Nima Shirazi and Adam Johnson’s podcast Citations Needed is one of my favorites; they never fail to illuminate their topic, and their research appears to be impeccable. I also like the slightly unsophisticated un-slick audio and editing; podcasting is metastasizing into a big business full of well-funded corporate drones that milk advertising opportunities, so it’s refreshing that there are a few hold-outs that stay resolutely old school. They’re just about the information.
This one episode I’d like to highly recommend. It was mind-blowing for me in a lot of ways, because I knew the basic framework of the situation, but not the details of how we got here.
Almost every wealthy country in the world has some type of universal healthcare system–except for the United States. With over 170 million of its citizens left to fend for themselves in a sprawling and complex maze of Medicare, Medicaid, private insurance, tax credits, child care subsidies, co-pays, deductibles and cost-sharing, the U.S. has not only the largest uninsured population, but also the most expensive system on Earth per capita.
Why America doesn’t have a universal healthcare system has historically been explained away with a reductionist mix of pathologizing and circular reasoning. “America hates big government,” “we love choice,” “Americans distrust anything that reeks of socialism.” And while this is true in some limited sense, it avoids the bigger question of why has American so-called “democracy” rejected the numerous proposals to enact a single payer or other forms of universal healthcare?
The episode is here: https://podcasts.apple.com/us/podcast/citations-needed/id1258545975?i=1000518075917
Since it’s about history, should I do “spoiler” alerts? I think not. The main take-away from this episode, for me, is that:
- Americans are stupid
- I have a new villain! I did not realize that the American Medical Association (AMA) was not just concerned with regulating medicine for good outcomes but is, rather, a monopolistic group that existed to create the hyper-extractive capitalist medical care system that the US endures
- The system is constructed and maintained in part so that employers retain leverage over their employees. It’s just another way capitalists fuck everyone over: we are all forced to be hyper-concerned with employment because it is tied to medical coverage. If you lose your job you may lose your life.
Nima and Adam are fairly calm as they deliver all this information, but it’s mind-blowingly rage-inducing, “pitchforks and torches” kind of stuff. But, no, we’re not going to grab the pitchforks and torches because we can’t afford to get fired for protesting, because we’d lose our medical coverage.
Give it a listen, please.
Nima and Adam do not belabor the point, but: one of the primary ways oligarchs reward themselves under the US system is by getting private medical care. So they don’t have to endure the completely bollixed-up shit system the rest of us do. Every congressperson and president that has failed to go to bat for the citizens’ rights (“you wanted medical care? well, I got you F-35s instead!”) has government-provided medical insurance. You know, the “socialist” stuff that they complain so much about. I’ll believe a god damned republican is serious about medical care when one of them forgoes the congressional plan and goes on medicare or Obamacare. Or, “pay as you go” – except that’s not a bad option for multimillionaires.
Not to defend the present situation, but we must remember it evolved over generations. When Truman, for example, first proposed a national health system, a visit to the doctor cost only a few bucks, and most people with jobs could afford even a hospital stay. So, it didn’t matter that much that Congress wouldn’t pass Truman’s plan, especially with unions strong enough to help distribute the post-war economic boom more equitably.
But as workers lost their leverage, technology drove costs higher, and elaborate bureaucracies and corporate monopolies added ever more “overhead” to each facet of health care, the combination multiplied the economic load rapidly and irreversibly. Politicians obediently did their part, screaming “socialism!!1!” at each reform attempt and distracting voters with attacks on abortion, “moochers”, etc – Ronald Reagan provides a perfect case study for this – and we ended up where we are now, with the world’s most expensive medical care (and rising) and approximately the 38th best quality (and surely dropping).
Pierce R. Butler@#1:
Politicians obediently did their part, screaming “socialism!!1!” at each reform attempt and distracting voters with attacks on abortion, “moochers”, etc – Ronald Reagan provides a perfect case study for this – and we ended up where we are now, with the world’s most expensive medical care (and rising) and approximately the 38th best quality (and surely dropping).
A good case study of how markets make things more efficient, cheaper, etc.
“how markets make things more efficient, cheaper, etc.”
Only when they are properly regulated. Which the AMA was formed to head off.
A blogger I used to follow looked at this as one facet of “the cost disease”. Certain segments of our socioeconomic system seem particularly susceptible to inflation rates far above the standard. “Higher” education is another prime example. Part of it is standards…ever more luxurious (in the case of fancy dorms and multiple food choices and student centers). You can also see it in residential development. I grew up in a midwestern subdivision with ditches for drainage and simple 24 foot wide asphalt streets. There were no sidewalks or even extensive street lights. Compare this to modern (California in particular) residential developments with huge streets (all posted for 25 mph, of course. while designed for 45!) sidewalks, elaborate landscaping, private parks, contributions for “affordable housing” and houses that are now double if not triple in size.
and the elaborate, complicated regulatory and financing system set up to pay for new development. So complicated that City staff struggle to administer it all!
Regarding the AMA’s opposition to healthcare reform: doctors in Canada were strongly opposed to it as well. Our current system owes a lot to Tommy Douglas (Kiefer Sutherland’s granddad), whose Medicare Bill was passed in late 1961 in Saskatchewan. Doctors went on strike, there was much moaning about socialism, etc. The strike was beaten, and the rest of Canada followed Saskatchewan’s lead in the next 10 years.
@6, so were British doctors re the NHS, strongly opposed. Now they are among the most supportive.
Regarding British doctors, they were hugely opposed, thinking they’d lose money. But as this article points out money was the solution,
I don’t know how plausible that strategy would be in the US as doctor’s pay already seems quite high, certainly compared the UK immediately post-WW2.
Almost every wealthy country in the world has some type of universal healthcare system
I believe both Brazil and Egypt both have basic universal health care. I am not sure if they can be called wealthy.
@ 6 Rob Grigjanis
I have read that Tommy Douglas* won when doctors (including the strikers?) finally realized that they would always get paid—in money, not chickens or firewood—for each patient visit.
@ 8 sarah00
I don’t know how plausible that strategy would be in the US as doctor’s pay already seems quite high
Possible selling points might be that it seems possible to run a private practice with the only non-medical staff being a business/office manager and a receptionist. The doctor is free to recommend any treatment that they feel is required, no need to deal with insurance companies. Patients have no such thing as a co-payment so they may show up before it’s a full fledged emergency. As I understand it Canadian doctors do not have as high an income onn average as US doctors but they do well and have much less non-medical hassles.
IIRC, my medical clinic with 6–8 doctors and a revolving set of 6 or 7 residents has one staff member to deal with the provincial billing system.
* For non-Canadians, Douglas was the Premier of Saskatchewan who first introduce a universal healthcare system in Canada.
American doctors also, like engineers, seem prone to hysterical claims of socialism. Although it might be true that the realities of a modern American medical practice, with blizzards of paperwork, Medicare stinginess, corporate finance dominance of HMOs and PPOs, may bring the system to a breaking point, even for doctors.
“American doctors also, like engineers, seem prone to hysterical claims of socialism. ”
Americans in general are prone to such. Our doctors and my fellow engineers are unfortunately just as susceptible as the rest of our population.
I just remembered a holiday visit to my sister’s years ago. Her daughter & husband were up from Virginia. He was changing jobs and seemed to spent hours on the phone discussing the new medical coverage.
I can never remember medical coverage ever being discussed when looking for a job. Some jobs offer supplementary health insurance but basic health care has nothing to do with one’s employment.
Something to remember is around 9 in 10 Americans have health insurance. Many of us are reasonably satisfied with it.
“Something to remember is around 9 in 10 Americans have health insurance. Many of us are reasonably satisfied with it.”
And therefore what?
@ 14 Numenaster
Partly it is for those who are not Americans and may not know this. For others, moving America to a single-payer system will require convincing a lot of people that are relatively ok with how it is now. And this is not about something trivial like switching to a different kind of baked beans. It is not necessarily stupid to want to stick with a status quo that is working for you and your family.
Having said that, subsidize Americans so that everyone has insurance and add a government run single-payer option for everyone who wants it; including those who have employer offered insurance. This would go a long way in convincing people that moving to a Universal single payer system is in their best interest.
marner @13: In 2008 it was only 83%.
And many are only happy as long as their current coverage lasts. But how many can keep the job from which their coverage comes? How many dream of doing something else in life but can’t afford to lose their current healthcare? How much is the country missing out on all this unused talent?
Next to the uninsured, the biggest problem with the American system is the way costs are driven up by the thousands and thousands of insurance company employees, HR drones, and hospital staff necessary to handle all the financial paperwork without adding one iota to patient care. How many of them are part of the AMA? Because most of the actual doctors and other health care workers I know are perfectly aware that the system is broken.
Before the ACA was signed in 2010, 17% of Americans were uninsured and only 70% of the insured people gave their insurance an A or B score. That works out to 58% satisfaction, not a stellar result.
Since the ACA went into effect the uninsured rate fell to 10% and satisfaction increased slightly (more among Republicans than Democrats). You may note that there is no longer any major public outcry to get rid of “Obamacare” and nobody other than a few elected Republicans grouses about socialized medicine. That tells me that US consumers are capable of recognizing when a change in the health system benefits them, but it may take a few years for that realization to break through the messaging.
I agree that single payer would be in the best interest of nearly all the actual humans in the US (I am not concerned with the wellbeing of corporate “persons”). I think our results from the ACA show that US residents are capable of realizing that, eventually.
What proportion of Americans have a car they’re reasonably satisfied with? What proportion of those people actually OWN that car? (i.e. how many of them only have a car because a car comes with their job?). The difference between where the US is now and, say, the UK, is that I *own* my car. It’s paid off. Yes, there are running costs (taxes), but when I need a car (doctor), it’s just… there. I’m not dependent on my continued employment for it to be there. (Not a perfect analogy, but you see what I’m getting at…).
@16,17, 18 and 19
I do not disagree with anything any of you wrote. I maintain, however, that:
Is important to remember when talking about a major policy decision and is sometimes overlooked.
The American dream is now in Denmark
I know someone who works in a hospital, and whose job is to apply the various codes for insurance coverage to various medical problems. Apparently each company has its own system of codes. Isn’t finding the most efficient solution allegedly one of the benefits of capitalism? It doesn’t seem to have worked out that way.
Glad you like the podcasts, it’s one of my favourites. You should give Blowback a listen, first Season was about the Iraq and the Iraq war, second Season just started and it’s about Cuba.
@ 22 Reginald Selkirk
Apparently each company has its own system of codes.
In Ontario there is one code book and anyone can examine it and see what the cost of any procedure is. It probably is on line now but when I needed to cost some things for a project I just wandered over to the local university health library.
There are A LOT of leftist podcasts of varying quality. But the three things I linked below are seriously like nothing else out there. I really do recommend them.
The Deathpanel: Specifically about how horrible American healthcare is, from the perspective of disabled folk. Terrific, tragic and funny. Seriously, at least give them a chance. They’re exceptional.
https://soundcloud.com/deathpanel
I don’t speak German: Two dudes examine American fascism in all its forms. Smart, modern and (ironically) way too late. Good if you can stand to know just how fucky your country really is.
https://idontspeakgerman.libsyn.com/
Struggle Session: Pop-culture (and political) critiques from a leftist angle, which is actually way rarer than one might think or hope. Super funny, too. Great if you need a diversion.
https://soundcloud.com/strugglesesh
OT, but one for your theory on making applesauce:
Something to remember is around 9 in 10 Americans have health insurance. Many of us are reasonably satisfied with it.
“Computer user with internet access, reads blogs” is probably a sample with some bias.
kurt1@#23:
You should give Blowback a listen, first Season was about the Iraq and the Iraq war, second Season just started and it’s about Cuba.
It’s excellent.
My current sub list is:
TWIV
TWIM
1865
Citations Needed
The Dollop
Behind the Bastards
Noble Blood
Revisionist History (not a fan of Gladwell but worth keeping an eye on him)
Dan Carlin’s various neepings (his waffly politics begin to smell of libertarian, though)
In Our Time
Reveal
Intercepted/Deconstructed
The Bowery Boys
Snap Judgement
Philosophize This
Others come and go, e.g. Worst Year Ever and I just dropped 99% Invisible.
Numenaster@#14:
And therefore what?
That was a well-deployed variant of one of my favorite replies to that sort of comment. e.g.: “Eat shit. 12 trillion flies can’t all be wrong.”
jrkrideau@#12:
I can never remember medical coverage ever being discussed when looking for a job.
In the US, capitalists have 2 big levers they can use on their employees. Salary and health coverage. So, it’s a big deal – although now it’s just become part of the landscape of shit jobs. I used to work for a tech company that did a good job of trying to take care of its people. As I was part of the executive team, I had some insight into management staffing – we had 4 people whose full-time job it was to figure out medical insurance. Because it changed constantly and the prices only ever went up. And, the insurers were always trying little tricks like “this plan, which is $100/month cheaper, does not cover any form of cancers.” And don’t get me started on pre-existing conditions.
I lost a friend to a couple cancers last year. He was comfortably retired but the medical bills and the endless fights with insurers ate all his money in under a year and he basically killed himself by refusing further treatment (or “bullshit” as he called it) In the US something like 95% of your typical lifetime medical bills come in the last 6 months. Basically, all the insurance policies and whatnot are a very thin shield, which you discover gets burned through instantly if you have a serious problem. Of course none of this affects the wealthy or policy-makers. I’m sure that’s a coincidence.
xohjoh2n@#26:
Yeah, I saw that. It’s past time for the War On Terror to include cops. On the terrorist list.
bmiller@#4:
Certain segments of our socioeconomic system seem particularly susceptible to inflation rates far above the standard
How do we distinguish inflation from common-or-garden price gouging?
If you want some good history in your podcasts, I recommend Revolutions by Mike Duncan. He’s on the last series now (the Russian revolution of 1917), but there’s a huge archive to binge on, with highlights including the various French revolutions and uprisings, Haiti, Bolivar and Latin American independence, and the Mexican revolution; the series on the Russian revolution of 1905 begins with an excellent primer on communism (Marx) and anarchism (Bakunin) that could be syllabus material for everyone.
Something like 95% of your typical lifetime velocity change comes in the last 6 seconds.
Marcus: I am guessing it is less “price gouging” per se and more a combination of neverending bureaucratization (more and more people processing ways to deny coverage) and excessive luxuries. Colleges, for instance, never had the luxurious amenities many do now-all to attract the full price elites (domestic and foreign). But mostly the layers and layers of functionaries. The biggest private employer in my town does nothing but process health payments for the conflicting and multilayered agencies and programs that somewhat….somewhat…keep (some of) the poor from dying in the streets. Hundreds of employees.
As others have described here, of course. :)
#21 Reginald Selkirk quoting an an article:
Something Adam Fuckin Smith said over two centuries ago in the book which most capitalists claim is as important as the Bible. You would think they would read the chapter on how a monarch should spend tax money to improve the economy.
Who am I kidding. They don’t read the Bible, why should I think they would have read The Wealth of Nations?
@37
Ah, Adam Smith. Praised by the right because they’ve completely failed to understand what he wrote. Hated by the left for pretty much the same reason.
I seriously preferred the healthcare I received in Guatemala to anything I’ve had in the United States since I’ve been outside university student health. Very reasonably price to see a physician, and they don’t fuck around because the people in that country can’t afford it. Quick, simple advice, easy prescription.
Note that despite whatever Marner is droning on about, ~63% of US citizens favor a single payer option. The problem is that democracy of the people in the US no longer works. The US is a corporatocracy.
Well here’s your answer to that – it’s NOT overlooked. Because, newsflash: I live in the UK, and I have private health insurance. Just because there’s a National Health Service here doesn’t mean I can’t have private health insurance. It just means that
(a) for the vast majority of the time I don’t need it (used it twice in over twenty years and both time it saved me a little time – days rather than weeks – off a waiting list for an appointment).
(b) people who can’t afford it don’t suffer more than absolutely necessary because of it.
The impression you’re giving is that those people who have health insurance and a satisfied with it will be – what? Pissed off that some people are getting something for free that they’ve been paying for, if healthcare is offered universally? Is there really a large number of people out there who are so venal and unpleasant as to begrudge others healthcare? (Rhetorical question, I know the answer is yes.)
@ 30 marcus
we had 4 people whose full-time job it was to figure out medical insurance.
I worked for a Crown Corporation with 60,000 employees and never even heard about anyone figuring out medical insurance. We had a supplementary plan that covered the entire country. We probably did have a few employees dealing with it. I find it hard to believe we had more than 5–6 employees dealing with the whole country.