Friday, April 29, 2016

The Public Disapproves of Health Law,  But Democrats Want to Expand It

Below is an  article from Kaiser Health News,  which encourages others to publish their material.

Democrats Increasingly Want Expansion Of Health Law, Poll Finds”

By Jordan Rau April 28, 2016
The results come as Democratic presidential candidate Bernie Sanders has repeatedly derided the law for including too many concessions to the private health care industry and costing consumers too much.
The Kaiser Family Foundation poll found that 51 percent of Democrats want to expand the law, a 15 point increase since December. (KHN is an editorially independent program of the foundation.)
“This increase may be due to the rhetoric surrounding universal health care in the Democratic presidential campaign, with both candidates advocating universal coverage as a goal,” the pollsters wrote.
This month overall disapproval for the law continued to climb, growing to 49 percent of the public while support for the law decreased to 38 percent. Views about the law have seesawed since it was passed in 2010, but opponents have outnumbered supporters consistently since last fall.
Democratic support for the law slightly slipped this month, and now a quarter of party members hold an unfavorable view. Among those, four in 10 want to expand what the law does and almost three in 10 want to scale it back or repeal it entirely. The pollsters did not ask specifically how people would like the law to be expanded.
The law remains unpopular with three-quarters of Republicans, while independents are split.
The poll found that voters of all persuasions view the economy and jobs as the most important issue in the presidential election, with 30 percent saying they would like the presidential candidates to discuss those topics. National security was the next subject the public identified as important, followed by immigration and border control and then health care, which 15 percent of voters wanted candidates to talk about.
The poll was conducted among 1,201 people from April 12 through 19. The margin of error is +/- 3 percentage points. The poll respondents included 379 Democrats; answers from them had a margin of error of +/- 6 percentage points.

The Indiana Primary and ObamaCare
As the Indiana Republican primary approaches next Tuesday, I am reminded of  then-governor.  Mitch Daniel’s,  2010 remarks on the state of the union and ObamaCare.   Daniels is now president of Purdue University.
“We’ve been through a global recession. Now we’re fighting through a stalled recovery. Revenues are the lowest they’ve been in half a century. Their finances a wreck, many states have effectively sunk into bankruptcy.

Indiana is still afloat. In fact, we’ve fared better than most. We continue to meet our obligations without raising taxes, and the reserves we carefully built and protected will get us through the downturn.

But as if we did not already have enough on our plates, the passage and implementation of Obamacare presents us with a whole new set of challenges and a costly to-do list.

I note with special sadness that first and foremost amongst the bill’s consequences will be the probable demise of the Healthy Indiana Plan (HIP). This program is currently providing health insurance to 50,000 low-income Hoosiers. With its Health Savings Account-style personal accounts and numerous incentives for healthy lifestyle choices, it has been enormously popular and successful.

Cost of “Reform” to Indiana

Obamacare’s expansion of Medicaid, soon to cover one in every four citizens, will not only scoop up most of HIP’s participants, but will also cost the state between $3.1 and $3.9 billion over the next decade.

Of course, it’s a misnomer to even refer to this as “reform.” It doesn’t reform anything. Instead, it perpetuates and magnifies all the worst aspects of our current system: fee for service reimbursement, “free” to the purchaser consumption, and an irrationally expensive medical liability tort system. It’s a sure recipe for yet more over-consumption and overspending.

Since my election, my state coworkers have had the choice of Health Savings Accounts in lieu of traditional health care plans. The first year this option was made available, some 4 percent of us signed up for it. Six years later, more than 70 percent of our 30,000 state workers have opted for the personal account.

This trend has had a startlingly positive effect on costs for both employees and the state. State employees enrolled in the consumer-driven plan saved more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. Indiana will save at least $20 million in 2010 because of our high HSA enrollment.

It has also been the source of significant changes in behavior, as state workers with the HSA visit emergency rooms less frequently and are more likely to use generic drugs than co-workers with traditional health care. Hoosiers enrolled in HIP have experienced similar changes in behavior with generic drugs now accounting for 84 percent of all prescriptions used by enrollees.

This is a sharp contrast to the prevalent model of health plans in this country that encourage individuals to buy health care on someone else’s credit card. What seems free will always be over-consumed, compared to the choices a normal consumer would make. Hence our plan’s immense savings.

The condescension of the ‘reformers’ is misplaced. It turns out that typical Americans are neither too dense nor too intimidated to make sound decisions about their own health. This is, of course, a fact that national policy makers sadly ignored during their overhaul of our health are system. Now the rest of us are left to pick up the pieces.”

Thursday, April 28, 2016

Pew Survey: Obamacare Disapproval Surges

The latest Pew survey shows views of the Affordable Care Act are still more negative than positive.

The number of Americans who disapprove of ObamaCare increased by 10 percentage points in a recent survey.

ObamaCare has extended health insurance coverage to nearly 20 million Americans – but that has done little to shift the public's opinion about the law.

54% Approve, 44% Disapprove

According to a survey just released by the Pew Research Center, 54 percent of Americans disapprove of the 2010 Affordable Care Act compared with 44 percent who approve of the law.. The divide has also become more pronounced since July, when 48 percent of respondents said they approved of the law and 49 percent said they disapproved.

The survey was conducted April 12 to 19, among 2,008 adults

Effects of Law More Negative  Than Positive

The findings showed 31 percent of respondents say the health care law has had a mostly negative effect on them and their families, while 23 percent say the result has been positive and 45 percent say they have seen little change. Pew noted that the percentage of respondents saying they have seen little change has declined in the last three years but that the law’s “personal impact” has consistently been more negative than positive in its polling.

Perception of  Law Deeply Divided along Party and Racial Lines

The survey found that 78 percent of Democrats approve, compared with only 9 percent of Republicans. Republican approval of the law had risen from 11 percent in February last year to 18 percent last July.  

Republican views of Obamacare became more negative after the exchanges, or marketplaces, experienced technical glitches, making it difficult for Americans to purchase tax-subsidized insurance. Though the website has improved, opinions from Republicans have not, the survey shows.

Differences in opinion by race also were apparent. Whites disapprove of the law by a nearly 2-to-1 margin – 64 percent approve while 33 percent disapprove – and blacks overwhelmingly support it, showing an approval score of 83 percent. The majority of Latinos, 57 percent, also approve of the law.
Source:   "Survey: ObamaCare Disapproval Surges, "  US News and World Report,  April 25, 2016

Wednesday, April 27, 2016

In One Era and Out the Other
Now this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.
Winston Churchill (1874-1965)
I listened to Donald Trump and Hillary speak after their sweeping victories in the East, and to Donald Trump’s foreign policy speech.   
From these listenings,  I sense the end of  the era of centralized  government and the Nanny state,  big  political establishments left and right,  traditional  elitist and intellectual dominance ,  a timid and hesitant  foreign policy ,  strict liberalism  and stringent conservatism,  top-down media messaging,  health policies dictated by HHS and CMS and  ACOs,   collectivism imposed from above as opposed to individualism bubbling up from below. 

I do not sense the end of dominant hospital systems.  In Connecticut, where I live, two huge hospital systems,  Yale New Haven and Hartford,  each with revenues over $1 billion, have the lion's share of medical markets, both inpatient and outpatient through their central hospitals, acquired hospitals, and peripheral facilities, which feed  the mother ships. 

Elsewhere,  however,  I sense the beginning of an era of dispersed and customer-oriented  markets,  smaller  and more flexible economic entities, a bolder and more decisive foreign policy,  a mix of liberalism and conservative views, more migration of businesses across national borders,  the economic rise of the IT-skilled and the a fall of those not skilled workers, and  an increase in hacking and terrorist related  crimes  and a decrease in physical violence and large scale wars.    

A Dual System
In health care,  I sense the rapid emergence of a dual health system.

One  will be dominated and controlled by government –Medicare, Medicaid, ObamaCare,  and large integrated hospital organizations.  These systems are generally reimbursed through 3rd parties,  and for the general run of patients,  have a significant flaw, high deductibles, which, for many patients, rules them out as a source of care.

The other  part of the system will be  characterized by cash-only and direct care delivered by individuals, small groups, and entrepreneurs offering convenient, personal, and direct care at multiple sites where efficiency is more important than power or size of the organization.  
In many cases,  these smaller outlets will be more economical for health care customers because of skyrocketing health premiums and deductibles, which render routine car unaffordable. 

ObamaCare will survive in the dual system because it has taxpayer dollars to prop it up. But because of surging premiums and deductibles and  UnitedHealth backing out of 34 markets, it is in trouble and financially unsustainable.     Its fate depends on public approval which has dropped to 44% and to politics.   Republicans have vowed to repeal either its mandates or the law as a whole. 

Transitions to More Market-Based Entities
The transition  to a dual, information and data- geared health system,  will not be easy, particularly among those who lose status, income, and benefits.   There will be suspicious and hostile to the information elite, rich people, the well-educated, the  immigrants,  and those with  disappearing jobs, and loss of income and status.
Among some, particularly the millenials,  I sense a revolutionary attitude. The millenials  are now the large demographic group in the U.S.  Many will throw up their hands and shout, “Let the government do it.  Let the government equalize incomes. Let the government tax the rich and the prileged.   Let the government provide Medicare-for-all and free college tuitions.” 
But the past era will  not be resuscitated.  It is breathing its last, for we are witnessing the end of  big government as we know it,  With the downsizing of government and politics,  will come the rise of efficient markets outside of government power and control.

Tuesday, April 26, 2016

These Crazy Times

Peggy Noonan hit it on the head when she wrote in the Wall Street Journal:
“We’ve had a lot to absorb, the rise of an outlandish outsider; the lurch to the left in the other party; the popular rise of a socialist. Alongside that, the enduring power of a candidate even her most supporters accept as corrupt. Add the lowering of standards, the feeling of no options, the coarsening, and all the new estrangements…too much is being lost…the great choice in a nation of 320 million may come down to a Crazy Man versus Criminal.”  (“The Moment When 2016 Hits You,” WSJ, April 23-24, 2016).
Add to this dismal thought the faltering, sputtering, downwardly spiraling health care law, with its skyrocketing premiums and deductibles and its ever narrowing choices of health plans and doctors, and you begin to wonder, why and how did it come to this?
To begin with, Donald Trump is not crazy, crazy as a fox perhaps.   Hillary Clinton is not criminal, opportunistic and self-serving, perhaps, but not criminal.  And although ObamaCare is badly flawed, with innovations. public revolts and withdrawals, and emergence of private sector alternatives, health reform will straighten itself out, but  perhaps only after repeal of its mandates.
Why these crazy times?   The answer may lie  in emergence and maturation and transition to the Information Age.   
With ubiquitous computers and sophisticated algorithms, we are now deep in cyberspace.   Everybody thinks they know everything.  From thousands of different sources, they think they, not the government, know the answers.   They should be the customers, not the victims of government.
Individualism and diversity reigns, and government and centralization fades.   People have become narcissistic and self-serving and have lost their sense of national collectivism and purpose.  They trust themselves more than government.
 There is a decline in the status and power of the traditional elites, the establishment, and of government itself.  
There is a rise in power and income of those with computer skills and a fall of those without those skills in the middle class, who are experiencing rising expenses and failing incomes and ballooning medical costs.  Unfunded entitlement liabilities  are bankrupting the nation, and taxes are climbing without a concomitant climb in benefits.
With universal access to information,  people believe they, not government, know the answers.  And they think they, not the establishment and all who that term signifies,  should be the beneficiaries of their taxes. 
People are mad as hell at social and personal injustices.   They are mad as hell.  They have decided they aren’t going to take the governmental paralysis that has set in and they are lashing out, frustrated and angry.  They want outsiders to articulate their cause and control their destinies  not government insiders who, they believe, have rigged the system against them.
Into the void created by government parylysis steps  Donald Trump.  He knows people  want action and straight talk.   He capitalizes on their  anger by talking straight in the language of the street,  by being omnipresent in the media and by being at their beck and call,  by issuing  multiple tweets, and saying he will make sweet deals to make America great again.
 Into the void steps Bernie Sanders,  who promises he will make government deliver, by routing insiders and delivering Medicare-for-a;; ,  college tuitions, and millions of infrastructure jobs  to save the middle class.
Into the void steps Hillary Clinton, who says the problem resides in racial and gender biases, capitalism greed,  and Republicans who do not give a whit about the middle class but only in enriching banks and Wall Street, of which she is an integral part.
People on all sides of the political aisle find this all hard to fathom.   As Peggy Noonan remarks in her column,  this is not history as usual.  “This is big, what we’re living through.”

Monday, April 25, 2016

Quote of Day:  Premiums and Losses Unacceptable
Working-class individuals are paying too much, and insurers are losing too much.  Something has to give.”
  ObamaCare isn’t likely to enter an insurance death spiral; there’s too much federal money propping the whole thing up. But it isn’t on track to become a stable, self-sustaining insurance pool either, because very few middle-class families want to get their insurance through the exchanges. Which means the law is not only unstable financially, it is politically unstable as well.”

James Capretta,  senior fellow of Ethics and Public Policy Center and visiting fellow at American Enterprise Institute,  “The Increasing Instability of ObamaCare,”  National Review, April 25, 2016

Sunday, April 24, 2016

 Government Health Reform Robots
The world of the future will be an ever more  demanding struggle against the limitations of our intelligence, not a comfortable hammock in which we can lie down to be waited upon by our robotic slaves.
Norbert Wiener (1894-1964), God and Golem (1964)

Government reform robots are a wondrous thing.
Efficiencies to the reform table they will  bring.
These robots require and demand no income.
They usually  produce a predictable outcome.
They are never pregnant, need no sick leave,
They take no breaks, work without relief.
They demand no benefits or pensions.
For robots these things require no mentions.
Robots  can take an instant medical history,
With an algorithm remove the clinical mystery.
They deliver food and drugs to the bedside.
Wherever in the hospital patients reside.
Robots are said to be foolproof
And from human errors aloof.

And yet,  and yet, and yet
About robots in medicine
I ponder
And I wonder
Are robots desirable
Are robots better
Will touching
And Handling
Become obsolete
Will everything be
It is possible
Robots do things
The same way
Every time
Real time
Robots do not deviate
From the straight
And narrow
Robots respond  to algorithms
Robots are checklists of the mind
IBM’s Watson  tell us
Robots are E-lementary
My Dear Watson
Robotic surgery is
And reportedly
More predictable
Less invasive
Produces faster recoveries
Reaches inaccessible places
Reduces hospital infections
Hospital marketers love robots
Specialists love new tech, high tech
The media and the public
Love breakthrough news
But I keep thinking
Humans design robots
And therefore
Robots have
Blind spots
And soft spots
And so I wonder
Will robots ever
Think outside the box
Are robots replacements
Or merely human assistants
Maybe, just maybe, robots
Being ever consistent
And error resistant
Will protect us from human terrors
And stretcher-bearers.
 Maybe robots,
 Being ever consistent and error resistant,
 Will protect us from health care errors
 And human stretcher bearers
But still I have my doubt,
Robots are reform’s best route.

1. “What’s Wrong with the da Vinci Robot?”, Health Leaders Media, January 26, 2012

2. “Robot Cleaners a ‘Game-Changer’ for Hospital Infection Epidemic”, Health Leaders Media, January 27, 2012

Government Health Care Cookie Monster
Me want cookies! Me eat cookies? Me eat anything and everything.
Spoken by the Cookie Monster, character created by Jim Henson (1937-1990), founder of Puppets, Inc, and developer on Sesame Street of Miss Piggie, Kermit the Frog, Fossie the Bear, and the Cookie Monster.
Sometimes it is useful to think like a child of lovable creatures  or of a  monster  that eats other peoples’ cookies day and night, incessantly without pausing.
Here is the government health reform cookie monster at work.
The cookie monster is always eating.  Its appetite is insatiable.    It eats in broad daylight. It eats at night. It eats behind closed doors. It eats out in the open.  It eats your breakfast.  It eats your lunch.  It eats your dinner.  It eats 24 hours a day.  It is always raiding your cookie jar. It eats things you are not even aware of.  It even eats your money.
·         Starting in 2013, if you earned  more than $200,000 as an individual or $250,000 as a couple, it ate 1.45% to 2.35% of Medicare Part A.

·         That same year, it will start eating 3.8% of your “unearned income” – investment proceeds from partn4rships, royalties, and rents.

·         Between now and 2018,  if you are an insurance plan bogeyman, it will eat $47.5 billion.  After that it will eat $14.3 billion a year.  

·         Along the way, it will  empty your cookie jar as you pay more for premiums and those unaffordable deductibles. 

·         Through 2019,   it will eat $16.7 billion out of drug company proceeds, and $2.8 billion a year thereafter, taking more out of your cookie jar to pay for drugs.

·         It will eat $2 billion a year out of the profits of sales of medical devices- pacemakers, prosthetic limbs, and insulin pumps- more out of your cookie har if you need those things.

·         On July 1, 2010, it began eating 10% on the profits of tanning salons.

·         In 2020,  it will tax and eat 40% of the costs of Cadillac health plans.

·         From 2010 to 2020,  it will eat $575 billion out of Medicare itself by eating away to Medicare Advantage plans and payments to doctors and hospitals.

·         It will even eat its own entitlement, though it has never eaten an entitlement before.  Federal entitlement as previously unknown.  Yet from 2010 to 2020, it says it plans to eat $575 billion out of Medicare by chewing away at Medicare Advantage plans and payments to doctors and hospitals.

·         From 2014 to 2024,  it will eat $1.5 trillion to  $2.5 trillion directly out of the federal budget.  The exact number does not matter.  A trillion here, a trillion there.  Pretty soon it will be talking about real money.
What a cookie monster is health reform! 
 It is like a big baby- an alimentary canal with a huge and growing appetite at one end and no end at sight at the other. 
It keeps saying ,”Me want cookies!”  
The trouble is: its cookies are your cookies.

Saturday, April 23, 2016

After ObamaCare, Health Care Anywhere
It is today possible, to a greater extent than at any time in the world’s history, for a company to locate anywhere, to use resources from anywhere, to produce a product that can be sold anywhere.
Milton Friedman, as quoted in The Sovereign Individual
The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.
Scott Fitzgerald, The Crackup
This week the heath care news foreboded  an approaching ObamaCare crackup – skyrocketing premiums in 2017, exchange  enrollments tumbling as people fled  from  exchanges after signing up and getting care, and a big insurer departing from exchanges because of unsustainable losses.
What manner of health system might follow the crack-up?
Two Part System
I believe it will be a dual system.
·         One part  will be government and integrated health care corporations featuring a vast interoperable  computer system, capable of making sense out of complexity, integrating information from multiple players and sources,  bringing together data to diagnose, treat, and manage  a diversity of conditions under federal and corporate umbrellas. That will be ObamaCare’s legacy. 

·         The other part, of equal size and perhaps of even greater magnitude ,  will be  a system consisting  of diverse organizations at diverse sites, delivering diverse  care anywhere and everywhere, in patients’  homes, at rehab facilities, in doctors’ offices, in urgent care centers,  and often at a distance,  virtually, personally, telemedically,   in cyberspace, outside the realm of government and third parties.
Because of the information revolution, we will see the rapid emergence of this dual system.   The federal and large organization part will be slow because of political controversies.  But it will be big in the news because government and political involvement.    T
he private, market-driven segment – more personal, market and customer-based, decentralized, and diverse will be rapid but  less in the news because it operates under the journalistic  radar.      It will be more high tech and high touch and more in touch with the will of the people, their personal  feelings, and their desire for more choices.
The changes will go as Steve Lahr foresaw in the New York Times (High Tech Alternati9ves to High-Cost Care,” NYT, May 22, 2010).
“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”
“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”
And as I forecast in my book, The Health Reform Maze (Greenbranch Publishing, 2011):
“There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors. “
Changes Well Underway

These changes are now well underway.   They are largely customer and market-based.  They are made possible by sophisticated computer systems and ubiquitous online use anywhere.  They are a response by health care consumers and physicians seeking refuge from unaffordable expenses, inexplicable regulations, and  inexcusable failure of government to deliver on its promises of lower cost more accessible t care.

Thursday, April 21, 2016

The Canary in the Coal Mine: UnitedHealth Leaving “Unsustainable” ObamaCare Exchanges in 34 States
On April 19,  UnitedHealthCare announced it was abandoning ObamaCare exchanges in 34 states.  United  CEO, Stephen Helmsley,  told investors that United’s  losses - $475 billion in 2015 and a projected $650 million in 2016,  were “unsustainable.” He said as a for profit company ($1.6 billion on revenues of $44.6 billion in first quarter of 2016),  United could not afford more losses and at the same time satisfy  stakeholders.
UnitedHealth’s decision  was symbolic.  The company insures only 6%, 795,000 of the 12.7 million subsidized in ObamaCare exchanges.  
United as the Canary in the Coal Mine
But United  is the “canary in the coal mine,” a warning for other insurers -  for-profits, Anthem and Cigna,  and not-for-profits,  Blue Cross Blue Shield.  

No company, for-profit or not-for-profit, can stay in business with continuous  heavy losses.
In earlier days,  coal miners placed a canary, who were sensitive to methane gases and low oxygen levels, in the mine.  When the canary kept singing,  miners knew the air supply was safe.  A dead canary called for them to immediately evacuate.  
Is UnitedHealth’s exit a signal for an exodus for insurers?  

Is its exit evidence that ObamaCare is about to collapse,  that  the time has come  to evacuate or to proceed to  single-payer, where heavy losses in the name of compassionate care for all  are a given?
These questions will be fodder for debate in the 2016 election,   The GOP candidate will call for repeal and a market-based plan.  The Democrat will call for an ObamaCare fix, and more steps towards universal coverage.

What's Wrong
Between now and the election,  however, we can ask what’s gone wrong and what can be done about providing care for the ObamaCare subsidized patients.
What’s gone wrong is evident.   For political reasons, to juice up the numbers joining the exchanges,  the Obama administration had a weak mandate promoting the sick to join,  even after enrollment periods were over.  People were allowed to come in and out of the system when they needed someone to pay for their illness.    Then, too, there were those promises that the government would bail out insurers for losses.
But as the United CEO commented, “We cannot sustain these losses.  We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

What to Do
So what to do until there is a political resolution? 
Avik Roy, a conservative policy maker,  in  April 19  Forbes  in  “Abandon Ship: UnitedHealth to Exit ‘Unsustainable’ ObamaCare Exchanges,” makes these suggestions to keep the canary alive.
One, make ObamaCare exchanges work like markets. Let people  be free to choose  health coverage that’s best for them. Deregulate them, something  President Obama and Hillary Clinton are ideologically opposed to doing.
Two,  stiffen the individual mandate.   Force people to buy costly insurance that they neither want nor need. Such a plan would never get through a Republican-controlled Congress, which would  rather repeal the mandate entirely.
Avik Roy's prediction?  “The stalemate is unlikely to change anytime soon. The most likely outcome is that the insurers who stay on the exchanges will have to jack their premiums even higher, leading to less affordable coverage and more people uninsured.”
The canary will  keep on singing until November, but the sound of its song will weaken. 

Either Democrats need to replace the canary with a federal vulture, or Republicans need to take the canary out of the mine and substitute a market-based machine to keep insurers and  subsidized miners alive.

Wednesday, April 20, 2016

Explaining What’s Going On – Politically and Otherwise
It’s the morning after Donald Trump’s and Hillary Clinton’s  big New York wins, and people are looking for explanations for  what’s going on.
Why are political outsiders like Trump and Sanders dominating the news?  Why does Hillary win despite  her record negative unfavorability ratings?   Why do 80% of  the millenials  vote for an avowed socialist ?  Why does the political establishment  seem so weak? What are traditional institutions -  Congress, the Presidency, corporate America,  Wall Street – held in such low esteem?  Why are the elite – liberals, intellectuals,  the rich,  the successful, even physicians – in trouble?
The answer to all of these questions,  according to James Davidson, a venture capitalist,  and Lord Reese-Mogg,  vice-chairman of the BBC,  resides in  the rise of the sovereign individual armed with computer  and who is part and parcel  of the Information revolution. 
 In their 1999 book.  The Sovereign Individual: Mastering the Transition to the Information Age,   they define such an individual was someone who doesn’t trust the government, who wants more power in the hands of individuals,  and who is willing to do things for him/her self.  

They explain what is going on as the fallout from the transformation to an Information Society, as differentiated from previous societies – 1.  hunter-and-gathering societies,  2. agricultural societies, and  industrial societies.
In Information societies,  access to information  empowers individuals to  gain wealth and power at the expense of traditional sources of power –  nation state,  political parties , and corporations.   As a result, the U.S. government is losing influence internationally,  the Republican and Democratic parties are in disarray,  Wall Street is on everyone’s no-no list, and the income gap between the rich, poor, and middle class  expands exponentially.
 Social media savvy individuals at their keyboards are scaling the income  heights -  Bill Gates at Micosoft,   Jeff Bezos at Amazon,   Mark Zuckerman at  Facebook,  and assorted CEOs in Silicon Valley.   At the same time,  governments, labor unions, licensed professionals,  and millions of middle class  workers without IT skills are losing favor and seeing their incomes collapse.
We are witnessing political devolution,  shifts of power and influence ,  and new market arrangements.   Online markets are replacing Main Street markets.  Widespread anger stalks the land among those left out.  There is suspicion and anger and opposition to globalization,  free trade, foreign workers,   immigrants,  rich people,  the political elite.   There are complaints about capital flight and disappearing jobs.    There are negative reactions among the newly educated young without jobs,  the crumbling middle class,  especially those with middling skills  but without IT know-how.    Life has become more complex, more commercial,  and more secular, with the decline of religion and the nanny state with demands  for lower taxes,  fewer regulations, and greater efficiencies.     Nations with growing financial obligations have reached the limits of taxation,  and individuals  are demanding  personal efficiencies rather than hassles of  bureaucratic  obstructionism.
Enter Donald Trump, with his mastery of media access,  his  tweets, and his exploitation of public anger.    Enter Bernie Sanders, with his talk of a political revolution, which is destined to fail because of his faith in big government which is the way out.  
Enter the new era of Information.  Enter  the diminishing returns of power and taxation, with the increased capacity of individuals to assert their will,  to protect themselves against predatory taxation, to protest redistribution of wealth, with less centralized social control,  less regulation and regimentation, and less ability to fund unfunded social entitlements.
It’s a whole new ballgame, designed for entrepreneurs  and innovators, who understand the dynamics of the Information Age and know how to exploit   its profound changes.