Obamacare Archives - Scott Adams Says

Episode 1360 Scott Adams: The Biden Speech and Senator Tim Scott’s Rebuttal Seen Through the Persuasion Filter

Scott Adams on April 29, 2021

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Content:

NYT admits they inject opinion into “news”
Rudy Giuliani raided by Feds
Review: President Biden’s speech to congress
Paycheck Fairness Act…potential blowback
Was Jan 6 an actual risk to America?
Senator Tim Scott’s rebuttal

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Episode 830 Scott Adams: Bloomberg as the T*rd in the Punch Bowl, Bernie and Fidel, Healthcare

Scott Adams on February 24, 2020

My new book LOSERTHINK, available now on Amazon https://tinyurl.com/rqmjc2a

Content:

Coronavirus worldwide impact
Twitter unfollowing mystery and the TikTok app
President Trump treated as a superstar in India
Why do Democrats see incentives as cruel?
- The child’s view versus the adult view
Explaining Bernie’s healthcare plan better than Bernie
Bernie, Fidel and despicable news coverage
2017 Bloomberg hit piece article on me

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Episode 471a Scott Adams: Healthcare, Socialism, Biden, Smollett, Climate Change, Venezuela

Scott Adams on March 27, 2019

Topics:

Jussie Smollett case, did Chicago PD waste their time?
CNN top level editorial content today…nothing by healthcare articles
If Obamacare goes away, and there’s no replacement plan
- A big, risky, radical change, like a socialist experiment
- How do we improve healthcare and lower costs?
Stimulating healthcare startups and cost cutti…
- We’ll never know, the broadcast cut off
- Continued in Episode 471b

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I Tell You How Citizens Can Fix Health Care (Now that Congress Failed)

Scott Adams on July 18, 2017

Congress just proved something that we all suspected: They are the wrong tool for fixing health care. The topic is too complicated, the politics are too corrosive, and the money interests are too strong. That’s why citizens will step in and fill the gap with their own proposals. I expect to see a number of citizen-created health care proposals emerge soon. To that end, I thought I would get the ball rolling by framing the problem in this short 4-minute video. This is how any large business would approach the problem of spiraling healthcare costs. Here is the graphic from the video clip:

The advantage American citizens have in 2017, that we never had before, is a populist president who can sell the bejeezus out of a health care plan if someone could come up with one that makes sense. But for that to happen, Congress first had to do a hard faceplant in the asphalt, to show the country they are not the right tool for the job. That phase is complete. Time for the next phase.

—

You might enjoy reading my book because Congress is broken.

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The Only Way to Fix Healthcare Insurance in the U.S.

Scott Adams on June 27, 2017

Our system of government has been amazingly robust for hundreds of years, but it fails when you have these two conditions:

1. An issue is too complicated for the public to understand.

2. Big companies are willing to distort the system for profits.

That situation describes the healthcare debate going on in the United States right now. Our undersized brains can’t grasp all the nuances and implications of any particular healthcare plan. And when our brains are confused, we default to our biases (usually party loyalty) or to whatever metric is simple enough to understand. With healthcare, the one metric that matters is how many people will be covered compared to Obamacare. If the Republican plan covers more people, it will pass. If not, it will fail.

Sure, Republicans will argue that the CBO projections are inaccurate. They will argue that comparing a mandatory plan with an optional one is comparing apples to oranges. They will be right about all of that, but it is irrelevant to the outcome. People will look at the number of people covered and stop there. So any Republican bill that covers fewer people than Obamacare is dead on arrival. That’s where we are now. And we don’t have a system of government that can fix this situation.

But what we do have is an active citizenry and social media. That’s a better system for designing a healthcare system. I’ll describe one way to go about it.

Some of you are aware of Github, a company that lets software developers contribute bits of code that are made available to all other Github users. Github is a big deal, and software developers almost can’t live without it. Perhaps it is time to build a similar system for fixing health insurance in the U.S.

Imagine a website where any interested party can contribute suggestions for improving any individual element of healthcare in the United States, with a focus on lowering costs while improving outcomes. Perhaps you have an idea about lowering drug prices, and I have an idea about online doctors. We submit our ideas, and the Github-for-healthcare users gets to improve on them or ignore them. The system would allow users to rank the ideas. In time, citizens could develop multiple ideas for every element of healthcare. Citizen volunteers could eventually create up to three plans and present them to Congress for a vote.

I’ll get the ball rolling here by framing the problem as an innovation challenge, not a cost issue.

I think Congress can pass a bill that overspends in the short run so long as it comes with a plan (or path) to greater coverage than Obamacare. In my picture above, you see the growing gap between future health care costs and tax revenue. That growing gap can only be closed by some combination of innovation, cutting regulations, improving competition, and improving prevention. Let’s call that a “moon shot” challenge. We don’t know how to get there right now, but Americans are good at figuring out this sort of thing.

My suggestion for getting a healthcare bill passed is for Republicans to create a credible story for how they will cover more people than Obamacare, at a reasonable cost. And the best way to make that case is with visual persuasion, starting with this sort of simple graph and extending to images of startups that promise to lower medical costs.

At the moment, Paul Ryan and the Republicans are trying to sell their plan with facts, concepts, details, and logical arguments. That won’t work. You need an aspirational story about how to get to better coverage than Obamacare via American ingenuity. Everything else is just noise.

I don’t mind letting Congress take its best shot at improving healthcare. But realistically, they can’t. They are not the right form of government for this sort of complexity.

Perhaps citizens can do what congress could not.

—

You might enjoy reading my book because it will make you healthier. (True story, according to my readers.)

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Why the New Healthcare Bill Will Be a Loser

Scott Adams on June 22, 2017

People accuse me of imagining that everything President Trump does is brilliant (persuasion-wise) no matter what he does. But I expect the next version of the Republican healthcare bill to be a complete failure. That’s because Republicans seem deeply committed to a losing path, thanks to what might be called the Contrast Problem.

Contrast is the driving principle behind all decisions. You have to know how your options differ, and by how much, or else you have no basis for a decision. President Obama solved for the contrast problem by designing Obamacare to cover more people than before. The rest of the details – especially the costs – were hard to predict, so our brains flushed that noise and focused on the greater number of people covered.

Everyone knew Obamacare would need future tuning to get it right. That gave us mental permission to focus on the good parts we understood – the greater coverage – and hope the other details would get worked out later. President Obama nailed the Contrast Problem like the Master Persuader he is.

That was then.

Now, President Trump and the Republicans have the “going second” problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered – does not compare favorably with Obamacare. The contrast is fatal.

We know Paul Ryan will do his wonkish best to tell us about all the amazing advantages of this new bill. And we know the public won’t understand any of it. But they sure will know it doesn’t cover as many people. Done. Bury it.

During the campaign, candidate Trump made some references to taking care of everyone. It sounded like universal coverage, but no one thought he meant it.

He did mean it.

He meant it because he understands the contrast problem. Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival. Any skilled persuader would see that.

Paul Ryan doesn’t see the Contrast Problem as important, evidently.

I think most trained persuaders would agree that the one-and-only path to a successful replacement of Obamacare should include AT A MINIMUM a plan to reach greater coverage. And the only way to get there is by goosing innovation in the healthcare field. We can’t tax our way to full healthcare coverage. We need to lower the costs. And President Trump also needs to solve the Contrast Problem.

To that end, I suggest creating a special low-cost (or free) plan for low income people who are willing to accept a bit more risk. If the plan is robust enough, it could provide a path to greater patient coverage compared to Obamacare and solve the contrast problem. As a mental exercise only, the plan might have the following elements:

1. Online doctors for 90% of routine cases.

2. Require big pharma to provide free meds for people in this plan as a condition of selling in the United States. The low-income people covered would be the ones who would not otherwise buy these drugs, so the companies would only lose the cost of the materials themselves, which is trivial.

3. Recruit and approve special doctors for this plan who are by law exempt from any malpractice suits so long as they provide reasons for their decisions. This would allow them to avoid some red tape and also use new and inexpensive medical technology before full FDA approval – but only for the new stuff that common sense tells the doctors would not be especially dangerous. I’m not talking about pills and internal medicine. I’m talking about medical devices, mostly. It would be up to the doctor to decide when it was safe to risk using the new methods.

4. Patients agree to wear health monitors – the newest prototypes – and to share their medical information (anonymously) for the greater benefit of society. This would allow early detection and treatment. Perhaps the low-cost insurance could be free to those who walk 10,000 steps a day, or something of that nature.

5. Shine a government light on any medical technology or systems improvements that would lower cost, to guarantee that the good ones are known to doctors and investors. (Then stay out of the way.)

This is just a starter concept for what a special low-cost plan (with slightly higher risks) might look like. The main point is that you could cobble together a low-cost plan if you had some government muscle behind it to clear out the useless regulations and to focus energy in the right places.

If President Trump presents us with a healthcare plan that doesn’t cover as many people as Obamacare, but will cover more people eventually, that’s a winning contrast.

Otherwise, the bill will die on the Contrast hill. And that’s the direction we’re heading.

As I’ve said before, America can’t make a strong claim to greatness if we can’t do healthcare right. So let’s do it right. Or at least have a plan to get there.

—

You might enjoy reading my book because it will keep you healthy.

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The Healthcare Confusopoly

Scott Adams on May 4, 2017

Years ago I coined the term Confusopoly to describe any industry that benefits by keeping consumers confused. For example, mobile phone carriers know their offerings are too confusing for consumers to compare one company to another on cost. That is clearly intentional. If consumers could compare offerings it would drive profit margins to zero fairly quickly. By keeping their service and pricing confusing, they keep margins high.

Insurance companies are also confusopolies. So are law firms. And the entire financial services industry is little more than a confusopoly. All of those services can be simpler, but to simplify would invite real competition. No seller wants that.

Now look at the healthcare bill in the news today. Do citizens understand all the implications? No, clearly.

Do members of Congress understand all of the implications of the new bill? Not a chance in hell.

Who is behind this confusion?

Duh.

The insurance companies are keeping the healthcare topic confusing because that’s how you keep margins high. If Congress or the public ever started to understand healthcare, we would know which buttons to push to lower the profit margins in the industry. But by keeping things complicated, no one can explain to anyone else what needs to be done for the public good.

My recommendation to the public is to refuse to re-elect any politician who votes for a healthcare bill that YOU don’t understand. If you don’t understand a healthcare bill, that means it is designed to screw you.

To be fair, I doubt politicians see this situation as a confusopoly. They probably just think some things are complicated by their nature, and this is one of them. They might also think they understand the big points. But that seems unlikely to me. A few politicians, such as Rand Paul, might dig into the details and grasp most of it, but the majority will not.

I’m opposed to any healthcare bill that isn’t easy for the public to understand. If the President wants the public to back a particular plan, he needs to give us something simple. Otherwise, my preference is for no new healthcare bill.

—

You might enjoy reading my book because of it is simple.

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Start-ups that Lower the Cost of Health Care

Scott Adams on March 15, 2017

[Update: fixed bad email address in step 3.]

Most of the remaining problems in the world are information problems in disguise. For example, our politicians in the United States are trying to figure out how to provide health insurance to low-income people without breaking the budget.

It looks impossible, at least with our political system as it stands.

So I thought I would help.

In my opinion, the only hope for affordable health care in the long run comes from startups that will dramatically lower the cost of medical services. There are many such healthcare startups in the pipeline, and some could make a big difference to society. As a public service, I’ll collect a list of them in this blog post so investors can see their options for helping the country lower the cost of medical care.

I started the list with one start-up (Sandstone) that I happen to know because I invested in it. Any healthcare startup that lowers the cost of medical treatment is welcome to add their information to the list. To add your company, do this…

1. Go to whenhub.com and create a schedule with one entry for your company, using as your event date the year you went live with a commercial product, or the year you plan to do so.

2. You can include any kind of documents, links, photos, or video to your one event. But please include at least a paragraph saying how your startup lowers healthcare costs.

3. Share your schedule, with its one event, to this address: healthcarestartups@whenhub.com. I’ll check it for completeness and add it to the list.

By the way, WhenHub – a start-up I co-founded – wasn’t designed for this sort of task, but I couldn’t think of an easier way to do it. I’ll use our new streaming feature to create one schedule (really just a list of start-ups) from the shared events. You’ll see the Whencast below grow as I add entries.

The nature of Whencasts is that you can share them on social media and embed them on blog pages. So if this list is useful, feel free to share it. Whencasts stay live and updated no matter where they travel.

I’m also imagining some sort of “digital doctor” healthcare insurance that is super-cheap and relies largely on startups that are not yet part of mainstream medicine. This low-cost insurance plan might be better (but slightly riskier) than traditional medical treatment. For example, if the low-cost insurance people get first access to IBM’s Watson for diagnosing problems, they are probably getting better treatment recommendations than the patients going to human doctors.

I can also imagine this low-cost health insurance plan asking patients to voluntarily give up more health-related privacy than normal, and perhaps agree to some sort of health tracking technology. The data from this group would help improve healthcare technology and treatment for all.

We probably can’t tax-and-spend our way to universal healthcare. The numbers just don’t work. But startups could get us more options for serving low-income folks if we decide to make that a priority.

Update 2: Here’s a great article by Benjamin Joffe explaining the medical tech device revolution ahead of us. This is one of the most underreported stories on the planet.

Speed is the New Intelligence

Scott Adams on January 27, 2015

If I told you the government was planning some sort of new program to benefit its citizens, your initial reaction might be, “uh-oh.” Governments aren’t smart. And the last thing you want from a dumb entity is “more.”

Governments have smart people working for them. But when you sum up the parts of government, you get less than the whole, thanks to bureaucratic inefficiency, political in-fighting and whatnot.

But what if that were about to change?

A smart friend told me recently that speed is the new intelligence, at least for some types of technology jobs. If you are hiring an interface designer, for example, the one that can generate and test several designs gets you further than the “genius” who takes months to produce the first design to test. When you can easily test alternatives, the ability to quickly generate new things to test is a substitute for intelligence. Will users on your website click the burnt orange button more often than the green one? With a tool such as Optimizly or Mixpanel you can test that hypothesis in minutes.

Smart people in the technology world no long believe they can think their way to success. Now the smart folks try whatever plan looks promising, test it, tweak it, and reiterate. In that environment, speed matters more than intelligence because no one has the psychic ability to pick a winner in advance. All you can do is try things that make sense and see what happens. Obviously this is easier to do when your product is software based.

That gets me back to the government. Over time, the practices of private industry infect the government. So we can expect the government to evolve to a mindset of trying something that makes sense, measuring results, and quickly iterating. President Obama essentially said that was the plan with Obamacare. It was an imperfect plan that the President said could improve in time. Did past presidents talk like that? It sounds a lot like a Silicon Valley start-up. You try something, see how you did, and adjust from there.

Obviously the government has always tried to measure its results and improve. But have we ever before launched a major program with known flaws and the intention of improving as we go? That seems new to me, at least in terms of degree. (Historians, please fact-check me in the comments. Wars don’t count.)

Thanks to the Internet, and Big Data, governments have powerful new tools. Now a government can try something, rapidly fix it on the fly, and end up with something good that was hard to predict. In other words – and this is new – a government could launch a program that citizens are skeptical about so long as it had a credible plan to measure results and tweak it to perfection.

Governments are dumb by design because any brilliance that slips into the system will be beaten down by the chorus of average minds and the distortions of political interests. But if speed can sometimes be a substitute for intelligence, things look hopeful. Because as governments become more software-based (Obamacare lives mostly as software, right?) you will see a world in which speed (plus testing and tweaking) are more important than intelligence. As a result, the perceived intelligence of governments should increase simply because the speed of iterating and testing will increase.

We are also seeing the measure-then-fix method play out in states with medical marijuana laws and doctor-assisted suicide laws. The states are seen as test beds. If things go well in the state of Washington, for example, that gives cover for the Federal government to follow their lead. And because we have fifty states, and each is capable of being its own test bed, we gain government speed through all of the individual tests that can be watched, tweaked, borrowed, and spread.

The biggest obstacle to a smarter government is the voters. It will take some time before a national politician can say some version of “We don’t know what will work, so our plan is to launch ugly and figure it out as we go.” In today’s world, that doesn’t sound leader-ish enough. But someday any other approach will appear backwards.

So here’s the summary:

1. Government programs are increasingly becoming software entities.

2. We can quickly measure, tweak, and adjust software.

3. In this environment, speed is more important than intelligence. (Or if you prefer, speed improves the intelligence you already have.)

Therefore, over time, governments will become far more effective. States will be understood as test beds for national programs. And new government programs will be launched with admitted flaws and a plan for iterating toward improvement. Obamacare might be seen as the first in this model.

That feels like good news to me.