Single Payer Health Care

So much of the health care debate is focused on attacking the ideological underpinnings of proposals instead of on their efficacy. The ACA has been attacked as much for the movement toward socialism as for any operational flaws. It seems now that those flaws, if corrected, would lead to greater government involvement in delivering health care. To not correct the flaws would be to destroy the health care system and return to the unregulated insurance market, which was even more of a failure than the ACA. What would happen if we asked this simple question: “what works in other countries?”

Most Western industrialized nations have adopted a single payer system or hybrid version. All the Scandinavian countries have a single payer system, as do Canada and Taiwan. Great Britain, France, Spain and Australia have hybrid systems where the government reimburses private insurers. How are they working? By almost every criterion, they work far better than our market-based system. Measured by patient satisfaction, all of the these countries have higher approval rates. Measured by costs, all have lower health care costs. Measured by actual outcomes to treatment such as infant mortality, or life expectancy, all are doing better. So, if everyone is getting effective health care for less, what is the problem with adopting and adapting one of their systems?

One issue is that of taxes. The taxes required to provide the single payer system are high. Putting aside the fact that people in these countries are satisfied paying more taxes to get guaranteed health care, what would be the costs of (as an example) going to a “Medicare for all” model? The CBO estimates that taxes would have to increase by an average of $5,000 per person to make the system financially viable. This makes a lot of people a bit weak-kneed, until they consider the costs of purchasing private health care now. The average cost of health insurance for someone not getting their insurance via an employer is $3,400.00 for individuals and $8,700.00 for families per year, not including deductibles. Most American families would actually pass less for their health care!

The most potent arguments against a single payer system are rooted in fears, not in data. Many people fear that government will somehow “screw it up.” This is not necessarily an irrational fear, but with decades of trial and error in other countries, the actual mechanism of the systems is established. Political leadership could be a factor, especially in our system where big money interests control policy. What would be the safeguards we need to put into place? Maybe a Supreme Court or FBI type of appointment where the term of the people in charge would not be related to political regimes?  The most powerful fear is irrational: a single payer system would be an ideological surrender. It would be an acknowledgment that at least with regard to health insurance, socialism offers an advantage over the open market capitalism. Never mind that we already acknowledge as much already with our national defense, or Social Security.

Because the arguments for a single payer system are so logical and empirical, it should be adopted regardless of how ideologues react. Whatever works should be the only measure. However, solving the health care problem is not the issue, as the GOP has proven already with their failure to replace the ACA with anything remotely as effective. Health Care for Congress is a political issue used to get votes. There is a lot of money to be made in Health Care and that means a lot of money to influence the debate in the form of campaign contributions. Your health is just a collateral issue.

Honoring the Flag

This past weekend “The Great Divider,” a.k.a. Donald Trump, condemned sports stars who “disrespect” the flag. Most people recognize his attacks as just another attempt to divert attention from his failed campaign promises, such as repealing and replacing the Affordable Care Act.

However, his selective condemnation of African-Americans while wrapping himself in the flag is clearly more than just a diversion. It may also be a pre-emptive attempt to defend a potential impeachment trial by instigating a culture war (or worse) and aligning himself with “patriotism.” Sounds conspiratorial I know, but let’s assume for a moment that his rantings are not the simple ditherings of a dotard, but are calculated to serve his purpose. Why consistently act to divide Americans, especially along racial lines? Is this just a continuation of the racism of the leader of the Birther Movement, or something even more malignant?

The current apoplectic Tweets were apparently precipitated by Stephan Curry refusing to attend a White House ceremony. Trump “disinvited” the team after the refusal to attend and criticized Curry by suggesting the slight was of the presidency and not the president (“… it is considered an honor to be invited …”). Notable in this regard is that Trump never criticized Tom Brady or disinvited the Patriots when Brady refused to attend. Speaking of double standards and quarterbacks … Trump suggests that Kaepernick is a “son of a bitch” for taking a knee while recently stating that people who marched with Nazis/Alt. Right in Charlottesville were “very fine people.” Race is clearly the target issue, but so is a dangerous appeal to faux patriotism. Defending racist policies as patriotism may have gone out of vogue after Jim Crow, but Trump is casting that same curse in different words. It began with the usual “law and order” stance in response to Charlottesville by morally equating the overwhelmingly peaceful counter-demonstrators with the Alt. Right/Nazis, and then suggesting that police violate the law by roughing up suspects being arrested (a suggestion apparently taken by the St. Louis City Police Department).

Most Trumpanzees will ignore the fact that the same man who invokes the sacrifices of soldiers who have died defending the country as somehow being offended by the protests was the same man who cowardly refused to serve the country during the Vietnam War. They will see Trump wrapped in a flag and articulating the same resentments they share about “entitled athletes” dishonoring the flag. The cult of Trump will follow where he leads, and that is to a superficial and very dangerous definition of patriotism. It isn’t even a conservative vision of patriotism. Antonin Scalia was no bleeding heart liberal, but he affirmed the right of protesters to desecrate the flag, writing that the flag only stands for ideals, such as the right to exercise free speech, especially as it relates to criticizing the government.

True patriotism may be a concept beyond Trump’s reach, but not so populism. If, and when, the Mueller investigation results in criminal indictments and an impeachment trial, Trump wants to be seen as the defender of the flag, the victim of America haters. He will suggest that the impeachment is a conspiracy of some shadow government intended to undo the election. He will imply that his attackers are Muslims, blacks, liberals hiding in the shadows of government and — most ironically — the lawless. He will try to position the charges of his criminality (or even treason) as an attack on America and not on him, just as he suggested Currey’s slight was to the Presidency. If that happens, then the possibility of violence will become real.

 

Changes

As I left for work this morning and saw the clear blue skies and the warmth of the sun, it reminded me of that fateful September 11^th. The memory is still so fresh that it is a little surprising to realize that it’s been 16 years since then. It was an historic moment of profound shock and vulnerability. The attack was followed by months of what became the realization of the best moments of our national character. President George W. Bush had stolen the election with one vote from the Supreme Court and had been playing golf at a record clip. But standing on the ruins of the World Trade Center while embracing a firefighter, he showed the strength of character and resolve that captured the best qualities of our country. He told Americans that we should respect Islam as a religion and that American Muslims were Americans who had also been attacked that day. He made the distinction between the terrorists who had attacked us and focused us on our response to them. However much his administration bungled the war afterwards, W. showed leadership in those early days and it led to a united country.

Now, we have a very different kind of president and country. He may have stolen his election as well, and has already been golfing more than W. did in four years as President. However, the similarities end there. This president is being investigated for conspiring with an enemy to attack our country, and whether he colluded or not, there is no doubt we were attacked and his response has been to deny and divide. Instead of uniting Americans with tolerance and purpose, he has targeted American Muslims with fear mongering, suggesting at one point that we should have give American Muslims special identification and watch them closely. Many of the same Americans who were incensed by the attack on 9/11 now dismiss the attack of 11/7 as “fake news”. Even worse, some Americans admit the Russian attack and say “so what?”. It is a divided, angry nation with the fear of terrorism (Islamic type) nurturing the ugly character of nativism. It is an America that reflects their president, rather than an America being led by their president to rise above fear.

God! I never thought that I would long for the days of W., but who wouldn’t now?

 

Reality Check

Last week we had flooding in Texas, a category 5 hurricane eventually hitting Florida, the largest wildfires in recent history in the West, the most violent earthquake in over a century in Mexico, which was also hit by a hurricane. Yet somehow it seemed like a good week with no major Trump Twitter-induced drama. I do recall something about a deal with Schumer and Pelosi and a very pointed and public diss of McConnell and Ryan afterwards. Oh, there was also DACA, or was that the previous week?

Am I getting numb or has life in the Trump era honed my capacity for denial to the point where reality no longer matters? Just when I was starting to doubt my orientation to reality, I was fortunate to hear a clip of Rush Limbaugh expounding on how there are no more hurricanes than in the past, and they are no more powerful than in the past. He went on to say that the mega-storms were not really mega-storms and that it was all a conspiracy to use the fake hurricanes for fake news on the hoax of climate change. Thank god for Rush. He is like the North Star for the reality challenged. Just when you begin to think you have lost touch with reality, Rush provides another petulant hurricane of his own insanity to serve as guidepost – a clear and bright baseline of insane ideology to measure against any slippage of our own.

Now that the insanity of right-wing media has shaken me from my disorientation, let’s look at what happened last week. Wildfires and hurricanes are increasing in intensity, and they are even more destructive if one considers the damage done even with the tremendous advances in disaster mitigation. Warmer temperatures worldwide have heated the oceans and the withered land mass. Storms, fires and drought are the predictable result. Hurricanes as large as Irma will be dwarfed in the next decade. The denial of the Trump Administration of basic sciences will only exacerbate the disasters. After cutting the NSF, NASA and EPA funding, scientists have begun to flee to European Universities where they can continue basic research, even if their findings will be denied here at home.

Pelosi and Schumer emerged from their “deal” with Trump with Cheshire cat grins – the kind of clueless grins that many people who make deals with Trump have until they realize that he has broken virtually every deal he has ever made from the first hotel in New York City to casinos in New Jersey to his failure to repeal ObamaCare and build Mexican-funded walls. Maybe they did benefit from what appears to be an intended humiliation of the GOP leadership by Trump, but if they are reality oriented then they will be looking for a knife in the back soon.

The Emolument lawsuit is proceeding and it will be interesting to see how these so-called “Federalist” judges on SCOTUS will interpret the clear language of the Constitution. Taken at their plain meaning, the Constitution prohibits exactly what Trump has illegally done since becoming President – enriching business at the expense of the country. Add to that the Facebook admission that fake companies connected to Russian intelligence bought adds that targeted swing voters in key counties in the U.S.; Mueller’s request to interview former White House aids; and the expansion of Mueller’s investigation of Trump family financial dealings (AKA money laundering), then we have three potential routes to impeachment.

Twitters to follow … no doubt.

Hypocrisy

There are so many instances of hypocrisy from politicians of every persuasion it almost goes without notice most of the time. However, the current level of hutzpah from Texas Republicans is worthy of notice for its sheer audacity. Virtually all the Texas Republicans voted against relief for Hurricane Sandy and insisted on budget reductions to offset the costs. While some of the Texans, such as Cruz, now insist they voted against the bill because it contained pork barrel spending not related to hurricane relief, they all insisted at the time that ANY relief bill would be blocked unless the money was found by reducing funding from social safety net programs. They wanted to homeless to suffer so that the other homeless could go back home. This is what conservatives do: complain about the evil of “big government” until they need the help.

Of course, I wouldn’t want the badly needed relief not to get to Texas, but it would be nice to rub their noses in their own stuff. Maybe they should call the bill the “Hurricane Sandy Payback Bill” or something similar. As much as conservatives complain about the self-righteous hypocrisy of liberals, there is more than enough among conservatives to match up, especially among evangelicals. Remember, evangelicals wondered if Sandy was a judgment from God against New York. Maybe God is punishing states that voted for Trump, or for denying climate change … it’s a slippery slope, my conservative friends.

Enough political fun. I do hope that people in Texas, especially the poor and homeless, will get the help they need and stay safe.