“7 And when you pray, do not keep on babbling like pagans, for they think they will be heard because of their many words. 8 Do not be like them, for your Father knows what you need before you ask him.”

They ain’t asking for it, but their Father knows that what these God-botherers really need is to be slapped silly.

Single payer would replace the insurer side of the cartel with a single, government run insurer. Yes, that single payer would have that much more market power, woudl have a momopsony, in fact. But the problem hasn’t been the lack of market power on the payer side. In my example, Wellpointe has more market power vis a vis US pharamceuticals than Canada’s single payer. Canada uses that power to get low prices. Wellpointe doesn’t.

Medicare doesn’t use its market power either. It’s actually worse than that. Between Medicare, Medicaid, military medicine, VA medicine and the Indian Helath Service, the US already has a market power giant that could dun all the medical prviders down to charging no more than their costs plus the bare minimum they need to stay in business. The US doesn’t do that. It tolerates big providers charging 2-3 times what a market would dun them down to.

Single payer wouldn’t add that much to the market power that the US govt already has. Most demand for medical services is generated by the over-65 crowd. The US already is the single payer for all of that demand. Add in the under-65s not already under the govt wing under one of the opther programs I mentioned, and you less than double the power the US already has. But power is not the problem. The lack of will to use it is the problem. Why would you think a US with a complete monopsony would use market power it won’t throw around with the near-monopsony it already has?

It’s not that I have any great love for, or faith in, markets; and certainly not markets in medicine. My preferred reform would be a National Health Service. It’s my idea, so I get to be Surgeon General.

But a US NHS seems to be my idea and not many other people’s, so we seem stuck with some or another market solution. Not my favored choice, but if we are going to have markets, we better set them up in ways that allow them to do their market magic. They have to be free. Monopolies and cartels have to be rooted out completely, or your market is obviously not free of gross restraint of trade. Of course such an unfree market will get you prices 2-3 times what they should be, and low quality care to boot from the misallocations that a distorted market produces.

We could have done something much more effective than the ACA at cutting costs and getting more people coverage simply by enforcing anti-trust laws already on the books rigorously within the health care and health care insurance industry. The fact that Wellpointe doesn’t dun Big Pharma down to Canada level pharmaceutical costs should trigger civil action and a criminal investigation of both Wellpointe and Big Pharma that would leave neither intact at the end. I’m not an expert in the field, but I believe that we would need to change some existing law, ERISA et al, because many aspects of this industry are specifically exempted from anti-trust. But we don’t do anti-trust anyway in this country anymore, even with industries that haven’t gotten their legislative employees to write them exemptions, so the first step is to redevelope the will to enforce the rules that are basic to free markets.

Either that, or just give up on free markets. Do markets right, or don’t do them. What we have now is crony capitalism, not capitalism. We don’t know what Adam Smith would have made of socialism. But he could hardly be more against it than he was against the crony capitalism he wrote an entire book to refute.

Except that he gets right up to the edge of the obvious real problem — the cartel — and punts with some doofus non-solution to what the facts he himself cites exclude as the real problem.

I don’t think fixing the prices that providers can charge to some sort of “international norms” would be nearly flexible enough to keep the big providers and insurers from gaming whatever price structure we set up in ways that would further harm quality of care and increase costs.

What we need to do is break up the cartels. When an insurer like Wellpointe has more beneficiaries than the whole Canadian health care system, yet fails to use that market power to bargain at least equally low drug prices out of Big Pharma, there could be many particular mechanisms at work, but they all boil down to a clear lack of free market competition. Just on pharmaceuticals alone, a Wellpoiinte that got Canada prices for its meds ought ot be able to kill the competition, except that the other insurers as well would have dunned down their pharmaceutical costs as well. Bt then we’ld all have Canada prices, wouldn’t we?

The problem is that the big providers and the big insurers, even when they are not overtly the very same corporation, function as cartels. They get away with charging their high prices because there is no free market to discipline them, just another branch of the same cartel colluding with them to cheat the rest of us.

No matter what the administration actually intends to do if the House lets the ceiling be reached and breached, they have to claim that they will absolutely, categorically, let breach cause default. They have to take this public stand because if the Rs are convinced that the administration will do anything to prevent a crash resulting from their letting the ceiling be breached, that takes all pressure off them to raise the ceiling.

Boehner doesn’t want to pressure his crazies to vote a rise in the ceiling. He also doesn’t want to cut his crazies off, and let a clean raise come to a vote in which it passes with universal D support and only minority R support. In fact, even his moderates, fearing being primaried if they vote for a raise, will only vote yes in the barest minimum numbers necessary for it to pass. It would make his life so much easier were Obama to take that cup from his lips by undertaking ahead of time to do anything at all to raise the ceiling. And it would be the gift that would keep on giving to the Rs. They would leave the ceiling in permanent breach in order to campaign on the lawlessness of whatever actually or fictitiously lawless method the president uses to not go ahead with default.

It’s also true that whatever the administration says beforehand it will do in the event of a breach, what it will actually do is ignore the ceiling. Treasury can’t observe the breach because that would force it to prioritize spending, and it hasn’t been delegated the authority to appropriate, which is what you need to decide who the US pays and who it doesn’t. Treasury can only follow instructions from Congress in paying out money. It can’t pay money unless the law tells it to, and it can’t fail to pay money the law says it must. Should it deviate from its instructions, and start making up its own spending priorities, it would instantly be sued 7,000 ways from Sunday. But no party with any standing can sue it for going on borrowing up to the actual debt limit, however much has to be borrowed to meet all legal spending obligations.

It is a matter of controversy whether or not the delegatiion to the Fed is too sketchy to be consitutional. But it is not at all controversial that there was some delegation. The Fed was not set up by presidential decree, it was created by public law.

There has been no delegation, overly sketchy or sufficiently limited, to the president to generate significant revenue by means of the platinum coin. Minting that coin would be monetizing debt by presidential decree.

It’s the “by presidential decree” part of that that ahould give even people who are enthusiastic about the “monetizing the debt” part pause.

The obvious reason to be against the coin is that, however good an idea it may be to monetize the national debt, neither the monetization part nor the debt part of that can happen by presidential decree. Monetizing the debt may be a good idea, but it could only be done, in our system, by public law. Win the next election and turn the House D if you want to monetize the debt.

Nor do you need to monetize the debt to defang the House Rs in their comic opera attempt to threaten default by refusing to raise the debt ceiling. If you don’t believe the House has the right to unilaterally repudiate spending obligations already passed into law when the budget bills were passed — obligations the House itself voted for, or they wouldn’t have become law — then you don’t believe the president has to do anythig beyind simply refusing to have Treasury cooperate in obeying a fake mandate that the House cannot actually mandate. Treasury instead has to follow the actual, legally effective mandate to meet all spending obligations.

What’s outlandish about the coin is not the idea of printing money, we’ve been doing that a good long time, it’s the idea of rule by presidential decree. We can’t have that, either in the form of minitng the coin, or of having Treasury observe the ceiing and spend by presidential decree rather than by the budget bills.