Death and Taxes
Two major issues bedeviling the Trump administration are health care and tax reform. The key to resolving both is remembering that President Trump was elected a populist, not a Republican. So far, what the Republican Party has offered on both issues has been its usual disinterest in the problems of people who are not from the .1%. That includes most people who voted for President Trump. Kicking your base in the butt is usually not smart politically.
What might the White House propose if it sought to offer populist solutions? The key to health care is attacking the root of the problem: vastly excessive prices. Just as with the word “military”, if you can label something “medical” you can move the decimal point: everything costs ten times as much as it should. I have a hospital bill sent to my grandfather, Bill Sturgiss, in 1952, his last year. Everything except medications (which he got at half price as a druggist) came to $10 per day. Accounting for inflation, that would equal about $200 a day now. But a hospital room is not $200. It is many thousands.
I know of only one way to rein in costs: Medicare for everyone, including prescription drugs. I have been on Medicare for five years, and it works well. It does not cover everything; I also have supplemental private insurance. But it covers the basics, which is what people most need. That is what populist policies seek to do.
How does Medicare control the cost? Simply. The provider bills x amount, but medicare says, “We only pay x-y.” The provider cannot charge more. Medicare for all would extend this pricing power to prescriptions. If some profiteering scumbag buys a patent on an old, inexpensive medicine and raises the price by a factor of 500, Medicare would say, “Sorry, you will take the old price and like it.” Any provider who now takes Medicare would have to accept the new, expanded Medicare. Of course, people could pay from their own pocket for treatments beyond what Medicare considered justified. But, again, for the people who voted for President Trump, the basics would be covered. He would have delivered for his base.
Medicare also has the clout to take on a big and expensive problem into today’s health care: keeping people alive who have reached the end of their natural lifespan. Often, the treatment is pure torture for the people involved. They know it is time to go. But the hospital will not let them. And after torturing them uselessly for weeks or months, when the release comes, the provider sends an enormous bill to Medicare. Who benefits? Certainly not the patient.
One step in the right direction would be to allow people to choose hospice care over life-prolonging treatments when they want to. Now, a doctor has to certify that further treatment is hopeless. The decision should belong to the patient, not an entity that makes a great deal of money from prolonging treatment. This is not assisted suicide. It is just letting nature take its course while providing relief from pain.
On taxes, the White House could propose a populist tax bill with two basic elements. The first is a series of reforms to the tax code, including large cuts in corporate taxes, that stimulate investment and create good-paying jobs. There are policy institutes in Washington that specialize in determining how tax cuts should be structured to foster economic growth. Not all tax cuts do so. And some taxes, such as the federal gas tax, should be raised. Our highways are falling apart and we need money to fix them.
What would make this tax bill populist is that it would raise, not lower taxes on the rich. It should include a tax rate of at least 75% on all earned incomes over $1,000,000 a year. Who needs more than $1,000,000 a year to live on? Are they feeding the cat caviar? The tax should not cover unearned income because that would discourage investment. But the President’s populist base would get it that he is not just proposing tax cuts for the rich.
By adopting a populist rather than a Republican agenda, President Trump could potentially remake politics for a generation. The next big political realignment will be uniting the anti-establishment elements in both parties, .i.e., the Trump voters and the Sanders voters. A populist agenda can do that. It is going to happen, from the left if not from the right. It is in President Trump’s interest, and ours, that it be done from the right.