The Argument over President Trump

The election of Donald Trump was a shock, both to his enemies and supporters, in the main because we had been led to believe by the major media and pollsters that Hillary's victory was a foregone conclusion. Immediately after the election, efforts began to reverse the result by recounts, attempts to change the votes of the electoral college and calls for impeachment. Failing that, collusion with "The Russians" became the new battle cry, somewhat ironic in that President Obama was overheard whispering to Vladimir that he would be more flexible after his election and generally placated Russia in multiple policy decisions.

 

Those of us who voted for Trump did not do so because of his moral virtue. We had tried this with Mitt Romney, a squeaky clean goody-goody whom the Democrats and media turned into a haughty aristocrat who mistreated animals and held women in disdain. We wanted Trump because he promised in his many campaign policy pronouncements to end the decades long slide of our federal government into a self-serving oligarchy with the concurrence of both political parties. The ideas and opinions of the east and west coast metropolitan areas were dominant and the concerns of the rest of us deplorables were being held in contempt.

 

In less than 2 years the President has more than fulfilled the expectations of his supporters on many levels. This is partly due to his governing style. He has been skillfully able to use tools that were unavailable to his predecessors, social media and other means, to communicate directly with the public, over the heads of an overtly hostile major media cabal. But his enemies are powerful, wily and relentless.

 

Evidence a special prosecutor investigation, purportedly for the purpose of identifying Russian interference in the 2016 election and now gone far afield to the point where it is unmasked as an effort whose obvious aim is to bring down the President. There seems to be little interest in the strong evidence that leading members of our own government's intelligence community themselves consorted to interfere in the election, exonerating Mrs. Clinton and seeking to undermine the Trump campaign.

 

What's going on now is very reminiscent of the attempt of the Republicans in the 90's to bring down Bill Clinton. That impeachment did not work out well, and Clinton was reelected handily. However Trump's sins pale in comparison with Clinton's. Although not the stated issue of his impeachment Clinton was credibly accused of rape and unwanted genital exposure to an unsuspecting campaign worker, things that landed Harvey Weinstein in prison, as well as using his dominant position to take advantage of a 21 year old intern in the oval office itself. Trump's purported dalliances occurred years ago and involved fully adult and consenting women. He took measures to avoid scandal by monetary inducement whereas Hillary resorted to an all out campaign to threaten, smear and destroy the reputations of the women who were Bill's accusers. Failing to uncover Russia collusion the special council has put incredible pressure on some of the President's aides, obviously more directed at catching up Trump than the accused themselves. Now it's said that his past business dealings are being scrutinized. These have been well documented in many biographies but it's impossible that anyone's activities involving years of complex financial and political maneuvering could avoid something controversial.  

 

Trump's enemies, liberals and many establishment Republicans, despise him in particular because he has been so successful in advancing his policies, and broadcast their animosity at every opportunity. His supporters, on the other hand,  tend to hold back, not being consumed by politics and to some extent disliking the invective they receive if they speak out. That's how I have felt about it personally. I don't like the bitter hostile responses, generally avoid them and when they inevitably arise try to handle them lightheartedly. However I'd like to make one serious point. I voted for Mr Trump wholeheartedly. I did not vote for him because of his moral qualities, although generally I don't find them more offensive than many of his predecessors, just more open, and I think most of the charges against him of ignorance and personal prejudice are obviously false on their face. I didn't vote for him because of his flamboyant style, although I feel that much of it is necessary in today's politics, and I find his forthrightness and openness to be a refreshing change in our politics. I, and millions of others like me,  voted for him because I viewed the situation in our country on many levels to have gone seriously astray, especially in our federal government. He campaigned on an platform of doing something about my concerns and so far he has performed much to my satisfaction and I want him to continue. I understand that many others don't agree with that opinion and wish to change course again. That's their right. But Mr. Trump won the election, fair and square, because those like me voted for him. The accusations that outside interference played a role have so far not amounted to much and in fact much has been revealed about possible election tampering by members of our own government that are seriously concerning. Other elections are coming soon and Trump's opponents should focus on trying to achieve their desires through that mechanism and forget once and for all about trying to remove the President from office by other means. In trying to get around the American system they are forgetting that the rest of us are watching, 

 

Medicare, the American Central Payer System.

There is no need to speculate about what American "central payer" would be like since we already have the bona fide model, Medicare, up and running and refined with the government's best efforts for 50+ years. Just as in the other advanced countries, it's so pleasant to simply present your card and all is taken care of. Who can argue that the same should not be extended to everyone. But there are some problems lurking in this scenario. 

Money will be saved say the proponents. And yet the details of Medicare's financial woes are well known but summarized best by the trustee's estimate that the unfunded liability, viz. the amount promised to present day citizens which is not covered by the present taxing structure, is in the range of $50 trillion. Consider that the benefits to today's elderly recipients are being paid for by present day workers. What will be the result of the Medicare for All system that is being called for so blithely wherein the present day funders would as well become the beneficiaries and we would all be paying for each other. Incalculable! So much for the vaunted cost benefits. 

What about the administrative efficiencies. Since there is no fear of business failure, Medicare is not constrained by the problematic actuarial details faced by private insurance. But a major administrative cost of Medicare is in the form of mandated regulatory compliance. Studies abound detailing the massive waste of time and resources devoted to such effort which has only increased over the years. Are we to believe that this will be lessoned by extending the system?

But the most problematic results of our Medicare system are the severe consequences implied in any centrally controlled system that have been detailed by the liberal economists.

 

Prices in the Medicare world have lost their signaling function. Medical providers do not compete to offer the most efficient economical services, but instead attend to maximizing income through fitting their services to the regulations. Medical records now have documentation for compliance as their primary function. Doctors have limited idea of the cost consequences of their decisions and decide based on other considerations. Their patient consumers act likewise and accept anything that is offered that is not too inconvenient or unpleasant. There is no such thing as shopping for the lowest price. 

Prices are fixed by central committees and are often grossly unrelated to reality. Providers rush to perform overpriced services and ignore underpriced ones. Our medical offices actively resist modern methods of communication with patients since only face to face encounters are paid for. How many millions of hours are wasted as a consequence while committees all over the country go through the farce of debating whether telemedicine should be permitted. 

Drug and device manufacturers focus on efficacy and devote limited R&D attention to innovations in manufacturing so that, unlike the computer industry, new medical products are always more complex and more expensive. Like the rest of the system they are focused on what arrangements they can make with the third party payers. And so we have the spectacle of multiple drugs with the same mode of action from different manufacturers that are heavily advertised but with no discernable open price competition. 

As doctors rush in droves to employment with large medical conglomerates which are tapped into government funding how many articles are written decrying the plight of primary care, the pressure to see more patients in less time, the burgeoning number of medical administrators. Who knows what primary care should be? A free market would sort the problem out far better than any expert committee. 

The U.S. is not Canada or England or France. It is a behemoth of a free wheeling, highly demanding, legalistic and contentious public catered to by a very unwieldy, often self-serving political and bureaucratic class. As a model of central payer the anti-competitive, wasteful, inefficient, fiscally unsound Medicare system is the best we can do. To extend it to all would be a disaster and then where do we go.