Bern Central

My contributions here are minimal, but hopefully useful…

Clearly, there is a need to first understand the ideal concept of how healthcare should be provided, so that we may hope to efficiently reach such goal. While there is always room for adjustments that are part of a process, getting the basic concept correct initially will likely save wasted effort later.

I only have a few thoughts to share on the subject below, made available as a public service. Although provided at no charge without copyright, I do require the text below be accurately transcribed, so as to verify what I did say, and also not have any confusion between this and something similar that someone else may have said.

Elemental basics

Question 1

At its core, what is health care? Answer, it is the generation of particular types of goods and services to enable a country to maintain and improve the condition of its populace as relates to the physical condition of health. Any other considerations aside as to why governments should go there, the healthier a country’s population is, the better it is likely to perform as to generating economic output, at least in theory.

Question 2

What approach best serves the stated goal, with an eye toward ever optimizing the condition while reducing the costs of delivering those goods and services? Answer, bernmeister opines that competition is usually the best way to improve results while cutting costs, but here the winning construct must maximize competition while not diminishing the human condition when prices are reduced.

Question 3

Follow up to 2, how can competition be maximized in such a construct? Answer, by making it understood that all participants work to serve the consumer, who is either a significantly interested underwriting party as a taxpayer, and or is the ultimate end user and material consumer of the products and services.

Question 4

Follow up to 3, how is such a focus on the consumer best realized? Answer, best will be an optimization over time, but for starters we need to look at basic sectors and be aware of overlap and interrelationship.

So for example, we have drugs. Our hospitals and medical offices have machines. What do those things have in common? All have a cost and all perform to a certain level, whatever that is. Well duh, that is true of other goods and services as well. Yes, but while I hope my MMS (“M Monetary System”) will indirectly help here by blueprinting how capitalism can prompt better choices leading to ever higher quality at less cost for most economic output, the current track record of the status quo shows need for reform which applies here. In the status quo, if a company rests on planned obsolescence and does not introduce a superior product until it has to at the last minute, that is undesirable, but in a vacuum is not the end of the world. That is, if car company X does not wish to roll out its latest and greatest model right away, consumers have the option of punishing company X by buying from a competitor [assuming that competitor is nudging ahead due to competition and not acting in collusion]. But we cannot do that in an environment where people’s lives are affected.

Then, there is the need to recognize huge amounts of R&D that are involved which have to be recovered. It takes a lot of research to identify and understand how the blue blood of horseshoe crabs, for example, can have medical or other useful application. I am not a patent expert, but my understanding is patents typically run 20 years. I expect that in some cases variants may allow for a variant product under a variant patent. What about a partial pooling of effort?

Say Company A has Drug 1 using Patent # 1,000. There may or may not be one or more competitors. But remember, the aim here is to improve, and go past the status quo of drug 1. So sure, dozens of investors fund dozens of research studies; most will fail, though it would be smart if, especially given modern technology with digital processing and storage, failed results were not effectively put in the garbage but made available for a second and third look at a later date. [History has many examples of inventions that failed for their originally conceived purpose, but succeeded in other uses later.]

Then let’s say for the public good some winning candidate level of research is pooled; I confess every detail has not been fully worked through. But there is a main point which is worth a try: shared risk, so as to extend focus more broadly more quickly. The reward for the compromise of agreeing to share the risk of partial short term profit loss is the otherwise undeserved reward of a shared profit temporarily from sales of successor inventions.

In other words, instead of saying one individual or group of investors will back one product or product group, which would have an all or nothing 20 year run, let’s say there is some construct in which investors/developers agree to pool their patents, and in return for actually not engaging in planned obsolescence, pretty much push the next better model along ‘sooner than later’ — as early as is appropriate without undue delay. In exchange for having the market welcome them earlier with less bloodbath, the developers of the next great thing have to contribute to a fund which helps recompense those who did not squeeze for every advantage in order to allow (those next great thing developers’) better product to emerge more quickly.

So given the above, the following appears logical: come up with some shared funding to cross research and cross develop results. Sure if a company wants to go it alone and the inventor of whatever is being researched/developed wishes to go retain that association with that company as a research/development partner, fine. But let’s create more, not less options. Let’s try and incentivize patent holders to start on their own, but if the patent yields a significant invention, let’s require they take less to make it more affordable and then provide a smooth expeditious cushion for a successor invention, but offer a reward for that.

Let’s say that once your invention crosses a threshold and is sufficiently if not significantly successful, you qualify for a participation program. In said program, for a time commensurate with what you offer and are sacrificing, that you can get a piece of related successor inventions. There may be other options to achieve that effect but you can imagine using a tax on high if not windfall profits on successor inventions, only for the duration each is most heavily carrying the proverbial ball, so to speak, as such a vehicle.

All of the above should result in less direct profit from exclusive exploitation of one’s own patent and resulting invention(s), but some indirect profit from related successor inventions. Since it is a given the original invention would not suffer loss of market share until a competitor emerges with a successful successor, no original patent creator is shortchanged. If/when such a competing successful successor establishes, then the earlier patent creator/holder would have access to partial indirect income, in some broad aspects parallel to a royalty.

The public interest would be served both by reducing planned obsolescence and by having more development of more inventions more quickly.

Again, haven’t fully examined this to the nth detail and it is only a broad idea not a fully developed concept at this point. But if someone wishes to develop this seed, please do, just take care not to misrepresent or misinterpret what I have actually said.

Political considerations and timing

 Joe Biden and Bernie Sanders suffer a seeming incongruity on their health care positions.

While being substantively in agreement to a large extent, is there a schism on a core point?

Sanders says health care is a human right for everyone. Arguably he is right, and some common sense backs him up. I have said elsewhere in my MMS premise that while we should all want to help (carry it to an extreme) an illiterate worker out of the goodness of our hearts, to do so for other reasons makes sense, as the literate worker is arguably more flexibly deployable, hence more versatile and more productive than his counterpart. Analogous to that, the worker who has health care coverage, and doesn’t have to worry about getting it in addition to the (physical) benefits (i.e., actual health) from the coverage itself, is more productive than his less fortunate identical twin.

I am unaware that Biden disputes this. However Biden understands the position of unions who have fought hard for certain benefits that include various measures of health care coverage. Such hard earned compensation should not arbitrarily vanish unilaterally. He too is right.

So who prevails? Fortunately, Democrats can have their cake and eat it too on this one. To keep everything truly universal, put union workers under the same umbrella as everyone else. Just have the company pay the union in cash for the compensation it would have received as medical coverage, including as to any added value where the union plan would have offered more than what everyone will now be getting.

In other words, have a short term adjustment required for the present, one that can be phased out well short of the next decade. Going ahead in the future, the company and union can negotiate directly on what agreement for what would have been this ongoing portion of compensation is to be provided to the union, be it increased vacation/personal time, stock ownership, improvements in working conditions, etc., with medical coverage, now in the arena of universal health care for all, not part of that equation.

Breaking down healthcare categories

 Medicare is a useful term for across the board benefits, but we need to be more specific, in this opinion. Medicaid would remain payments by state or other governments to local or regional areas to cover the cost of health care.

The breakdowns I am think of are as follows:

Name the program ‘FedMed’ if that term is available [presumably the government can direct for it under, let’s call it, fedmed.gov.

Have the following age driven demographics to help focus efforts for each:

1. prenatal (prior to birth)
2. infant (birth and post birth)
3. child (toddler to preteen)
4. adolescent (teen including thru age 19)
5. prime youth (ages 20-40)
6. prime middle (ages 41-50)
7. middle age (51-59)
8. early senior (60-69)
9. senior (70-79)
10. elder (80 and beyond)

Medicare is principally financed through the federal government.  Medicaid is financed principally by each state and the federal government. Unfortunately, there is a problem. You would hope that each state in competition with other states would want to do all that it can as to Medicaid programs and services. Unfortunately, the states and/or other regional governments often appear to be competing with each other to get away with providing the least amount of such services and/or financing. This has resulted in undesired consequences, i.e., Medicaid based services not automatically being portable by a citizen of one state visiting another state. For this and other related reasons, Medicaid (supplemental financing) must not only target  corresponding demographics more efficiently, but should also be 100% federal controlled with the federal insisting that state and regional governments chip in accordingly as is appropriate.