Thursday 17 October 2013

Privatizing Parts

"Privatization came on slowly. When something very big happens, like privatization, historians and economists like to think you must have had very big causes. That is not how it happened."
-Kenneth Baker

Transforming public assets into private ones sounds like something most moral parents would agree with, doesn't it? Like you are doing something to make the world more chaste and wholesome? Alas, the sad truth is that privatizing public assets has literally nothing to do with puritanical notions of butt-covering. Which I agree makes it far less interesting but maybe just as important.

In reality, deciding how goods and services will be provided, either by the public collectively or by people in their role as autonomous citizens seeking profit, is what a lot of human conflict has been about since the industrial revolution. It is the essential dichotomy that drove the Cold War, the fight between free-market capitalism and state-centered communism.

As usual, the correct answer appears to be in the middle since the extremes are both terrible. I don't think there are any attempts at communism that I personally would have liked to be a part of. Maybe they just didn't do it right and it would work some other way and with different leaders but I've pretty much lost faith in any centralized government running an economy and coordinating production without having to resort to sinister totalitarian methods. Cuba, the USSR, Mao's China. Those all sound terrible.

As for going to far the other direction into unrestrained capitalism, what you wind up with can be equally bad. Our form of capitalism is a liberal capitalism and is based on liberty, that is, having freedoms from government which are usually dictated in a constitution or by historical precedent. This is basically the opposite of communism where the government has total control. Liberalized capitalism is what allowed the west to emerge as the strongest bloc of nations in the world, complete with quite decent standards of living for the majority. It did this by harnessing the power of market-capitalism to create wealth while keeping society stable because governments had to be respectful of the voters or be removed.

Of course, it's worth noting that we didn't get the good standards of living for the many by engaging in pure liberalism, what is generally referred to now as libertarianism or neoliberalism. Following the industrial revolution, the situation for workers was atrocious despite all the wealth they were producing. After long, hard battles by labor, we tempered our classical liberalism with some traditional conservatism and socialism until a middle-class emerged for pretty much the first time ever. This is why liberalism today has different connotations than it did in the past when it simply meant total freedom of trade and some basic protections from the arbitrary judgments of the government and nobility.

Just so I don't get criticized for completely equating neoliberalism with libertarianism, I'll do my best to briefly differentiate the two. Neoliberalism is what the US has essentially pushed on the world since the 80s and consists of policies that intended to restore the dominant position of capital over labor, social movements, and voters. It was pushed on other chunks of the world like South America and consists of totally freeing financial flows and forcing everything into market-relations while removing the role of the state as anything but an arbiter for contracts.

The collection of policies it entails are often referred to as the 'Washington Consensus.' Generally, it tries to reduce taxes as low as possible and to get rid of things that are not controlled by market mechanisms such as welfare nets, government-provided services, organized labor, minimum wage, worker's rights, environmental protection, any forms of trade protectionism, etc. 

Neoliberalism is essentially the prescription Grover Norquist demanded when saying, "I'm not in favor of abolishing the government, I just want to shrink it down to the size where we can drown it in the bathtub." The neoconservative movement that dominated the George W. Bush administration essentially came out of neoliberalism. As neoliberalism is about corporate rights, minimizing regulatory power of government, and reducing people's obligations to each other through a total reliance on monetary market-mechanisms, there was very little in neoliberalism to attract people to its tenants since it is fragmentary by nature. That is why the theory was merged with conservative aspects like trying to undo the separation of church and state, emphasising the governing of morality, and empire building via war. As traditional US Republicans already supported these ideas, neoliberalism was able to find a base to support the dominance of capital by throwing them some bones that didn't negatively affect the profitability of transnational businesses.

Libertarianism is similar in some respects. It also believes in a very small government, one that is only able to mediate contracts and ensure people are compensated for damage to their private property. Unlike neoliberalism/neoconservatism, it believes in minimal laws, an isolationist military, and as much freedom from government as possible. This means no drug laws or government intervention when people are only hurting themselves.

People who advocate it claim it that it would truly rely on free-market principles instead of simply a corporations-first agenda. If ever enacted anywhere, it would apparently abolish the market-corrupting special deals that the biggest corporations have with domestic governments and with international governing bodies like the IMF, World Bank, and WTO. The idea would be a truly level playing field.

Personally, although it sounds nice, I have my doubts that libertarianism could ever work. It seems like it would fracture society as we are constantly reminded that we are not our brothers keepers as the bible informs us we are. In addition, the idea of allowing the infinite concentration of capital while keeping government as small as possible seems like a recipe for corruption and oligarchy, the rule of money, since the government would simply not be capable of being a counter-weight.

The US went the farthest in enacting policies that limited government's ability to regulate capital and seems to have a more of a bought-and-paid-for government than any other developed nation. Also, with such weak regulatory systems, how could libertarianism do anything to protect our environment, prevent the exploitation of people, or moderate destabilizing swings in the business cycle? Market mechanisms don't seem like they will be able to do it, at least not quickly enough. As for those few hard-core libertarians and anarchists who believe in no government, I would suggest living in Somalia for a while and seeing how much fun it is.

Capitalism is like a horse. Although it may be putting out a lot of energy as it bucks around unbroken and untethered, it's not actually doing any good until its calmed and its efforts put to work for the good of people. Regulations are necessary for this or else the powerful horse kicks the world in the face through unbridled greed like during the 2008 financial collapse. Before that, there was the Gilded Age of the Robber Barons and the severe inequality and stock-market gambling that led into the Great Depression. All examples of capitalism allowed to go wild that were terrible for the masses. After the Great Depression, regulations like Glass-Steagall were added that limited the freedom of banks to gamble with other people's money and the system would work quite well until these regulations were removed.

This has turned into a bit of an incoherent rant that has little to do with my starting premise. Which is fine. Basically, my point is that smart societies rely on the huge power inherent in private citizens interacting for their personal benefit while using government to prevent the worst excesses.


Essentially, I feel there are some things that government should provide and some that it shouldn't. The fact is that governments tend to be less efficient than the private sector as they are not forced to compete to survive. They are natural monopolies when they want to be. This means they should stick to things that cannot be safely or cost-efficiently provided by the private-sector for whatever reason. In addition, the government should provide services that society as a whole should take responsibility for like justice and a minimum level of welfare. Governments should be responsible for providing defense, police/fire services, water/road/power infrastructure, justice, a minimal level of healthcare, basic welfare, and regulatory agencies to police private-sector standards. The government should also have influence in key industries like agriculture and telecommunications while not actually running them.

As for resource extraction, personally, I believe governments should actually take a more active role in extracting and selling resources ourselves since they belong to all Canadians, not just the energy companies that control them, too many of whom are foreign-owned and wind up filtering Canadian resource-wealth away from the people who have natural right to it. Although the government would no-doubt be less efficient in running them than the private sector, considering the very limited royalties we receive and the large amount that leaves the country without helping the economy by being spent here, it seems that we would still make more money as a country even with the inefficiencies and higher wages we'd likely pay. The fact that Alberta was running big deficits even when oil prices were at record high shows that we are getting a bum deal.

However, this would likely be politically impossible as the oil industry has huge influence and the Americans would be extremely displeased with any move towards nationalizing aspects of the energy sector. I'm not even sure we could do so under NAFTA and a protectionist showdown with the US would likely result in Canada losing badly. A better idea would probably just be to have our provinces stop competing for corporate investment in a royalties race to the bottom. Our country's federal debt belongs to us all and we have transfer payments between provinces which means we share our wealth. Bargaining as a bloc to get the best return on non-renewable resources from the energy industry seems obvious and in no way violates the tenants of free trade.

The main issue is that having the private-sector provide any of the truly essential services means there are dangerous conflicts of interest that create incentives to work against the public good. Private prisons have meant corporations lobbying to change laws to fill these prisons. This has corrupted the justice system, resulting in lengthier sentences which has created a larger tax-burden with less available tax-payers. Privatized healthcare in the US resulted in expensive care, insurers trying to get out of providing services owed, huge numbers of uninsured and untreated, a lack of preventative medicine, and a generally bad system compared to countries where the point of medicine isn't profit. Obamacare doesn't change this much and is unlikely to fix things. In addition, the overly large influence of private weapons manufacturers in the US has lead to an extremely aggressive foreign policy that produces huge profits for certain companies. Ike Eisenhower, probably the last principled Republican elected president, would warn about the power and influence of this "military-industrial complex" in his farewell speech.

Privatizing key services also means losing democratic control of them. In Bolivia, Aguas del Tunari was granted a contract to provide water and waster services to Cochabama. Rates were promised to be raised by only 35% in order to expand operations and services when in reality, people's bills as much as tripled for no reason and with no regard for how little money many of the citizens had to live on. A referendum had 96% of the people wanting out of the water-privatization contract but the government refused to cancel it. It took massive protests with several deaths in order to return things to normal. Still, Boliva is being sued for $25 million for breach of contract despite the supplier lying regarding what the rates would be and being generally negligent.

Of course, sometimes it's the opposite and publicly-owned things should be privatized. My home city of Winnipeg has 12 public golf courses owned by the city that are running yearly deficits of $850,000. It seems to me that privatizing these is a no-brainer. Having everybody pay for golf courses is ridiculous and is subsidizing people who already have the money to play the fairly expensive sport. It's true golf courses may help make Winnipeg more attractive to golf-enthusiasts planning to move here. However, the private sector should be providing non-essentials like these. If the demand isn't there for the private sector to make a buck than we can do away with some of them and use the land for other things. Unfortunately, city council recently voted against leasing out four of the courses for a profit.

These are just general rules however. In cases where the government has proven itself capable of running a business properly, it is generally advantageous to leave it in in the hands of the public as it cuts out middlemen and supplies needed funds to pay for government services. When they start failing and need new blood and leadership, then it may be time to privatize as long as this doesn't create any major conflicts of interest and the selling of public assets is done in good faith.

One such idea that has been floating around Canada is to remove the monopoly possessed by the government in most provinces on selling hard liquor. Alberta did this 20 years ago and has seen a huge boom in the number of stores, the variety of alcohol available, and has enjoyed longer store hours. However, it has come at a cost. Alberta is one of the few provinces where government revenue from alcohol sales has been falling despite drinking levels remaining stable. In addition, Albertans tend to pay higher prices for hooch although the occasional sale means that sometimes they can pay considerably less than the country average.

In 2002, BC began closing some government stores and opening private ones that could sell hard liquor. What was noticed was the private stores would charge between ten and thirty-five percent more than their publicly-owned counterparts. Not surprisingly, in both Alberta and BC, they are having more problems with private stores selling to minors. In addition, wages are only about half in the private sector of what they are for unionized government LC employees. Higher wages are generally desirable in the private sector to maintain a strong consumer base while lower ones are desirable in the public sector to avoid government debt. Reducing wages for government employees working in liquor stores might be something worth mimicking in these deficit times and would allow the greater profitability to justify keeping the stores publicly-owned.

This is an interesting conundrum within the private-public debate. If the government can run an industry at a strong profit and manage it in ways that are superior to how the private-sector can do it, does that mean they should do it? Even if it is not a necessary service? It seems this way for liquor, at least for the moment, since alcohol is such an easy cash cow. Ontario was able to bring in $1.63 billion from booze sales in 2011 alone, not including the taxes on them. Considering the governments of most western nations are running deficits, it seems that bringing in more cash is more important than neoliberalism's desire to be rid of anything government-run.

An interesting example of a government operation being able to be as effective as the private sector was during the Thatcher years in the UK. Thatcher was Ronald Reagan's point-woman during the neoliberal 80s and was just as big into privatizing friggin' everything. Her opponents referred to her actions as "selling the family silver." One ironic twist was that British Energy, the largest state-owned power company in the UK, was privatized so as to be hopefully run more efficiently and cheaply. The joke is that it was purchased by Electricité de France, a French state-owned power company. In addition, French state-owned Areva now makes and controls the UK's nuclear power stations. Essentially, the energy industry that Thatcher privatized was renationalizd by their neighbors who now get to reap the profits. This seems a good lesson if anyone ever considers privatizing Manitoba Hydro.

There is also a concern about choices to privatize being made via special interest lobbying. In the last few years, there have been several cases where public assets have been sold off stupidly cheap in what were likely crooked deals. Again in the UK, they have recently sold off the Royal Mail service. While 67% of British people were against the sale and even Margaret Thatcher had thought it was too historically important to sell, the deed was finally done. The main problem was how intentionally undervalued it was when sold. The shares jumped by 38% on the first day of conditional trading which means the citizens brutally lost out on the sale. When sold, all of the Royal Mail's real estate was valued at 787 million pounds even though a single one of its depots in London has been estimated at 1 billion pounds. And there were 44 other sites. Now the Royal Mail is selling 8 of its 45 sites by 2016 and the profits are all going to the new, private owners. Even worse, the private investors left the pension fund liabilities, estimated at 37.5 billion pounds, with the public!

Of course some people made money off of this. They had promised that only 'responsible, long-term institutional investors' would be allowed to purchase shares. Lansdowne Partners was allowed to purchase a large stake and its co-head of developed market strategies, Peter Davies, was best man at UK Chancellor George Osborne's wedding. This likely explains why they were allowed to purchase shares. Lansdowne made 18 million pounds the first day of Royal Mail share trading. In addition, the horrible people at Goldman Sachs made 21.7 million in fees for advising the sale of a company that the British public didn't want sold. If people think that this will save them money in the long run, it might be worth remembering that Britain's privatized rail companies received about four times the government subsidies given to the publicly-owned British Rail.

So in conclusion, knowing what to privatize and what not to can be a tricky subject. As a rule, you don't want people's profits directly tied to society doing badly like with private prisons, private healthcare, and private weapons production. In those cases, incentives are created to make people into criminals, keep people unhealthy, and create conflicts where guns and bombs are needed.

If you want real innovation, the private sector will generally always be superior although government regulations must be in place to protect workers, protect the environment, and keep things like gambling by financial institutions under control. When privatization must occur because government bureaucracy has built itself up to an unsustainable level, make sure the process of selling is not simply cronyism and a chance to rip off the citizens.

Pragmatism needs to ultimately triumph over ideology. Communism lost and neoliberalism is showing itself to be unsustainable as it turns out that both government and corporations are dangerous when left unopposed. A middle way is needed that spreads the power around, something like what the Germans and the Scandinavian countries have. A decentralized capitalism with a hefty dose of socialism appears to be the best hope the west has.

AS


Tuesday 8 October 2013

The Wealth and Health of Nations

"Blessed are the young for they shall inherit the national debt."
-Herbert Hoover

Or maybe they won't. Considering the US government's current position on paying their debts, it's kinda hard to tell. As of Oct.17th, there will be only about $30 billion left in the US treasury while the government's daily spending can be as much as $60 billion. There are also $120 billion worth of short-term bonds due on that day and a total of $417 billion worth of interest payments due by Nov. 7th. The Republican-controlled House of Representatives has so far refused to raise the debt ceiling to borrow the money needed to meet these commitments until their concerns regarding government spending and Obama's Patient Protection and Affordable Care Act are alleviated.

As of Oct.1st, the US government has already undergone a partial shutdown due to lack of funds and has given unpaid, involuntary leave to about 800,000 "non-essential" federal employees although the Pentagon is ordering 350,000 of its employees back to work. This means about 450,000 of the 2.9 million federal employees will still not be allowed to fulfill their duties. Active-duty military personnel and civilian pentagon workers on the job will continue being paid on time under a new law passed by Congress last week. Other federal workers will need to wait for the government to be reopened whether they are required to work through the shutdown or not.

Strangely, the Republican-led House of Representatives has passed a bill that will provide all federal workers with back pay for their time off, even if they are considered unessential and stay home. The Democratic Senate followed suit although questioned the logic behind such action. Honestly, why send them home then? It seems to make more sense to keep them working and just pay them once the debt ceiling is raised instead of having them sit on their butts. It's a confusing method that allows the Republicans to keep the government technically closed while still spending the money it would cost to be open, all without the benefit of any work actually being done.

If this whole situation seems familiar to you, it's because it is. There have been 18 government shutdowns since 1976 although the US hasn't actually defaulted since 1790. More recently was the 2011 showdown over the debt ceiling which seems painfully like the one occurring today. The government didn't shutdown but the United States got extremely close to defaulting on their debt which freaked out financial markets. Standard and Poor's, a major credit-rating agency, would downgrade US bonds for the first time ever and stock-markets around the world would take a hit as $6 trillion worth of stock-value was wiped. The Dow Jones fell 5.6% in one day, the worst since the 2008 financial crisis.

If getting close to a default is quite bad, let's just say that the US actually defaulting would be nigh-apocalyptic. Which is why it probably won't happen. But if ideology somehow wins out over common sense on this one, it could be many magnitudes worse than the 2008 crisis when Lehman Brothers was allowed to go belly-up. If it remains unclear for any length of time after the initial default whether the US will pay its debts, trust in the dollar could collapse and the world would likely fall into recession and depression. The US owes $12 trillion, 23 times more than the $517 billion the Lehman Brothers owed when they filed for bankruptcy. Considering the stock-market fell by almost 50% and unemployment raged after that as credit seized up, it's troubling to predict what would happen following a US default. Borrowing would certainly be much more expensive in the future which would make getting out of a recession far harder. It's even possible the US dollar could lose its status as the world's reserve currency and at the very least, other countries would do their best to work out trade deals amongst themselves in their own currencies.

Funnily enough, the group that brought the US to the brink in 2011 are basically the same group doing it today. The Tea Party faction of the Republican Party consists of about 50 members of the House of Representatives who are adamantly opposed to Obamacare and are using the threat of default as a last-ditch effort to defund it. This is quite an unorthodox maneuver considering the act has already passed both houses and been confirmed as constitutional by the Supreme Court. Obama would go on to win the election over Mitt Romney, further entrenching the bills legitimacy.

Republican Texas Senator Ted Cruz has been extremely vocal on the issue, building up emotional pressure amongst constituents who voted in Tea Party members. There has been some argument that he is looking forward to a presidential run in 2016 and is just wanting to earn his credentials with the far-right. Some people have noted he's a little bit crazy considering how he engaged in a 21-hour, filibuster-style rant, to a basically empty Senate chamber, about how bad the Affordable Care Act is The reading was complete with a rendition of Green Eggs and Ham by Dr. Seuss because he obviously didn't get the moral of that story. A filibuster is used to delay the voting on a piece of legislation, either to simply stall or to get time to get enough votes on your side to win. However, this wasn't technically a filibuster and couldn't stop legislation, thus making it basically a long, crazy rant. It even compared the fight against Obamacare to the fight against the Nazis because expanding healthcare and Nazis are pretty similar now that I think about it. 

Essentially, Obamacare has been made into a line in the sand that the Tea Party will fight to the death of the country over, even if they get blamed for it. More moderate Republican congressmen justifiably see this attempt as counterproductive and dangerous for Republican chances of holding onto the House in 2014. Polls have indicated that more people blame Republicans for shutting down the government than the Democrats. Still, Republicans have been forced to tow the line by the wealthy Tea Party backers who can fund primary challengers to have them replaced.

This is a problem since it means Republicans need some victory to take home, even if it's just symbolic, to justify voting to fund the government without killing Obamacare. Obama has fully stated he is refusing to re-fight the health-care battle and considering the Republicans are blocking any changes he wants to make to immigration and gun control, it seems clear he is not planning on budging on his main achievement. Doing so could make what is essentially extra-legislative extortion into a routine part of negotiations. Obama knows he'll be blamed less if a default did happen but extreme ideology may mean the Tea Party are willing to shoulder that blame anyway. Considering the lack of support for Obamacare amongst Republicans, many of them really are doing what their constituents want by taking this approach. This explains their 42 votes to defund the law in the House of Representatives, well-aware that the Senate would never pass it themselves.

Republican Speaker of the House John Boehner has been put in a tough spot. He knows he's being blamed for the shutdown but he's unwilling to look weak to the far-right. This means he's still refusing to hold a clean vote to refund the government without some concessions, saying that it wouldn't pass anyway. He may be right but there are at least 20 Republicans who have already agreed to side with the House Democrats in such a vote. Trying the vote makes sense and I don't think it is personally helping his position to wait until the last minute to cave. And let's be serious, he will take the blame for any economic problems that occur from spooking the markets with a last minute ceiling raise, regardless of how he feels, if he fails to try a vote. Obama has already called him out to quit being a wuss:

"The only thing that is keeping the government shut down, the only thing preventing people from going back to work…is that Speaker John Boehner won’t even let the bill get a yes or no vote because he doesn’t want to anger the extremists in his party. That’s all. That’s what this whole thing is about.”

I might as well make my own position clear here. I am adamantly opposed to this method of shutting down the government and trying to kill legislation they don't like in this undemocratic way. In a healthy political environment, they should take control of government via elections and then repeal the law. That being said, I'm am opposed to Obamacare as it stands. Not because I don't think the US health system needs an overhaul. It does. Badly. In 2010, per-capita spending for health care in Canada was $4,445 per person. This is compared to $8,233 in the US. And it's not even like Canada's health care system is very well ran. Of course if you're rich in the US, your health care will be better than in Canada. Still, for the vast majority of people, it's not.

I think most people agree it makes economic sense to provide at least limited healthcare, just like it's good sense to feed hungry children. The stresses and disadvantages associated with lacking these basic things saps a lot of energy and creates damaged people who then make up a damaged society. Essentially all developed countries acknowledge this with the exception of the US. However, assuming Obamacare will improve the situation may be premature. Obama sold out early on a single-payer system like we have here in Canada. He also sold out on a public-option like they have in most European countries where you can get your own health care from private companies but there is also a basic government option available for those who can't afford it. France uses this system and was rated as having the best healthcare system in 2000 by the World Health Organization. The US ranked 37th, right behind Costa Rica. Canada did fairly poorly also, coming in 30th.

Obamacare is instead entirely private and actually creates a mandate requiring people to buy from private-insurers. This sounds unconstitutional to me but apparently it's not. The question of why Obama stuck with private health care can probably be best answered by Otto von Bismarck's quote that, "Politics is the art of the possible, the attainable..." Considering that the health care industry spends more money lobbying Washington than any other sector of the economy, it's probably not surprising that they were never at risk of losing their cash-cow. During the health-care debates in 2009, the industry was spending $1.4 million per day on influencing politicians. This emphasis on the private-sector means that they won't get to enjoy some of the benefits of a single-payer system like we do in Canada. These are savings on administrative overhead, increased bargaining leverage for drugs and medical gear, savings on advertising, savings on shareholder dividends, reduced burden on employers to provide health coverage, savings on excessive executive pay, and no incentive for providers to weasel out of providing care owed.

So what does the act actually do? Well, on the plus side, it subsidizes the very poor/unemployed in order to get insurance and forces companies to cover people with pre-existing conditions. It also allows young adults to stay on their parents plan until age 26 and provides some preventative care in the form of free mammograms, colonoscopies, and check-ups for seniors. Very importantly, it got rid of insurance companies ability to pull your coverage for technical reasons like spelling mistakes on your forms. Insurers are also forced to provide insurance premium rebates if they spend less than 85% of premiums on health-care services or quality improvement. All of these are noble and useful things that may justify the system on their own.

On the negative side, there are as many as 20 new taxes that will be applied to help pay for it. Americans generally don't like taxes and Republicans have traditionally preferred running massive deficits instead of raising them so you can see why this makes it a tough sell. Another problem is a reduction of hours for employees. Under the act, companies with 50 or more employees have a mandate to offer health care to workers who do at least 30 a week or else face a $2000 dollar fine per employee per year. This means many of them are cutting down below 50 employees if they can and are reducing hours if they cannot. Actual unemployment in the US ranges between 14% and 24%, depending on which measurement you choose, so people will take whatever work they can get.

Depending on your company, part-time workers like those at Trader Joe's and Home Depot can be shifted from private-coverage through their employers to public healthcare exchanges. This will almost definitely cost them more than their previous work insurance, even with subsidies, while often resulting in them working less hours. This means unfortunately the poorest workers will likely be hit hardest as companies use the act as an excuse to relieve themselves of all responsibility for part-timers.

It might be worth remembering that in upstate New York, following a food poisoning outbreak, it cost $546 dollars to get 6 liters of saline into patients. Saline is just saltwater by the way and one of these liters goes for between $0.44 and $1.00 from the manufacturer, so that's a pretty decent markup. This means the main question really is whether Obamacare will reduce health care costs from their ridiculous levels? The answer, it seems, is quite likely no although nobody knows for sure. The law is designed more to generalize access to care and the cost of insurance for individuals. It was not really created to reduce the costs of procedures, drugs, or medical supplies that define the amount spent in total. Considering the lobbying power of the groups involved in writing the bill, this is not surprising.

Supporters say the larger pool of insured people and increased insurer competition will keep costs down. Detractors say there really won't be enough added to matter. Supporters say increased copays for drugs and the high-deductible plans being offered will keep people more cost-conscious. Detractors say expanding preventative care will cost more and the insurers will just take in more than ever through the deductibles.

In the end, I'm leaning towards the idea that it is not going to help much. I may be wrong and it already seems that some of the worst excesses, such as cutting insurance right as it's needed, won't be able to destroy lives anymore. Which is good. Still, the same group of illness-profiteers remain as the only ones to go through for most Americans and they were essentially gifted 50 million new customers through the mandate. The high deductibles will also mean that most people will be fairly limited in actually being able to take advantage of their coverage except in worse-case scenarios.

It's sad because the US could have simply dropped the age requirement for Medicare and they would have had a single-payer system while allowing the private-sector to provide extra care for those with the cash. Instead, all the political will to make such a change has been blown on this mess. Nobodies gonna want to open this issue again for quite a while except to possibly scrap it.

On the other hand, Canada would probably do good to open it again. Our health-care system is extremely expensive and wait times are getting too long. With our aging baby-boomers, this is going to only get worse. We could probably do with adding limited fees for check-ups and small procedures in order to prevent abuse of the system. Likely we could change doctor compensation to be more in line with quality over quantity. Having a discussion around limiting end-of-life care to something actual doctors and nurses feel is appropriate would probably go a long ways as well. Interesting fact is that doctors tend to have less money spent on them when they are dying since they know when the battle is lost and don't want to go through unnecessary painful and undignified treatment associated with desperately clinging to false hope.

We could also probably do with a bit of private-sector competition, especially for quality of life things like joint replacements. If the European countries can do it and get better results than us, than I suggest we take a look.

Tommy Douglas wanted all Canadians to be covered and we are. I don't believe he ever said anything about having the government monopolize that coverage.

AS