AI tax – The Health Care Blog

Enough of Asshole Capitalism

Oct 26, 2026• 1

By KIM BELLARD

I recently read both Plastic, Inc. (Beth Gardiner) and These Are the Plunderers (Gretchen Morgenson and Joshua Rosner), and, boy, am I mad. Nothing in either book really came as a surprise, but the degree to which some people are willing to be greedy at the expense of others is still daunting. The latter introduced me to the phrase “Asshole Capitalism,” a phrase that comes from the work of Aaron James, a philosophy professor at University of California, Irvine. It can be summed up as a system where “citizens feel entitled to unlimited personal enrichment even at social cost.”

In other words, capitalism. No wonder a recent survey found that 43% of U.S, adults view socialism favorably (although Vice President J.D. Vance finds it a hard term to define and seems to think it has to do with foreign workers and transgender athletes).

Plastic, Inc. tells the story of how, over the course of several decades, the petrochemical industry has worked to have us consume ever more plastic while not only absolving themselves of the responsibility for what happens to all that plastic but also boldly attempting to make consumers feel guilty about not doing a better job of recycling it. Those of us of a certain age might remember the “Crying Indian” littering ad. Well, that ad was sponsored and paid for by the industries that were producing the litter.

These Are the Plunderers shows how private equity firms blithely take companies and strip them of valuable assets, enriching themselves while often essentially destroying the companies. The authors focus much attention on healthcare, such as nursing homes or emergency room staffing, in which private equity ownership leads to demonstrably higher costs, job cuts, and worse care, while making boatloads of money for the private equity owners. Manufacturing, retailing, and other industries have also had victims.

Capitalism is replete with disregard for the common good. E.G., the fossil fuel industry giving us cheap gas without being responsibly for the ensuing climate change, mining companies that strip the earth while wrecking ecological damage on the environment, or manufacturers that pollute their local communities then close the factories when asked to clean up their waste. Capitalism has a very bad habit of not recognizing either costs imposed on others or costs to clean up their actions. It’s someone else’s problem, and that someone else usually ends up being those of us who pay taxes, or whose health is deemed unimportant.

Cancer alley is no secret, nor are the health risks of the fracking craze that has supercharged the profits of oil & gas companies. We’re becoming more aware of how pervasive microplastics are, and just starting to realize how bad that is for us.

Universal Coverage Might Be Nice, but an AI Tax Is Necessary

Aug 18, 2026• 0

By KIM BELLARD

I was amused – oh, I should be polite and say “interested” — to see a new study, led by researchers from Yale School of Public Medicine, about the benefits of a universal single payor health system. It concluded that we could save 100,000 lives annually and save some 1.04 trillion each year – some 20% of our health care spending. What’s not to like? I’m sure Bernie Sanders is already drafting the bill.

The savings come from five sources: using Medicare payment rates for all providers, using “international reference pricing” for pharmaceuticals, reducing administrative costs to Medicare’s levels, reducing fraudulent billing (“consistent with the experience of other single-payer transitions”), and reducing emergency room visits and hospitalizations due to improved access to primary care. Good goals, all.

Steffie Woolhandler and David Himmelstein, among others, have been making these or similar arguments for decades, and they are not without merit. It is shameful that we don’t have universal coverage. It is distressing how much money we spend on healthcare. It is embarrassing that we spend so much money on administration. It is maddening that so many people don’t get the care they need, get the wrong care, or get their care in the wrong places/at the wrong times.

We could do better, we should do better, but, if anything, we’re doing worse: more people are losing coverage, more providers are going out of business, our rates of chronic (and some infectious diseases) are going up, and we’re dying sooner.

I want to quickly point out some of the problems with the proposed sources of savings, then discuss other courses of action that might lead to these or even better outcomes.

Medicare payment rates: yes, a lot of money could be saved by using Medicare payment rates, but I doubt you would find many providers who would say they could survive. They make their money on private insurance rates, are lucky to break even on Medicare rates, and lose money on Medicaid. This one is not going to happen.
International pharmaceutical reference pricing: first, I’m not sure such a thing exists. It is true that drug prices are typically lower in other countries. Both President Biden and President Trump seized upon this, with some signs of modest success. But, as with the Medicare pricing, it would be a shock to the pharmaceutical industry to have prices slashed across the board, wiping out trillions of dollars of value and, oh-by-the-way, eventually reducing investments on new and better prescriptions.
Administrative costs: as a percentage of spending, Medicare’s administrative costs are lower than private insurance, but that is partly due to Medicare spending per capita being so much higher. Also, costs incurred by other agencies – e.g., Social Security or the IRS – are not always counted. But certainly the complexities of so many plan designs by so many health insurers while tracking the current eligibility of everyone is a cost that is much higher than it should be.
Reducing fraudulent billing: I mean, really: do people really think that Medicare does a better job of reducing fraudulent billing than United Healthcare or Anthem, much less than other countries?
More primary care: reducing emergency room visits and hospitalizations has been the goal of countless private health insurance efforts, such as disease management or chronic health programs, and the track record has generally been underwhelming. But the real problem is – where are we going to get all the primary care physicians to handle all the underserved people?

So, much as I agree with the goals, count me a skeptic that single payor is going to magically make everything better.

Here’s where I inevitably turn to AI.