Blog #33 MAGA Outreach - We Only disagree on The Remedy

Roots of this website: Kidney Dialysis Intro:

After reading this article, it helped me understand the MAGA mind more.  One statement that stuck out was: "Youngstown (Ohio) is remarkable for the consensus between people of opposing views about the underlying problems and the frustrations that stem from them. They disagree only on the remedy.".  The citizens of Youngstown have been living in one of the most depressed cities in the US and politicians of both stripes have let them down.  The impression seems to be the Democrats will lie to your face, but the Republicans will screw you over straight to your face - many Ohioans seem to prefer the honest crook!  The alleged honest crook, Trump, whose "success was a symptom of the Democrats’ failure to address the catastrophic impact of international trade agreements on manufacturing jobs in the US – a failure he (Trump) pins on Bill Clinton and Barack Obama – and its further failure, under Obama, to take any meaningful action against Wall Street or the big banks after the housing collapse of 2007-08 (which Bush Jr. caused).  I'm understanding the reasoning of the Trump voter, there is the saying "It takes a thief to catch a thief" and there is the fact Trump was looking rough on the campaign trail.  Possibly he is starting to feel the limits of his mortality!  Maybe he would want to hedge his bets and actually do some good before he leaves this earth!  Where would be a good place to start?  How about healthcare!

As of this writing though, we are still waiting for things like his "concepts" of a healthcare plan to come to fruition, something we waited for during his first term.  Something he and his people could have been working on during Joe Biden's term.  Something that looks on a bad trajectory right now with Trump in his usual 'Weapon of Mass Distraction' mode with his plan to make Canada our 51st state (and here MAGA voters thought they were voting to bring down inflation and healthcare costs). Trump's statement at the end of January 2025 concerning Canada: "They’d have much better health coverage. I think the people of Canada would like it,” this isn't exactly inspiring confidence.  The people of Canada just might need some convincing about how much better off they would be under our wing: healthcare poll,  opinion of two physicians who have practiced in the US and Canada.

But before we give up, there are rays of hope that better angels maybe at work - even in the Trump administration!  There are signs that healthcare private equity investors might be facing some disappointment.  JD Vance, yes the fellow who declared war on cat ladies, has been known to find common ground with Biden's FTC chair Lina Khan - only the best monopoly fighter chair since the New Deal!  And yes, even Senators Josh Hawley and Marco Rubio (current Secretary of State) have been to known to make anti-trust noises!  From an article about anti-monopoly author Matt Stoller (book-Goliath):

That conservatism has to figure out how to embrace a kind of post-Trump populism that uses political power to build a capitalism that, as Rubio puts it, “promotes the common good, as opposed to one that prioritizes Wall Street and Beijing.”.

Many of the MAGA voters in the article at the beginning of this blog are people who would bump heads with MAGA true believers.  They were people who worried "about the cost of living and taking care of friends they’ve loved for decades and what it means to be working class in an era that has either outsourced or mechanised the work they used to do."  The non-ideologue Trump voters have felt abandoned by a political class that has seemed more intent on pleasing their big-money donors.  The wisdom of voting for the same sort of people who got us into this mess decades ago could be argued.  But some might point out a mercurial leader - who might be facing his maker sooner rather than later - could start thinking about what is in store for him in the Great Beyond.  It might be a wild card, but looks like something people have put their money and vote on.

So where could Trump start looking for a "Road to Redemption" - just in case death isn't just an eternal dirt nap.  Trump is a fellow who doesn't seem to mind bumping heads with just about anybody.  Who knows?  He might turn his gaze towards a very rich DINO.  This Democrat-In-Name-Only has managed to avoid the public eye recently - and avoid the fur flying about.  Once upon a time this writer thought the aforementioned DINO was a benevolent teddy bear who only wanted to do good in the world - while making himself very, very rich!  Turns out this teddy bear investor is a monopolistic capitalist with little regard for "product quality" to put it mildly - to the point of allowing unnecessary deaths!  Yes, this DINO is none other than Warren Buffett - someone called America's 'Folksiest Predator'.  Do you have this feeling in you dear reader, a feeling similar to finding out Santa Claus isn't real?  This is the same feeling this 20+ year kidney dialysis advocate experienced when finding out who was at the top of the garbage heap that is for-profit kidney dialysis (numbers - scandals).  After years of trying to make Mr. Buffett aware of what is going on with one of his investments it looks like not much has changed.

So let's say Trump did decide to go after an evil that has been allowed to fester for decades (and bump heads with a DINO), how could he proceed?  Below is a roadmap:

*Encourage the formation of 'Community Dialysis Houses', there is already at least one prototype right here in the U.S. that has been running since 2009!  Kidney dialysis patients in rural areas often times have to drive many miles to receive care in clinics in more urban areas (rural areas, often times Trump strongholds).  Even in urban areas there are patients who would like to do more self-care, but aren't finding it in their clinics - and are unable to setup home dialysis in their homes.

*Revive the Lina Khan's FTC effort to ban noncompete contracts - it would have affected kidney dialysis by allowing the doctors to leave less than stellar clinics and go to clinics more in line with their values for one thing.  More on that and a latter article on the status of the noncompete ban.  (as mentioned Lina Khan has often times found common ground with Vance, Hawley, and Rubio)

*Get rid of the exemption the nephrologists, kidney doctors, have to the Stark Law - a law that says doctors aren't allowed to profit off their patients.  Doctors will often times have a financial stake in these dialysis clinics.  Guess where doctors will often refer their patients, not the best clinic, but the one where they have a financial interest!  A restaurant example helped me understand this.

*THE BIG ASK: bust up the huge for-profit dialysis companies like DaVita and Fresenius into a bunch of manageable itty-bitty pieces - right now they are stock market driven near-monopoly companies more beholden to upper-management bonuses, and the whims of their biggest shareholders than the needs of their patients.  These companies provide their own oversight for the most part.  This is a classic case of the fox watching the hen house.  Choice and competition are two main factors that make capitalism work.  THESE TWO FACTORS ARE SEVERELY LACKING IN KIDNEY DIALYSIS.  These companies could be busted up into something like small care-coops where staff and patients could do the hiring and firing of management!

In conclusion, if Trump and DOGE are serious about saving money - while also saving lives - they ought to take a hard look at kidney dialysis!

Roots of this website: Kidney Dialysis Intro:

For a Deeper Dive
Reading List 
(includes NYT's best-selling author Tom Mueller's book 'How to Make a Killing' about kidney dialysis)