Alan: David Brooks concludes his article "Medicare For All" by saying the implementation of Medicare for All would "require" the undoing of The American Revolution.
I say such undoing is likely to be a good thing.
Indeed, if the nascent United States had not poisoned its national wellspring with unnecessary bloodshed against the British (in order to escape taxes that were not overly onerous), but instead exhibited Canadian restraint by never invoking violence, we would have evolved into a civilized country rather than developing into "The United States of Barbaria" under Donald J. Trump, a political - and personal - monstrosity of epic proportion.
Indeed, if the nascent United States had not poisoned its national wellspring with unnecessary bloodshed against the British (in order to escape taxes that were not overly onerous), but instead exhibited Canadian restraint by never invoking violence, we would have evolved into a civilized country rather than developing into "The United States of Barbaria" under Donald J. Trump, a political - and personal - monstrosity of epic proportion.
Furthermore, as witnessed by Trump's "revolution," 40% of Americans are fully prepared to trash American democracy, substituting our system of governance with political forms that are markedly more absolutist and heavy-handed, if not totalitarian.
Indeed it is the diehard intent of Trump's "revolution" to trash Truth itself. http://paxonbothhouses.blogspot.com/2015/12/donald-trump-and-denise-de-rougemont.html
Indeed it is the diehard intent of Trump's "revolution" to trash Truth itself. http://paxonbothhouses.blogspot.com/2015/12/donald-trump-and-denise-de-rougemont.html
In recent years, Brooks has moved to the left if only because his authentic conservative instincts are understandably outraged by the moral and ideological bankruptcy of the Republican Party which Brooks recently compared to Caligula's Rome.
Ever since Reagan's "Me Generation," the GOP has epitomized -- or perhaps I should say "brought to light" -- the bedrock truthfulness of John Kenneth Galbraith's observation:
Notably, Galbraith (a JFK advisor) was born and raised Canadian.
Pax On Both Houses: Blog Posts About Canada
‘Medicare for All’: The Impossible Dream
There’s no plausible route from here to there.
By David Brooks
Opinion Columnist
The Brits and Canadians I know certainly love their single-payer health care systems. If one of their politicians suggested they should switch to the American health care model, they’d throw him out the window.
- Founder Of Canada's Single Payer Healthcare System Is "The Greatest Canadian Ever"
- Canadian Letter To The Editor: "You Americans Have No Idea How Good Obama Is"
Pax on both houses: More Than Twice As Many Canadians Happy With Access To Care
Pax on both houses: Canadians Live Longer And Have Better Health Than Americans
Pax on both houses - Canada's Fiscal Success
Pax on both houses: Canada, Sweden and The Collapse of American Culture
Pax on both houses: Canada - America's Reminder That Civilization Is Possible
So single-payer health care, or in our case “Medicare for all,” is worth taking seriously. I’ve just never understood how we get from here to there, how we transition from our current system to the one Bernie Sanders has proposed and Elizabeth Warren, Kamala Harris and others have endorsed.
Despite differences between individual proposals, the broad outlines of Medicare for all are easy to grasp. We’d take the money we’re spending on private health insurance and private health care, and we’d shift it over to the federal government through higher taxes in some form.
Then, since health care would be a public monopoly, the government could set prices and force health care providers to accept current Medicare payment rates. Medicare reimburses hospitals at 87 percent of costs while private insurance reimburses at 145 percent of costs. (Alan: WTF!?!?!)
Charles Blahous, a former Social Security and Medicare public trustee, estimates that under the Sanders plan, the government could pay about 40 percent less than what private insurers now pay for treatments.
If this version of Medicare for all worked as planned, everybody would be insured, health care usage would rise sharply because it would be free, without even a co-payment, and America would spend less over all on health care.
It sounds good. But the trick is in the transition.
First, patients would have to transition. Right now, roughly 181 million Americans receive health insurance through employers. About 70 percent of these people say they are happy with their coverage. Proponents of Medicare for all are saying: We’re going to take away the insurance you have and are happy with, and we’re going to replace it with a new system you haven’t experienced yet because, trust us, we’re the federal government!
Alan: Brooks fails to ask how many Americans have no insurance at all and how many Americans have shitty insurance but won't realize their coverage is crap until they experience a signficant medical crisis.
And what about the 30% of insured Americans who are already unhappy with their private insurance? Not a peep from Brooks - just the assurance that Canadians and Brits are happy with single payer but we Americans can't possibly make it work.
Like other American conservatives, Brooks does not ask important questions because a central feature of conservative ideation is that many people are, at bottom, n'er-do-wells who don't deserve insurance.
Brooks may not harbor this view consciously but his lifelong conservatism has saturated him with the disposition that some people "deserve care" and others do not. Hence his blasé dismissal of "medicare for all" and, by extension, every other healthcare plan that actually covers every citizen. Shame on you David.
In keeping with his American conservative roots, Brooks would jeopardize life-and-limb of "the undeserving poor" - as George Bernard Shaw described "the unwashed masses" in his play "Pygmalion," the progenitor of "My Fair Lady."
And if "the undeserving poor" only get shitty insurance, then shit is what they deserve.
Of course, the suppositions that underly this complex of attitudes-and-beliefs is as "valid" as Hitler's belief that dirty, traitorous, theiving Jews deserved to die.
It is high time that Americans scrutinized the underpinnings of all their belief system - religious and political.
Just because people can "justify" monstrosity does not mean they themselves are not monsters.
Given that several dozen other "developed nations" -- each of them with wildly divergent histories -- have found viable ways to enact the equivalent of "Medicare for all" -- reveals Brooks as an essentially hopeless conservative acolyte, which is to say someone whose economic selfishness impels him toward cowardly ideology and justification of uncharitable acts that cause people -- chiefly "the undeserving poor" -- to die unnecessarily, and to experience needless pain en route to their early graves.
Warren Buffett: "A Rich Family" Takes Care Of Its Own And The United States Should Too"
(Brooks resumes...)
The insurance companies would have to transition. Lots of people work for and serve this industry. All-inclusive public health care would destroy this industry beyond recognition, and those people would have to find other work.
The insurance companies would have to transition. Lots of people work for and serve this industry. All-inclusive public health care would destroy this industry beyond recognition, and those people would have to find other work.
Hospitals would have to transition. In many small cities the local health care system is the biggest employer. As Reihan Salam points out in The Atlantic, the United States has far more fully stocked hospitals relative to its population and much lower bed occupancy than comparable European nations have.
If you live in a place where the health system is a big employer, think what happens when that sector takes a sudden, huge pay cut. The ripple effects would be immediate — like a small deindustrialization.
Doctors would have to transition. Salary losses would differ by specialty, but imagine you came out of med school saddled with debt and learn that your payments are going to be down by, say 30 percent. Similar shocks would ripple to other health care workers. (Alan: Notably, Brooks makes no comment about other societies which have long been structured to accommodatre lower physician salaries.)
The American people would have to transition. Americans are more decentralized, diverse and individualistic than people in the nations with single-payer systems. They are more suspicious of centralized government and tend to dislike higher taxes. (Alan: Brooks makes no comment about the toxicity of "rugged indivividualism" and "cowboy capitalism," and does not question whether these characteristics are public health "pathogens" which a healthy society would seek to mitigate if not eradicate.)
The Sanders plan would increase federal spending by about $32.6 trillion over its first 10 years, according to a Mercatus Center study that Blahous led. Compare that with the Congressional Budget Office’s projection for the entire 2019 fiscal year budget, $4.4 trillion. That kind of sticker shock is why a plan for single-payer in Vermont collapsed in 2014 and why Colorado voters overwhelmingly rejected one in 2016. It’s why legislators in California killed one. In this plan, the taxes are upfront, the purported savings are down the line. (Alan: Again, several dozen countries make "single payer" work and the citizens of those countries are considerably happier with their healthcare than Americans are.)
Once they learn that Medicare for all would eliminate private insurance and raise taxes, only 37 percent of Americans support it, according to a Kaiser Family Foundation survey. In 2010, Republicans scored an enormous electoral victory because voters feared that the government was taking over their health care, even though Obamacare really didn’t. Now, under Medicare for all, it really would. This seems like an excellent way to re-elect Donald Trump. (Alan: Are Americans too dimwitted to realize that "single payer" is preferred by societies that have enacted it?)
The government would also have to transition. Medicare for all works only if politicians ruthlessly enforce those spending cuts. But in our system of government, members of Congress are terrible at fiscal discipline. They are quick to cater to special interest groups, terrible at saying no. To make single-payer really work, we’d probably have to scrap the U.S. Congress and move to a more centralized parliamentary system. (Alan: Perhaps Brooks is making a case that the United States "deserves" to fail in its efforts to become a livable, genorous, caring society. I wonder how "all this" looks through the eyes of "God" - at least as Judeo-Christianity has traditionally conceived God.)
Finally, patient expectations would have to transition. Today, getting a doctor’s appointment is annoying but not onerous. In Canada, the median wait time between seeing a general practitioner and a specialist is 8.7 weeks; between a G.P. referral and an orthopedic surgeon, it’s nine months. That would take some adjusting.
If America were a blank slate, Medicare for all would be a plausible policy, but we are not a blank slate. At this point, the easiest way to get to a single-payer system would probably be to go back to 1776 and undo that whole American Revolution thing.
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David Brooks has been a columnist with The Times since 2003. He is the author of “The Road to Character” and the forthcoming book, “The Second Mountain.”
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