By Lambert Strether of Corrente.
Hillary Clinton* gave two back-to-back speeches on health care in the 2016** swing state of Florida. The later one, at the University of Miami, was “visionary” (I think the word is) and a sales pitch to UM students to sign up for insurance. The earlier one, the keynote at the Healthcare Information and Management Systems Society (HIMSS) annual conference, is more interesting. Sadly, as of this writing an official transcript is not online, and reporters were not allowed in the hall (!). So I’ll have to cobble the Clinton* quotes together from multiple sources.
Here’s what I think is the key section (which is not the same as what the press thinks is the key section). From Health Populi’s live transcript in the hall:
“[CLINTON:] I am a believer in the idea that good data helps to make good decisions. It’s true in life.
It’s important to be guided by evidence about what works and what doesn’t…not ideology or personally held beliefs.
Unfortunately we’ve seen too often in Washington recently that many of our public debates take place in an evidence-free zone. (Applause) That is bad news for anyone who wants to get something done who would rather choose common ground over scorched earth. (Applause)
For example, the hyper politicized debate from the beginning has been often more about ideology than about data and what we can learn. The scare tactics have not necessarily helped us understand how best to improve care, lower costs, expand coverage…but to keep what works at the same time. That’s why we need what you’re doing so badly. To get back to evidence-based policy debates. And to use that when we need to fix things.
OK, let’s talk about “evidence-based” just for one second. As I wrote:
The key point to remember in all discussions of ObamaCare is that neither it, nor indeed the entire private health insurance “industry,” should exist. They are rent-seeking parasites, economic tapeworms. One does not improve a tapeworm; one removes it.
To understand this simple point, all we need to do is look north to Canada, where we see a single payer system — they call it “Medicare” — delivering equal or better health outcomes at dramatically lower cost, without a health insurance industry, and without ObamaCare’s bizarre, mystifying, and above all unfair Rube Goldberg-esque complexity. In fact, if we’d passed HR 676 in 2009, we would have saved hundreds of billions of dollars by now (more than enough to cover everyone) and thousands of lives, though ObamaCare apologists don’t like to talk much about the excess deaths that ObamaCare’s achingly slow rollout caused and is still causing.
To put this another way, since the mid-70s, when Canada adopted its single payer system, we’ve conducted the largest controlled experiment in the history of the world. We’ve had two political systems spanning the same continent, both nations of immigrants and once part of the British empire, both mainly English-speaking but multicultural, both with Federal systems, and both with a free market system backed by social insurance. And the results of the experiment? The “evidence”? Canadian-style single payer wins hands-down.
So what, exactly, is the problem with the “evidence-based policy debate” as Clinton presents it? A debate that won’t even mention single payer? A debate that leaves billions of dollars in savings on the table? And thousands of lives? Could it be…. Ideology?
I’d say yes. Because look how Clinton takes single payer off the table without actually mentioning it:
[ClINTON:] I want to see us have a debate where our differences are fully aired. [No, you don’t, because if you did, you would do that yourself.] We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque. We have to have people looking for common ways of approaching problems using evidence, but leaving their gaming, blaming and shaming, and their point scoring, at the door.
(I’m perfectly happy to blame the political class for taking simple, rugged, and proven single payer system off the table. For which they in general and Clinton particular ought to be ashamed.) I’m reading “one size fits all” as a dog whistle for “single payer” and/or “gummint-run health care.” And if “one size fits all” doesn’t decode that way, what else can it mean? That different patients have different needs? A truism? Clinton’s statement is either vacuous, if not not a dog whistle, or disingenuous, if it is. Come on. Try this on for stupid: “What works in Toronto, Ontario doesn’t work in Saskatoon, Saskatchewan.” Yes it very does, because that’s what the evidence shows!
And I’d say yes because look what Clinton points to as an example of things to “fix.” Quoting Political Wire, since the transcriber Health Populi apparently doesn’t transcribe weak tea and small bear:
“Hillary Clinton offered a defense of Obamacare – but struck a note of concern for small business owners who’ve complained about mandates required by the law – in a twin set of speeches in Florida,” Politico reports.
That’s it? That’s really it? The mandate to buy junk insurance through the ObamaCare marketplace, already enforced for citizens, is too much for small businesses. Nothing about the crapified policies? Nothing about narrow networks? Nothing about balance billing? Nothing about over-55s being forced into Medicaid and then having their estates clawed back? Nothing about the random and capricious nature of who gets covered for what? Nothing about the millions left out, even when Obamacare is fully implemented? That’s it? Clinton’s suppression of ObamaCare’s issues — and her willful refusal of engage in an “evidence-based policy debate” — can only be ideological: “Because Markets,” as Neo-liberalism In Two Words™ puts it.***
To round matters out, Political Wire quotes the quote that everyone is quoting. Here’s what the press believes is the key section:
“[CLINTON:] I think we are on the right track in many respects [no, not in any respect whatever] but I would be [but, apparently, are not] the first to say if things aren’t working then we need people of good faith to come together and make evidence-based changes.”
There’s evidence! I swear! There’s evidence right on the same continent with us! Some of the evidence even speaks English! And I’d like to think that single payer advocates are “people of good faith” who want to make “evidenced-based changes.” But Clinton apparently doesn’t think that, or else she’s not saying what she thinks. Political Wire concludes:
First Read: “But do note: Hillary really didn’t say anything different than we’ve heard from President Obama on fixes.”
So there you have it. If the Democrat really want to run as “new populists,” they’ll have to do a lot better than this. “Fine words butter no parsnips” applied to Obama, and it applies, with equal force, to Clinton.
NOTE * For those who came in late, there are actually two Clintons; Bill Clinton, the former President of the United States, and Hillary Clinton, Secretary of State in Obama’s first term, and Bill Clinton’s wife. Hillary Clinton ran for President in 2008. Both are Democrats. In this piece, “Clinton” denotes Hillary Clinton.
NOTE ** Despite the headline,
the Chthulu-like, soul-sucking horror of 2016 speculation makes me want to claw out my eyeballs. So I’ll just introduce the ever-useful qualification “barring health problems”.
NOTE *** To be fair, Clinton’s failing here could also be the result of the catastrophic lack of imagination and/or empathy common to our political class.