By David Stockman at Brownstone dot org.

Once in a blue moon even a blind squirrel finds an acorn, or so the saying goes. But, boy, did the occupant of the office of presidency find a MOAPA (Mother Of All Policy Acorns):

THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH.

THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE!

Congress, do not waste your time and energy on anything else.

This is the only way to have great Healthcare in America!!!

GET IT DONE, NOW.

President DJT

Trump hit the nail squarely on the head. Above all other factors, the reason we have runaway health costs is that the fundamental payment mechanism for health care in the US is ass-backwards.

The third-party payment system for the $5 trillion US health care sector is totally opaque when it should be blindingly transparent. It is also radically collectivized when it should be thoroughly individualized; and is completely bureaucratized and cartelized when competitive free market economics are of the essence.

That is to say, individual consumers should see charges hit their credit card or other payment accounts each and every time medical care services are utilized or premiums for an honest form of health insurance are paid. Likewise, providers should always be looking over their shoulders - like in all other economic markets - at the prices, practices, and value propositions of their competitors.

But what we have, instead, is a clunky, pooled, opaque, pre-payment system that is the very opposite of transparent risk-based insurance. This perverse system utterly euthanizes both consumers and providers when it comes to any knowledge of, and incentives for, economizing on the use of medical services.

Indeed, if automobile purchases were on this kind of homogenized, pooled pre-payment system everyone would be driving a Lamborghini, Rolls-Royce, Mercedes, or even a Cadillac or two. You'd be a sucker to drive a Korean-branded, Mexico-assembled econobox - of which there are actually millions on the US roads today.

Of course, they are pleased to call this pooled, homogenized method of health care pricing "community-rated" underwriting. But there is nothing that resembles insurance "underwriting" about it. It's just a case of adding up all the costs for an accounting period and dividing by the number of "insured" units in the pool. After this primitive math exercise, every insured unit gets tagged with the same price, save for family-size differentials and, under ObamaCare, a virtue-signaling discount for not smoking.

To get to the heart of the matter, therefore, the only real appropriate word for what passes for "health insurance" in America today is "socialism." That is, essentially a one-size-fits-all pricing algorithm that is inherently an engine of inflation, excess, and waste like few other economic arrangements in America or communist China, for that matter.

Accordingly, it doesn't really matter whether we are talking about Medicare, Medicaid, ObamaCare Exchange plans, employer group plans, or the odds and sods of individual commercial insurance plans that still hang around the basket. The common characteristic of all of these plans is that they radically homogenize beneficiary payment rates by wholesale elimination of risk-based pricing to the individual consumer/beneficiary, which by definition, of course, includes an ixnay on pricing for "pre-existing conditions."

Moreover, when push came to shove, that was always the end game of the decades-long drive in Washington for "national health insurance," which finally ended in the 2010 hybrid called ObamaCare. The core proposition of the latter, which finally gave it enough political traction to pass, was the elimination of pre-existing conditions in health insurance underwriting and thereby almo...