Jared Bernstein on Health Care Policy: Appalling Ignorance, or Deliberate Obfuscation?

By Lambert Strether of Corrente.

I was going to write a much more detailed post on this year’s ObamaCare enrollment period (no, they still haven’t fixed the back end) but I ran across this piece from Jared Bernstein that was so egregious that I felt I had to post on it. The title is, I think, an example of economists’ humor; here it is: “A high-tech ‘event analysis’ of the Affordable Care Act.” This is the “high tech” part (I’ve helpfully highlighted the funny part in yellow):

So the “event” is ObamaCare, and the share of Americans without (some form of) health insurance goes down. That’s the analysis.

It would be churlish of me to draw attention to the tricks Bernstein plays with the non-zero Y-axis, and the carefully selected X-axis, so I’ll go ahead and do just that. Here’s Time’s version of the same Council of Economic Advisors data:


Granted, Democratic loyalists are shameless in their triumphalism, but doesn’t my horizontal line make ObamaCare’s achievement — bringing insurance coverage back to the level of the mid-70s, when the neo-liberal era began — look a wee bit less impressive?[1]

But let’s be fair; we all know Bernstein isn’t making a serious economic point, assuming that to be possible for him by now; he’s making the political point that it’s hard to take away perceived benefits from people once they’ve begun to receive them:

I post this not only to show that at least by this metric, Obamacare is proving to be highly effective, but to try to bring some desperately needed perspective to this idea that the law can or should be repealed. It is a very big and positive deal to go from being uninsured to having coverage, with far-reaching positive impacts on your health, financial security, and even your longevity.

Here, Bernstein commits the first fundamental fallacy of ObamaCare defenders and neo-liberals everywhere: He confuses health insurance with health care. In reality, the positive impact health comes, not because you write an insurance company a check, but because the health care system delivered services. And the second fundamental fallacy — let me drop a hint, for new readers, of where I’m going with this — is like it: He defines insurance always as private insurance, and never as social insurance. Going on:

So my guess is that not just for policy reasons, but for political reasons, any replacement will certainly have to meet this benchmark.

That is, any replacement that fails to sustain this trend, or worse, reverses it, should and probably will be unacceptable to the public.

Heaven forfend that we try to exceed the benchmark, eh? And now here comes the Big Lie:

Which brings me to my three-sentence summary of the economic architecture of any [any?] health-care reform plan.[2] To provide affordable coverage, there must be risk-pooling. Thus, there must be a mandate to avoid adverse selection (where only those who need coverage participate). Thus, there must be some form of subsidies for those who can’t afford coverage on their own.

With social insurance, the pool can be the entire country, so there’s no “thus” the first, and there’s no “thus” the second. (Or rather, there is only “thus” if, because markets, you rule out social insurance, and confuse health insurance with health care.) Bernstein appeals to seemingly self-evident neoliberal truths in the same way that Clinton appealed to “evidence-based policy”: Tendentiously and dishonestly, to take single payer off the table without actually mentioning it:

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.

Of course, it’s obvious what Bernstein why Bernstein makes this political point now; he’s running interference for the administration in case King v. Burwell goes against them, and consumers citizens in the 34 states that use the Federal ObamaCare exchange lose their subsidies. To show you the sort of column Bernstein might have written, let’s look at what they’re doing at the other end of the Overton Window, from Yuval Levin and James C. Capretta on The Wall Street Journal editorial page:

If the court rules today’s subsidies illegal, those state officials could face a choice between creating a state exchange (and so reinforcing ObamaCare) or seeing some residents lose coverage they now have. ObamaCare’s opponents in Congress should give them a third option: a viable alternative to the Affordable Care Act.

The first step is to introduce legislation that would allow any state to opt out of all of ObamaCare’s mandates, regulations, taxes and requirements, and instead opt into a far simpler and more flexible alternative system. In that system, state residents not offered health coverage by their employers could receive a federally funded, age-based credit for the purchase of any state-approved health-insurance product…

Now, if Bernstein were a principled and progressive creative thinker, instead of a Democratic waterboy with a stultified neo-liberal mentality, he’d be thinking of King v. Burwell as an opportunity to create a “a viable alternative” to ObamaCare, but from the left. I mean, seriously: What do Levin and Capretta give the Blue States? Take what Levin and Capretta wrote as a baseline and revise it:

If the court rules today’s subsidies illegal, those state officials could face a choice between creating a state exchange (and so reinforcing ObamaCare) or seeing some residents lose coverage they now have. Progressives in Congress should give them a third option: a viable alternative to the Affordable Care Act.

The first step is to introduce legislation that would allow any state to opt out of all of ObamaCare’s mandates, regulations, taxes and requirements, and instead opt into a far simpler and more flexible alternative system. In that system, the age for Medicare eligibility would be set at birth.

(Pause to note that: 1) The “Medicare” proposal above is for effect, though Edward Kennedy advocated for progressive lowering of Medicare eligibility before Obama conned him; it probably would make more sense to implement either the Sanders or Conyers single payer bills for those states; 2) I know that Medicare has a neoliberal infestation all its own, and that would have to be dealt with; 3) the idea of regional single payer interstate compacts might also have appeal; for example, New York, Massachusetts, Vermont, and Maine, New Hampshire living free, and dying.

See the difference? How about we give people “a viable alternative” that’s simple, rugged, proven, and cheaper, and that covers everybody, saving thousands of lives and a boatload of money? Why not raise the baseline?

So let me close with a little joke of my own:


I’ve drawn a “low-tech” black censor bar (my “horizontal line”) across Bernstein’s eyes. Perhaps he is merely appallingly ignorant, in which case the black bar symbolizes how he can’t see what’s right in front of him[3]. Or perhaps he is deliberately obfuscatory, in which case I’ve done him a real favor by anonymizing him, and I suggest the Post do likewise, using this handy image as a design comp. Jeff? Yo, Jeff!

Appalling ignorance, or deliberate obfuscation? Readers, you decide!


[1] It would also be churlish of me to point out that the administration’s enrollment numbers are consistently soft, and have been inflated; churlish also to point out that the CEA averages conceal much higher rates of uncovered people in some populations; and even more churlish to point out that enrollment doesn’t equal payment, and only payment means coverage, given that health care is not a right, because markets.

[2] I suppose a logic chopper could argue that single payer is not a reform; I’d argue that it is. First, provision of the delivery of health care is left in private hands; something like nationalizing delivery, a la the UK’s NHS before its neoliberal infestation, would be far more radical. Second, expanding the application of proven programs, like Medicare, to greater populations is the very essence of reform; ObamaCare, which mandates the purchase of a defective product (private health insurance) is far more radical.

[3] Or, to be fair, a few hundred miles north of him. Perhaps the real problem is that Canada is not on the Acela, and so Beltway apparatchiks like Bernstein don’t know it exists?

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. abynormal

    ive picked up a p/t ‘job’ avg 25-30hrs wk. @ GA min wage…went online to file for ins. and was quoted 249.00 a month with no place to apply for a subsidy. i closed my laptop and said my first christian prayer in yrs…Please don’t let me limp away and Please Please don’t let them take me alive.

    All hail, Delusion! Were it not for thee
    The world turned topsy-turvy we should see;
    For Vice, respectable with cleanly fancies,
    Would fly abandoned Virtue’s gross advances.

      1. Crazy Horse

        Not sure moving to the former Soviet colony of Georgia is the answer. But if you want a better health care system might I suggest Canada, Colombia or even Cuba? Or any of the 27 other countries ranked ahead of the US by the World Health Organization.

        As an added benefit you no longer will be giving financial and tacit support to the American Empire as its policy of permanent warfare bleeds the country dry and creates enemies all over the globe.

  2. Timb

    Soooo, neo-liberal is some sort of secret term for Reagan conservatives and their miserable 30 year experiment on the rest of us and Bernstein is stupid for being pragmatic and excited over how a mixed system has improved coverage AND we could just have single payer if we hoped hard enough?

    I swear, puritans are the saddest ideologues. We will get to single payer soon enough, as the American people learn that “socialized medicine” is not scary like they were told

    1. NOTaREALmerican

      Re: neo-liberal is some sort of secret term for Reagan conservatives

      That seems to be the closest definition of neo-liberal I can come-up with too. But, still not sure what the point of neo-liberal is (or neo-conservative for that matter).

      Limousine liberal is (somewhat) descriptive, but “new” liberal? “New” conservative? Why not just crony-liberal and crony-conservative? Or crony-socialist and crony-capitalist? All it does is confuse the peasants when trying to define who the enemy is.

      1. vidimi

        neo-liberalism is an economic doctrine based on free-market ideology

        neo-conservatism is a foreign policy (political) doctrine based on interventionism and american exceptionalist (might makes right) ideology

        the two mostly exist hand-in-hand and complement one another though they could, in theory, exist independently.

    2. Lambert Strether Post author

      Oh, please. See here on The Road to Mount Pelerin and the “neo-liberal thought collective.” See Jacobin on neo-liberalism transforming the state. See “Neoliberalism Expressed As Simple Rules” — 1) Because Markets (amply demonstrated in Bernsteins little crotte of a column) and 2) Go die (amply demonstrated by comments on this post). I’d argue that it’s possible to reduce neo-liberalism to simple rules because it’s been the dominant ideology since the mid-70s; it exists now in degenerate form, and yet “thought leaders” like Bernstein cannot free themselves from it.

  3. Ratsrepus

    This summer when the subsidies are probably declared illegal, will I have to repay the subsidy back to the government, or will the insurance companies have to return the money, and Bill me directly for now illegal subsidy received?
    Of course the Obama care penalty will still be in effect unless the $750 monthly premium allows me to be exempt from the penalty as unaffordable at my current income.

  4. Faye Carr

    I am alway grateful when people smarter than me publish something that clearly articulates my position.
    So, then, thanks Lambert!

  5. Carolinian

    I think it’s perfectly obvious to anyone who doesn’t have a vested interest in believing otherwise that our healthcare system in the U.S. is utterly broken. The NYTimes, to their credit, have been doing a long series on the irrationality of current arrangements with particular emphasis on pharma. Wonks like Bernstein and, sadly, Dean Baker defend Obiecare, but Baker at least does talk about the real problem which is cost. Put simply, you can’t allow a group of people to say ” your money or your life” and not expect them to abuse the privilege. Baker’s solution is to reform of patent and intellectual property laws and allow importation of less greedy foreign physicians. But the truth is this is an area of society that only government can fairly administer. So-called liberals who aren’t adamantly in favor of single payer, medicare for all, aren’t serious people.

    1. JCC

      “Baker’s solution is to reform of patent and intellectual property laws and allow importation of less greedy foreign physicians”

      Importation of “less greedy foreign physicians”, another classic example of blame-the-victim, lower-the-wages-of-technicians solution a-la H1B for IT Tech Workers, and a great solution to increase the profits of Insurance Companies.

      As the son of a small town surgeon I can tell you that they are just as much a victim of this stupid program that is designed for more profit/not-so-hidden bailouts of Big Phama, Insurance, and private “Health Care” facilities as the rest of us are. It’s all about killing off labor costs at every level while forcing everyone to contribute more of their hard earned dollars to the perpetrators of this farce, the politicians and the fore-mentioned Big Businesses.

      1. Carolinian

        Yes our high dollar health system has gone on for so long that the Wall Street big money investors couldn’t resist becoming involved and are taking over everything. But for the record American doctors make double or more what their counterparts in Britain make. And if you read those NY Times stories I mentioned you will see that doctors are very much involved in pushing overly costly drugs and unnecessary but wildly expensive tests. Of course doctors aren’t just in the profession for the money, but their trade organization, the AMA, has always fought tooth and nail against getting any less. So you can’t say they are just in the profession for idealistic reasons either.

        1. Michael

          Not sure how importing doctors will help reduce health care costs. Doctors over prescribe because they is how they get paid. Change the reimbusement policy and wages/salaries will go down.

          Importing doctors only drains resources from other countries and may only reduce healthcare costs if and only if their employers do not take the reduction in labor costs as profits.

          I like Dean Baker but I disagree with this policy idea. Anything that encourages a brain drain is problematic if not immoral in this case.

          1. zaster

            We need more doctors–many many many more doctors. Vast areas of the country have almost none now. My son’s gf had to wait weeks to see an orthopedist for torn ligaments, my son is now permanently crippled from broken vertebrae that had to wait too long to see specialists. They had set up. He was told he should have been in a brace as soon as it happened, but there were no doctors available..

            This is a massive crisis.

    2. Jeremy Grimm

      Physicians belong to one of the most ancient of fraternal guilds. Their guild controls practice of their art, the number of practitioners and sets standards for their fees. While I am not enthusiastic about breaking one of the few remaining unions, the AMA is a very special union controlling a very special service. The AMA has broken its covenant with society.

      The process for selecting physicians assures selection of too many whose calling is to grab money and rejects too many whose calling is to heal and care. It accepts too few to provide a basic standard of service to society. How does the long grind of multiple washout classes in Biology and Chemistry select the best candidates for becoming physicians? The traits of a good physician seem very remote from the traits of the academic grind. I don’t know whether it is still the case, years ago, veterinary schools were more selective from these same pre-med candidates than medical schools. Assume the pre-med programs really do select for the best candidates — our pets and farm animals have better physicians than their owners.

      The hazing of interns and resident physicians combines with the pre-med selection process to instill a sense of entitlement. Once a full member of the guild, a physician is protected from responsibility for all but the most willful and egregious malpractices. The AMA takes care of its own.

      Medical schools raised their costs which will force beginning physicians into serious debt locking them into a system designed for profits rather the service. The next generation of physicians will leave medical school indentured to the medical-industrial profits machine. Even those called to heal and care will be coerced into making money as their first concern.

      All our hospitals are run for profit without constraint on how much profit they can command for themselves. Like physicians they can bill however much they please. However much physicians and hospitals may complain about the medical insurance companies controlling fees and services, I am of the opinion the medical insurance companies helped drive up those fees. As fees increase, it gives the insurance companies a rationale for raising their rates. As fees increase those increases compel the purchase medical insurance to offset the financial risk of becoming ill.

      Obamacare fosters rather than fixes these corruptions of medicine.

      1. Malcolm MacLeod, MD

        I am an old and retired general practice pediatrician, who spent three years in the Army
        and the rest of my career working for the Northern California Kaiser Permanente health
        system for a salary which was more than fair. I graduated in 1962 with no debt (GI Bill),
        and in retrospect would change nothing. Mr. Grimm’s comment of 19 Dec. is completely
        on track, and I absolutely agree with his opinions. Oh, I never bothered to join the AMA.

        1. katiebird

          I was born in the San Francisco Kaiser hospital in the 1950s and all my doctors were Kaiser doctors until we left the bay area at the end of the 60s.
          We really liked the Kaiser system – especially compared to what we had in Kansas. I never liked the random luck of finding a good doctor once we moved to Kansas.

  6. Jim Haygood

    Source: White House Council of Economic Advisers

    The CEA is an interested party, cheerleading a program whose popular appellation ‘Obamacare’ bears the president’s name.

    I don’t believe there’s been a 3 or 4 percentage point plunge in uninsured. During 2Q and 3Q 2014, new sign-ups weren’t available, and some policies were cancelled for non-payment.

    So if one even wants to lie credibly, it’s essential to admit to at least a little counter-trend bounce during the period when enrollment is closed. This is the mistake that caught out Bernie Madoff: if he’d only admitted to some small losses during down years in stocks, he might have got away with it. But he insisted on claiming bulletproof strong returns every year, with no correlation to the assets he allegedly invested in.

  7. Banger

    When I think about health, healing and all subjects that are connected with it I want to tear out my hair. Not because the field, at all levels, is dominated by parasites but because the vast majority of the American people cannot see the obvious–even the extraordinary example of Canada just across the border. As I’ve often said here if we can attribute one overriding characteristic of American culture it is “denial” and thus reality has become far more arbitrary than it ever has been. If I hold up three fingers and, for whatever reasons, the number three is forbidden, then you will see two or four fingers. Even if it causes you great harm, endangers your children, shortens your life you will not see the number three anywhere. This is how we live.

    American medicine is a business–but not any business it is one that we are forced to use and that has a lot of legal force. It is no accident that Obamacare turned out to be a draconian measure forcing people to pay a tax to insurance companies. Big Pharma exists to make sure that all cures will be expensive and of questionable quality. There are all kinds of alternative ideas about healing out there that sometimes make it into mainstream medicine–like stress causes or triggers 80% of disease but does society attempt to address the issue of stress? No, it attempts mainly to increase it through all kinds of authoritarian measures from police to NSA to handcuffing five year old kids as well as keeping a significant part of the population in a state of anxiety over whether they will have a source of income next month, living paycheck to paycheck hoping they don’t need a new roof or face a medical emergency or a whatever.

    The fact the “left” generally supports the health-care atrocity that Obama created is perhaps the most tragic aspect of all this but it is part of a general pattern I’ve alluded to many times. I want to thank Lambert for keeping his eye on this ball–he is one of only a few that seem to notice what is going on in this area.

    1. Carla

      Banger, may I suggest one finger, the middle one?

      Thanks to Lambert for this post, and to abynormal, Faye Carr, Carolinian, Jim Haygood, and you. I endorse all of your comments.

      Just one more thing I don’t see addressed very much yet: the degree to which Obamacare has crapified Medicare, a trend that I imagine will only intensify.

      1. Jim Haygood

        I’m not aware of how Obamacare has affected Medicare (maybe you can elaborate). But another aspect of Lambert’s chart is that about half of the decline in uninsured represents Medicaid sign-ups. In August, HHS claimed 7.2 million Medicaid enrollments (probably an accurate number) and 8 million sign-ups in subsidized private plans (a soft number, as Lambert has detailed).

        These are really two separate markets. Since Medicaid is totally subsidized, not many of those 7.2 million new sign-ups are going to drop out unless their income goes up. It’s the private plans which have experienced some dropouts, owing to non-payment or inability to afford the deductibles.

        To make the uninsured rate drop, enrollment has to increase in the subsidized private plans. And does HHS have a deal for you:

        ‘The lowest-cost silver plan in each market saw modest [premium] growth of 5 percent on average before tax credits. More than 7 in 10 current Marketplace enrollees can find a lower premium plan in the same metal level by returning to shop.’


        This weaselly report is all about the supply side — how many insurers are participating. A 5 percent premium hike is still 3 percent above inflation. Not a word about the ‘consumers,’ except the patronizing advice that when the going gets tough, the tough go shopping.

        1. Carla

          Examples of Medicare crapification:

          “The 2015 Medicare changes are beginning to be realized. Most Medicare recipients will likely have their Medicare plan changed in some fashion, whether due to increased deductibles and premiums of original Medicare or reduction in benefits and increased copays and premiums for 2015 Medicare Advantage enrollees. Even 2015 Medicare Supplement enrollees are likely to be affected by the changes…

          The biggest change for the upcoming year is likely to be with Medicare Advantage 2015 plans. Due to doctor reimbursement rates shrinking, the pool of doctors who accept Medicare is also shrinking in many areas. Early indications are that in many areas plans are increasing their premium and copays, while many of the zero premium plans may have to begin charging a monthly premium. As in past years areas with fewer Medicare eligible individuals will see the most drastic changes including the removal of some plans altogether.”


          Another crapification wrinkle: large employers such as G.E. are cutting off defined benefit plans for retirees that have had them for years, and throwing them into the Medicare supplemental and Advantage plan marketplace with the rest of us plebes. This is happening to a couple of relatives of mine in their mid-80s, one of them very seriously ill and the other not especially healthy. They are terrified.

          1. MaroonBulldog

            “large employers such as G.E. are cutting off defined benefit plans for retirees that have had them for years, and throwing them into the Medicare supplemental and Advantage plan marketplace ”

            Yes, it happened to me this year, and to my sister-in-law.

        2. Lambert Strether Post author

          “[T]he going gets tough, the tough go shopping”. I hadn’t thought of applying that meme — who invented it? Fran Liebowitz? — but you’re spot on. And I have a “shopping” post in my mind on the exchanges, so thanks very much!

  8. fresno dan

    What’s more, in medicine’s version of mission-creep, the thresholds for many risk factors have been lowered so as to encompass ever larger pools of patients. People who believed they were normal in a particular health category abruptly learn that they are not – and that they probably need treatment. That they lack symptoms is misleading. Today’s patient is declared to be in good health not because she feels well, but because her latest scan or blood work indicates no abnormalities.
    Recently, the American Heart Association (AHA) recognised that things had gone too far. Since studies had shown that blood-pressure medication was of no benefit to those with prehypertension, the AHA raised the level at which people aged 60 and over should start taking drugs. Now the recommended trigger is a systolic pressure of 150 or higher. With the change, some 7 million Americans, more than half of whom were taking medication, were moved out of the at-risk column. It’s unlikely that 3‑4 million people will drop their medications, however. Once launched, a medical regimen of that magnitude is hard to turn around.
    This I declined to do, fortified by another calculation. It took some digging to get the numbers but, according to experts, statins would lower my risk by only four percentage points, from 15 to 11 per cent. Here’s how to visualise the math. Imagine 100 people like me: white men aged 67, with identical blood pressure (125) and cholesterol values (total 184, HDL 39). No cigarettes, diabetes, or antihypertensive drugs in the group. The AHA/ACC calculator predicts that 15 of us will suffer a nasty cardiovascular event within a decade.
    Now let’s give statins to all 100 of the group over a 10-year period. Right off, five of us will have muscle pain as an unavoidable side effect. (Statins are also reported to have caused cognitive and psychiatric problems in some individuals.) Of the 15 subjects who were slated to have a heart attack or stroke, just four are spared by the statins, leaving 11 men who were stricken in spite of having taken medication and 85 others who would have been all right had they not taken medication. The bottom line is that doctors have overtreated 85 people in order to protect four. If statins could eliminate my cardio risk entirely, that would be one thing, but to lower it by four percentage points, when it wasn’t high to begin with – no, I’d rather bet that I’m one of the fortunate 85.

    I would point out one thing – the adverse event reporting system is VOLUNTARY, so finding adverse events is often due to serendipity…

    Just as health insurance is not health care, the profit motive in health care skews to over PRESCIPTION of drugs and over utilization of devices and surgery, while perversely preventing the gathering of data to truly determine the most cost effective treatments…

    1. fresno dan

      Oh, I forgot. Excellent article.
      It just shows how little perspective there is. Would “health” reform had passed if the motto had been, “getting insurance coverage back to 1975?” OR reducing the uninsured by 4%???
      Who knows? Maybe that is the best we can do…BUT don’t advertise it as universal health care.

    2. MaroonBulldog

      “The bottom line is that doctors have overtreated 85 people in order to protect four. ”

      It’s what medical doctors do. Because it’s what medical schools teach them to do. Because it’s what pharmaceutical chemical companies endowed the medical schools to teach to do. Push pills.

  9. TarheelDem

    Good job of nailing Bernstein’s “Mission Accomplished” rhetoric. But all of the recalibrating of scales likely misses the still large number of people without health insurance and the still larger number who are postponing healthcare because of co-pays, deductibles, and the fear of balance billing.

    An infrastructure that would deliver health care instead of health insurance would be a national health system or Veterans Administration coverage for all, which is why Congress has be privatizing and ratcheting back traditional VA coverage and VA hospital capacity.

    The number of physicians who understand their license as a license to print money is still very high, and they are the ones who drive the lobbying in Congress (or are members of Congress and legislatures themselves) and also set the salaries for lesser physicians in what as become as much a two-tier system as universities have become.

    Politically, the first thing to attack is the annual enrollment date nonsense on both Obamacare and Medicare Part D. The expectation that all seniors are capable of this sort of harassment shopping and will not just rollover increasing expensive plans with less coverage by default is going to become more apparent as everyone else faces the same hassles. The other, and more difficult, political challenge is to end the shell game of employer fringe benefits for the ordinary workers in order to get large tax deductions for executive fringe benefits.

    1. NOTaREALmerican

      Re: An infrastructure that would deliver health care instead of health insurance would be a national health system or Veterans Administration coverage for all

      Who would run it? The same people running the VA now? The “nice people”?

      Single-payer would be wonderful in a society of “nice people” with a government that represented the “nice people”. We’ve never had a government like that. Why do the “Progressives” want a single-payer system run by “the people who run America”?

      1. hunkerdown

        It works well enough in societies of gruff people too. Maybe it can’t work in a society that prides itself on its arrogance and refinement — no, wait, it works just fine in France too.

        It works just fine in societies that decide it should work. You don’t need perfection, just better than we’ve got. What’s more, if the rich aren’t even allowed to get into their own boat, we can be reasonably sure *they* will use their whiny consumer power to push the government for quality health care for all, just as assuredly as they’ve been pushing for quality wealth care for themselves.

      2. Lambert Strether Post author

        What a steaming load of crap. You’re saying Canadians are nicer than Americans? Or that Medicare or VA patients are somehow nicer? Single payer is a proven system that is not dependent on cultural factors.

  10. Northeaster

    Just did our healthcare signup the other night, just North of $13k/year. There is nothing affordable about that. Compounding this though, is my spouse has a lifelong commitment to a relatively common drug, but is charged an astronomical monthly fee. Meanwhile, my sister company (pharma) is fined multiple times for breaking the law, the penalties of which equaled .009% of the profits made from said drug.

    It’s not just healthcare, there’s whole heck of a lot of things gone wrong as we traverse this “new normal” dystopian/Orwellian journey.

    1. Jim Haygood

      ‘a relatively common drug, but is charged an astronomical monthly fee’

      Offshore pharmacies are a possible remedy for that. Canada, Mexico, India …

    2. NOTaREALmerican

      Re: there’s whole heck of a lot of things gone wrong

      Well… over many generations some people are going to figure-out how to manipulate the system for their own gain. Seems like all that has “gone wrong” is the number of people now gaming the system for their own gain.

      It’s really tough to turn-back-the-clock to more innocent times (as any “conservative” can tell ya). Once the manipulation technique is known there’s no going back (unless “the nice people” break-up the scam into small pieces so that the pieces have to fight with each other, but I think that would be “austerity”).

  11. aletheia33

    this reminds me of “gradualism”. people whose egos depend on feeling that they are virtuous and caring about those “less fortunate than us” are very uncomfortable with themselves and others unless they can see themselves, and be seen, advocating for reforms that will benefit those less fortunate people. but they are not comfortable going out on a limb to push through major changes that are truly equitable, because this would require them to risk their standing in society as good, decent people, to risk their careers, and to risk the futures they hope to give their children. they are not willing to join the rabble (not that they would ever offend anyone by using that word), the “great unwashed” (they carefully won’t use that expression either) who are marching in the streets screaming and yelling in a nasty, enraged manner that they fear could get “ugly”. in their deepest interior selves, they are uncomfortable actually associating and working on the ground, at the nitty gritty level, with those people, whom they basically, unconsciously, regard as their inferiors. (jonathan gruber, anyone?) they like to imagine themselves fighting FOR them, but they cannot fight WITH them, because they do not truly feel that they ARE equal to them.

    and so they devise a cause, a phony reform “movement”, via which they are enabled to act out their virtuous feelings without having to endure the discomfort of modifying their basic social modus operandi and becoming a member of a more honest and direct effort to change the status quo. they need a “progressive” cause and they need for it to feel safe. so we get gradualism. “we’re doing it; it just takes time; progress IS being made; if we push too hard there will be serious problems, backlash, even a bloodbath, we’ll only be set back; the sources of money we depend on will walk away and we’ll have nothing to work with; progress IS being made; be patient, we’re getting there; incremental steps is the pragmatic way; progress IS being made; we can fix that later; etc.

    to take just one example, this is what went on from the top down regarding the horror of segregation, intimidation via torture and lynching, and the rogue rule of the KKK in the American South for decades, until finally some brave african american teenagers went out on a limb and risked their lives at lunch counters etc. because they were unwilling to wait patiently any longer for humanity and fairness to come and find them where they were while their spirits gradually got snuffed out like they saw their parents’ spirits had been. they simply, directly, cleanly up and took that humanity and fairness for themselves. their parents were by and large terrified for them as they did this, but then came around quite quickly to perceive the power and effectiveness of what their children were doing. while the gradualists, the virtuous club of white liberals with their pet african americans, kept on holding on to whatever they could think of to remain socially comfortable via their mutually agreed-on compromises.

    gradualism has its place, and surely it is helpful to have people at the top who have a need to be seen as egalitarians who want to do the right thing, but on any given issue it will never reach its fantasized goal of equality and fairness for all, because it is just as dedicated to preserving the status quo as it says it is dedicated to bringing change. it is ambivalent. gradualists want to have their cake and eat it too, and they manage that quite well. all politicians by definition are gradualists. if we want better and sooner change, we have to simply claim what we know we are entitled to in a fair world. we need to create that world now. (the possible ways of doing so are endless because this is a creative act, hence it is erotic, it is love, which is inexhaustible.) as long as we remain not yet willing to engage the risk and sacrifice that entails, we will suffer the risk and sacrifice that the unfair system opposes on us.

    certainly not the whole story but one aspect of it that is salient to me.

    1. AQ

      Interesting premise. I agree with much of it. But I would add this piece by Peter Buffett about how there are also blinders on in regards to the fact that one is creating the circumstances that require charity or charitable industrial complex to begin with.


      This plays into Yves article about obsetity. Create the problem with corporate food subsidies, lower wages, government food pyramids, hectic and never completely stable employment opportunities. Then turn around and call out an obesity problem with solutions to treat the symptoms instead of the root causes.

      Looking at Lambert’s graphic might tell us that once we had a semi-solution to the root cause then “we” decided to create a new root cause problem that “we” now solve by going once again after the symptoms instead of the root problem.

      The root problem: we allow the few to accumulate transferrable wealth and power. It doesn’t matter if we talk health care, war, militarization of police forces, corruption of politians or looting/destruction of the environment. It all ultimately stems from the same well.

    2. Michael

      Look I love the story of teenagers and a conservative black church overturning segregation but that completely over looks radical unions and communists (usually one and the same) working towards equality. I love the feel good story but that never happens unless men and women outside the church pushed for equality.

      Others were involved but I don’t have time.

  12. Bill Michtom

    Countries with universal single payer healthcare have average costs that are half of what we pay. Since annual costs have been above two TRILLION dollars annually (last year 3.8 trillion) since before Obamacare started, we are not talking hundreds of billions but a thousand billion each year.

    Just saying.

    1. NOTaREALmerican

      Sure, but are any of them run by the American government (or Americans, in general)? Just saying…

      (Maybe there’s something about a highly competitive screw-or-be-screwed culture that doesn’t lend itself to large “morally good” organizations?)

      1. hunkerdown

        True enough. Now, what can be done to destroy the competitiveness of this culture? Not competing would be a good start, I think.

      2. Lambert Strether Post author

        This is a variant of the idea that any solution is hopeless because — gasp!!! — ZOMG!!!!!!!!! politics might be needed to implement and protect it. It’s a counsel of despair. You and banger need to get a room on the cultural stuff. I’d strongly urge, with gay marriage and the civil rights movement as examples, that politics can drive culture just as much as culture politics.

        You don’t have to wait with your thumb…. in the wind for the culture to change. If a program is good, get up and support it.

  13. Oregoncharles

    Churlish is good, and very well done.

    Yet another example of just how fundamentally dishonest (or ignorant, if you prefer that meme) mainstream, even “liberal” economics is.

  14. Jay M

    It would be hard to find a more condign system than the ill-health care that the savvy American consumers slurp up year after year. You feed dogs dog food, I guess.

  15. Jeremy Grimm

    I love the new word you have given me — condign. However I hope it is not fitting to the discussion of our system of ill-health, though I greatly fear the truth of your comment.

  16. vidimi

    the only problem canada has with its healthcare, and it’s a problem that is magnified by free-market ideologues pushing for an american-style system, is allocation. you may often hear about how canadian wait times are long, and that’s certainly true (ignoring the fact that waiting hours is always preferable to afford to pay or die).

    but 90% of the canadian population lives within 1 hour of the u.s. border, or 5% of the area, whereas the remaining 95% of the country is underpopulated. the government, therefore, has to ensure that there are enough doctors in the rest of the country which means reallocating mostly young doctors to remote areas which often means that, per capita, there aren’t enough in big cities.

    america doesn’t have this problem. it doesn’t have huge swathes of unpopulated land the way canada does and, therefore, could have a much more equitable distribution of medical professionals. therefore, it is my opinion that, if it were ever to give single payer a serious go, america would be a much bigger success story for it than even canada.

  17. philm

    Why is Jared Bernstein considered ” an economist”? From Wikipedia:

    Bernstein graduated with a Bachelors Degree in Fine Arts from the Manhattan School of Music where he studied double bass with Orin O’Brien. He earned a Masters Degree in Social Work from the Hunter College School of Social Work, and, from Columbia University, he received a Masters Degree in Philosophy and a Ph.D. in Social Welfare.

    There is no great expertise in anything he has to offer on the economic front.

  18. TomL

    Not having been trained in mainstream neoclassical economics can be an advantage these days (if you intend to live in the real world), which is not to excuse Bernstein for his unwillingness to advocate actual solutions.

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