How Stupid Do They Think We Are? – Plutocrats Using Logical Fallacies to Defend the Health Care Status Quo

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal

In the early 21st century, the debate about health care reform in the US ramped up.  The result ultimately was the Patient Protection and Affordable Care Act (PPACA, ACA, “Obamacare”), which arguably improved access to health care, made some reforms in the regulation of health care insurance, but did not affect the fundamental reliance of the US on employer-paid, for-profit health care insurance to finance health care for many patients.  Nor did it really affect the issues we discuss on Health Care Renewal (look here for details).

After the tumultuous election of President Donald Trump, the debate started up again with his and his party’s attempt to “repeal and replace” Obamacare.  Arguably, Obamacare ended up damaged but not repealed.  Once again, the issues we discuss on Health Care Renewal were ignored, including threats ot the integrity of the clinical evidence base, deceptive marketing, distortion of health care regulation and policy making, bad leadership and governance, concentration of power, abandonment of health care as a calling, perverse incentives, the cult of leadership, managerialism, impunity enabling corrupt leadership, and taboos, or the anechoic effect.  (Look here for a detailed discussion. )

It is time once again to discuss health care reform in the US.  Now the push is from the Democrats and the left, with the stated goals of making care more universal, and perhaps decreasing or even ending the role of for-profit commercial health care insurance companies.

It is no surprise that those who benefit the most from the current system (even as modified by Obamacare) are rushing to its defense.

Dark Money to Defend Commercial Health Insurance

We already discussed  how large health care corporations, including pharmaceutical and biotechnology companies, have been using dark money to funnel money for distinctly partisan purposes, to defeat whom they perceive as too left-leaning politicians, almost all Democrats.  They seem to fear such politicians might promote health care reform efforts that would be based on “anti-free-market, anti-business ideology,” that is efforts to decrease the role of commercial, for-profit health insurance in financing health care.

More recently, the focus has shifted to Democratic proposals for government run single-payer, or “Medicare for all” health insurance. In early January, 2019, the Hill reported

Thomas Donohue, the president and CEO of the Chamber of Commerce, on Thursday vowed to use all of the Chamber’s resources to fight single-payer health care proposals.

‘We also have to respond to calls for government-run, single-payer health care, because it just doesn’t work,’ Donohue said during his annual ‘State of American Business’ address.

The US Chamber of Commerce historically has had many executives of big health care corporations on its board.  We listed 10 such members in 2015.   It also historically has received financial support from some corporations.  We listed 17 in 2018.

Then later in January, The Hill reported that a group called Partnership for America’s Health Future started digital ads attacking “Medicare for All.”  The Hill stated its

members include major industry players such as America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America

So here we have the leaders of big health care corporations funneling corporate money into propaganda campaigns to defeat government run single payer health insurance, an old policy idea that suddenly is looking politically credible.  Current US regulation and practice allows them to hide the exact amounts spent on such campaigns by processing them through dark money organizations.

Such stealth health policy advocacy is now not new.  What is surprising now is how some top leaders are willing to jump into the debate themselves, rather than just trying to manipulate public opinion through public relations/ propaganda proxies.  Here are some telling examples. in chronological order.

Quest Diagnostics CEO Attacks “Medicare-for-All” Using an Appeal to Authority, an Argument by Gibberish, the Non Sequitur Fallacy, (and an Incomplete Comparison) 

On January 24, 2019, Yahoo Finance reported

A top health care CEO is sounding the alarm on ‘Medicare for All,’ an idea gaining steam in political circles, including from newly-elected Rep. Alexandria Ocasio-Cortez (D-NY).

Most people don’t understand the basics of health-care economics in the United States,’ said Steve Rusckowski, chairman & CEO Quest Diagnostics (DGX), in an interview with Yahoo Finance editor-in-chief Andy Serwer at the World Economic Forum in Davos, Switzerland….

Mr Rusckowski implied that he knows a lot more about health care economics than most people, so most people should listen to him.  Thus, he began with an implied logical fallacy, the appeal to authority.

He then presented the justification for his argument.

‘The majority of people get their health care from their employers, and the majority of healthcare costs are paid by employers and employees,’ he said. ‘If you look at the $3.5 trillion spent on healthcare costs, that portion is actually funding the Medicare and Medicaid programs throughout this country.’

The syntax was fractured, and so this was incoherent and confusing. In particular, it was not clear to what “this portion” referred.  $3.5 trillion? Health care costs paid by employers and employees?

The context of  his use of that phrase did not help.  Note that US total health spending was reported to be approximately $3.5 trillion in 2017 by the US Center for Medicare and Medicaid Services (CMS).  However, that was total health spending, not just the amount spent by Medicare and Medicaid.  Furthermore, Medicare and Medicaid are funded by sources other than employers and their employees.  While employers and employees pay tax on employee income to fund Medicare, general funds from the federal government, and from state governments funds Medicaid. Furthermore, many employers pay parts of their employees’ private health insurance premiums, while the employees make up the difference in premiums. Self-employed people may may for their own insurance, etc, etc.

Mr Ruskcowski, not to put to fine a point on it, seemed to speaking gibberish, and would use this gibberish to justify his next point.  So in formal terms, he used the logical fallacy of an argument by gibberish.

When incomprehensible jargon or plain incoherent gibberish is used to give the appearance of a strong argument, in place of evidence or valid reasons to accept the argument.

In any case, Mr Rusckowski went on to argue that he

remained skeptical of a Medicare-for-all plan funded by corporations and employees. ‘I don’t think [corporations and employees] can affordto provide that access as described.’

However, not only were his earlier statement gibberish, they were not clearly arguments in support of his contention that corporations and employees cannot “afford to provide that access as described.”  So this appeared to be an example of the logical fallacy of the non-sequitur.

Mr Rusckowski’s total compensation as CEO of Quest was over $10 million in 2017, as estimated by Bloomberg News.  So it is perhaps not surprising that is self-interest in preserving the status quo was strong enough to motivate him to jump into the debate.  One would think, however, that someone who managed to become a rich CEO of a medical diagnostic company could manage to be a bit more logical.

Anyway, he has some strange bed-fellows in this cause, including two billionaires who are not directly involved in health care corporations, but who have obviously benefited from the current economic status quo.

Michael Bloomberg and Howard Schultz Used the Incomplete Comparison Fallacy

Two billionaires provided striking examples of one logical fallacy.

First, from the New York Times, January 29, 2019:

Mr. Bloomberg, the former New York City mayor who is considering a 2020 bid on a centrist Democratic platform, rejected the idea of ‘Medicare for all,’ which has been gaining traction among Democrats.

‘I think you could never afford that. You’re talking about trillions of dollars,’ Mr. Bloomberg said during a political swing in New Hampshire, which holds the nation’s first primary in 2020.

‘I think you can have ‘Medicare for all’ for people that are uncovered,’ he added, ‘but to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time.’

Second, from CNN on January 30, 2019:

‘Why do you think Medicare-for-all, in your words, is not American?’ CNN’s Poppy Harlow asked Schultz on Tuesday.

‘It’s not that it’s not American,’ Schultz said. ‘It’s unaffordable.’

‘What I believe is that every American has the right to affordable health care as a statement,’ Schultz said, lauding the Affordable Care Act, otherwise known as Obamacare, as ‘the right thing to do.’

He added, ‘But now that we look back on it, the premiums have skyrocketed and we need to go back to the Affordable Care Act, refine it and fix it.’

He argued that the Democratic progressive platform of providing Medicare, free college education and jobs for everyone is costly and as ‘false as President Trump telling the American people when he was running for president that the Mexicans were going to pay for the wall.’

So both billionaire Bloomberg and billionaire Schultz stated that Medicare-for-all would cost too much.  Yet neither addressed how much our current health care system costs.  However, as a subsequent op-ed in the Washington Post by Paul Waldman pointed out, it only makes sense to talk about affordability in the context of a comparison with a reasonable alternative, say, the current health care system:

there is one thing you absolutely, positively must do whenever you talk about the cost of a universal system — and that journalists almost never do when they’re asking questions. You have to compare what a universal system would cost to what we’re paying now.

there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.

That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade.

Again, you can criticize any particular universal plan on any number of grounds. But if it costs less than $50 trillion over 10 years — which every universal plan does — you can’t say it’s ‘unaffordable’ or it would ‘bankrupt’ us, because the truth is just the opposite.

These are text-book examples of the fallacy of incomplete comparison.

By the way, buried amongst his use of gibberish and non-sequiturs, Quest Diagnostics CEO Rusckowski also opined that Medicare-for-all would be unaffordable without any reference to the costs of the status quo, and hence also provided an example of an incomplete comparison.

The Waldman op-ed noted

The fact that these two highly successful businessmen — whose understanding of investments, costs and benefits helped them become billionaires — can say something so completely mistaken and even idiotic is a tribute to the human capacity to take our ideological biases and convince ourselves that they’re not biases at all but are instead inescapable rationality.

Maybe.  However, it may also be a tribute to their arrogance bred by decades of public relations (which Bernays thought sounded better than “propaganda“) and disinformation meant to soften up the minds of the public so that they will follow the lead of the rich and powerful.

Schultz Also Added an Appeal to Tradition (or to Common Practice)

Also on January 29, the Washington Post reported that

Schultz referred to a town hall hosted Monday night by CNN in which Harris embraced a ‘Medicare-for-all’ single-payer health insurance system and said she would be willing to end private insurance to make it happen.

‘That is the kind of extreme policy that is not a policy that I agree with,’ Schultz said on ‘The View,’ adding that doing away with private insurers would lead to major job losses.

That’s not correct. That’s not American,’ Schultz said on CBS. ‘What’s next? What industry are we going to abolish next? The coffee industry?’

Presumably, by saying “that’s not American,” Schultz means that is not what we have always done, that is not what has been traditional American practice, begging the question of whether that practice could be ill-advised.  Thus Schultz appeared to ladle on an appeal to common practice, otherwise known as an appeal to tradition.

As an aside, the quote also suggests that Schultz’s real concern is not with the affordability of Medicare-for-all, particularly in comparison with that of the current system, but with the financial health of the insurance industry.  But that is for another day….

Summary

So, to protect against the dread “Medicare for all,” that is, proposals for a government single-payer health insurance system to replace our current practice of financing health care through large, mainly for-profit  insurance companies, we see an acceleration of public relations/ propaganda paid by undisclosed donors, that is, via dark money.  We also see prominent multi-millionaire and billionaire executives laying down a barrage of logical fallacies to support the status quo.

It is hard to believe that the defenders of the current system are not mostly self-interested.  That status quo has made some people very rich.

It is also hard to believe they are stupid.  However, a close reading of their arguments suggests they may think we are stupid, or at least befuddled by repeated public relations/ propaganda/ disinformation campaigns.

In 2011, we wrote,

Wendell Potter, author of Deadly Spin, has provided a chilling picture of health care corporate disinformation campaigns and the tactics used therein.

In particular,

Mr Potter recounted how deceptive PR campaigns subverted the health care reform plans of US President Bill Clinton, reduced the impact of Michael Moore’s movie, ‘Sicko,’ and helped to remodel the recent health care reform bill to reduce its threat to commercial health insurers.  He further noted how PR distracted public attention from the growing faults of a health care system based on commercial health insurance, and how practical and legal safeguards against abuses by insurance companies were eroded.

Furthermore, Mr Potter

described ‘charm offensives;’ the deliberate creation of distractions, including the planting of memes for short-term goals that went on to have long-term adverse effects; fear mongering; the use of front groups, including ‘astroturf,’ (faux disease advocacy and/or grass roots organizations), public policy advocacy groups, and tame (and conflicted) scientific/professional groups; and intelligence gathering.  He provided some practical advice for detecting such tactics. For example, be very suspicious of policy advocacy by groups with no apparent address or an address identical to that of a PR firm, or with anonymous leaders and/or anonymous financial backing.

Now it is 2019, once again health care reform is in the air, and once again the defenders of the status quo are hard at work.  Now, they are even wealthier than they were 10 years ago, and have even more sophisticated tools, like social media and its hacks, at their disposal.  Still, however, their arguments are ultimately built on sand.

As I did in 2011, it makes sense to quote Wendell Potter

onslaught drastically weakened health-care reform and how it plays an insidious and often invisible role in our political process anywhere that corporate profits are at stake, from climate change to defense policy.
[Potter, Huffington Post]

So,

The onslaughts of spin will not stop, the distortions will not diminish, and the spin will not slow down. To the contrary, spin begets spin, as the successes of corporate PR functionaries increase the revenues of their employers, further funding their employers’ efforts to create a more hospitable climate for their business interests. Americans are thus being faced with increasingly subtle but effective assaults on their beliefs and perceptions. Their best defense right now is to understand and to recognize the sophisticated tactics of the spinners trying to manipulate them.

Most important is a singular mandate: Be skeptical.
[Potter, Huffington Post]

I still hope that summarizing some of Mr Potter’s amazing points will help us all to be much more skeptical.

You heard it here first.

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99 comments

  1. Disturbed Voter

    Can any system of incentives work, for both the patients and the care providers? The tendency is for patients to seek professional help over over-the-counter remedies when it is unnecessary (hypochondria) and for care providers to over-test and over-medicate (avoid malpractice and promote snake oil). Either you use market-based incentives or bureaucratic incentives. And the bureaucratic incentive can be public or outsourced to commercial enterprise. There is no spontaneously self regulating system, it has to be designed-in.

    Reply
    1. Yves Smith Post author

      Bullshit. Every other advanced economy had a fully or heavily government funded system. Their costs are 50-60% in GDP terms compared to ours with generally better health outcomes.

      Hypochondria is present in only 1-5% of the population. That isn’t a “tendency”. The overtesting is due mainly to bad norms and bad economic incentives like it being perceived to be normal to have an EKG every year with your annual physical (another questionable practice in healthy people) when only people at heart disease risk need an EKG. MDs own the EKG equipment, so this is a profit center for them. Similarly, I knew instinctively that annual mammograms and annual Pap smears were overkill and I’d refuse those tests and get lectured for that. My take has now been confirmed. But those MDs were driven by bad collective beliefs as to what good medical practice was at the time, and not some personal liability fear.

      As for overprescribing, again my perception is that this is more patient that MD driven (save possibly for elderly people who tend where they should be taken off certain meds for a month or two and tested to see if they are still needed). You forget that Big Pharma now advertises on TV and tells patient to ask their doctors about their wares! But the real sins like prescribing antibiotics for flus comes (as in with other cases) with patients wanting the doctor to Do Something.

      I lived in Australia and MDs were very much of the “let’s monitor this” (as in do nothing right now) school, which says that patients are perfectly fine with that if the doctor seems confident and also make clear that he’ll change course if warranted.

      MDs ought to be allowed to prescribe placebos or aspirin at real med prices with some mystery med name and have the pharmacy plan quietly rebate virtually all the price months later for the patients with real problems where meds are not indicated (the problem need to run its course and the most that is called for is palliatives).

      Reply
      1. Redlife2017

        +1000
        From my own experience I completely agree. In particular with your point about the Doctors being in the “let’s monitor this” school of thought outside of the US.

        I’ve lived in the US and the UK for extended periods so can compare and contrast. I actually think that due to the structure of the US system that the US medical system builds a dependency on subscribing more and more drugs to people because MDs and pharmas get the money (not a shocking statement). In the UK a doctor will never overprescribe – even if you want them to. It’s just not a thing at all since there is no incentive except to be a, uh, doctor. They are trying to make sure you either get or stay healthy. The system is built to make sure people have healthcare without weird profit incentives. They even have signs at the GP stating that if you have flu you should just rest, drink lots of fluids and stay home – don’t get other people sick.

        And to pre-empt someone noting that the NHS is having lots of problems – that is completely the choice of the current government (and the government in their ConDem days of 2010 – 2015). The NHS would be in much better shape if they a) stopped all the stealth privatisation (it’s shocking what is going on) and b) just made sure local services were properly funded.

        Reply
        1. Amfortas the hippie

          aye. the stealthy neoliberal colonisation of NIH, and all the scandinavian happy places is studiously ignored.

          with my own experience with healthcare—6 1/2 years to get a hip to replace the literally dead one i was hobbling around on…and now, all the time i’ve spent in and around the gleaming medical center for my wife’s cancer….talking to all and sundry…listing to all and sundry…from wastrels at the bus stop to suits riding the elevator with me…healthcare is a Right, dammit. there is no place at all for markets, privatisation or profit. it is immoral to profit off the suffering of a human being, period.
          that moral argument is what will win the day…even the suits acknowledge it, before passing off responsibility to the System(“well, yes…but we can’t do anything, because the Great God Moloch must be appeased”)
          I am a sacrificial victim to that cruel deity….i’ll be in pain for the rest of my life because i couldn’t get timely care…i still walk around on an ankle that is an enervated bag of gravel, since no ankle guys in texas take medicaid(and i’m kicked off that, now, too,lol)
          I am thankful for my hip, hard won as it was….and i am more than grateful for the level of care my wife is getting…but damn.
          let these ceo’s walk a mile or two in bloody shoes before they lecture about affordability and access.
          their sin is gross indifference to suffering in the service of their own greed.
          fie.

          Reply
          1. Susan the Other

            Exactly. The phrase “providing access” is nauseating. It really means “preventing access” unless you pay. This is nothing more than an obfuscation of blatant extortion. Do any of these patriotic capitalists understand capitalism? I don’t think so. Too much liike a priest understanding god. Is god otherwise unaffordable, if you don’t have a pious priestly middleman to do spiritual arbitrage? For a small fee, of course. They really do think we are stupid. But they forget The Reformation. There just comes a point in time when you can’t politely ignore the lies and destruction. It takes on a life of its own and is unstoppable. This post is encouraging because there is a guy out there named Roy Poses who is connected with something called Health Care Renewal and there is another guy, Paul Waldman who works for the WaPo; and we are reminded of the wonderful Mr. Wendell Potter. And a whole nation on the march. Hope your hip and your wife are feeling better.

            Reply
            1. GF

              Here’s a retweet from Bernie about the latest big pharma price gouge:

              “Bernie Sanders
              ‏Verified account @SenSanders
              Feb 20

              Bernie Sanders Retweeted CNN Health

              Catalyst’s decision to raise the price of a life-saving drug from $0 to $375,000 is causing patients to suffer and ration their medication. Outrageous!

              Catalyst must immediately lower the price of Firdapse.”

              Reply
            2. amfortas the hippie

              danke. i endure w bruxist tenacity. what doesnt kill me…
              wife just went into theater a minute ago. big scarry surgery to remove a volleyball size tumor from belly.
              im fixin to go back and. taker her ring and kiss her on her head and go pace and chainsmoke for a few hours.
              candles are welcome

              Reply
              1. amfortas the hippie

                it was more like basketball sized.
                all is well.
                im lurking around waiting til they get her settled in icu for observation.
                surgeons wings were poking out of his scrubs. even he seemed amazed at the size… and relative ease of removal.

                Reply
            3. animalogic

              Spot on STO. The Catholic Church did indeed work as a middle between you & the Boss.
              The reformation spelled the being of the end of that lucrative nonsense.
              Reformers helped by turning to bibles written in the native tongue (ie Latin on the way out.) Also they made the individuals relationship to God absolutely central: a man & his Bible (not sure how much women were encouraged to read in the beginning.) Thus, we’re the seeds of universal childhood education sown.
              Also wish the very best to Andorra’s.

              Reply
          2. NotReallyHere

            @Amfortas the hippie
            I must say I found your post quite moving. The cynicism of private health insurance companies to protect their moolah is sickening. The mendacious trope that there are no queues in the US while “socallized” systems suffer infinite “rationing” delays is usually trotted out early in their campaigns.

            Reply
            1. amfortas the hippie

              they get away with that bc relatively few americans travel abroad… not to mention the normalised ignorance of the world. add in reality tunnels and “we’re number 1!”… lol

              Reply
        2. PlutoniumKun

          A relative of mine is actually nearly through research on exactly the topic of prescribing differences between Europe and the US. He says he found a very different culture among US doctors (if and when its published I’ll certainly let Yves know, it might make an interesting article or link here).

          As you and Yves says, there is very little evidence of overprescribing or overtreatment in ‘free’ or heavily subsidised health systems. On the contrary, there is evidence of massive overtreatment in the US for people willing to pay and / or with good insurance.

          Here in Ireland there were problems in hospitals because it used to be free to be an out-patient, so the poor/hypochondriac, etc., would clog up waiting rooms instead of going to their local doctor where they would have to pay. They introduced a charge solely to stop this. It was crude, but it worked. It would of course have been much better to co-ordinate charges or put a better system in place to triage real patients from those who just want a bit of sympathy.

          Most GP’s will tell you that about 5% of their patients represent 90% of their workload. Some people either need lots of care, or they are just demanding and go to the doctor for every little ache and pain, while others practically have to have a limb falling off before they’d go. That’s just the way it is, and all systems come up with ways to deal with it.

          Nearly all doctors will give prescriptions even when not needed, because they know people feel better for it. The doctors I know invariably give mild painkillers on prescription for minor things like colds and backaches. Its really a form of acceptable placebo. I’m lucky to have a really good local doctor who runs a small team who are very firm on explaining to people why they don’t always need treatment or prescriptions, even to the point of it being a little annoying sometimes – he refused to burn off a wart I had some time ago, telling me just to go to a pharmacy and buy an over the counter freeze tab. And when I had a diagnosis for mild arthritis in my hip he told me to walk lots and eat natural anti-inflammatory foods – again, no prescription, even something very mild. He seemed surprised that I didn’t argue the point.

          That said, being strict on prescriptions can backfire. I know of a young man who died from a rare bone cancer. He was from a very poor background and looked like a typical junkie – pale skin, skinny, Nike sweat pants (he wasn’t, he just looked like one). His doctor thought he was trying to scam opiates and told him the pain was all in his head. He was a little bit innocent and believed her. It was when he literally collapsed while visiting his girlfriend in hospital that he was examined and diagnosed – it was too late by then.

          Reply
          1. Yves Smith Post author

            One thing I neglected to mention, and it may come up in the study you reference, is that US med schools are all about prescription drugs and operations. So the bias towards turning to the RX pad may come from education (which is how the bad norms I mentioned may become institutionalized) and not fear of liability as the main driver.

            Reply
      2. Carla

        Yves, thank you so much for calling bullshit on Disturbed Voter’s comment. After spending more than two decades as a single-payer supporter, I cannot improve upon your response.

        Reply
        1. Disturbed Voter

          i work in medicine, do you? Mind you, you can have single-payer or Medicare-for-all … but it isn’t free (not free in Cuba or other locations). And medical care will always be triaged on some basis … so expect delay or denial of care. What you see is dishonest accounting, moving costs from one column to another, and hiding the change. And providers won’t work for free either, unless you intend to enslave them. I am happy France etc has good open access care. You might ask how that is done, it isn’t magic. The answer is, they pay high taxes, and don’t spend that on things they don’t want (like endless warfare). As far as drug prices go, Americans subsidize the cheaper prices found elsewhere (not that I agree do this).

          Reply
          1. Dwight

            Do Americans really subsidize cheaper prices found elsewhere, or do they just get gouged?

            Doctors will keep on being doctors, and those that don’t like the new system are free to work in another field.

            Reply
          2. Sanxi

            We ‘all’ work in medicine or get worked over by it. Working in the system does not per se confirm on you any special enlightenment as to public policy. But as to the question yes. In many capacities, the one I like the best is as a trauma surgeon for Doctors Without Borders. Happy?

            Reply
          3. jrs

            Even if all that was all true, you have no idea how unaffordable healthcare has gotten if you think people wouldn’t get down on their knees and literally beg for higher taxes for a decent (and it goes without saying cheaper overall) system.

            If you self-insure and are older it can be $1000 or more a month in premiums for a barely covers much at all plan. People are literally paying more in premiums than their mortgages or rent (if they are older and the housing costs aren’t say San Francisco rents). And then still about 1 in 10 people have no insurance or other coverage at all. And then there are the narrow networks, the places with only one provider for ACA plans, the never knowing what procedure will be covered or not, the fear of accidentally going out of network, the fear of losing insurance (say if it’s employer provided) when you need it most, etc..

            Reply
          4. Angie Neer

            “medical care will always be triaged on some basis…”
            Yes, and the current basis is profit.

            “expect delay or denial of care.”
            As if we don’t have that now? How many people never even make it to a provider to ask for care?

            Reply
            1. Yves Smith Post author

              Yes, and “work in medicine” covers a multitude of sins, like working for a health insurance company, being a MBA administrator in a hospital system (the sort Poses has criticized for years for ruining medicine) or even being a clerk in the office of some doctors. So even his claim of authority is pretty weak.

              Reply
          5. Ape

            As far as drug prices go, Americans subsidize the cheaper prices found elsewhere.

            I suggest you investigate how capitalism works. To show that, you would need to show a capital redistribution in basic research and infrastructure over the long term. Not an easy thing to do, thus something I doubt is actually documented.

            The big subsidy is likely to be government university funding done by wealthy goverments around the world which subsidizes friendly corporations. Not unique to the US.

            Reply
      3. AdamK

        +100000. It is also very common to create a package of services that are provided by the government insurance and leave the rest to private insurance. This package is revised every few years according to scientific reviews and adds or drops services. Plastic surgeries are out unless there’s significant affects to the person’e quality of life. If a patient is interested in an experimental, or not proven, innovation, he can shop for it himself as long as there’s solution that is covered. The same way private insurance deals with such cases presently. As for meds, with big data you can pinpoint to a patient that over uses or a physician who over prescribes, and use this info for integrative medicine purposes to optimize the use of meds to better results. Those methods do not go well with the healthcare industry of course. No one now has an incentive to cut services or meds.
        In general every method has it wastes and frauds which cannot be quantified in advance, the issue here isn’t just cost, it is first and foremost MORAL.

        Reply
      4. Tomonthebeach

        At age 71, I have lived my entire adult life on Medicare for All right here in the USA! I am talking about the US Military Healthcare System. When I retired, I shifted to Medicare A&B. What HHS did not pay, DOD paid via TRICARE for life. I have had 5 surgeries – they all went fine. I often saw a different physician every time I got sick – and they all cured me.

        OBJECTION #1: MEDICARE FOR ALL IS TOO EXPENSIVE? The USA healthcare system is based on legalized extortion. “Pay me or get sick and die.” That is what Americans have. Of course, if shot or in an accident, the hospital will save your life – so you can spend the rest of the life they saved working to pay off the medical bills. Name another country in which the #1 cause of bankruptcy is healthcare debt! How is it that the Defense Department is not going broke offering free medical care to its troops and deeply discounted care to their families? How is it that most prosperous countries (most of the EU) have national health services and are not going broke?

        OBJECTION #2: I WANT TO PICK MY OWN DOCTOR! Does anybody know a person on US Medicare who cannot pick their own doctors? How many lay people are even qualified to know a good doctor from a bad one? Referrals come from neighbors or friends who might assert: “I scoured the Internet and this doctor has 4.8 stars in Yelp.”

        In America, the reverse is sometimes true. Some doctors refuse to accept patients on Medicare because of the cap on reasonable fees. Private insurance lets them gouge the free market. What is an unreasonable fee? I know a GI doc in Missouri who makes about $2 Million a year. My GI doc in Florida makes $200 Thousand a year doing the same work with a similar patient load. Does it cost 10 times more in Missouri to cure a bowel obstruction?

        OBJECTION #3: PEOPLE DO NOT WANT TO WAIT FOR HEALTHCARE. They read an article or saw on TV that in the UK and Canada people have to wait months to see a doctor. The last time you had a routine doctor’s appointment, how long did you sit in the waiting room? 30-60 minutes is a US norm. Last time you needed urgent care how long did you wait? Immediate treatment is the urgent care norm everywhere in the world. Elective procedures often take severla months to schedule because a) they are not urgent, and b) interviews, tests, diets, etc need to precede the surgery.

        Reply
        1. jrs

          people really should be able to pick their own doctor, noone is going to do very good trying to get medical care from that doctor that gives them the creeps/ignores them/causes them pain/etc. every time they go. It won’t work.

          But I think in any decent system they would pick their own doctor (as it is existing narrow networks limit this). I just don’t know why anyone would post as if picking one’s own doctor was a problem, because someone reads yelp. Newsflash: a lot of picking a doctor isn’t about being qualified to know a good doctor from a bad one but about the doctor’s BEDSIDE MANNER. It matters.

          Reply
      5. baldski

        I agree Yves. if the doctors get together and own the facility it will be used. Case in point, my wife had a kidney stone. The urology doctors owned the facility that housed the lithotripsy machine and the machine itself. This was only found out after a due diligence search in the corporations registered in the State of Nevada. It was hidden among three different LLC’s . Also, some years ago the NYT published a study of doctors who buy their own MRI machine and how their use of MRI exams increased in their practice when they owned the machines. It was amazing.

        Reply
      6. Ignacio

        When my wife was working and had private health insurance, physicians recommended yearly mammographs. Then she retired and is now on public health, mammographs are recommended every 2 years. Her parents were rich and she was introduced from childhood in private medicine. (I am the opposite) Particularly in the case of gynecologists, there are many attending via private health services in Spain and my wife had several problems that were mistreated by those fracking busterds called gynecologists that systematically collected high consultation fees and provided very basic old fashion care. Anything they didn’t know (and it was a lot) was “genetic” and I have witnessed such gibberish more than once from VIP-physicians behind their luxurious wooden tables. My respect to these physicians is close to 0.

        Reply
    2. rd

      This graphic is a great visualization of healthcare cost and longevity increases over time from 1970 to 2014: https://www.visualcapitalist.com/u-s-healthcare-system-global-outlier-not-good-way/

      The US is the only developed country that had not cracked 80 for longevity by 2014. The US was the only one that had massive cost increases over that period.

      So, even if the other countries do have hypochondriacs, they are much better at treating them at a fraction of the US costs and get them to live longer to boot.

      Reply
      1. MED

        This could help or hurt the argument.

        Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim (קופת חולים – “Sick Funds”) which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance.[1] In a survey of 48 countries in 2013, Israel’s health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51.[2] In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings[3] and ranked eighth in terms of life expectancy.

        Reply
  2. Mark

    As a non American, I find it quite bizarre when claims like this are made. Universal health care and free/affordable quality education is available in many countries that are far less prosperous than the United States.

    If only the US could look outside it’s bubble and take a few hints from how things are done elsewhere. However being the “leader” of the “free world” seems to make the USA blind to looking outside its own sphere for how things could be done better.

    (Not that the US is alone here. But it probably is one of the stronger examples.)

    Reply
    1. notabanker

      The isolation that Americans live in is a problem when it comes to this. I use the Alice in Wonderland on the other side of the lookinglass metaphor frequently to describe my expat experiences. Being immersed in a different culture, you see first hand how ‘normal’ is so relative.

      Americans do live in bubbles, and within the US there are bubbles, the country is so vast and it’s media is captured. I find it encouraging when people like yourself speak up and call bullshit. I’ve seen some of Sanders healthcare threads on twitter completely ratio’d with Canadian, British and Aussie’s calling BS on the US propagandists that try to attack their systems. We need more of that.

      Reply
      1. Kurtismayfield

        The isolation that Americans live in is a problem when it comes to this. I use the Alice in Wonderland on the other side of the lookinglass metaphor frequently to describe my expat experiences. Being immersed in a different culture, you see first hand how ‘normal’ is so relative.

        You have to consider their news sources as well.. my theory is that the only point of the 5 and 6 O’clock news is to feed into middle class anxiety or advertise a product. The corporate run media wants people scared and to buy buy buy. I would love to see a politician start a campaign where they discuss 20 different country’s health care systems that are better and cheaper than ours, and see how deafening the silence will be from the corporate media.

        As I have said here many times before, just get someone to propose the Swiss system. Anyone that argues that the Swiss are some bastions of communist thought can be laughed at entirely.

        Reply
        1. notabanker

          I did mention the media being captured. And unlike the UK, there is no European influence to counter / add breadth to the BBC. Brits and Europeans have a far more global-centric view of things, if for no other reason than geography.

          Reply
      2. Phacops

        Having to work in other countries provides a swift reality check regarding ways of social organization and doing things. I count such experiences as saving me from believing conservative propaganda here in the US.

        Reply
        1. notabanker

          I am so very glad my kids spent crucial formative years outside of the US. It’s the best possible gift I could have ever given to them.

          Reply
      3. Ape

        Let’s be blunt. US-Americans are massively jingoist (with a few self hating counter jingoists who think that some place else is utopian due to the “love it or leave it”). Part of this is that the US self-propagandizes at Soviet levels.

        It makes people delusional at every level from the working class to the elite. People are nutz.

        Reply
        1. rob

          As long as we are being blunt….. yes people are nutz.
          And for the whole of this century the US is leading the world into the dark ages again. Touting an “information age” while really all the information is propaganda, and people have completely lost their minds and argue as if we want to be the dumbest we can be. WTF?

          Reply
    2. Phacops

      What do you expect for a people who actually hate to travel except for pre-programmed experiences or resorts walled off from the surrounding community? That, and the lack of adequate holiday time to even enjoy their own country. I don’t wonder at the ignorance of the American public about better ways of providing human services and better health outcomes, though I think some such ignorance is deliberate.

      Reply
    3. Buzz

      How very, very true Mark. I’ve yelled and screamed this same meme over and over to no avail. Look around, we’re not the only country on this planet and we DON’T always have the right answers !

      Reply
    4. Grant

      On so many issues though in this country, when we talk about the “US”, we should be clear about what we are talking about. The opinions of rich people in the media, rich and corrupt politicians, strongly ideological people with a class bias that are appointed by politicians, and paid propagandists and “think tanks” don’t constitute the country. I don’t think that those groups have anything to learn about other countries because I think most of them are fully aware that they are not being logically factual or honest in what they say on healthcare, the critiques they give of single payer, etc. Some people maybe are (willfully) ignorant, but I think most of it is gaslighting. It doesn’t matter that every single payer system has lower overhead, is more efficient, has far less social costs, is cheaper as a percentage of GDP and on a per capita basis. It doesn’t matter the reasons why this is the case. There was a WHO study in 2010 that showed that administrative overhead in private systems around the world is three times higher than overhead in public systems, and why that is the case. It doesn’t matter how many studies show massive aggregate savings from adopting single payer here. The data on overhead with traditional Medicare versus private insurance, polls showing that the public parts of the healthcare system (the VA, Medicare, Medicaid) are all more popular than private insurance or things like the Rand study showing that care at VA hospitals are often better than the care veterans get at private healthcare providers. None of it matters, if any person on TV actually cared about factual accuracy on stuff like this, they wouldn’t be on TV. Someone else that was willing to manipulate people and lie would be in their place, and they would be paid well to do so instead of them. You can’t tell me that Jake Tapper isn’t fully aware of what he is doing when he “fact checks” single payer like he has done.

      The public, however, does seem to get it, especially when things are described accurately to the public. Kaiser does polls, they are opposed to single payer, and so they frame their questions in really biased ways. For example, they will ask, would you support single payer if it raised taxes? Well, some respondents say not, although there is still majority support. Beyond the MMT arguments of not needing to raise taxes, let’s just assume that we are trying to make single payer as revenue neutral as possible, for arguments sake. Wouldn’t a more accurate question be, would you support single payer if it raised taxes, but the tax increases were more than offset by a reduction in out of pocket expenditures? Polls show strong majorities of the country support single payer, and that is with very little of those in power and with big microphones supporting the idea. We all know the studies showing the large gap between popular opinion and what the state does on policy. Like every other issue, people want one thing, and worthless people in power want another, and our system doesn’t make it so that those worthless people are really directly controlled by us collectively nearly as much as donors and other interests control them.

      Reply
      1. BCD

        I get the feeling that Jake Tapper and the rest of the CNN/MSNBC neoliberal opinion disseminaters are true believers in the group think about how being fiscally conservative and socially liberal is some kind of moderate sanity that everyone can agree on. Unfortunately for all of us they are wrong and need their opinions checked. The news personalities on TV whether “liberal” or “conservative” are followers not leaders, as soon as conventional wisdom on healthcare, economics or any other issue becomes accepted by the “sane” middle of their group these talking heads will be disseminating new opinions like an echo chamber. These people are chosen or promoted for their ability to follow conventional wisdom that resonates with Oz behind the curtain with his hidden agenda and big wallet to pay for it.

        Reply
        1. Ape

          Its crazy to believe that you can over the long term enforce social equality under vast economic inequality.

          The reality principle always bats last.

          Reply
    5. nothing but the truth

      the reason why no one “in the field” in the US speaks the truth is career risk. People and employers will avoid you like the plague if they sense any bad luck around you.

      Ones career basically depends on the blessings on colleagues (maybe senior). By telling the truth about the sector, they are not pleased. Because, to please their bosses, they have to toe the party line. And so on. So it is eventually a system of keeping you in line, because you know, mortgages, health insurance and stuff. (my main motive to work is to have health insurance – just trying to get a dr appt with insurance is humiliating enough)

      This is the problem in all sectors. The only economists who dare speak the truth never get any jobs of consequence.

      Reply
  3. greg

    Since it is becoming increasingly obvious that our current management team of wealthy white males are both too venal and too incompetent to sustainably manage a global economy, perhaps we should start looking for alternatives.

    It is delusional to think that US healthcare, or any of the problems which beset both the United States and the world, will be effectively dealt with as long as they are in charge.

    It is unreasonable to expect that the over exploitation of natural resources, or sustaining the environment, addressing global warming, and so forth, will happen under their management. This is simply because they are the ones who control the earth’s resources, and they are the ones who most profit from their unregulated exploitation and destruction.

    It is unreasonable to expect that pollution will be effectively dealt with, because the wealthy make a profit from every ounce of pollution, and every scrap of litter, that has ever been, or will ever be, produced.

    Every ounce of CO2 produced, is profit for some wealthy businessman.

    Overpopulation is profitable for the wealthy. It both expands their market for goods and services, and lowers their price for labor.

    Have you not noticed that we have been aware of all of these problems for over 50 years, and nothing has actually been accomplished with any of them?

    Nothing effective will be done, with any of these problems, while they are in charge. It’s all been talk, talk, talk, and from the wealthy, always the seeds of confusion and division.

    Once a problem has been solved, it is no longer an opportunity for profit. As long as a problem festers, there is money to be made.

    Every cost imposed on society is a profit opportunity for someone with wealth and power. There is money to be made, as civilization declines and collapses.

    Reply
    1. Mac na Michomhairle

      You seem to start of suggesting that things would be fine, if it were not for wealthy white males being in charge.

      That is a peculiar perspective that appears to attempt to divert attention from the actual horrifying system itself, and divert potential energy from attempts to change that system, to focus on a mere feature of the system.

      As though, if an investment house screwed over my parents, I devote myself to bettering the world by fighting the men of Connecticut wherever I encounter them, because the house agent who was point person was from Connecticut.

      If individuals in the system stand to profit from it, of course they have a stake in its continued existence; any individuals do.

      Reply
      1. greg

        You won’t be able to change the system without dealing with the people who profit from maintaining the system as it is. They will fight to keep it. As it is, as horrible as it is. And as they have been fighting all efforts to change the system, with increasing success, for the last 50 years. That is the point of my argument.

        And as it is, there is no mechanism to restrain the appetites of the people who run it, nor any longer to restrain the methods they use to satisfy their appetites.

        Any system requires people to run it, and for any system to be sustainable, they must always be those capable of self restraint, in both appetite and method.

        On what occasions do you recall, anyone changing any system, without at least changing the thinking and actions of those at the top? Too often, trauma is required.

        Reply
        1. Yves Smith Post author

          Hate to tell you, but this is about MBAs and lawyers, the professionally educated who see their jobs as increasing profits and are very good at putting on blinkers regarding other consequences.

          More women than men are graduating from law programs. Women are now nearly 40% of MBA programs.

          This is not about gender or race. The blacks and Hispanics who climb the greasy corporate pole are just as bad. I’ve met them in banking.

          Reply
  4. Mike Mayer

    Why don’t businesses in the USA want to have the burden of providing health insurance taken away from them? It is a cost they bear because they need to find, negotiate, buy and administer the health plan. I am surprised most businesses are not lobbying to have the government provide it.

    Reply
    1. voteforno6

      On the other hand, the system of employer-based health insurance does offer additional ways for employers to keep the serfs in line.

      Reply
      1. rd

        I tend to align with incompetence and neglect in lieu of conspiracy theories if the former can explain it, because it takes a lot of effort and smarts to pull off a conspiracy and both of those are usually in short supply across a large population.

        I think we have most companies for whom the health insurance system is just something they have to have and they just go along with the flow because their competitors based in the US have similar costs.

        The one organized group on this is the healthcare industrial complex that are lobbying against any nationalization type of change and even want to get more into the VA and Medicare than they already are. This IS their business and they are focused on it like a laser beam. so the conspiracy theory works for their sector.

        BTW – I am surprised that the inexpensive healthcare in the rest of the developed world hasn’t been a talking point of Trump’s as a “subsidy” to their businesses justifying retaliatory tariffs by the US. The difference between what the US and the rest of the developed countries spends on healthcare is bigger than the entire US military budget as a percent of GDP, never mind the delta between US military spending and the other G-20 countries. So if we could drop our health care per capita spending to a bit below Switzerland’s (next highest), we would have paid for the entire US military budget. If we could drop it down to Canada’s level, we would have saved a year and a half’s US military budget every year.

        And “American Exceptionalism” pretty much ensures that nobody will look outside the US borders for solutions. If we are doing it, then it must be the best way. End of story. No further research required.

        Reply
        1. jrs

          besides the fact that it only makes a little bit of sense even as a conspiracy theory, a few people work just for healthcare and would retire otherwise (they are of course comparatively well off it goes without saying, and yes they SHOULD be able to retire, make room for those who actually NEED to work!).

          But most work for survival day to day and if healthcare comes with it that’s great, but many work without any form of employer provided healthcare at all (because they still need money to survive). I’ve heard 30-40% of the working population has NO employer provided healthcare. The serfs are still kept in line just by even more basic needs like food, shelter, and climate control, or they wouldn’t show up for such jobs, but of course they do.

          Reply
    2. antidlc

      As mentioned by other posters, companies want to use healthcare to keep employees captive. They don’t want employees to leave for smaller firms or start their own companies. It’s a way to limit competition.

      Companies also have a vested interest in keeping the employer-based insurance model:
      https://www.wsj.com/video/why-big-tech-wants-access-to-your-medical-records/F9C51DC8-5238-4D0C-B8BD-73F0FAC92048.html

      They want to be able to use your medical history to decide whether to hire or fire you. The video is quite alarming.

      Reply
    3. Oh

      I think some of the bigger businesses receive some kickbacks for the policies from the insurance cos. Although many pretend that they pay a certain percentage of the premium, a closer look may reveal that they divvy up the total cost by the no. of employees with no real employer contribution. This is just my theory right now but one of these days I’ll find facts to back it up.

      Reply
  5. oaf

    ” the financial health of the insurance industry”

    …Perhaps Government should mandate the profitability of all sectors of the Economy……
    ..or justify why they pick *favorites*…

    Got to keep the trough full; that’s an important pig!

    Reply
  6. zagonostra

    > It is also hard to believe they are stupid. However, a close reading of their arguments suggests they may think we are stupid, or at least befuddled by repeated public relations/ propaganda/ disinformation campaigns.

    Unfortunately, I think in the aggregate both are true: They are not stupid, rather cunning and evil, we are stupid, or rather easily manipulated by a very sophisticated propaganda machine that goes back to Edward Bernays. If you repeat a lie often enough it doesn’t matter if it’s true or not, and by the processes of association (socialism/Venezuela) we are wired in ways that makes us susceptible to blaring lies (some of Koestler’s works come to mind).

    There has to be a tipping point where enough people have built up defenses to the propaganda that enable “we” to go after the bloody bastards.

    Reply
    1. tegnost

      I think it’s less a matter of defenses and more the numbers game, the PTB have been pretty successful winnowing the field. Say a 1000 people work in an industry, someone of those 1000 figures that 100 of those can be replaced (h1b, computers, undocumented immigrants) but the amount they charge stays the same, or more likely is increased to reflect the leaner machine being more productive. Big bonus to top guy. Then it’s well we have 900 employees, we could do the same with 700 employees etc… and on down the line. This has worked really great for the 40 years since reagan. Add crippling student loan debt, winnow out some more people as they have been effectively neutered, basically only able at best to maintain as a steadily depreciating labor unit (hmmm, we need that persons shoes to touch the ground in a medical establishment so the gov can pay us, since that poor schlub obviously can’t, thanks ACA, and once again imo, the whole reason for the medicaid aspect of the ACA) the end result is fewer and fewer successful lives being led, and more and more precarious lives being led. In 2016 the dogs wouldn’t eat the dogfood. Nothing about the numbers have changed so the dogs are going to be more grumpy and indeed some of those dogs which sat on the sidelines last time might be grumpy enough to vote in 2020.

      Reply
      1. Oh

        This is true everywhere you look. From Levis cuting back on their belt loops, using thinner fabric, cuttting back on zippered hip pocket to moving their manufacturing to cheaper labor countries each year or two. Some of these jerks actually run ads to tell you that tags (labels) on the tee shirts are a nuisance. Do they lower the price of the products when the effect these changes? Of course not. Top guy get more $$$ and stock options priced for profit. Screw the customer! We have an oligopoly; where are the customers going to go (jusy like that ba$%@rd Rahm Emmanuel.). AIrlines keep charging fuel surcharges long after fuel prices have declined. Oh, no you can change your ticket to a different person’s name OR changes will cost $150 minimum. It’s because the idiot dogs will keep eating the dogfood even as it’s adulterated with junk!

        Reply
        1. nothing but the truth

          when quality increases, that counts as decreasing inflation.

          when quality decreases, (or you have to assemble the ikea furniture) it gets ignored.

          The other day the Fed vice chair was saying inflation is too low. Where?

          The restaurants i go to have been raising prices 25-30 % pa.

          Even dollar stores are raising prices.

          Except TVs and maybe gas (which is not counted anyway), we easily have 8% inflation or higher.

          The ones on min wage are getting destroyed.

          Reply
    2. Ape

      They don’t need to be particularly cunning.

      Connected, ambitious, willing to sacrifice family, friends and self to climb should be enough. No need to infer intelligence – but no reason to infer lack of intelligence. Its just not relevant beyond a minimal cut off like for health and vigor.

      Reply
  7. katiebird

    It seems like there is a logical fallacy somewhere in this story. ….

    Arizona college student could die because she can’t get copies of her medical records

    The files are locked away in a repossessed electronic-records system while creditors of bankrupt Florence Hospital at Anthem and Gilbert Hospital bicker over who should pay for access to them.

    ….

    The medical records are the only thing standing between her and a lifesaving surgery by a top physician at Johns Hopkins Hospital.

    The doctor has refused to perform the operation without a complete understanding of Secrist’s health history, including what her pancreas looked like when she was originally diagnosed, she said.

    Every week that goes by, the danger increases of another attack of acute pancreatitis that could cause her organs to shut down.

    “Without those records, we can’t go forward. We can’t make me better,” said Secrist, who lives with her parents in Florence. “Having my life, practically, in the hands of a judge and people I don’t even know, who don’t even know my situation, it’s upsetting.”

    Secrist and her primary-care physician sent letters this week to Maricopa County Superior Court urging swift release of her records. Federal and state law require medical facilities to send patients copies of their medical records within 60 days of a request.

    Reply
    1. Sanxi

      No logical fallacies. Instead, at least two violations of law. And just lying by the newspaper. By federal law the records must be made available, any bankruptcy judge would so order it. Second, the physician, may want the records, but it is clearly unethical not to perform the surgery under terms of his state license. That which is stated is almost and urban legend and meme. Seems like the paper was trying ensure an outcome for reasons not stated.

      Reply
  8. taunger

    Thank you for this post that clearly identifies the logical fallacies. This can be useful in conversations #fieldwork

    Reply
  9. Norb

    In the long run, Medicare-for-all lays the groundwork for a more healthy and productive society. Healthy citizens require less healthcare, so there is potential savings over time. Healthcare is most efficient when built around a healthy society. But healthy citizens must be the primary goal, not some abstract argument about affordability and jobs protection. The jobs created by the system must be oriented toward societal health, not the profit generation for a few plutocrats. No wonder they are bemoaning the cost- they have been impoverishing the citizenry for 40 years and sooner or later that bill has to be paid.

    The plutocrats, always attempting to hide their true motives, now seek to obfuscate their abject disdain for working people by using arguments of cost to continue restricting access to healthcare. Their inhumanity must be driven home and called out, but the social discourse is still in “polite” mode. Using the term ‘stupid’ to describe the plutocrats falls in this category. They know exactly what they are doing, and are given a social pass to continue acting in an inhumane and antisocial manner. Chants of USA USA are obscene in this context. The longer this trend continues, only decline can result.

    If people are not responsive to a moral argument, the argument for comparative costs is the strongest one that needs to be constantly driven home. We are already paying- and as pointed out, will be paying much more in the future for less. Everyone can understand that and can see it in their own pocketbooks.

    The moral bankruptcy of the current leadership must be called out. The propaganda bubble that Americans live enshrouded in is showing signs of weakness. That bubble will burst when pricked from forces outside the impirum- and there are many- failure is everywhere and the rest of the world is not as delusional as most Americans.

    Reply
  10. a different chris

    Do these billionaires realize that, in this case the word “unaffordable” specifically means “go die”? Wow.

    Reply
    1. bassmule

      As Lambert has frequently pointed out, NeoCon policy regarding health is this:

      1. “Because markets!’
      2. “Go die!”

      Reply
        1. JBird4049

          The two sets have been merging to where they would be almost the same in a Venn diagram. Almost the entire Washington establishment agrees on what is call the Washington Consensus which is cutting taxes, reducing regulations, free trade, and now apparently the Forever Wars.

          Most of the differences that remains are cosmetic and focus on the social issues so that the selected base will organize, donate, and vote for them.

          For example, gun control, LGBT rights, and pro-choice (abortion) for the Democratic Party and gun rights, religion, and pro-life (anti-abortion). Note that the goal is not to solve or even ameliorate any issue, but rather to inflame them so that they can be used as cover, distraction, and agitation.

          Reply
  11. Carolinian

    It’s all about the Benjamins–logic has nothing to do with it and never has. The largest business in my county is the hospital system which also has the highest paid CEO. And they just became even larger by buying a smaller competing hospital. Yves has pointed out how fearsome the DC health lobby is and, as cited above, the Chamber of Commerce is fully on board. There’s been some excitement because announced Dem pres candidates support Medicare for all but Dem candidates always say they are for reform whereas in reality we get Hillary care in the ’90s or Obamacare after both he and Hillary campaigned on the issue. Probably none of this will stop unless the economy crashes to the point that the medical complex has to accept reform and reality.

    Reply
  12. justsayknow

    ’‘That is the kind of extreme policy that is not a policy that I agree with,’ Schultz said on ‘The View,’ adding that doing away with private insurers would lead to major job losses.

    ‘That’s not correct. That’s not American,’ Schultz said on CBS. ‘What’s next? What industry are we going to abolish next? The coffee industry?’

    I’d say Shultz gives the game away as he reveals he sees the current “system” as a make-work-make profit center.
    I imagine he and Bloomberg et al have significant investments in the health industrial complex. Otherwise wouldn’t it benefit all other commerce sectors to have customers with lower health costs thereby freeing up money that could be spent with them.

    Reply
    1. Eclair

      “What industry are we going to abolish next?”

      Great question, Schultzie! Where were you (or your ilk) when we ‘abolished’ the US textile industry? Or our furniture industry? Or our electronics industry? Or our clothing industry? Or our rail car manufacturing industry?

      And the jobs that went with them.

      Reply
        1. JBird4049

          I think any industry that could be and was dismantled and shipped overseas, with its products being made by cheap, cheap labor and then imported to the now under or unemployed Americans “does not do good for the American people.” does wonders for the fat-cat “Job Creators” f@@@s’ stock options, bonuses, and salaries.

          And can I add much of the tool and die, and glass making, industries? I realize that there are always changes in the industries of any country, and this is a somewhat rhetorical question, but seriously, what industries have we not dismantled and shipped overseas? I know the United States still has a large manufacturing base, but is seems to exist by accident if that makes any sense.

          Reply
  13. antidlc

    Meet the propaganda outfit fighting against Medicare for All (podcast)

    Why do we believe the things we do? Whistleblower, New York Times best selling author and Tarbell.org founder Wendell Potter, along with millennial co-host Joey Rettino, are joined by politicians, activists, journalists and pretty much everybody else to figure it out.

    https://www.tarbell.org/2019/02/the-potter-report/

    Reply
  14. Summer

    I laugh when they say they are worried about “jobs” of people in the health insurance industry. They aren’t worried about the jobs, but exec pay. Everytime I look up there are articles about more automation and tech in the administrative and medical pafts of the industry.
    It’s like Uber claiming to worry about drivers while claiming their future is driverless cars.
    So a good number of people that staff the health insurance industry (talking to you non-wealthy execs) need to get on board now and get their health care covered.

    There aren’t too many industries that aren’t salivating overways to have fewer employees and then you hear all this BS from the same industry “leaders” touting how employer based system is the only thing imaginable.

    Reply
  15. rd

    BTW – latest number I can find

    Canada military spending 1.0% of GDP; healthcare spending 10.4%: Total military + healthcare = 11.4% of GDP

    US military spending 3.5% of GDP; healthcare spending 16.9%: Total military + healthcare = 20.4% of GDP

    So between those two economic sectors, Canada has an extra 9% of GDP to spend on other priorities. No wonder they can have an inflated housing market as well as paid parental leave.

    Reply
    1. Disturbed Voter

      Exactly. To reallocate resources, you have to look at the whole picture, not just the health industry. That is a huge question. What you do with a particular allocation, is pertinent.

      Reply
  16. D

    i always wonder if they are really thinking through when the say that the government (us) but that if we let patients and insurance can pay for it?? Really????

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  17. Susan the Other

    Thanks for this post, Yves. It was really good. It did all the demolishing for us. Deconstructing the whole building. I love the phrase (whether facetious or not) “argument by gibberish.” I mean, it could be a necessary part of a logic curriculum – please analyze this argument for gibberish – because we were once so oblivious. So, more accurately, the pushers are now the oblivious ones. The full court press against “socialism” and “unaffordable health care” and holding up the decrepit free market isn’t going to work much longer.

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  18. Hepativore

    One thing that I also hope that gets changed in the US, is combining dental care with a Medicare For all Program. It is ridiculous that people have to carry both dental and health insurance as good dental care and physical well-being are related. Left untreated, oral maladies can quickly become serious and more expensive to treat. Effective dental care is far from a vanity service.

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  19. DolleyMadison

    Thanks to the Bankster backlash against my trying to stop them repossessing service members cars illegally I lost my job as a Compliance Officer and found myself with breast cancer and no job/insurance. Thank God my county has a Breast and Cervical Health program through Medicaid. And guess what? Had exemplary care by one of the best surgeons in the country (who is, interestingly, a Serbian refugee who came here as a child.) Lumpectomy and radiation, can’t even see a scar. The fee to Medicaid for the surgery was $49,000. (I arrived for surgery at 7:00 a.m. was home by noon so no frills) My mother 7 years earlier had a mastectomy while on Medicare as well as TWO supplemental insurances, one from work and one she bought, by contrast paid $492,000. She stayed in hospital 20 hours. I realize a mastectomy is more serious, but her time in surgery was the same as mine. So why the difference? Her doctor admitted they charge as much as they can and then “negotiate” with the insurance company. Whereas if she had JUST been on Medicaid her cost would likely be the same as mine. Single payer would eliminate this kind of grifting IMO

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  20. richard

    Thanks Yves for posting this. I especially appreciate investigating arguments within the context of logical fallacies.

    Reply
  21. oaf

    …How about ship the *healthcare insurance* industry jobs overseas; where employee, and other, costs would be lower…
    …Maybe if we apply the same logic to them, they will see the light…

    No, that was about the dummest thing i ever said!….

    Reply
  22. Xrystia

    There is no conspiracy but there is a system. It is called capitalism and it’s only framework is the Market in which you must make a profit or lose everything. It’s a high stakes game in which there are only competing individuals. (Use or be used) The more money and power you accumulate the more power you can wield to your benefit. It’s a brutal system which most people don’t recognize has them in its sway. They have been propagandized “individual responsibility” so are blind to the systemic oppression. Capitalism’s profit mandate leaves no room for the social or the Public. Like Thatcher said “there is no society.”

    Capitalism, the Market is now the life blood of the US and most in this isolationist country cannot even conceive of any alternatives. It was not always so. There was a strong Socialist movement in the mid-west around 1800 to about 1910.

    And yes, today there are some alternative voices, Sanders AOC. They might be able to tinker around the edges of the system. But how do you change the belief system (capitalism) of the entire nation? How do you change the belief that the government (public) is always bad and private is good. The elites, the MBAs, the CEOs, the managerial culture and people’s individualism all support and are vested in this system. During the prior New Deal there was still a culture of public service. Some elites were capable of working for the public good and there was a country supportive of those goals. Today the concept of the public good has been banished via neoliberalism. Today MBAs primary guiding principle to the exclusion of everything else (climate, poverty, death) is profit. The people within the system will not change it and will fight to keep it in place. IMHO only a mass movement on a country wide scale has a chance of effecting any change.

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  23. Pablo

    Employers in the US love our current Health “Care” system. It is a “lose your job, lose your Health Care “system”. This has multiple benefits. One is employees are more pliable if not just their paychecks but their Medical care is lost if they lose their jobs. If an employee can change jobs and not worry about his/her medical care they are much quicker to change jobs. If this happens, Employers may actually have to treat their employees better–and that costs money. Not good. A second reason Employers LOVE the current Health Care “System” is that it is extremely expensive. This allows Employers to deny their employees Health Care benefits by saying it is too expensive. Employers get the best of both worlds. Think of it this way. If the US Chamber of Commerce announced this coming Monday that their official position was the US should have a Medicare type Health Care System for ALL US Citizens, the Political Wh#res in Congress would have a Bill written and passed in record time.

    Reply

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