While one can certainly create government programs that are grotesque corporate give-aways, by default government programs are usually cheaper and more efficient than the free market. This seems counter-intuitive, but the government has two enormous advantages over regular business-consumer transactions: information parity and scale.
Obamacare (which should be called Pelosicare since it was her efforts, not Obama’s, that got it passed) is actually a great example of this dichotomy:
ACA Was A Failure
No, really, a total failure. Yes there were some good regulatory changes. Yes the exchanges make it possible for some people to buy on the individual market (though that insurance is mostly…not good). Yes the Medicaid expansion was great.
But the important thing to remember about the Medicaid expansion was that it was a last minute fix to keep the price tag down. Think about that. It was cheaper to provide free health care for more people than to throw them onto the subsidized exchanges at subsidy levels that they could possibly afford. If they’d taken it up to 500% of FPL and 600% of FPL it would have been even cheaper! And that became a political problem, because your poor neighbor has free health care and you have to pay for a bronze plan which sucks.
The failure was the exchanges. Now we’re supposed to talk about all of the other good things in ACA, but remember back in 2009, the exchanges were Obamacare. They were the plan. Everything else was tinkering. The exchanges were going to free us from employer-provided health care (a good goal!) by letting everybody buy “affordable” individual health insurance. The exchanges were going to be great, because there’s nothing we love more than buying health insurance every year through a website, and employer-linked health insurance would, over time, just fade away. ACA wasn’t about the exchanges because a few million more people would be able to buy insurance. ACA was about the exchanges because the exchanges were THE FUTURE OF HEALTH INSURANCE, my friends.
Nobody involved wants you to remember this. And the same people are going to bullshit you in 2020 and beyond.
Yeah, I don’t think that “Medicare for all” would be a Wild West spending scenario. It wouldn’t be the government sending unmarked bags of money to people who could then use it to warehouse unprescribed pallets of Vicodin.
In my view, Pelosi represents everything wrong with the current Democrat party. The pandering to corporate interests that began in earnest with Clinton is only viable because the other side has become the party of regressivism.
Oh you need a drug to stay alive? Well you can go on the free market and there are several suppliers competing to keep the price low for you and your insurer. Oh wait - no there isn’t there is only one supplier and they just increased the price 1000% because you have only the option of buying it or dying.
Nice free market there.
If we are not going to have a free market for drugs we therefore need government control on pricing, just like we do for other captive markets.
This is what I was saying above about different ways governments spend money. ACA falls under the private-public-partnership model where businesses basically get to go to an all-they-can-eat public-money buffet. It’s a disaster.
It is definitely worth remembering that when people propose medicare for all and other people argue that we need to stick with capitalism over socialism, the current system is not capitalism. I mean, unless capitalism is defined as discrimination based on how much capital people have (a la sexism).
The Lesser Evil is by definition the better choice; “less evil” is right there in the name. I’ll vote for the lesser evil every single time.
There exists no possible candidate for any office, and especially no candidate for the office of President of the United States, who agrees with you in principle, degree, and kind, on every topic. Pick someone with whom you personally disagree the least, who has any chance of defeating Trump, and back them.
Capitalism requires not only a market but a free market and the drug market is anything but free. They have regulatory capture and laws ensuring that the market will not become free except in a few limited ways, which they try to game anyway.
Capitalism isn’t capitalism without competition and the drug market has precious little, but where there are (generics) SURPRISE the prices are low.
I have a very pro-capitalist economic historian in my family who is absolutely appalled by the US in general. They just hate it when people use the US as an example of capitalism (and prefer to use Switzerland). My point of view is that capitalism leads to the concentration of wealth that ends up causing regulatory capture - that is, the US is what capitalism looks like in practice much like the USSR was what communism looked like in practice.
Of course I can differ with someone on that point as long as we all still agree that the US drug market is downright horrific, no matter what “ism” label someone slaps on it.
I’m not going to suggest that the criticisms of Pelosi in the comments above are wrong, but I do want to remind you of one important fact:
Nancy Pelosi is the reason we have the Affordable Care Act, which, while far from perfect, is orders of magnitude better than what came before. Pelosi knew at the time that pushing as hard as she did for it would likely cost her the Speakership, which it did. She did this anyway. The idea that this somehow disqualifies her from leading the efforts to improve the ACA strikes me as misguided at best.
I’m sorry. Change is needed, and my vote, our votes, are our only leverage. If defeating trump is the leverage point that the Dems really care about, then the Dem leadership needs to step out of the way or risk loosing again.
I suspect the Dem leadership would rather lose to trump, then lose their monied support. Which is the crux of the problem, and why you should not roll-over so obediently.
Thanks to you
(and others) for clarifying
a complex issue.
I’m still suspect of corporations/contractors/etc.
that overcharge the government
based on perhaps highly inflated
“market values” (of whatever).
This area is Most Definitely Not
in my lane, to say the least…
Which, come to think of it,
I should have abided by!
I definitely agree that looking at their actions rather than their words is a better indicator of their beliefs. But I don’t assume they have a level of competence to actually know how different policies will affect them.
Unregulated capitalism lacks a fast enough feedback loop to not destroy itself. Left to it’s own devices it will ravage the land and the people mercilessly until it reaches a breaking point at which point you are in a very deep hole you need to dig yourself out of. Capitalism dearly needs regulation and socialism needs free market. Neither system taken simply on their own is likely to survive and support their peoples.
Sadly I think the pendulum has swung much to far towards capitalism in recent decades. Crumbling infrastructure, poor healthcare, run away concentration of wealth. We have seen it all before but will we correct course before it is too late?
