One-stop shopping comes to American medicine

Congressional fireworks over health insurance legislation may ultimately seem a minor footnote compared to a subtle, but seismic shift toward something reformers have long yearned for–one-stop shopping.

The idea is to combine insurance, where the economic incentive is to spend as little as possible on care, with medicine, where money’s to be made by providing maximum treatments. One such iteration is a health maintenance organization, like Kaiser Permanente, which Washington has been relentlessly pushing a resisting system toward since the Nixon Administration.

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So…Where’s the pony?


Forget about the impeachment fantasies. But the Congress does have other tools. It can control the White House by limiting its powers, either by overtly taking back responsibilities it has delegated to the executive branch or by making spending decisions that limit options. We already know there will be no wall built on the border with Mexico unless Congress authorizes funding to pay for it. The President doesn’t always get what he wants. Recall the cliché– the President proposes, but the Congress disposes.

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Challenging the FBI


Only the foolish or fearless challenge the Federal Bureau of Investigation, a hard lesson learned by a diverse roster that ranges from Al Capone to Hillary Clinton. If there is a deep state in America, the FBI is near its core. Whether the White House is oblivious to this history or trying to notch its belt by challenging the Bureau is worth pondering. This is an agency that defied recent White House attempts to get with the program of minimizing the import of contacts between the Trump campaign and the Russians as well as arguably sabotaging last year’s Clinton campaign.

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“Inaction” is not “malfunction”


I remain a part of the dissenting minority who argue that our system isn’t broken. Action on a number of thorny issues — ranging from immigration to education reform — is stymied because of big disagreements on what should be done. Our experience with the Affordable Care Act illustrates the peril of making big changes in the absence of substantial majority support.

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Follow the Leader (or not)


On the one hand we’re told that politicians cautiously hold a finger to the wind before acting and lack the courage to get ahead of their constituents. On the other, when politicians step forward—as Obama did on the TPP or ACA or David Cameron did on EU affiliation or Angela Merkel on immigration—their positions are deemed proof of the growing gulf between the governing elite and the masses who would be impacted. Continue reading Follow the Leader (or not)