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Regarding the polarizing issues of the day, the grand bargains offered in this book will simultaneously attract support from President Barack Obama, House Speaker John Boehner, Senate Majority leader Mitch McConnell, House Minority leader Nancy Pelosi, and Dr. Rand Paul.

The book proposes 29 highly interconnected public policy changes, all designed to appeal to people throughout the political spectrum—hence the term “grand bargains.” For example, the Grand Bargains’ plan to fix Obamacare will appeal to liberals because it provides universal health care that is affordable and of high quality. Conservatives will like the plan because the health care will be delivered by private organizations that are competing and self-regulating. They will like it also because it provides universal health care that is affordable and of high quality.

The Grand Bargains’ plan takes into account that health and health care are powerfully affected by public policies regarding welfare, jobs, healthful food, criminal justice, energy, national security, retirement security, and governance, including taxation and regulations. Health care reform and better public health cannot be accomplished without getting rid of the waste and corruption in the rest of the economy. And vice versa, a sustainable economy without passing burdensome debt to future generations requires good health outcomes. Achieving those good health outcomes calls for universal access to high quality health care that is affordable for individuals and society.

What are the main components of the Grand Bargains’ plan?

The Grand Bargains’ plan artfully combines free-market capitalism, which will comprise two-thirds of the gross domestic product or GDP, and communitarianism which will consist of the other one-third of the GDP. This restructuring of the economy will provide the following:

• Affordable, universal, high quality health care through private, competing, self-regulating organizations that provide not only health care but also a range of vital human services;
• social services that will be much better integrated with health care than now;
• jobs: a net increase in employment of 40 million workers– about half of the new paid workers are already working but not being paid.

1. about 10 million parents will be paid to care for children, and
2. about 10 million caregivers for the disabled and elderly will be paid for their work

– the other 20 million net increase in jobs will come from employment throughout the economy. Just a few examples:

1. infrastructure: $3.6 trillion invested over the next 10 years creating over 4 million jobs;
2. green energy: at least 4 million jobs will be needed to wean us off fossil fuels and nuclear energy;
3. sustainable agriculture and healthy food production: at least 3 million jobs will be needed to improve our diets while providing social and economic justice for food services workers. This must be done while taking much better care of the land and our natural resources, and
4. terrorism prevention: Training and employing 5 million U.S. citizens as overseas development workers is a crucial component to winning the ideological war on terrorism. Investing over $2.5 trillion over the next 10 years in this program will help people in Third World countries develop in the areas of agriculture, education, infrastructure, and health care.a living minimum wage: the minimum wage will increase to $15 per hour in a way that promotes not just workers’ well being but growth of U.S. businesses;a balanced federal budget: the Grand Bargains’ plan will grow jobs and the economy, allowing a balanced federal budget while dramatically increasing infrastructure investments and improving conditions for the poor;

The Grand Bargains’ program promises to provide the following:

• national debt reduction by $100 billion – $300 billion per year;
•  a Social Security system that is secure again because of shifting the administration of Social Security to the private, competing organizations that provide comprehensive health care and human services;
•  Social Security recipients that are financially secure over the long term;
•  the corporate income tax will be eliminated;
•  personal income taxes will no longer paid by the bottom 90% of earners; and
•  reduced income tax revenue will be offset by instituting consumption taxes on products and services that harm the public health, the economy, or the environment.

How will the Grand Bargains’ plan accomplish all these things?

Beginning with health care, the Grand Bargains’ plan will substantially change Obamacare’s so-called “accountable care organizations.”

First, what are accountable care organizations? And what is the matter with them?

Some long-standing U.S. health care enterprises have been transitioned into accountable care organizations, including Kaiser Permanente, the Mayo Clinic, and the Cleveland Clinic. Owned by doctors, hospitals, and investors, they provide health care according to government-dictated clinical practice guidelines. Obamacare, Medicare, and other government health insurance programs provide accountable care organizations financial incentives to limit health care services to patients. When money is saved in providing patient care, the money saved is split by the accountable care organization workers and the government. Inevitably, some patients will perceive that needed care for them is being denied so accountable care organizations can increase profits and the government can decrease costs.

Instead of Obamacare accountable care organizations, the Grand Bargains’ plan introduces “accountable care cooperatives,” owned by the members. These accountable care cooperatives will deliver comprehensive health care AND wide-ranging human services that can positively impact health. These human services will include job opportunities, healthful food, legal counsel, financial literacy training, enhanced educational opportunities, child care, elder care, and retirement security, among other services. These health care and human services will be delivered according to guidelines and benefit packages determined by accountable care cooperative providers with input from members. Instead of being regulated by the U.S. Department of Health and Human Services, the accountable care cooperatives will be self-regulating. Each will decide independently which health care services and other human services to provide and which they will not offer.

For example, the government now recommends that all patients receiving Medicare, Medicaid and other public insurance should have screening mammograms for women and screening prostate specific antigen (PSA) tests for men without cost to the patient. Whether there is overall net benefit to patients with these screening tests is highly controversial. However, the cost is in the billions of dollars, and over-diagnosis and misdiagnosis of these conditions causes great harm to tens of thousands of patients each year from complications of unnecessary surgical procedures. Yet public medical insurance and consequently private medical insurance universally cover the cost of these screening tests. With self-regulating accountable care cooperatives, each cooperative will decide its policy for its members about whether or not to routinely offer screening mammograms and PSA tests free to all members or whether members that want these tests will need to pay for them.

Why should health care regulation be decentralized by creating these self-regulating cooperatives?

Many reasons:

• Much of medical care is controversial—not just screening mammograms and PSA tests. Honest, well-meaning, authoritative medical experts often disagree about what works and doesn’t work in medicine.
  Clinical practice guidelines change rapidly because medical practice changes quickly.
  It’s not a secret that drug company money and other special interest money may corrupt the drafting of medical treatment guidelines.
  Many times in the past the government has been wrong in its recommendations to physicians about medical tests and treatments.
• People want real choices in health care and other services:
  • For example, obstetricians delivering babies in hospitals are fine for many women. However, some women may want midwives to deliver their babies at home or in free standing birthing centers. Government health insurance never pays for midwife assisted births at home and private medical insurance rarely does so. Decentralizing the clinical practice guidelines would make midwife assisted births more accessible to women that chose accountable care cooperatives offering this health care service.
  • Another example, for common lifestyle related diseases like overweight/obesity, type 2 diabetes, hypertension, and coronary artery disease, most people accept the currently standard treatments of medications and invasive cardiac procedures like angiograms, coronary vessel stents, and coronary bypass surgery. However, others may want insurance that instead covers state-of-the-art lifestyle change programs, including better nutrition, more exercise, and stress management. Decentralizing the clinical practice guidelines will make the lifestyle change programs available as alternatives to drugs or invasive cardiovascular medical procedures.
• By having private, competing, self-regulating accountable care cooperatives giving people health care services that they want delivered efficiently, we can redirect over $1 trillion per year in unnecessary medical bureaucracy and unneeded tests and treatments to the medical interventions people want and to lowering costs for patients.
• Medical researchers will be much better able to determine what does and does not benefit people by comparing health outcomes in patients from different accountable care cooperatives that offer different tests and/or treatments for the same conditions.

Will the Grand Bargains’ plan cost more, the same, or less than the status quo for the delivery of health care and human services?

The cost of the Grand Bargains’ plan will be about the same as the status quo in 2016. Subsequently, the government will save money because the overall government funding for health care and human services will be frozen at the 2016 rate (≈$4 trillion/year) for the next decade. The plan will shift about one-third of the U.S. GDP into these communitarian cooperatives (about $6 trillion out of $18 trillion in 2016). The health care and human services will all be provided through the accountable care cooperatives rather than through the current inefficient government bureaucracies. About two-thirds of the accountable care cooperative funding will come from the government (≈$4 trillion in 2016). The remaining one-third of accountable care cooperative funding will come from health care premiums and other funds paid by members. This translates to about $18,000 per capita on average from block grant transfers of government funds and from member premiums.

How much members will pay in premiums will be based on the totality of the services provided. Consequently, the efficient provision of health and human services by the cooperatives will be favored by members because it will mean lower member premiums. Efficiently providing health care and human services will benefit the staffs of accountable care cooperatives because they will attract more members. The U.S. Treasury will save about $10 trillion over the next decade because the government funding of health and human services will be frozen at the 2016 level ($2.6 trillion) instead of increasing at the rate projected by the government: 6% per year.

Capitalism will be energized by fewer taxes and regulations. The corporate income tax (over $500 billion projected for 2016) will be eliminated, replaced by taxes on tobacco, alcohol, fossil fuels and other commodities that harm health, the economy, or the environment. The responsibility for funding and providing many employee benefits (e.g., health insurance, Workers’ Compensation insurance, unemployment insurance, etc.) will be shifted from employers to the accountable care cooperatives. Corporations now sheltering trillions in profits in overseas subsidiaries will have every incentive to return the money to the U.S. to employ more people and grow their businesses.

The Grand Bargains’ plan will be great for individuals, businesses, the economy, the environment, and the country.

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