64: Covered services include: Doctor visits, inpatient and outpatient hospital services, emergency services, laboratory services, diagnostic testing, prescription drugs, mental health/rehab services, vision and dental checkups, screening colonoscopy after age 50, hospice and palliative care.

Women Aged 26-64: Covered services include: Doctor visits, inpatient and outpatient hospital services, emergency services, laboratory services, diagnostic testing, prescription drugs, mental health/rehab services, vision and dental checkups, maternity services, annual gynecological exams, screening mammograms after age 40, screening colonoscopy after age 50, hospice and palliative care.

Family Coverage: Covered services include: Doctor visits, inpatient and outpatient hospital services, emergency services, laboratory services, prescription drugs, mental health/rehab services, maternity services, annual gynecological exams, screening mammograms after age 40, screening colonoscopy after age 50, pediatric services including vision and dental, childhood immunizations, sports exams up to age 18.

Age 65+: Additional services covered include nursing-home services, Alzheimer’s treatment.

Level Two Coverage

Services designated as Level Two can be purchased as riders to a base plan. There is a 90-day waiting period before coverage purchased under these riders takes effect if not purchased during the open enrollment period.

These services include: dental services, orthodontics, eyeglasses, hearing aids, infertility treatment, bariatric (weight-loss) surgery, smoking-cessation treatment, LASIK and similar vision services.

Level Three Coverage

Services designated as Level 3 are optional; individuals may purchase these coverage as riders to the base plans. There is a 90-day waiting period before coverage purchased under these riders takes effect if not purchased during the open enrollment period.

These services include: cosmetic surgery (non-reconstructive), liposuction, Botox and similar procedures, Viagra, Rogaine, hair transplantation, cosmetic dental procedures.

Non-Covered Services

Services not covered under the plan include:

Massage therapy, naturopathy, religious practitioners (Christian Scientists), homeopathy, acupuncture, acupressure, hypnotherapy, biofeedback.

General Plan Provisions

The plan year runs January 1 to December 31. Each year, there will be an open-enrollment period running from January 1 to February 28: during this time, individuals may opt to change their coverage without incurring a waiting period. After open enrollment, there will be a 90-day waiting period for plan changes. There are no referral or authorization requirements; any licensed medical provider (including MDs, DOs, APRNs, PAs, chiropractors and physical therapists) may provide services under this plan.

The plan takes effect at age 18: children under 18 are covered under their parents’ policies. At that time, the child registers with the national plan; there will be four options for the child’s coverage.

College waiver: Premiums due are waived while the child is enrolled as a full-time student. The waiver can last as long as eight years (until the child’s 26th birthday): at that time the child will enter the regular plan.

Military service waiver: Premiums are waived for active-duty military members; credit is given towards the total premium “nut” for military service at the rate of 10% of per full year of service.

National-service waiver: Premiums are waived for individuals enrolled in a designated national-service program. Credit is given towards the total premium “nut” for national service at the rate of 10% per full year of service to a maximum of 50%.

Individual enrollment: The child can simply enroll in the national plan.

***

Why single-payer healthcare?

America’s healthcare insurance system has too many moving parts. Every extraneous moving part diminishes efficiency and increases the number of dark corners in coverage where vermin thrive.

Blame capitalism; capitalism is competitive, not cooperative. Healthcare can’t be competitive, but healthcare insurance is, as it should be, competitive as hell. The dichotomy creates absurdities, both logical and financial.

Don’t sprain yourself, we can see you waving: “What do you mean, healthcare is cooperative? Healthcare isn’t cooperative!”

If healthcare was competitive, rather than cooperative, there would be piles of dead bodies in every hospital parking lot. We’re exaggerating; they’d have them removed, but it would be a genuine problem. People would die because they lost the healthcare insurance competition.

Some would die because they couldn’t afford to pay for healthcare, some would die because they didn’t understand their healthcare plans, and some would die because fake healthcare insurance companies fleeced them, leaving them holding healthcare policies as useless as piles of Monopoly money.

Medical professionals, unbound by cooperative concepts like the Hippocratic Oath or human charity, would ignore anyone not waving a thick wallet or a valid insurance plan, leaving them to pray. self-medicate or join the body pile. This is common in some areas of the world.

Not here, though. American medical professionals don’t refuse patients in dire need. it’s comforting that our society – the part of the world we live in – remains at heart a kind, caring society. We feed our hungry and we care for our sick and infirm, even when we know they have no means to pay. Charity is one of the nicest of all human traits. It’s beautiful. It’s sweet. It’s kind.

And it’s expensive.

There are bills that have been in circulation for decades, floating around like ghostly little IOU slips. that will never be paid. Insurance companies and medical professionals have to compensate for the lost revenue, so they overcharge those who pay to cover those who don’t. In a competitive system nobody volunteers to pay the insurance company’s bills, so this is how it has to work.

Is this what we want? Should sick and injured citizens without medical insurance be given access to expensive care without bearing any responsibility, while the working poor overpay for confusing, manipulative insurance plans to cover their overpriced medical bills? Should restaurants be obligated to feed everyone who walks through their front door, then charge these “free” meals to their other customers?

We need a system that requires every American to take responsibility for his or her future healthcare needs. We need a national healthcare umbrella that will cover everyone, designed with safeguards so it won’t fold up the first time it rains. Hospitals need the freedom to serve anyone who needs care, without worrying about who will pay for it.

In order to reconcile the two incompatible financial models – competitive with cooperative – there has to be some sort of buffer, a payment-to-coverage ligament, that holds the competitive insurance markets and the cooperative healthcare markets together. We need a system where the afflicted will know they are covered, but also a system where the bills will be paid. There is no such thing as a free lunch; the buffer has to account for that harsh but unavoidable fact.

That buffer exists. It already covers nearly 10 million Americans. It might even cover you.

The model for our buffer, the single-payer conduit that keeps both sides in line so they don’t try to kill each other, is the Veteran’s Health Administration. The VHA can be converted and expanded into a national single-payer health system; already has in place priority mechanisms for payment through national service, and its outlets are used to dealing with a single insurance provider.

***

Slack Chat: Wing-Heir’s Folly

T: Did you see this yet, John?

J: I did. It’s a really good idea; the state of Alaska has agreed to pay catastrophic claims, and therefore the main insurance carrier in Alaska changed their planned rate increase from 42 percent to 7 percent. Other states are looking at doing that as well.

Having the state – or the feds – as a backstop for catastrophic claims could go a long way towards calming the markets and dramatically reducing rate increases.

T: So Alaska is putting air bags in the system, so to speak?

J: Basically. Since Alaska is a relatively small state, just a few catastrophic claims could break the system. Having the state act as the “air bag” and pick up catastrophic claims, say over $100,000, would make it much easier for the carrier to make money – or at least not lose money – on exchange policies.

T: Has anyone from the GOP’s national leadership said anything about it yet?

J: I haven’t heard anything. I think that GOP moderates – the ones who didn’t promise to by God repeal everything Obama ever signed – would probably embrace it. It’s a realistic fix for one of Obamacare’s obvious system bugs.

T: Do you think the Alaska model can work elsewhere?

J: I think that it can. Other states are looking at it and trying to get the federal government involved, trying to get the feds to act as the air bag.

Insurance carriers love certainty. If they knew for sure that their losses on any one claim would be capped, they would feel better about offering exchange plans.

T: Will the federal GOP wonks appreciate a plan that works, or see it as a political setback, effectively ending their drive to repeal Obamacare?

J: There are a good many moderate Republicans – particularly in the Senate – who realize that kicking 24 million people off their insurance is just bad optics, not to mention bad politics. If they get their way, a properly crafted Alaska plan could pass Congress.

Whether Trump would sign it, I don’t know. It would probably depend on who talked to him last.

T: So Foghorn Leghorn will get on board. What about Yosemite Sam?

J: Well, the Tea Party Republicans will certainly look at it as a nonstarter, given that they’ve nailed their flag to beating Obamacare to death with an iron bar and roasting its rotting corpse over a fire on the Fourth of July.

T: If the general public polls in favor of the Alaska plan, at what point will the Yosemite Sams be forced to throw up their hands and accept it? Are they so at war with the Beltway that they’ll go down with the repeal ship, or will they find a way to cut their losses?

J: I think there are probably 20-30 hardcore Tea Partiers in the House who won’t be able to go back to their ruby-red districts if they vote for anything short of full repeal. The larger mass of House Republicans are sensitive to the political winds, though. If the Alaska fix gains traction in their home districts, they’ll fall in line.

They’ll drag the Sams along with them – by their hair if they have to.

T: How will the Alaska plan, if enacted at the federal level, affect a potential move towards single-payer healthcare? Is it grease, or gum?

J: I’ve always considered Obamacare to be a step on the road to single-payer. Stabilizing the ACA for the short- to intermediate-term would make it easier over the long haul to implement a Medicare or VHA expansion.

T: Do you think the current administration will get on board with expansion, or dig their heels in?

J: My money is on a lot of heel-digging. Trump promised to repeal Obamacare and he came out in favor of that fetid swamp of a Ryancare bill, so unless the Obamacare fix is wildly popular I doubt he’ll get on board.

Unless, of course, he can take credit for the fix.

T: The smart people in Congress should be able to convince the president that it was his idea, right? Like Hogan making Klink think everything was his idea.

J: Shu-MER!

download (3)T: Maybe that’s who Trump needs to be now – Colonel Klink. Does that make us the POWs?

J: Sure – and Trump’s base is Sgt. Schultz.

T: There is always another way to skin a stubborn cat. A little pragmatic truth goes a long way, doesn’t it?

J: It does. A stream of pragmatic truth can knock over walls a firehose full of idealistic truth can’t budge.

T: Jiu Jitzu politics.