Yours Truly, charging — uh, kinda.  Grim Reaper Rapid, Lochsa River, ID   Mike Beiser photo

One of the most distressing things occurring in the Trump administration is its destructive focus on dismantling the Patient Protection and Affordable Care Act, arguably the largest legacy of the Obama administration.  To start, this post is not about how wonderful the ACA is.  I’m not interested in that, otherwise known as Obamacare, because for one thing, I think it’s deeply flawed.  We should have a single payer insurance plan, like every other civilized country.   People regularly, across the world, pay about half what is paid in the U.S. for equivalent services.  (One of the perverse ancillary benefits, however, is that in the long run, what might get most Americans out of the country and perforate our continental bubble is health care tourism.  I already have had multiple friends travel to Mexico for dental care. But I digress.)

We have to have some modern health care safety net if we want to have a modern economy.  You simply can’t have the personal agency needed to drive job creation, as well as social mobility, without it.

There’s also a series of wicked feedback loops that are manifesting in contemporary healthcare that really didn’t even exist 20 years ago.  When you couple the skyrocketing cost of health care, with the absolute necessity of having health insurance, add in a population basically collapsing from metabolic syndrome, mix in the ability of companies to perform debt collection, and then add an increasingly authoritarian government into the mix, you have a recipe for societal control and real collapse — not just creative collapse.  Here’s a great piece with lots of numbers and little politics to give you perspective.  In 1960, 5% of our GDP was health care.  Now it’s almost 18%.

The upshot of those kinds of numbers is that you reach a nonlinear point where people can’t afford to not have a job, because the buried wage paid through employment with a large employing institution, once externalized, crosses the survival threshold for rent, food, and such.  And then an individual can’t move from their current position.  When you add to this increasing obesity, cancer, and general ill health from metabolic syndrome, as well as the slow creep of more catastrophic illnesses earlier in people’s lives (and away from the age-based safety net of Medicare) the chances of something bad happening increase — and people won’t take the risk.  Just how lucky do you feel, punk?

All this, viewed from a v-Meme lens, is terrifying.   As well as putting a damper on entrepreneurship.  You want to start a company?  You want to risk personal medical bankruptcy? Here’s a pretty good dissection of the possibilities on Snopes.

Into all this walks our current President, whom I’ve written about earlier regarding his predilections.  It’s easy to focus on Trump and his disordered empathy perspective, but the problem is larger.  He requires the submission of agencies under his control, as well as many other elected representatives, to derail that signature accomplishment of the Obama administration.  And since he is a chronic relational disruptor, part of the strategy is sowing fragmentation in the connected community, which interestingly enough involves the insurance companies.

It’s easy to argue that the insurance companies are a bunch of pirates, and if we didn’t have their influence in the electoral process through subversions of the public will like the Citizens United decision, we’d be far better off.  But interestingly, what really comes through in this piece on NPR in the conflict described here  is v-Meme conflict.  The insurance business is highly regulated, and pretty much a guaranteed profit business.  Insurance pricing runs heavily on data, which is combined into actuarial tables.  Companies then take those projected costs, add a fixed percentage as granted by law, and rake in the dough.  Naturally, they work hard to undermine the system through denying claims and such.  If you think the game is rigged in their favor for them (as long as they’re not cut out of the game, especially with health care) well, it is.

Why this is interesting is it means that the insurance companies are fundamentally solid Legalistic v-Meme occupiers.  They have a whole business built on stasis, and played by certain rules that guarantee profits.  They don’t like any change, of course, but they can tolerate change if it can be quantified in rules, with data, that allows them to continue to rake in the dough.

But the Trump administration doesn’t like Obamacare, whatever the rules are.  And it’s Trump’s authority uber alles.  He’s the Truth Decider.

So the latest thing Trump is doing is this:  because Trump hates Obamacare, in order to establish his authority, he has to disrupt it.  He’s done lots of different things, including working to get it repealed.  That’s historic.  The latest thing involves two legal cases regarding the formula to establish ‘risk adjustment’ payments across pools.  One judge found the calculation schedule ‘arbitrary and capricious’.  Another did not.  So, in classic v-Meme borrowing form, when a player (in this case the Trump administration) is motivated to assert their v-Meme, they ‘borrow’ from a higher v-Meme (in this case, Legalistic- there were two court cases) to assert their authority, and their direction.  They select the truth to act on, and (dependent on their v-Meme) assert their values.  Which in Trump’s case, is all about controlling the truth.

What this means is Trump is now ordering his folks to simply not pay certain “risk adjustment” payments, totaling $10.4B to the insurance companies for balancing risk pools between high- and low-risk health care subscribers.  Insurance only works as a distributed pool — and by doubling down on the fragmentation card (exactly what we would expect to see in any v-Meme devolution!) he’s causing relational disruption and chaos in the industry.  You want to mess with a bunch of rule followers, which is what the insurance industry is?  Just start arbitrarily and erratically changing the rules.

Here’s a pull quote from the NPR piece:

“Insurers hate uncertainty, and when faced with it tend to raise premiums to hedge their bets,” says Larry Levitt, Senior Vice President at the Kaiser Family Foundation. He says halting the risk adjustment program will disrupt the individual markets, and might even cause insurers not to participate next year.

That’s exactly what psychopaths do — create uncertainty, so others just go away.  Fewer players, communicating with each others less, allow the empathy-disordered to control the playing field.  In this case, it’s forcing the folks in the Out-group to get in an In-group where they’re controlled.  Or, essentially, die.  At some level, it’s boring, it’s so predictable.  But of course, this has a profound effect on people’s lives.

There’s a lot more to write here, but the short version as far as more generalizable insights is this:  narcissistic psychopaths will use whatever tool they can get a grip on in their toolkit to achieve their aims.  It doesn’t matter whether the behavior comes from a higher v-Meme or not.  It’s about their control.  And when it comes to the ACA, Trump won’t stop until he’s out of office.  He’s just gotta be better than Obama.  At least in his own head.

The even larger view, though, gets back to the title of the piece.  Without a large enough authority protecting you in U.S. society, in a world where everyone’s getting fatter and more unhealthy, you’re dead meat.  You don’t need a gun being held to your head to feel The Man’s boot on your neck.  You just need to eat another donut at the office.  Not very empathetic.