Our Next President?

[dcarrigg]

Re: Our Next President?

• lack of price transparency
• heavy consolidation to scrub the market of actual competition
• non-enforcement of antitrust laws COUPLED WITH making drug reimportation illegal to juice profit margins on them
• forced purchasing of insurance
• CON laws ... you have to get DIRECT COMPETITORS (and/or those bribed by them) to approve a certificate of need for you to be able to compete with them

These are all huge factors. But even more than that, the truth is, I think, that for-profit competition never works in lots of healthcare scenarios. Even if you resolved all these, issues, nobody can shop for price when they're unconscious in the back of an ambulance. They can charge you literally whatever they want in the meanwhile. That's what I mean by natural monopoly at point of service. No time to drive an hour to the next hospital that's cheaper when you're in the middle of a heart attack. And there's only so many hospital beds any arbitrary geographic area can support. So it really does function like a natural monopoly. Worse? They can and will perform services without your consent, and you're still stuck with the bill, which you cannot know ahead of time. Worse than that? You can't always control what your doctor orders. If they put you on a brand name vs a generic or whatever when you're out, or coming to, what can you do? I've never gotten to pick what pain meds they put me on after a surgery. You can't control this stuff, but you do get billed for it.

The largest share of healthcare spending in the US still happens at hospitals. It's more money than all the retail drugs and physician and clinical services combined. If you've ever been in an ICU, you know the patients don't exactly have the luxury to "send price signals to the market." They're basically meat that's barely breathing. And the assumption is that they'll pay anything not to die. This is not a great environment into which to inject the profit motive. BUT, I still think it can be done reasonably, if prices are regulated. If they're not, as in the US, and they've got their hands on an unconscious lump of meat whom they can charge any amount they feel like charging without informed consent, then it's just a plain old extortion racket masquerading as "freedom." And people eat it up, I guess because they worship The Market®, or whatever. I always liked this scene. Who better than a crook to know when he's being shaken down?

[seobook]

Re: Our Next President?

And I always thought the solution was simple competition; that if you are faced with a powerful entity, taking more profit that necessary to achieve results, anyone could simply start up a competitor. Surely, that was always the underlying philosophy of a capital based society; the competitor was always going to have access to the necessary capital to allow them to compete. So, why not? What has changed?

• lack of price transparency
• heavy consolidation to scrub the market of actual competition
• non-enforcement of antitrust laws COUPLED WITH making drug reimportation illegal to juice profit margins on them
• forced purchasing of insurance
• CON laws ... you have to get DIRECT COMPETITORS (and/or those bribed by them) to approve a certificate of need for you to be able to compete with them

[Chris Coles]

Re: Our Next President?

Kaiser seems to do some good work, and I don't have any direct experience with them. But they don't seem to really keep costs down either. In some ways, the Catholic Church and a few other university schemes have created a somewhat similar alignment around here.

But here's the thing: I think of hospitals as a natural monopoly and as something more or less like a public utility.

I mean, we live in a country where we are fine with regulated electric prices, but people scream socialism when you talk about regulating healthcare prices. People in the US don't realize what regulation does for them.

Imagine if the electric systems in the US were run like the healthcare system.

• There'd be variable opaque pricing that changed by the street and by the second. It might cost you hundreds or thousands of dollars to run the AC on that 100 degree day or run the heat when it drops to -20 degrees. And you wouldn't be able to know the price until after you used it and you got the bill. You'd just be terrified to use the heat or AC on the days when you most need it, aware that the price might ruin you and you have no control over it.

• They'd force you to buy blackout insurance, otherwise they'd shut you off at times of peak load. Some companies might not even serve you without it. Each of the power suppliers would send you bills separately from the power distributors, system operators, and transmission companies, and most people would probably want some sort of third party insurance or other negotiator to handle rate negotiations even during regular times. The bills would be confusing and outrageous.

• Likely 10% or so of the country would simply go without electricity on the regular. There would be counties in Texas with less than 50% of households having power.

• Veterans, the poorest, and the elderly might get their own special government systems of blackout insurance to try to ensure they don't freeze to death. Maybe something called Electriccare or Electriccaid. These systems would vary enormously in effectiveness and coverage by state. Electric companies would complain that the rates those systems paid were below market rates.

• Maybe in California you'd have Kaiser Electric, who managed to unify the distribution grid and the blackout insurance. But even if they did so, they'd still have to interact with other third party insurance companies and the three government systems. And they'd still have an unregulated natural monopoly at point of service. So prices would stay the highest in the world.

• Over time, tangential businesses would pop up and become standard parts of the process. Backup batteries and generators with automatic refueling delivery services would become standard parts of the insurance package, because they'd be cheaper than if the insurance company just paid the price gouging of peak rates. Soon they'd be ubiquitous for the middle class, and every household would treat having a $30k battery in the basement and a giant generator running on hot days or cold nights as normal.

• The lack of direct price regulation would lead to not only the electric sector eating up a greater share of GDP, but the strain and stress the expenses it causes would lead to ever more political solutions and insurance schemes in a futile attempt to indirectly get prices under control.

• This would lead to ever more complicated regulations on everything but the goddamn prices. Soon you wouldn't be able to screw in a lightbulb yourself legally, and you'd have to hire someone with a postgrad degree to do it for you for hundreds or thousands of dollars. And they would be encouraged to ration them to try to get prices under control. It wouldn't work, but it would result in an ever more bloated advertising and marketing budget. "Ask your certified professional engineer if LG LED lightbulbs are right for you!" Meanwhile, in every other country where they did regulate prices for electricity directly, tangential products like LG LED lightbulbs would cost $3 a pop instead of $300.

• Concierge and superlux electric services would pop up, along with vanity electric consultants even though there's a shortage of electric consultants and relatively long wait times to get a lightbulb screwed in. More and more PEs would get out of the volume game and just serve the wealthiest, offering regular home infrared scans and insulation touch-ups and other luxury services that are expensive, but mostly non-essential.

• Political movements for years would cry "Elecriccare for all!" as the system grew ever more convoluted and the costs spiraled out of control.

• Of course, people wouldn't actually care about Electriccare per se. It would all be a means to an end, and the only one people could imagine. Really the goal would be getting everyone access to electricity and lowering rates out of the stratosphere. But, since in this universe price regulation for electricity is out of the question, the best people can imagine is getting everyone on a government blackout insurance plan and hoping that price negotiations would occur that way rather than direct price regulation.

• Yet even still people would insist that if we just restructure blackout insurance and have people call into their certified professional engineers on 100 degree mornings to make $200 copayments to get a referral to an air conditioner specialist to turn the AC on, we'll reduce electric consumption, and thereby control prices. We'll literally try absolutely everything and every institutional arrangment to control prices, except actually controlling prices.

• Since we won't control prices, soon enough every blackout insurance plan and every address will have different pricing for every time of every day, leading to a massive bloated administrative staff that makes super-kludgy IT systems and builds ultra-complex smart-meters and codes and bills for all the variables.

If this sounds absurd to you, I think it should. But I also think it's pretty damned close to the reality of how the healthcare system works in the US. Pretty much an unregulated natural monopoly at the ultimate point of service. So they've got you by the shorthairs. And if you're not going to regulate prices on the natural monopoly, then it's going to eat up an ever-increasing share of national income. People will realize this and it will become a political issue. Soon this whole system's going to sprout up around it as people who can't see the forest through the trees try to solve the problem in myriad indirect ways. It will never work, because the unregulated natural monopoly's still an unregulated natural monopoly. And now all these ancillary appendages the system grew over time exist and have lobbying power.

Why doesn't this happen with electricity in the US? Because we either A) run the electric delivery system as public and municipally owned, or B) regulate prices directly in the event the system is privately owned. Either way, rates are set, usually by a quasi-judicial commission or board, and for any given 6 or 12 month period in any given municipality, the cost of a kilowatt-hour of electricity is dictated, knowable, and constant. There may be some variation. Big industrial users will probably pay less per unit than residential users, etc. But there are a limited number of combinations and rules about that stuff. Power suppliers may be deregulated too, and consumers may be able to select them. But even there, the billing is mandated to occur through the distribution company and so the negotiations are not complex. And if people don't want to do that kind of shopping, they don't have to, and the electric company will provide a standard default supply offer that everyone gets just for signing up. Even then, some of the poorer areas of the country couldn't manage the infrastructure investment, so things like the TVA pop up and are still around. And in the 30s we sent guys through rural and urban residences that were unpowered and wired them up on Uncle Sam's dime. But we basically had the makings of a universal system with affordable prices.

I suspect we will never, ever have that in healthcare the way the system is designed today, where there is no price regulation, nor a universal negotiator, nor a standard offer service, nor even broad agreement on the concept that everyone deserves access.

This is extremely weird to me. Americans collectively have come to terms with the idea that electricity is essentially a universal right of citizenship, but healthcare is not. It's a really bizarre choice, out of step with the old hierarchy of needs. But here we are. People will kick and scream and fight you tooth and nail if you suggest that healthcare delivery prices ought to be regulated. But nobody bats an eye about the fact that electric delivery prices are regulated. Nobody calls it "socialized electric." Nobody even thinks about it. They just take it for granted that electricity will be available and affordable. What a concept!

And I always thought the solution was simple competition; that if you are faced with a powerful entity, taking more profit that necessary to achieve results, anyone could simply start up a competitor. Surely, that was always the underlying philosophy of a capital based society; the competitor was always going to have access to the necessary capital to allow them to compete. So, why not? What has changed?

[dcarrigg]

Re: Our Next President?

i can only see 2 possible reasonable destinations for u.s. healthcare. one is a medicare-for-all kind of single payer. people who scream about the cost seem to forget what we're already spending on our current system. the only other reasonable system i can foresee is universal coverage through kaiser-like systems. kaiser is both insurer and healthcare delivery system- they have their own clinics and hospitals, and as the insurer too the incentives are all aligned.

most places in the country will have a natural monopoly because of limited local resources. these monopoly systems, however, can be benchmarked against systems in regions dense enough to support multiple delivery systems. kaiser, for example, operates in many markets in california. the sutter system is looser and differently structured, but could easily be turned into a kaiser-like operation by incorporating the insurance function. thus there can be competitive systems to set standards and prices.

Kaiser seems to do some good work, and I don't have any direct experience with them. But they don't seem to really keep costs down either. In some ways, the Catholic Church and a few other university schemes have created a somewhat similar alignment around here.

But here's the thing: I think of hospitals as a natural monopoly and as something more or less like a public utility.

I mean, we live in a country where we are fine with regulated electric prices, but people scream socialism when you talk about regulating healthcare prices. People in the US don't realize what regulation does for them.

Imagine if the electric systems in the US were run like the healthcare system.

• There'd be variable opaque pricing that changed by the street and by the second. It might cost you hundreds or thousands of dollars to run the AC on that 100 degree day or run the heat when it drops to -20 degrees. And you wouldn't be able to know the price until after you used it and you got the bill. You'd just be terrified to use the heat or AC on the days when you most need it, aware that the price might ruin you and you have no control over it.

• They'd force you to buy blackout insurance, otherwise they'd shut you off at times of peak load. Some companies might not even serve you without it. Each of the power suppliers would send you bills separately from the power distributors, system operators, and transmission companies, and most people would probably want some sort of third party insurance or other negotiator to handle rate negotiations even during regular times. The bills would be confusing and outrageous.

• Likely 10% or so of the country would simply go without electricity on the regular. There would be counties in Texas with less than 50% of households having power.

• Veterans, the poorest, and the elderly might get their own special government systems of blackout insurance to try to ensure they don't freeze to death. Maybe something called Electriccare or Electriccaid. These systems would vary enormously in effectiveness and coverage by state. Electric companies would complain that the rates those systems paid were below market rates.

• Maybe in California you'd have Kaiser Electric, who managed to unify the distribution grid and the blackout insurance. But even if they did so, they'd still have to interact with other third party insurance companies and the three government systems. And they'd still have an unregulated natural monopoly at point of service. So prices would stay the highest in the world.

• Over time, tangential businesses would pop up and become standard parts of the process. Backup batteries and generators with automatic refueling delivery services would become standard parts of the insurance package, because they'd be cheaper than if the insurance company just paid the price gouging of peak rates. Soon they'd be ubiquitous for the middle class, and every household would treat having a $30k battery in the basement and a giant generator running on hot days or cold nights as normal.

• The lack of direct price regulation would lead to not only the electric sector eating up a greater share of GDP, but the strain and stress the expenses it causes would lead to ever more political solutions and insurance schemes in a futile attempt to indirectly get prices under control.

• This would lead to ever more complicated regulations on everything but the goddamn prices. Soon you wouldn't be able to screw in a lightbulb yourself legally, and you'd have to hire someone with a postgrad degree to do it for you for hundreds or thousands of dollars. And they would be encouraged to ration them to try to get prices under control. It wouldn't work, but it would result in an ever more bloated advertising and marketing budget. "Ask your certified professional engineer if LG LED lightbulbs are right for you!" Meanwhile, in every other country where they did regulate prices for electricity directly, tangential products like LG LED lightbulbs would cost $3 a pop instead of $300.

• Concierge and superlux electric services would pop up, along with vanity electric consultants even though there's a shortage of electric consultants and relatively long wait times to get a lightbulb screwed in. More and more PEs would get out of the volume game and just serve the wealthiest, offering regular home infrared scans and insulation touch-ups and other luxury services that are expensive, but mostly non-essential.

• Political movements for years would cry "Elecriccare for all!" as the system grew ever more convoluted and the costs spiraled out of control.

• Of course, people wouldn't actually care about Electriccare per se. It would all be a means to an end, and the only one people could imagine. Really the goal would be getting everyone access to electricity and lowering rates out of the stratosphere. But, since in this universe price regulation for electricity is out of the question, the best people can imagine is getting everyone on a government blackout insurance plan and hoping that price negotiations would occur that way rather than direct price regulation.

• Yet even still people would insist that if we just restructure blackout insurance and have people call into their certified professional engineers on 100 degree mornings to make $200 copayments to get a referral to an air conditioner specialist to turn the AC on, we'll reduce electric consumption, and thereby control prices. We'll literally try absolutely everything and every institutional arrangment to control prices, except actually controlling prices.

• Since we won't control prices, soon enough every blackout insurance plan and every address will have different pricing for every time of every day, leading to a massive bloated administrative staff that makes super-kludgy IT systems and builds ultra-complex smart-meters and codes and bills for all the variables.

If this sounds absurd to you, I think it should. But I also think it's pretty damned close to the reality of how the healthcare system works in the US. Pretty much an unregulated natural monopoly at the ultimate point of service. So they've got you by the shorthairs. And if you're not going to regulate prices on the natural monopoly, then it's going to eat up an ever-increasing share of national income. People will realize this and it will become a political issue. Soon this whole system's going to sprout up around it as people who can't see the forest through the trees try to solve the problem in myriad indirect ways. It will never work, because the unregulated natural monopoly's still an unregulated natural monopoly. And now all these ancillary appendages the system grew over time exist and have lobbying power.

Why doesn't this happen with electricity in the US? Because we either A) run the electric delivery system as public and municipally owned, or B) regulate prices directly in the event the system is privately owned. Either way, rates are set, usually by a quasi-judicial commission or board, and for any given 6 or 12 month period in any given municipality, the cost of a kilowatt-hour of electricity is dictated, knowable, and constant. There may be some variation. Big industrial users will probably pay less per unit than residential users, etc. But there are a limited number of combinations and rules about that stuff. Power suppliers may be deregulated too, and consumers may be able to select them. But even there, the billing is mandated to occur through the distribution company and so the negotiations are not complex. And if people don't want to do that kind of shopping, they don't have to, and the electric company will provide a standard default supply offer that everyone gets just for signing up. Even then, some of the poorer areas of the country couldn't manage the infrastructure investment, so things like the TVA pop up and are still around. And in the 30s we sent guys through rural and urban residences that were unpowered and wired them up on Uncle Sam's dime. But we basically had the makings of a universal system with affordable prices.

I suspect we will never, ever have that in healthcare the way the system is designed today, where there is no price regulation, nor a universal negotiator, nor a standard offer service, nor even broad agreement on the concept that everyone deserves access.

This is extremely weird to me. Americans collectively have come to terms with the idea that electricity is essentially a universal right of citizenship, but healthcare is not. It's a really bizarre choice, out of step with the old hierarchy of needs. But here we are. People will kick and scream and fight you tooth and nail if you suggest that healthcare delivery prices ought to be regulated. But nobody bats an eye about the fact that electric delivery prices are regulated. Nobody calls it "socialized electric." Nobody even thinks about it. They just take it for granted that electricity will be available and affordable. What a concept!

[Polish_Silver]

Re: Our Next President?

Kasier is very efficient, in my experience. So were medical services run by universities, who had a stake
in controlling costs.
Universal coverage is not necessarily expensive. It is very cost effective in Taiwan, Hong Kong, Singapore, etc.

The problem I see here is that interests are so entrenched they will rig it to keep the costs up. (pharma, insurance companies, hospitals, doctors)

[jk]

Re: Our Next President?

i can only see 2 possible reasonable destinations for u.s. healthcare. one is a medicare-for-all kind of single payer. people who scream about the cost seem to forget what we're already spending on our current system. the only other reasonable system i can foresee is universal coverage through kaiser-like systems. kaiser is both insurer and healthcare delivery system- they have their own clinics and hospitals, and as the insurer too the incentives are all aligned.

most places in the country will have a natural monopoly because of limited local resources. these monopoly systems, however, can be benchmarked against systems in regions dense enough to support multiple delivery systems. kaiser, for example, operates in many markets in california. the sutter system is looser and differently structured, but could easily be turned into a kaiser-like operation by incorporating the insurance function. thus there can be competitive systems to set standards and prices.

[dcarrigg]

Re: Our Next President?

It's also true that we haven't taken what is, in my opinion, the obvious first step: ending (or at least modifying) the employer sponsored tax break. It seems to be an issue that is mostly non-partisan, yet it doesn't get done. Presumably that's because the insurance industry, like any other, likes when there's huge tax breaks for buying their products and they lobby to maintain it.

You're not wrong. I still don't think it would have a major effect on the underlying cost structure. Even if you abolish employer sponsored healthcare and force everyone on to the exchanges, the price would remain high for all the reasons I outlined earlier. The incentives just don't work; when you need a hospital stay, there's really no good way to shop around or even determine prices ahead of time. It all just reminds me of Crassus' private sector fire brigades. When your customers are necessarily vulnerable, you can squeeze them for whatever you want.

[thriftyandboringinohio]

Re: Our Next President?

It's also true that we haven't taken what is, in my opinion, the obvious first step: ending (or at least modifying) the employer sponsored tax break. It seems to be an issue that is mostly non-partisan, yet it doesn't get done. Presumably that's because the insurance industry, like any other, likes when there's huge tax breaks for buying their products and they lobby to maintain it.

They like more than the tax break.
They like selling a product to one person at corp HQ benefits dept but delivering the product to someone else, a pipe fitter two states away.

[DSpencer]

Re: Our Next President?

I think you're right that folks would benefit from those kind of changes. But in the US they've spent so long stigmatizing it that it's probably not going to be a political winner even if it's a policy winner. Millions of folks just won't take them. Millions more don't know how. The middle class is largely completely detached from this stuff.

The healthcare system desperately needs to be hit with a sledgehammer and totally rebuilt. It's really beyond tweaking or fixing. Hospitals are run by reits like retail malls now. There's 17 different profit companies operating out of each one. There's thousands of different prices for every little thing, which makes coding, billing, and IT a total nightmare. There's layers on layers of insurance, pharma, device operators, and others all with layers on layers of marketing, sales, and advertising. And I've yet to see any comprehensive plan to get it under control by small technocratic tweaks, largely because I suspect it's not possible. We tried the Romneycare/Obamacare/Heritage Foundation thing. We've tried HMOs, PPOs, HSAs, FSAs, EPOs, HDHPs, POSs, etc. etc. There's a new scheme every few years that's supposedly going to get costs under control. None of them do. The results are not good.

It's also true that we haven't taken what is, in my opinion, the obvious first step: ending (or at least modifying) the employer sponsored tax break. It seems to be an issue that is mostly non-partisan, yet it doesn't get done. Presumably that's because the insurance industry, like any other, likes when there's huge tax breaks for buying their products and they lobby to maintain it.

[dcarrigg]

Re: Our Next President?

I think low income people could be helped by changing the benefit threshold structure. As wages rise, you lose benefits very quickly. So your effective income tax rate is very high. And the medical costs are a burden for families up to $150k income. The country has a some really serious problems.

I think you're right that folks would benefit from those kind of changes. But in the US they've spent so long stigmatizing it that it's probably not going to be a political winner even if it's a policy winner. Millions of folks just won't take them. Millions more don't know how. The middle class is largely completely detached from this stuff.

The healthcare system desperately needs to be hit with a sledgehammer and totally rebuilt. It's really beyond tweaking or fixing. Hospitals are run by reits like retail malls now. There's 17 different profit companies operating out of each one. There's thousands of different prices for every little thing, which makes coding, billing, and IT a total nightmare. There's layers on layers of insurance, pharma, device operators, and others all with layers on layers of marketing, sales, and advertising. And I've yet to see any comprehensive plan to get it under control by small technocratic tweaks, largely because I suspect it's not possible. We tried the Romneycare/Obamacare/Heritage Foundation thing. We've tried HMOs, PPOs, HSAs, FSAs, EPOs, HDHPs, POSs, etc. etc. There's a new scheme every few years that's supposedly going to get costs under control. None of them do. The results are not good.

[Polish_Silver]

Re: Our Next President?

I think low income people could be helped by changing the benefit threshold structure. As wages rise, you lose benefits very quickly. So your effective income tax rate is very high. And the medical costs are a burden for families up to $150k income. The country has a some really serious problems.

[seobook]

Re: Our Next President?

Good call, on the surface. A newcomer with a relatively blank slate onto which bits and pieces of voter preference can be written as the campaign goes on, ala Obama, starting with "opposite of Trump" positioning of "love for each other and for our country." Ideal as a marketing campaign president for more of the same policies as Bush and Obama but without the Trump crazy.

She was highly involved in the Great Recession & its aftermath, actively choosing to look the other way while a San Francisco DA & then as the AG of the state of California.
https://market-ticker.org/akcs-www?post=234916

She is arguably the reason that not one single bank executive went to prison for rampant fraud all across California when the housing market blew up.
She was AG from 2011 to 2017, when the location of all the buried bodies from the crash were known. In addition she was DA of San Francisco from 2004-2011 and thus was a willful participant in looking the other way in one of the hottest parts of the nation while all the mortgage, securitization and servicing fraud was going on during the bubble itself.
She knew good and damn well that WaMu, for example, was paying out more in dividends than it had in free cash flow, making up the difference with "capitalized interest" -- in other words, exploding "teaser rate" loans that negatively amortized

That mean's she'll get plenty of campaign contributions from deep pockets painting her as a new and different path while in reality she represents a continued bet on failed policies from the recent past.

[dcarrigg]

Re: Our Next President?

absolutely. not even a symptom, really, just an excuse or cover-up

from the "how i learned to stop worrying and love the national debt" piece i linked above:

Modern Monetary Theory – which is neither modern nor a theory – is a post hoc rationalization of political expediency and power-expanding action.

Yeah. Don't even need tinfoil when you think about it. Doesn't have to be coordinated. Just politics. Who gets what, when and how. If the wealthiest among us can appropriate themselves trillions borrowed out of the treasury, why can't the rest of us do the same? Pick any excuse you like. The example has already been set. It's not like MMT is any more dangerous than the idea that tax cuts pay for themselves. Anyone can rationalize it however they want. In the end of the day, it's almost certainly worse if the looting is asymmetrical. Better to have a deeply indebted state with rule of law in tact than a somewhat less deeply indebted state run by a handful of ruling families who are above the law.

[jk]

Re: Our Next President?

Symptom, not a cause.

absolutely. not even a symptom, really, just an excuse or cover-up

from the "how i learned to stop worrying and love the national debt" piece i linked above:

Modern Monetary Theory – which is neither modern nor a theory – is a post hoc rationalization of political expediency and power-expanding action.

[dcarrigg]

Re: Our Next President?

anyone have any doubts that mmt's day is coming?

Symptom, not a cause. The goal is ancient; oligarchy with power hard-wired down bloodlines. Borrowing $10 trillion from the treasury to pay it out as free and clear cash to billionaires and large corps is just a means to an end. Unlimited printing is just a consequence of the means.

Assume, just for a moment, that there are those who have no love for the republic, who would rather see it destroyed and replaced with a series of ruling kleptocratic families. Then ask yourself what would they do?

People often think the threat to the republic is the majority; the common people printing themselves too much out of the treasury by the vote. But the truth is, there's no real threat of that. The common people haven't gotten so much as a crumb in 40 years. Wages stay flat, rents go up, fees go up, healthcare goes up, services get rescinded, pensions get rescinded, so on and so forth. But guess who got $10 trillion of Uncle Sam's money free and clear for doing nothing in the biggest bill passed in the last decade by dollars under Trump?

The game's the same. Trump, Schultz, Bloomberg; Republican, Independent, Democrat. The billionaires all want the same thing. They all golf together. The rest is just window dressing.

The real struggle isn't over GDP or numbers or resources anymore. They already robbed that cupboard blind. Now it's over power and rights. And there's precious little time left to exercise them.

And I'll tell you something else, the Bezos, Trump, Pecker Pic feud is just a preview of what's to come. They're all morally bankrupt. Every one of them lies, cheats, steals, and whores, and so every one of them is open to extortion, and none of them are beneath it. The only thing that kept them from each others throats was the common goal of fleecing Uncle Sam. But once they think Uncle Sam's tapped dry, they'll turn on each other.

I mean it. As we rapidly approach the point at which they write this country off, as more and more of them vacation and invest in dictatorships that cater to them, like Dubai and Singapore, increasingly they will view the real power struggle not as with the republic, which is weak and dying and no real threat, but with each other. We've never seen billionaires toying with running for office in the numbers they are today, and it's not because political office is more powerful than it was in the 00s or 90s or 80s. If anything, the union is relatively less powerful than then. It's because they want to use the office to attack each other and defend themselves from each others' attacks.

The story is the same in any failing republic for the last 2000 years. Crassus and Sulla and Caesar. Mercer and Trump and Bloomberg. Not a patriot among the lot of them. But plenty willing to move against the republic and each other to ensure their own families' power.

One way or another, big change is coming in the next few years. It could be good; it could be bad. It will be up to the lot of us. But we'd be fools to discount the possibility of these folks abolishing the estate tax--the oldest American tax, the only one Jefferson and Adams; slave owners and abolitionists; the founders across the board could agree on for the purposes of promoting merit instead of bloodlines--and following it up with attempts to declare emergencies and suspend government and otherwise install their families as rulers in perpetuity.