Private vs Public

 Paul Krugman takes a swing at the actual place to cut down on wasteful government spending: payments to private insurance companies. In particular, he looks at privatization in Medicare, which has been a slow-rolling process of Republicans trying to push more people onto Medicare Advantage. What Krugman seems to show is that "hiring" private companies to provide Medicare services does not, in fact, reduce costs. What's more, the quality of service has not improved.

The issue, in some ways, goes back to the basic function of markets. Markets work best when there is competition and choice. I might pay less, relatively speaking, for socks than for ties, because people see my ties more than my socks. Or I might splurge on really good, thick wool socks because I live in frigid New England, and simply not update my neckties at all. In fact, I chose the latter, and because I had a choice, I was able to determine where my clothes spending went.

There are certain segments of the economy where "choice" rarely works. Education is one, where geography limits the ability to send your 8 year old off to school. We rightly determined that education - at least through 12 grade - should be a public good. Same goes for some utilities, like water and electricity, those are privately held and highly regulated.

Health care is a sector that most countries have decided is a public good. One of the problems we have is that we are a very large country. Rural hospitals are struggling and often closing. Because they are for-profit, it's tough for large health care providers to justify keeping rural hospitals open. Urgent care centers, though, provide a decent stop gap, I guess. That's in many ways a market solution to a supply and demand issue.

The problem, though, is that our health care system is fundamentally a profit-driven enterprise. Not just health insurance companies, doctors and the monopolistic health care "networks" are also looking to maximize payouts.

One of the (uncredited) successes of the Biden Administration has been reducing the amount of money that pharmaceutical companies can charge people. That's an actual saving of government money. I feel confident in saying that Trump's people will destroy that.

DOGE is not about saving government and taxpayer money. It's about rewarding private equity.