The Murky Future for US Health Care

Republicans vow to repeal Obamacare, but President-elect Trump has injected confusion by claiming that the replacement will provide health insurance for all. But many health experts fear what comes next, reports Dennis J Bernstein.

By Dennis J Bernstein

All eyes are on the Republicans and Obamacare, as the dominant GOP now proceeds toward dismantling President Barack Obama’s signature healthcare policy plan, formally known as the Affordable Care Act. What they plan to replace it with is still anybody’s guess.

I spoke recently to public health care expert and single-payer advocate Dr. Don McCain about the debate, the negatives and positives of Obamacare, and what kind of health care system we need in the U.S. to really attend to the medical needs of all people.

McCain, a senior health policy fellow with the group Physicians for a National Health Program, said recently about the current debate, “President Obama meeting with the Congressional Democrats, and Vice President-elect Pence meeting with the Republicans are being touted as a strategy efforts on the two opposite sides of the health care reform debate. But are they really opposites?”

Dennis Bernstein: What do you mean by that? Aren’t they opposites? It does seem like the Democrats are on one side, and the Republicans are on the other.

President Barack Obama signing the Affordable Care Act on March 23, 2010. (Photo credit: Keith Ellison)

Dr. Don McCain: That’s certainly the way they framed it. Of course, they passed Obamacare. The Democrats passed that even though it was a Republican plan. And now the Republicans claim it’s a Democrat plan that has to be repealed. Yet, what are they talking about, as far as reform is concerned? They are talking about tweaking our current system. Well, that’s all that Obamacare did.

We have a highly dysfunctional system, fragmented, with extreme administrative excesses. And a system that doesn’t function very well because it leaves people with insurance in debt. It leaves too many people uninsured and takes away choices for our health care providers, through these narrow networks that are increasing in prevalence.

The Democrats did improve that, but the improvements were very small compared to what needs to be done. The Republicans would turn around, and maybe repeal some of those things, and then introduce their own tweaks. But these are all only tweaks to our current, highly dysfunctional, wasteful, fragmented system.

So the opposite would be an integrated, universal system that provides healthcare to everyone, and eliminates this profound administrative waste. And gives people their choice again. Of course, that’s a single payer, national health program commonly known as an improved Medicare For All–fixing Medicare, and providing it to everyone.

DB: Well… the Republicans would say that’s a budget buster, that’s a big government program, that’s socialism, and ultimately it will be a disaster.

DM: Of course, it is paid through taxes but we already… two-thirds of our health care is already paid for through the tax system. In fact, we pay more in taxes for health care in the United States than other nations pay for their entire health care system.

So tax isn’t the problem. Getting the tax right is the problem, and we’ve got to make it much more equitable through progressive taxes where everyone can afford to pay the taxes that we would need to run the system. But it doesn’t bust budgets.

In fact, the efficiencies of a single payer system actually slow down the increases in health care costs. So we would not be having these high increases every year. Yeah, there’s been slowing for a couple of years, but they haven’t really fixed the fundamental defects, whereas through a Medicare-like system, they do control healthcare costs, much more effectively. So we would all be ahead and we would all have health care.

Signs and buttons at a rally celebrating the TPP’s defeat and supporting Medicare For All. November 17, 2016. (Photo by Chelsea Gilmour)

DB: … Let’s do a compare and contrast: Under Obamacare, how does the U.S. system compare to, say, Europe?

DM: It is much less efficient [with] extreme administrative waste. We pay about a trillion dollars a year in just administration of our system. It’s because it’s this fragmented system of multiple programs, and other reasons, for the excesses. We could recover about one-half of that trillion dollars, and redirect it into health care. They don’t have that in the European systems. They have much more efficient financing systems. None of them pay near what we do, in administration.

DB: And, in terms of actual health care?

DM: The health care systems… the health care delivery systems are pretty comparable. There is a difference and that is that many people in the United States, either because they are uninsured or underinsured, they have excess deductibles that they cannot afford, are unable to access our system. Whereas in the European nations [and] Canada there’s no problem with access.

Yes, there may be some delays in some countries, but that’s mainly for elective care. Any urgent care is taken care of right away and so, overall, the performance of their systems is superior. Commonwealth has done a study a few times of eleven nations and we always fall in last place, the eleventh, as far as the functioning of our healthcare system.

DB: And, what is your concern if the Republicans simply dismantle Obamacare? Will it matter… [if they don’t] have any program to put in its place? What do you think is going to happen here?

DM: It will matter because many of the people who gained insurance under Obamacare will lose it. And they will do virtually nothing to control our increasing health care costs. So overall, it would be worse. …

If they eliminate the subsidies and yet, as they said, they’ll continue the right of anyone to buy insurance regardless of pre-existing conditions…. [Then] the insurance model breaks down, because sick people buy insurance. Healthy people don’t until they get sick. Then insurance will be affordable for no one.

DB: So, what happens in terms of your own experiences as a medical doctor? What have been your struggles and how might they be mitigated so that you can spend your time doing health care, instead of being a businessman? Talk about that. What does that look like?

DM: It really happened with the managed care revolution in the ‘80s, where the insurance companies basically gained the right to contract with doctors, and, of course, they contract with patients by selling them insurance plans. But this physician contracting, they have used to try to slow the race that way, while they continue to ratchet down on the way physicians can provide care to their patients.

So the reimbursement rates do not keep up with inflation. The prior authorization requests that you have to go through make it more and more difficult to get care for your patients.

And now [with] these narrow networks, they’ve made it extremely difficult to get the specialists that your patient needs, because they are not in these networks. So we’re losing choice in care.

Rally in Support of Obamacare outside the US Supreme Court during King vs Burwell hearings. March 2014. (Flickr LaDawna Howard)

And then the hassles, the computers. The computers are designed to assist the insurance company, and assist the government bureaucrats. But they are sure a headache, because they come between the physician and the patient.

Computerized records are a good thing, but the way the computers are being used, it’s increased the hassle factor. And, in fact, physicians now, over 50% of physicians are experiencing burn out, from a Mayo study.

DB: Wow. Now, before we let you go, I want to talk to you about something that’s personal to me. I know you’re a medical doctor, but dental care is very much a part of medical care. I don’t know the exact figures for how many people don’t have medical care now, but more people don’t have adequate dental care. I mean, I have a health plan here at KPFA, Pacifica. But it’s a joke. It’s gone with the second cleaning.

DM: That’s correct. In our proposals for health care reform, we include dental care. Because that’s a very basic, essential health service. And we think it needs to be part of the national health care program.

DB: But, again, it is interesting that in this country … I mean, I remember traveling as a student, and traveling in England, and having a massive toothache. I walked into an office and they took care of me. And I was done. I didn’t get a bill.

DM: Right. That’s the way it should be.

DB: And how would you explain it in this context–Health care is a human right?

DM: Yes. In fact, [on January 3rd] JAMA, The Journal of the American Medical Association, the editor-in-chief wrote an editorial and they’re allowing access for free, that says “healthcare is a right, and as we reform health care, we have to accept that fact.” And it’s a very interesting editorial, and your listeners should look it up.

Dennis J Bernstein is a host of “Flashpoints” on the Pacifica radio network and the author of Special Ed: Voices from a Hidden Classroom. You can access the audio archives at

71 comments for “The Murky Future for US Health Care

  1. Lisa
    January 25, 2017 at 17:32

    Not been following (as few have done) the so called ‘christian religious right’. Since they dominate the Trump Govt then their view will prevail, which is ending all medical insurance (private or public) and social security.

    People make the mistake that the religious right (RR) are just right wing socially (anti-women and anti-LGBTI) and hence if they are male and straight they tend to ignore them, but they are extremist right wing on economic matters as well (as they were created and supported to do by US big business and people like the CIA as part of cold war strategies).

    The umbrella front group the FRC (funded by all the evangelical and extremist churches, including the Catholic church) is quite clear on this, representing the consensus of the RR:

    FRC website: ” As I’ve written elsewhere, serious problems exist with the American economy, largely due to the fiscal, tax, and regulatory policies of the Obama Administration and the looming problems of entitlement spending and obligations and a steadily growing national debt which the Left is particularly disposed to ignore.

    Thus, the drive toward an increasingly socialized, federally-directed economy is animated not by economic fact but political ideology. Us-against-them rhetoric, “class” warfare agitation, and redistributionism under the guise of populism are dangerous avenues down which any nation can trod – ours included.

    So, then, it is simply untrue that all is bleak for America’s families in today’s economy. Furthermore, the way to induce needed higher growth and income is not through the Left’s program of higher tax rates and suffocating regulation. Instead, there are many ways consistent with economic liberty to increase the volume of the tide which lifts all boats. Such ways include tax simplification and reduction, modernizing and making fiscally sound our entitlement programs, streamlining and reducing federal regulations, and so forth.”

    On health:
    ” The National Center for Policy Analysis, for instance, estimates that families pay only 15 cents on the health dollar (i.e. 15 percent of health care spending); third-party payers account for 85 cents on the health care dollar (i.e. 85 percent of health care spending).
    A significant consequence is overconsumption, resulting in rising cost for all families.
    This development occurs through preventing relevant information about costs and prices to influencing behavior in the market. Another subtle effect that goes unchecked is a slow, gradual, but persistent removal of personal responsibility from these important decisions.
    This moral hazard – as health economists call it – not only makes families indifferent to prices”

    This is creepy and would end coverage for any serious illnesses.
    It means the end of risk pooling, a fundamental tenet of health coverage (private or public), if carried to its logical conclusion it means the end of insurance of any kind.
    In the end their ‘position’ is that ‘it is your fault for sinning’ if you get a heart attack or cancer.
    ”risk sharing involves cross-subsidization within the group to pay for the medical claims of the group.
    It is critical that these private transfers are based on criteria fair to all families and promote personal responsibility within the group.
    Of course, compassion dictates that families help one another with costs that are beyond their control, such as unknown genetic diseases.
    But compassion is reciprocal such that all parties need to avoid risky behaviors that result in conditions that unduly drive up premiums.”

    The whackier end of this bunch (difficult to believe) are more honest In that they state more bluntly that any illness is because you ‘don’t live a proper christian life’ and are being punished by god’. To them no proper ‘christian’ has ever been sick, employing breathless ’logic’, if you do get sick it is because you ‘sinned’, therefore you are not a proper ‘christian’ and all ‘true christians’ still never get sick (a classic logical fallacy).

    If you want to understand them you have to actually go and check out their stuff. As the US moves steadily towards a theocracy their positions will dominate the Govt and if Trump doesn’t go along then he will get the boot and theocrat Pence will do it.

  2. SnowflakeCrat0r
    January 20, 2017 at 01:20

    I’m a casual visitor, I came to read these comments to see if what KD said was true; that the comments are all demanding a free healthcare system while ignoring the math in the pursuit of profit of some type.

    The second thing I notice is LOUD Bad Advice dictating the thread.

    I have a dozen friends who were the healthist people I know died from heart attacks, strokes and cancer…..go back into your tea bagger hole

    First off, I Call Augie out as a shill attacking people trying to fix the problem.

    they were not HEALTHY if they had a heart attack.
    I won’t speak to stroke or cancer–I don’t know about those.

    The fact I am still alive shows I know what I am talking about and that the current obamacare nutrition advice is Killing people. Yes DEAD.

    Second, what you put into your mouth is under your control.
    I am bringing friends and family back to LIFE again by getting that sugar, wheat, booze, smoke out of their mouths. apples, carrots, beets, salads with no dressings,74% chocolate, meat, fish, eggs vs statins and muscle damage and more stents. Yeah I know others who got stents at the same time as me, they got MORE stents I got OFF all the DRUGS. Your nutrition is EVERYTHING. you need supplements too, so those arguing against that are wrong too.

    Third, the math does not work for a FSA (Free Socialist Army) healthcare system. It’s a self perpetuating death spiral which never takes responsibility for individual health or does it allow for freedom.

    Fourth, With the 36 federal agencies, and insurance companies exploiting your data today. People need to stay the heck out of the hospital not be going there. That means a new paradigm shift away from the food pyramid of death and boycott of stupid people and business who perpetuate bad health habits. Is it possible to live and die and never see Federal Government? NO? WHY…

    death cults socialists marxists and communists
    Freedom and Liberty

    That’s the STATE of AMERICA 2017

    • backwardsevolution
      January 20, 2017 at 03:26

      Snowflake – you are so correct re diet. The Food Pyramid is a crock. Good for you for improving your health. Keep at it. Best of luck.

    • Realist
      January 20, 2017 at 03:47

      Who ever said that health care should be “free?” I said that costs must be covered, but profits can certainly be constrained from the free-for-all grab-for-as-many-bucks-as-possible privately financed system we have only in this country. You want examples of alternative systems that have worked well? Just look to Europe. Look to Germany, which developed the first national health system under Otto von Bismarck. Now, maybe with the influx of a million non-tax-paying immigrants from the Middle East their system will be stretched to the breaking point and collapse, but it hasn’t in nearly 150 years. And, I don’t think that Germany (except East Germany) has ever been communist and needed that crutch.

      I’ll let Augie speak for himself, but my address to him concerned his recognition that laissez faire free markets are NOT the magic bullet to optimise health care and expedite its development. I’m sure a lot of Milton Friedman wannabees will disagree with me on that point. A bit of advice, Snowflake: do not be too dogmatic about your economics or your embrace of nutrition fades and fixes that may be rather ahead of the actual science, though I realise it’s a lot easier to read a magazine article by Dr. Oz than to slog through the medical journals. Much of today’s “common wisdom” is probably more wishing than thinking, as in wishful thinking.

      • backwardsevolution
        January 20, 2017 at 04:12

        Realist – we are being lied to about Russia, the unemployment rate, the economic recovery, rate of inflation, wars, and on and on. Why would you ever believe you’re not being lied to about nutrition or medicine? Because you are being lied to, and there’s big money behind keeping the lie alive.

        • Realist
          January 20, 2017 at 04:55

          Lied to by whom? Whose regimen did I endorse? I merely said to beware of celebrities who claim to know more than the professionals. I did not say the professionals are always correct. In fact, it is the nature of science and medicine that advances are made slowly and methodically, sometimes involving taking one step back for two steps forward, sometimes getting sidetracked or obstructed from the truth for long periods of time. Admitting that is the nature of science (conditional truth arrived at through trial and error) including biomedical science, which I practiced for a lifetime, does not negate its efficacy or its superiority over other avenues toward “enlightenment” about the physical world.

          The major distinction about science is that it is kept in recorded form (the published journals) which can be checked and corroborated or disproved and discarded. Dr. Oz and a whole raft of popular writers or speakers can opine all they like about how to live the healthiest possible life, but where can we check their assertions? If they cite articles in the literature, fine, we’ll go there and see how the assertions stack up with the consensus, and how they are consistent with first principles of biology and chemistry. If not, your bartender’s opinion might be just as valid.

          That is certainly not to say (as I have already alluded in my definition of scientific truth) that many assertions in the literature are not overturned sooner or later. That is part of the process. It is also not to say that there are no charlatans out there who willfully publish fraudulent material for whatever mercenary or vainglorious reasons. Over time, due to the self-correcting nature of the scientific method, they will be exposed and the asymptotic spiral towards the “truth” (conditional as it is) will resume. I just don’t get how you consider me to be the naive one when I warn Snowflake to consider the provenance and accuracy of the information he chooses to believe.

          • backwardsevolution
            January 20, 2017 at 17:58

            Realist – where did Snowflake mention that he got his information from celebrities or Dr. Oz? You’re assuming that because he is not a scholar, he must be listening to some quack. There are lots of good sites on the Internet where you can find alternative information, where intelligent, learned people have distilled the information they’ve found down to where the common man can understand it. Of course, you must always do your own research. With me, if I read something, I pretty much start looking for criticism of it right away. I question everything. If you go back and forth, back and forth, and back and forth a few thousand times, you begin to understand what each side is talking about and you actually learn yourself. If you really look closely, you can even begin to follow the money.

            I’ve never even watched Dr. Oz, although his program is in the background sometimes at my brother’s house. From what I’ve heard and seen of him, it appears that if you followed Dr. Oz, you’d be going in circles, as he pretty much advocates for everything: do this, do that, this, that. He’s selling a program and filling up hours.

            Many assertions are overturned sooner or later and, yes, over time they are exposed, but there is money in medicine/nutrition and vested interests who want to steer the population towards their particular drug, which does nothing at all but control the symptoms. I’m interested in the time lag between monied interests pushing something and the time when it’s discovered that we were going in the wrong direction. This time lag is much, much too long. Heck, you could actually end up losing a lot of lives (or a loved one) in the meantime. It would be nice to have the extra years, wouldn’t it? The years it took to discover AGAIN what had been BURIED for a long time because money talked more than science or the health of citizens. I’m saying that in some cases the money steered the conversation AWAY from answers.

            We sit here day after day exposing lies. We say “oooh, aaah” over and over again. We follow the money that’s involved in politics, the vested interests who pay off the politicians (arms dealers, weapons manufacturers, resource companies, etc.) Lies are buried, hidden, and it’s only because of people like Robert Parry and others that the truth is found, and that’s years later. Heck, most of the criminals are dead by the time the truth is found out.

            I’m saying that the truth in nutrition/medicine is no different. It is YEARS later that the truth is found. It should not take YEARS or DECADES. Science doesn’t HAVE to be slow, not decades slow. Why are these people allowed to bury truth like this, or steer research AWAY from where they know the truth will be found? Why do they get to dictate what research is going to be done? Why do professors keep spewing out crap, blindly following the textbooks? It should not take decades to realize we’ve been duped, because your loved one doesn’t have decades.

            Anywhere there is money to be made by some vested interests, you can pretty much figure that we are being lied to. Diesel emissions with Volkswagen? Airbag explosions because they were trying to save a dime? The evidence is there in everything we read. It is all around us.

            Why would it be any different in nutrition/medicine? It’s not.

          • Realist
            January 21, 2017 at 01:21

            I did not accuse Snowflake of being a Dr. Oz acolyte, I was just giving advice not to fall into that trap… and Oz is just a convenient catch-all for the plethora of pop medical advice flowing freely on all forms of media today. Proper nutrition is certainly important for health but it is not the explanation for all maladies. And there is far from agreement (less each day it seems) on what an optimal diet should be.

            I would hope that Snowflake or anyone else reads a LOT of medical websites if they are not getting advice directly from a physician. By all means read as much as you can and run it past your MD, if you have one. Lay people can unknowingly miss or misunderstand a lot, not having a background upon which to judge all that they may read. Just consider all the folks who don’t have a clue about the science behind global warming (still a valid description, as the heat content of the planet–atmosphere, land mass and oceans together–rises due to trapped infrared radiation). In certain areas, which may include nutrition, it seems that it is actually the majority that is misinformed or misled. The relevant term is “junk science,” which numerous charlatans are actually fond of applying to the real science. Unfortunately, nutrition science is an area in flux and still not completely understood as many long held paradigms may be falling. All the more reason to take heed of what expert professionals have to say rather than picking and choosing what you just happen to like. There seems to be a “diet,” sworn to by media personalities, for every possible taste.

            I said that much, if not most, of science is far from being settled. I also admitted that there is fraud perpetrated by both individuals and major corporations the main purpose of which is to either gain unwarranted fame or boatloads of money. Those facts will always hinder our ability to make absolutely guaranteed optimal choices in our own health care. The best you can do is to make the most educated decision possible, which is all I was advising Snowflake to do. Don’t just follow the herd because some appealing personality has a segment on Oprah or some similar show, as many people are wont to do.

          • backwardsevolution
            January 21, 2017 at 08:08

            Realist – thanks for your reasoned response. My main concern is the time lag. It shouldn’t have to be this long, not in this day and age. I think if there was a more coordinated effort between researchers, more could be found in much less time. It seems there is too much competition between research facilities when there should be more cooperation, and too much time and money goes into finding drugs to cure the effects (where the pharmaceutical money is made) instead of finding the cause.

            Yep, between Oprah and Oz, I’ve got to go with the bartender too.

  3. Brisa
    January 19, 2017 at 23:33

    The problem with providing dental care is that someone who has a sugar rich diet and poor oral hygiene practices will require repeated restoration and eventual tooth replacement (implants) throughout their life. My 35 years experience as a practicing general dentist has been varied, including being a Medicaid provider. The care funded by State programs is limited and basic, making for a frustrating experience for the practitioner and a less than optimal result for the patient.

    The solution might include non for profit healthcare insurance companies, lots more providers by creating government owned and run professional schools at minimal cost to the student (many who qualify are not accepted) in return for five years of practice in government owned and operated facilities, multi patient ward style organization of hospitals and putting a leash on Big Pharma. Break up the healthcare monopoly and drive down costs.

    The ACA, as it is, dumps 9 million people into an over burdened Medicaid system in which doctors are increasingly not participating. It also has allowed for profit insurance companies to charge outrageous premiums to self employed individuals making over $60K to the tune of $30K per year. It’s a bad law if one wants to fix a broken healthcare system.

  4. Ted Tripp
    January 19, 2017 at 16:18

    I wonder if the rising costs of healthcare just reflect the increasingly poor health of Americans. If we really had access for all to quality medical professionals of all stripes (chiropractors, acupuncturists, herbalists, et al), we might get healthier. However, unless those professionals can adjust the way we eat, nothing will change.

    • backwardsevolution
      January 19, 2017 at 17:44

      Ted Tripp – yes, Americans are in increasingly poor health. It is their diet and their sedentary lifestyle. I just worry that if single payer gets brought in, it might act like a benevolent parent to kill the patient with kindness: sending patients from one specialist to another when really what ought to happen is that they get up out of the chair, turn the TV off, and start eating well and exercising. And all that has to come from the patient. Addicts have to hit bottom, and we don`t want to let that happen. I`ve witnessed this firsthand, the enabling of the addict (making excuse after excuse for them) until it damn near kills them. No one is capable of pulling you up; you have to do it yourself. The minute you take an obese person or an addict and start pandering to them, enabling them, you are in the process of killing them.

      • augie
        January 19, 2017 at 21:56

        ur a fool and perpetrating this myth that everyone should just be more healthy and we won’t need healthcare…..I have a dozen friends who were the healthist people I know died from heart attacks, strokes and cancer…..go back into your tea bagger hole

        • backwardsevolution
          January 20, 2017 at 03:18

          augie – it’s evident you’re rude, but can you read? If you read my posts above, I’ve been saying you need to get rid of the monopolies in healthcare, education, banking, media. Strip out the middle man, the insurance companies.

          Unless your friends were very old, if they died from heart attacks and strokes, then they were most definitely not the “healthiest people”. I like tea, but I’m not a tea bagger, sorry.

  5. Dennis Merwood
    January 19, 2017 at 12:00

    It’s the For Profit Insurance companies stupid!

    Get this bunch of vampires out of paying for our healthcare.

    Our Government should collect a payroll tax from every worker.

    And pay the doctors and hospitals.

    And the doctors and hospitals compete in a truly free market.

    Isn’t it this simple when we cut through all the “isms”?

  6. Herman
    January 19, 2017 at 10:31

    Again, the comments are as or more perceptive than the article. Perverse incentives, overly expensive educational systems, barriers to innovation, restrictions on market entry because of licensure, high administrative costs all add up to the overly expensive health system. Early on we were enamored by Dr. Kildare and never got beyond letting the medical profession dictate how the medical system should work. Top that off with elected officials who fall all over themselves to improve the health system meaning more money, and you have what we have today.

    The advantage of a single payer system beyond universal coverage would be the incentives that would arise to lower costs, and the likely course that would take is an examination of how we provide care and how we could provide an even better product at a cheaper price—kind of like the example of the cheaper and better TVs mentioned earlier.

  7. Drew Hunkins
    January 18, 2017 at 15:41

    It’s just so bananas.

    Single-payer, national health insurance or “Medicare for All” is much more efficient, much less bureaucratic and less costly, it’s worked spectacularly well for decades and decades in the entire rest of the industrialized world yet we in the United States are not allowed to have it.

    We’re a laughingstock on the international stage for failing to provide this simple human right.

    Over the last 70 years anytime national health insurance is earnestly proposed the Medical-Media Industrial Complex gear up and run absolutely relentless and vulgar propaganda campaigns based on fear mongering and half truths. The propaganda is on the level of the 2003 pre-Iraq war WMD hype and the current Russophobia. You soon witness struggling working class folks, who’d benefit greatly by single-payer, railing against socialized medicine with all the anger they can muster, bemoaning how communist doctors will pull the plug on granny and that they’ll be forced to wait two years to have a physician assistant glance at an ingrown toenail.

    It’s absolutely bananas.

    • backwardsevolution
      January 18, 2017 at 16:41

      Drew – I agree with everything you’ve said. The only reason I posted the links to Karl Denninger is because he does have a point re capitalism and innovation. How many discoveries/inventions/innovations would have occurred if you took the profit away? Profit is what makes many of these innovators tick. It’s the air they breathe. Many of the machines that save lives all over the world were brought into being by U.S. innovators who chased “profit”. Take that away, and I’m not sure that government workers, with no incentive, would come up with new ideas.

      Split up the cartels and get rid of the middlemen, and you will have low prices. Innovators should be allowed patents for a short amount of time, but not forever. But take all profit away from innovators? Why would they bother to innovate?

      • Drew Hunkins
        January 18, 2017 at 18:28

        Salk has always claimed that he came up with his wonderful invention simply b/c it was his life’s passion and that’s what he did as a professional. He said making oodles and oodles of money never really entered into the equation.

        Much of high technology and life saving machines were invented and honed in university settings (many public univ.) and the thinkers and scientists who put it all together initially often didn’t necessarily have the thought of making billions of dollars in their minds. It was merely their life’s work and passion.

        Gov’t workers came up with the internet and all sorts of innovations and didn’t really have the profit motive urging them on, same with many of the innovations in aeronautics. It was only after these products worked out well that they were spun off to the private sector. Gov’t workers do wonderful work in all sorts of agencies and public university settings. Sure, the profit motive is an impetus for some, but for many of these professionals it’s simply their life’s work, making boat loads of cash is a distant secondary consideration.

        • backwardsevolution
          January 18, 2017 at 20:58

          Drew – yes, my heart says you’re right. Faraday with electromagnetism (he hated math, refused to use commas or any punctuation, no capitals). It took Maxwell (who thought mathematically) to come along and see the math in Faraday’s work, which he put down on paper. It took Einstein, using Maxwell’s work (from Faraday) to come up with his theories. One working off the other.

          I remember reading about one of the guys who discovered the structure of DNA saying that (I hope I remember correctly) he never wanted to be bogged down with too much information, didn’t ever want to go too deep, but that if you gave him a problem to solve, with just the outside parameters of the subject and an objective in mind, he could solve it. I think they use their intuition more than anything else and they like to connect dots, see connections in things.

          I know in my heart you are right, Drew, because that’s the way my mind works too. Universities (through corporate sponsors) steer research, usually AWAY from a cure, ALWAYS on a money fix (prescription). IF we paid people who were born to do research a decent wage (just something they could barely live on), we could probably solve a lot of things. There are people who would do it, as you say, just for the love of it.

          But money talks as well, and usually not in a good way (not interested in finding the cause of an illness or curing it, but interested in new pharmaceuticals that just treat the effects of the disease, that make them a lot of money).

          With socialism you could end up with another huge bureaucracy (or not; depends on how it’s set up). With capitalism you could end up with much lower prices (Denninger says 80% lower) and no government bureaucracy (again depending on how it’s set up).

          Thanks for the conversation, Drew.

          • Realist
            January 20, 2017 at 03:21

            Oh, that doesn’t sound like either Watson or Crick (or Wilkens, or Pauling). I met them both and worked in the field myself (years after them). Crick had absolutely eclectic interests ranging from physics to molecular biology to cosmogeny to brain chemistry, but he was no dilettante in anything he pursued. He immersed himself in whatever field interested him and in a short time would come to know more about the subject than lifetime practitioners. Watson stayed focussed more on molecular biology alone, but he strayed off into administration–doing more mentoring and sponsoring than his own research, and occasionally put his foot into his mouth on controversial politically-charged peripheral issues, like the genetic contribution to IQ, so now he’s condemned as a racist by activists who couldn’t pass a high school biology course to save their soul. E.O. Wilson was also the victim of a similar hatchet job by the politically-motivated. Become famous enough and a lot of things, many quite unfounded, will be said about you. (Don’t propose to identify genes linked to human intelligence or even human behavior if you want to avoid controversy and land a big grant without a lot of hassle, though some have succeeded.)

          • backwardsevolution
            January 20, 2017 at 18:21

            Realist – my first guess was Crick, but I couldn’t remember. As you say, he was eclectic. I think you have to be that way if you want to see, because each discipline will have similar truths, connections.

            “He immersed himself in whatever field interested him and in a short time would come to know more about the subject than lifetime practitioners.” Yes, why is that? Because he said he didn’t NEED to go too deep, he didn’t need to know absolutely everything. He said that’s where most researchers got in trouble, they went too deep, ended up not seeing the forest for the trees. Became so immersed in trees that they didn’t see the patterns/connections.

            Watson – “…like the genetic contribution to IQ, so now he’s condemned as a racist by activists who couldn’t pass a high school biology course to save their soul.” Ain’t that the truth. I don’t know why people get so upset about stuff like this. IQ isn’t everything. In my mind, all it means is that the person with the higher IQ is probably going to be able to figure stuff out, find answers to questions, but might not be able to hold a really good conversation, wouldn’t want to hold the hand of a dying person, or couldn’t draw a flower if their life depended on it.

            We are all good at something, all of us. If your IQ isn’t as high as others, you can bet you’ll be better at something they can’t or wouldn’t want to do. It doesn’t mean you’re stupid; it just means you probably don’t want to problem-solve.

      • Joe Tedesky
        January 18, 2017 at 18:45

        A marketing friend of mine was brought in to analyze why this medical equipment company was having a hard time selling a portable medical testing machine to hospitals. This was in the 80’s. My marketing friend after doing his research to see why this machine couldn’t sell for $850.00 per unit, came back with the answer. The answer was to price this $850.00 machine at a selling price of $8,500.00, because at the lower price the medical field wasn’t taking this piece of equipment seriously. At that time any medical testing equipment under the price of 5k was thought to be inferior. This particular piece of equipment flew off the shelves at the new higher price like the all you can eat hot cakes at a fat mans buffet at I-Hop…or at least to say the sales were very very huge.

        • backwardsevolution
          January 18, 2017 at 20:05

          Joe – that’s a funny story, and I’ll bet it happened just that way. It was probably a great piece of equipment too. Nowadays, most things that are manufactured in China are junk (tools, appliances, etc.) Things made in the U.S.A. way back when were often things you had for life, not just a few years. I hope that happens again. Well, it’s just got to because we can’t keep filling up our garbage dumps with more useless stuff.

          Speaking of garbage – I watched an interesting program on what happens to computers that are sent to the recycling depots. The stores tell you they recycle them, but what the TV program highlighted was that they’re recycled onto the coast (dumped!) of Africa, where the children strip them apart. Big huge piles of metal all over parts of the African coast. Out of sight, out of mind, I guess.

          • Joe Tedesky
            January 18, 2017 at 21:54

            That story about children in Africa reminds of a documentary I saw where sea going ships are taken to India where they deconstruct the ships into scrap metal. Now, don’t get me wrong the issue wasn’t about this business being done in India, but it was more about worker safety issues, and environmental concerns that are being thrown to the wind to yield higher profits. It would be one thing if technology wasn’t there to avoid such calamities, but we do know better, and these nonunion workers who are desperate to make a living die from all kinds of unnecessary accidents, and even more so from toxic related illnesses. Remember most of these old tubs are asbestos coated to the hilt. Oh, but the profits, in this case deregulated savings, is beyond the imagination.

            I can’t remember what medical machine my marketing friend researched, but he said that every time after working for the equipment firm when he went to a hospital he saw these pieces of equipment everywhere. This can only happen in a country that puts profit ahead of human life. We citizens should do what Anna above suggested, and sue these bastards where hurts them the most, and that would be where that 3 trillion dollars is that you talked about in your comment earlier.

            Oh and that product longevity thing is just another evil word to a manufacturer no matter where it’s made. Stay well live long Joe

    • Rob Ert
      January 19, 2017 at 01:16

      Insurance is a contract whereby a group shares the risk of a low probability but costly event. What we call health insurance in the US is not insurance at all. It is a cost shifting mechanism that allows the costs of very probable or even already existing problem, to be transferred to a larger group to be paid for by all. Can you buy insurance coverage for your home when it is already on fire? Auto insurance after your car has already been stolen? Liability insurance to cover someone your dog bit last week? All of the actual insurance policies you do buy have requirements you must keep up with to avoid losses as well like don’t leave your car unlocked with the keys inside at the store, or don’t get a bunch of speeding tickets. If you want to share risk in a pool with others then you damn well better expect to have some basic rules to comply with. Start with the obvious health risks. Anybody want to join the group of 400 pounders that smoke, do IV drugs, already have high blood pressure and type II diabetes,and get winded pulling the lever that puts up the foot rest on the Lazy-Boy?

      • backwardsevolution
        January 19, 2017 at 01:52

        Rob – your last sentence painted quite the picture. Thanks for the laugh.

      • backwardsevolution
        January 19, 2017 at 02:18

        Rob Ert – just what Karl Denninger (above posts) was talking about. You could buy insurance for the “low probability/costly events”, but the rest could be paid out of pocket with cash. If you are in good health, if you have looked after yourself, your expenses will be low. If you are, as you say, 400 pounds and a smoker with high blood pressure and Type II diabetes, then it’s going to cost you to maintain that lifestyle. Maybe paying for it yourself might concentrate your mind, forcing you to get healthy. Could be the best thing that ever happened to people in this situation (who are increasing in numbers every year). If people are never allowed to hit bottom, then the bottom eventually comes up to meet them.

    • augie
      January 19, 2017 at 21:53

      you are exactly right….I recall when Obama was trying to pass single payer…seeing signs at the tea party rigged town halls that said….”take your government hands off my Medicare”… a lot of Americans are idiots like most today after 7 years that ACA passed still don’t know that Obamacare IS the Affordable Care Act

  8. January 18, 2017 at 14:39

    Anna, the first commentor to this article, had an excellent idea. Why don’t the America people join in a huge class action suit against the government for lack of health-care and corruption in implementing current systems, the latter for which would also probably fall under anti-racketeering laws.

    Anyone interested ???

    • Sam F
      January 19, 2017 at 14:52

      There is an excellent idea. I expect to enter such a racketeering suit against the judiciary itself. But for the same reason you can see that the USG will not permit a racketeering suit against itself, regardless of the facts and extremity of need.

      Our judiciary is so corrupt that facts are never a problem. I say this from long experience, with no interest in anything but the truth. Indeed facts are never even mentioned or considered, and neither is the law or prior decisions, if the defendant is a USG agency, any government entity including towns, a Repub, or is rich, Jewish, or shares the ethnicity of the judge, or is female with a female judge. There are exceptions, of course, such as when both parties are of the same group, but those are the real rules of the judiciary, state and federal, at all levels. Judgments are nothing but a propaganda product of legal-sounding excuses that anyone with knowledge and experience can see are absurd and utterly unlawful (except in the cases mentioned).

      There are no constitutional rights. Those are just excuses for prejudice when it suits the judicial racketeers, and are completely ignored at all other times.

      However, if you could get enough publicity, it would certainly be interesting. People would be interested to hear the excuses in such a case. Communism, subversion, etc., etc…

  9. Zachary Smith
    January 18, 2017 at 13:54

    A medical issue which I seldom see discussed is the rationing of Medical Degrees in the US. My link says it is related to the much higher status afforded to the US citizens who actually do get through the program. I have a gut feeling there is more to it, but don’t know enough to say. In Florida a few years ago some family members had health issues and I was amazed by the numbers of foreign doctors involved in their treatment. My main objection to these people was their relatively poor English – understanding what they were saying was not a trivial issue.

    I wonder about how much “supplementary” education the foreigners must take – do the Medical Schools have a dog in this fight?

    Then there is the issue of “interns”. Do these cut costs at hospitals, and is this an issue in the rationing?

    Speaking now about strictly my own opinion: US doctors ought to be well paid and have decent lives when their work-day is over. But they ought not be allowed to become multi-millionaires by setting up networks of “Clinics” with captive testing devices and labs which are in full use whether those tests or labs are needed or not. Getting back to Florida, the doctors I saw were all well off, but the Americans were definitely the richest. All of them were heavily invested in those “Clinics”.

    My relatives had first-class care – though extremely expensive – so long as their money lasted. When that money or insurance ran out, all of a sudden it was time for hospice, and that’s a place where they saw to it that the patient wouldn’t be a drain on society for very much longer. One Hospital Hospice executive I encountered could have climbed into H.G. Well’s time machine and gone to Nazi Germany without missing a beat.

    • backwardsevolution
      January 18, 2017 at 16:14

      Zachary Smith – there is a blogger I visit frequently who detests unions. He goes out of his way to cream them every chance he gets. One day I happened to state that the largest and most powerful unions were not the little guy working in some factory, but outfits like the American Medical Association. He stated that that was ridiculous, that the AMA was an association, not a union. I answered back that they just had a fancier name, but they were still a union of people who were intent on keeping prices up and, instead of just wanting to make a decent living (of course doctors should make way more than the ordinary fellow), were rationing licences in order to keep wages way up.

      There are a ton of Canadian doctors who end up in the States, along with every other nationality. They go to subsidized universities in their country of birth, and then hightail it to the States to make their fortune. The U.S. is a magnet for the big bucks. Now, what does that tell you about how much fluff is in the system?

      I spoke with a doctor from Egypt often. She had been a practicing doctor for at least 20 years in Egypt. They soak these doctors, who must take years of education again in order to practice in the West. Of course, some of this extra education is probably necessary, but years of it? Even if they just allowed them to set broken bones or just handle patients coming in with colds or the flu, their sheer numbers should bring prices way down.

      This is a closed system that functions in order to KEEP prices high, keep numbers low. These guys are masters at supply and demand: lots of demand, not enough supply.

      And what is the reason for bringing in lots of foreign doctors, anyway? I mean, shouldn’t they be making it easier for Americans to get into medical school? I’m sure there are many people who would love to enter the field.

      Interns? Probably like law students who must article beforehand? Good environment for them to learn in; they get immersed in the mayhem.

      I spent the better part of an afternoon in an adjacent room in a doctor’s office one day (as I had injured an eye and this kept me out of the light), and one after another of the patients who came in (I could barely hear through the walls) were coming in for a sniffle. One after another! 99% of the patients I overheard were there for that reason. Surely they could set up cold and flu clinics to handle this traffic (maybe interns or nurses could do this). This would bring the price way down. If they at all suspected it was something other than a cold (perhaps a heart problem or suspected pneumonia), they could send the patient immediately down the hall to the doctor’s office.

      The whole system needs to be streamlined, more clinics set up at a far lower cost. Health care could and should be affordable, very affordable. Get rid of the monopolies and see the prices slide. Of course, it would help if people started to take care of themselves (not that I’m great), made healthy lifestyle choices (diabetes is exploding and will be a tremendous drain, and it could be almost eradicated if people changed their ways).

      Get the AMA out of its own way. If lobbying and campaign financing was stopped, and they weren’t able to influence the politicians, that would go a long way to fixing the problem. The politicians could then act in favor of helping the public.

      • Brad Owen
        January 19, 2017 at 13:17

        There is also an interesting history where, in the late 19th/early 20th centuries, the MDs (allopathic Doctors) practically ran the naturopathic and homeopathic Doctors outta town, in a naked power-play to “corner the market”.

  10. Peter Loeb
    January 18, 2017 at 08:23


    It may be just a coincidence that the health care complex was
    a prime donor to the campaign of Barack Obama in 2007-
    2008.(In the millions of dollars). See: Paul Street, BARACK OBAMA
    AND THE FUTURE OF THE DEMOCRATIC PARTY (2009, esp. Chapter on “Dollar

    —-Peter Loeb, Boston, MA, USA

    January 18, 2017 at 08:16

    I am impressed with the quality of almost all of the previous comments. Joe, nice chatting with you again today.

    I want to make two points.

    (1) Bernie, I thank you for reminding us that Trump came out in favor of single-payer some years ago. I think that’s close (if not exactly) what he will do. He’s going to cut out the insurance companies who are the true benefactors of Obamacare, which probably did, thankfully, cost Hilliar the election. It’s nice that the people realized how pathetic Obamacare was and still it. It will be repealed. If you apply “America First” to the medical coverage situation, it logically yields a form of medicare heath care benefits for every American. That is how I wrote my little book on Trump, simply applying his criterion for public policy, “America First,” to every situation and I came up with the book. I am not surprised that the real life President-elect Trump is “following” in my logical footprints.

    (2) My wife and I lived in Ireland for six years. They have a universal health care system. For us oldsters—we were over 65 for our entire stay in Ireland—we paid for nothing. Not for drugs, not for specialists, not to see our EXCELLENT physician. There were clear divisions of labor. Our personal physician, called a “doctor,” could do absolutely no procedures whatsoever. For shots and “minor” surgery we had to make an appointment with the nurse in his office who would do the procedure. For slightly “bigger” things our doctor would refer us to the local hospital where a specialist would take care of us. Cost us nothing. We often had to wait a long time at the hospital to see the new physician, but it was worth it. Everyone we saw, both my wife and I, were truly expert and caring physicians. My wife needed some extremely sophisticated blood tests—no problem. We had to wait an extra four hours for the results and as a result we were the last people (except for the caretakers who had to stay longer just for us) to leave the hospital. No problem. No charge. They even served my wife British tea and toast since she was the patient and, for some reason I forget, in a wheelchair. I didn’t get any because I was out in the waiting area.

    In addition to all that free care, the Irish Medical System also gave me two free high-tech state-of-the-art hearing aids. I wept on the way home listening to a CD of Irish music. Again, no charge but excellent and friendly care.

    I did need an upper body MRI and I didn’t want to wait my turn in the public queue. So I hired one out at a local private hospital. I was in the “machine” for almost an hour as they were taking pictures of my shoulders and some muscles in my back—car accident stuff. This was a for-charge service. In the USA the charge would likely have been several thousand dollars. Here in Limerick City in Ireland, the full-private-pay-cost to me was $450. That was it—and my auto insurance covered it.

    Obamacare and the American profit-incentive “competition” in medicine is very expensive. From paying insurance premiums via Obamacare to paying outlandish costs for such procedures as MRIs, the American Way of Medicine needs to be fixed and President-elect Donald Trump is going to do that.

    Fear not (one of the dumb themes in the article).

    • backwardsevolution
      January 18, 2017 at 15:36

      Bart – I wonder if the insurance/pharmaceutical companies have been raising prices like crazy because they KNEW this was going to happen (they’d be cut out), and so they went to town on gouging and making gross profits while the going was good?

      Same with the bankers. Instead of splitting up the big banks that caused the 2008 financial crisis, Obama brought them in for a nice chat, and then sent them back out to gouge some more, pay themselves gross amounts of money, and get much, much larger than they were before the crisis happened.

      For a start, the medical, banking and media monopolies need to be ended, like yesterday. They’ve all been instrumental in sucking the U.S. dry.

    • Joe Tedesky
      January 18, 2017 at 16:01

      Bart just about when I start wondering where you have been, and there you are. Thanks for sharing your Irish medical experiences. There is a lot to take away from what you told us. Take care Joe

    • augie
      January 19, 2017 at 21:49

      there is only one problem with your theory….Trump will NEVER get the corrupt GOP to pass single payer….not in a million years pal

  12. backwardsevolution
    January 18, 2017 at 06:55

    Last post by Karl Denninger:

    “No, “bidding for drugs”, as Trump said, will not fix the problem. Last year Medicare Part “D” (drugs) spent $95.2 billion. Yes, that was up 26% from the previous year, but the fact of the matter is that even if you cut that acceleration rate to zero the rest of the $1,417 billion would continue to accelerate, with hospital payments up by 8.4% last year.

    You have to put a stop to all of the medical pricing games, the collusion and the rank violations of long-existing law found in the Sherman, Clayton and Robinson-Patman Acts.

    You cannot simply “negotiate” on the government side. I remind you that outside of prescription drugs the federal government already mandates “reimbursement rates” for medical procedures including hospital charges on both the Medicare and Medicaid programs, and yet that spending went up 8.4% last year anyway.

    8.4% is wildly beyond even the most-optimistic view of economic expansion under a Trump administration — and those optimistic views are unlikely to be met. Some improvement is likely due to tax and regulatory reform but there is no way it’s going to eclipse an 8.4% acceleration in spending.

    Further, any attempt to do so on the “government” side for Medicare and Medicaid without forcing the private-sector side to adhere to the very same set of laws will simply cause the medical firms to shift the expense to those not on the government dole.

    That’s probably you.

    If Trump does that then you get butt*****d. If Price manages to get balance billing into Medicare (which he has formerly advocated for and in fact tried to get passed!) then every Senior will get butt*****d and as they get older and sicker, after being forced into Medicare, they will all have their entire net worth stolen.

    If Medicaid is block-granted to the states, then the states will have a fixed pile of money “given” to them, but the mandate for Medicaid will continue and with a ~9% acceleration in cost not matched by the block grant, every single state budget will detonate within five to ten years.

    Medical spending is approximately 19% of total GDP today and 37% of federal spending last fiscal year.

    The only solution to the problem is to take the ~$3.5 trillion “medical industry” and make it a $1 trillion a year industry by enforcing the Sherman, Clayton and Robinson-Patman acts against each and every actor in same. […]

    We don’t need new laws — we need vigorous enforcement of existing, 100+ year old law.

    Folks, it is this issue that Trump either must address now, in the first 100 days, or the rest doesn’t matter.

    If you’re a Trump supporter then you need to be 100% on board with this and make damn sure he is held accountable to it because if he doesn’t address this specific issue in this specific fashion, then the rest of his agenda literally does not matter. The federal budget will collapse and attempts to stave it off will at best buy a couple of years while forcing said collapse down on the states as well.

    Again, there is no “halfway” measure that will work. The only answer is to break up all of the medical monopolies and enforce all of federal (and state) anti-trust, anti-competitive and deceptive practice laws against every medical provider, whether it be a drug company, a pharmacy, a hospital, a practice, diagnostic centers and even individual doctors.

    We either do this and return health care to a $1 trillion a year industry from a $3.5+ trillion industry or this nation dies fiscally, and if you currently suffer from a chronic condition that requires ongoing medical care or pharmaceuticals there is a good chance you will die physically as well.

    This is not politics.

    It’s math.”

  13. backwardsevolution
    January 18, 2017 at 06:39

    Karl Denninger makes a case for capitalism over socialism (providing the monopolies are ended):

    “Roughly one dollar in five spent today in the United States goes toward health care. This is double what other developed, industrial nations spend and virtually all of them have socialist health care systems. Capitalism always beats socialism because capitalism adds the motive to undercut your competitor(s) on price along with developing new means of efficiency that lower your cost, allowing you to earn the same margin while charging less money.

    It is this motivation that has led to $200 TVs that weight 25% as much, use a fifth of the energy and have four times the resolution of a TV set 20 years ago that cost $800. It is this motivation that has led to the development of $35 computers the size of a pack of cigarettes that are 200 times faster and have more than 1,000 times the memory of a $2,500 computer sold in the 1980s. It is this motivation that has led to the development of $50 cellphones you can hold in your hand, have a $30/month “all you can talk” bill and run a week on a charge with 30 minutes of talking a day. The same capability used to require a device the size of a small briefcase that cost $1,000, it weighed 20 pounds, had a battery that was good for an hour of talk time and cost $2/minute to send or receive a call.

    I personally have owned all of the predecessor devices I mention in the above paragraph, and many of you have as well. Medical care and technology should follow the same cost:benefit curve but it has not. The reason is not because it is different than anything else. […]

    Capitalism only works when it actually exists. For an economic system to be capitalism you must have (1) the risk of failure, (2) the pressure of competition and (3) a level playing field in which anyone who wishes to can enter your line of business if they perceive that they can do whatever you do better, faster, cheaper — or all three. As soon as you can force someone to buy your product instead of someone else’s (or you can prevent them from refusing to buy at all), you can price-fix, you can refuse to provide a price at all before someone is obligated to pay or refuse to honor a price you quote, you can form cartels and discriminate against buyers of like kind and quantity based on some third-party affiliation or status or you can deny potential competing entrants the ability to compete with you and any or all of those acts are not met with prosecution and imprisonment you do not have capitalism — you have racketeering.

    It is for this reason that 15 United States Code exists — to protect capitalism by making illegal the formation of cartels, price-fixing and similar acts — in other words, to make cheating and using force to block competing business entrants instead of innovating illegal. […]

    It will take about one day if these changes are adopted for the cost of medical care to collapse to a tiny fraction of what it is now. With that collapse it will be unnecessary and undesirable for you to buy “insurance” against already-existing conditions because it will be cheaper for you to simply pay in cash. For nearly everything you will be able to pay.

    For those possible catastrophic situations that haven’t happened yet you will be able to buy reasonably-inexpensive insurance because the product of p(event) + cost(event) + profit will be small enough that the premiums will be affordable to virtually everyone, even those of very modest means.

    Finally, for the truly indigent we can certainly keep Medicaid and, since this cost reduction will occur across the board we can also keep the promises made for Medicare both for today’s Seniors and tomorrow’s. The cost of those programs will fall like a stone — a more than 50% immediate reduction is assured, and instead of going up in cost every year as technology and productivity improvement will no longer be able to be stolen by said medical providers (since the price is the price for everyone including those in Medicare and Medicaid!) the cost of these programs will go down every year instead.”

    • Realist
      January 18, 2017 at 07:21

      In a capitalist enterprise the object is to realise a profit from the specified activities. This means excess money accrued after the required raw materials or equipment have been purchased and everyone has been paid for their services in the endeavor. There are many necessary services that are performed in society without any goal of producing a profit. Law enforcement is not carried out for profit, neither is fire-fighting, military service, or public school teaching. Numerous social programs and safety nets were also included, some covered by government, others by private foundations or religions. Organized religions themselves may be considered services that come at a cost rather than existing to make a profit. That doesn’t mean the practitioners of all these endeavors are not paid for their work. It merely means either that society is willing to fund these activities at an economic loss (paid for with tax money), or that the expenditures and outlays balance to zero.

      Health care was not always for-profit in this country. Wendell Potter, noted critic of the American health care industry, has laid out its history in detail, and it has only been in the last few decades that for-profit medicine has come to dominate the American landscape. Before that there were numerous non-profit hospitals and other medical facilities, a great many of them run by religious institutions–in fact, they dominated the industry. These were either all bought up by corporations out to make a buck or were converted from non-profit to for-profit by their governing boards. If I remember my history as it was actually unfolding, most of these transitions occurred during the “greed-is-good” days of trickle down Reaganomics. Everyone and his uncle became preoccupied with garnering as much buck for his bang as possible, and that included medicine, its practice, administration and allocation amongst the public. And, suddenly what was affordable for most folks (say, setting a broken bone or getting a simple appendectomy) in 1977 becomes impossible to afford in 2017 unless you have a “Cadillac” insurance plan. Turns out greed wasn’t so good after all.

      • backwardsevolution
        January 18, 2017 at 08:32

        Realist – yes, I agree that everything began to go downhill about the time that Reagan came on the scene (along with Thatcher and the movie “Wall Street”). I’m not saying Denninger is right, but he does have a good point about technology/innovation/price reductions and capitalism. Debatable whether socialism and “no profit” or “greed is bad” would have produced the technology and resultant price reductions everywhere else like it did (except for health care).

        It is the cartels (same as with the media and banking industry) and the middle men that need to be gotten rid of. If the cartels were smashed, prices would collapse and you could pay cash for your broken bone, which you should be able to afford. Of course, you’d still need insurance for the once-in-a-lifetime catastrophic emergencies, but, as Karl said, these policies should be very affordable.

        I always remember a blogger posting about regulations, how it was always the cartels who brought in massive regulations in order to prevent new entrants from competing against them. The cartels would apparently lobby and get barriers put in front of new innovators, make it hard for them to enter the market by making sure small start-ups had to hire lawyers, fill out massive amounts of paperwork (things that a large company could handle, but not new ones), etc. I hadn’t even considered this, but it made sense.

        Makes you wonder just how efficient and cost-effective it could all be if it wasn’t so hard to compete against these corrupt giants. These are the “regulations” that people complain about. They are there to stop them from entering the market.

        • Joe Tedesky
          January 18, 2017 at 09:43

          Realist, I would be all in favor of a government run healthcare system, but… My worry would be of how it would operate in continuity from one political Adminstration from another. On the other hand before our country would yield to a government run system, I would be willing to put in place a capitalist system something upon the lines of what backwardsevolution is talking about.

          I would imagine that if the insurance companies such as Nationwide, Geico, etc., were to offer healthcare amongst their many other insurance products, that by having our healthcare be sold in a truly hard nosed capitalistic system that this may work. Imagine these insurance companies offering deals if you bundle up your healthcare coverage alongside your home, life, and auto insurances. Of course this system would need to have no State border lines to make it work to it’s fullest, but it actually may prove better than what we already have.

          I’m sure there are many good ideas that would work better than what we currently have, but a government run system would be like impossible to sell to a brainwashed anti-socialist public. It is a shame that within a country who prides itself on innovation that we can’t do better when it comes to providing one of life’s most essential needs such as our having access to our maintaining good health. This couldn’t happen if anyone of any superior means were to give a dang, but as Frank sang about, ‘that’s life’.

          • augie
            January 19, 2017 at 21:38

            having a national healthcare system does NOT mean it is government owned like in England…..many instrialized countries use private sector Drs, hospitals and clinics that do not work for the Govt. but something like single payer would eliminate all the waste and greed that there is today

          • augie
            January 19, 2017 at 21:43

            never work pal…..u can try to sell insurance across state lines but the insurance companies have already said, they will setup shop in the state or states that have the worst regulations so they can provide the shittiest coverage for the highest premiums price kind of like how all the corps set up shop in Delaware and few other states to avoid paying taxes…..without a national system like single payer where everyone pays something it will never work which is why every other country has that system because they figured it out long before our idiotic corrupt politicians and people have…..profit doesn’t work in providing healthcare and never will

          • Realist
            January 20, 2017 at 02:42

            That’s what I was trying to say, Augie. Of course, you have to cover costs in any system, for-profit or non-profit. But, it’s been the corporatisation of the American health industry AND higher education that has given carte blanche sky’s-the-limit license to charge whatever the market will bear to bring in PROFITS for the CEO’s and major shareholders. Realistic limits have long ago been breached, which is why BOTH these systems are now at the breaking point where middle class families, even those of many professionals, can no longer afford the services.

            Back in the 50’s and 60’s a working man could afford to send his kids to a state university and cover the cost of setting a broken leg or getting an appendectomy right out of pocket–without needing a Cadillac health insurance policy, the premium for which eats up a third of his income, or taking out a second mortgage on his home. The physicians, the hospital administrators, the university provosts and chancellors (who, by the way, used to come from WITHIN the ranks of the hospital staff or university faculty rather than being recruited from some large corporation for their business acumen) made a reasonable salary, not the routine seven-figure checks now cut to such privileged characters.

            You are absolutely right, Augie, privatising and corporatising every service in sight has made the rich ever more wealthy–our economy is a roaring success for them–but it has bankrupted the rest of us. I think it is a specious argument that unfettered laissez faire capitalism with no upper bounds on profits is the formula for making the most rapid and efficient advances in science, technology, health care or space tourism for billionaires.

            We’ve seen the results of such a system over the past 30-40 years: all of those excess profits end up in the bank accounts and investment portfolios of wealthy investors (now artificially inflating the stock market after the real estate bubble burst, which destroyed the middle class) who don’t need it rather than circulating amongst the general public who do! We need regulated capitalism, not laissez faire, which is not the same as “socialism,” but rather capitalism with both a heart and a brain. I thought we learned that lesson back during the Great Depression, but obviously it did not stick with Bill Clinton or the GOP Congress that he was (as was later Obama) “blessed” with to dismantle the still quite functional New Deal. I didn’t learn this from Bernie, but Bernie was right about all these things, and Obama and Hillary were wrong to sell out completely to Wall Street. Just see where it got them. The Democrats obviously have not. They’d rather fall back on tropes from the 1950’s, blame Russia, and impugn the opposition like Joe McCarthy. Crazy, is it not?

    • Bill Bodden
      January 18, 2017 at 14:22

      Capitalism, socialism and most other “isms” are human constructs that can work for good or for ill. It depends on which people make the decisions.

      • backwardsevolution
        January 18, 2017 at 17:00

        Bill – very well said.

      • Brad Owen
        January 19, 2017 at 08:26

        That is the key; the quality of character in a given society of people…does this make education the paramount concern for any given society? Also; how prevalent good character is: very prevalent=a functioning democracy; limited prevalence=a de facto aristocracy (NOT plutocracy or oligarchy which prevails in a society that tolerates, or fails to perceive, wickedness).

        • backwardsevolution
          January 19, 2017 at 17:28

          Brad – I don`t think the molding of character can be taught in school. I really believe it comes from the home. While we have gained productivity, efficiencies, competition, a treadmill type of life, we have lost everything that`s important – moral character.

    • John
      January 19, 2017 at 04:22

      Except that every single example you give was allowed by government funding of the R&D behind it. They are examples of Corporate Socialism, not Capitalism.

      Not that it was the economic system that was responsible for their decrease in cost, but ephemeralization (see R. Buckminster Fuller). In fact, Capitalism (Really Existing Capitalism, as opposed to a theoretical construct which would never be able to last beyond the point that Capital is accumulated by a small group disproportionarely, thus allowing them to buy the government) has slowed the process of tech becoming even more powerful and cheaper than it is now. Hard drives are a good example – holographic storage, which has orders of magnitude greater storage potential than magnetic discs, with orders of magnitude faster retrieval, was developed over 20 years ago, but has never made it to the consumer market because it would require complete retooling of factories, and there is much more money to be made by making minor tweaks to what was already being manufactured, and only letting relatively minor improvements to hit the market at a time.

      However, there is an even bigger flaw your position in that, though electronics are easy to improve and manufacture cheaply, that does not mean that good doctors and nurses and techs are also easy to improve and manufacture cheaply. The human body is infinitely more complex than even the most powerful computers we have yet created, and we are a very, very long way from the point that machines can carry out health care on their own.

      • backwardsevolution
        January 19, 2017 at 05:52

        John – “…there is much more money to be made by making minor tweaks to what was already being manufactured, and only letting relatively minor improvements to hit the market at a time.”

        Kind of like “planned progress” or “stretching profits” as far as they can be stretched. Okay, kids, you get to go from Windows 7 to Windows 8; small increments. Milking the market for all it can take. Change the color, change the handle, change the dials, change from stainless steel to brushed stainless steel, and then market like crazy.

        But you are correct, it’s a lot easier to tweak technology than to tweak people. I just wonder if they don’t tweak medicine in much the same way as they tweak technology, meaning there’s more profit in not finding cures than finding them. The human body is complex, but there are patterns there.

      • Realist
        January 20, 2017 at 04:02

        Two major contributions to the discussion here that I hope nobody missed: i) the role of government spending in corporate research and development and ii) the delay and unequal distribution in sharing the benefits of such with the public by making the breakthroughs proprietary, and protected by corporate patents though they were publicly funded. In short: socializing the risks but privatizing the profits as is the American way.

  14. backwardsevolution
    January 18, 2017 at 06:21

    Karl Denninger is a “math” guy. He believes that socialized medicine is fine, but that true capitalism (not the monopolies currently in place) would bring the prices down even lower. He makes some good points. He believes Social Security is fine, but that Medicare and Medicaid are going to bring the U.S. to its knees in the next few years.

    “The budget deficit was in fact $1.4 trillion — not the claimed $587 billion (which is bad enough, incidentally).

    Last year the Federal Government spent $1,417 billion dollars out of $3,854 billion, or 37% of every dollar it spent, on Medicare and Medicaid. This was a 9.3% increase over last year’s expenditure of $1,296,731 (million), all-in.

    But inside this figure are even-more damning numbers.

    Payments to the health care trust funds were up 13.4% (!)

    Spending on CHIP, the plan for poor kids, rose last year by an astounding 56%. While the total spent was only $14.3 billion, that rate of rise is utterly astronomical by anyone’s measure.

    Don’t believe for a second that administrative expenses are under control, which is a claim often made for Medicare and Medicaid: They were up 32% last year for the primary hospital insurance trust fund. No, that’s not a misprint.

    Hospital benefit payments for Medicare? Up 8.4% — the bright spot, believe it or not.

    Medicare Part “D” (drugs)? Sit down: Up 26.2% to a total of $95.2 billion.

    Folks, at this rate of change within the next four years Medicare and Medicaid will consume just over $2,000 billion a year, or $2 trillion — an increase of $600 billion a year in spending.

    Let me remind you that last year taxes (receipts) rose by a paltry 0.55%, and at this rate of increase over the next four years government revenue will absorb only $72.9 billion of that $600 billion in additional spending — and this assumes that absolutely nothing else in the budget increases in cost at the same time, an utterly fanciful notion.

    In other words there will be at least another $500 billion of additional annual deficit, and likely far more than the $600 billion denoted here, bringing the total to more than $2 trillion in actual deficit being run per year.

    If this pattern were to continue for 10 years then Medicare and Medicaid would rise to $3,448 billion, or for all intents and purposes all of the $3,854 billion the government spends now! Worse, increased tax revenue would absorb only $184 billion of that additional cost — for all intents and purposes ZERO.”


    “And by the way it is not possible to tax our way out of this and certainly we cannot do so by “taxing the rich”, as is often claimed. If you confiscated all of the money made by those who make more than $500,000 a year you would not even close the deficit gap for one year. Of course if you did that the amount of money those who make over $500,000 a year would choose to make next year, and thus be subject to said tax, would be no more than $499,999, and thus you’d get zero in tax from them via this approach in year #2. Anyone running a “pay your fair share” claim is lying and they know it; again, that’s the math.

    We must — and can — stop this crap with existing law. Specifically, by applying 15 USC Chapter 1 to all parts of the health care industry. This will collapse the cost of care for both the government and private parties by as much as 80% and permanently end and reverse the budget problems it is causing — for the federal government, for state and local pensions, and for private firms and individuals.”

    • augie
      January 19, 2017 at 21:34

      good luck with that pal….too many people are getting rich off this corrupt healthcare system….other countries bring costs down by competing with these greedy bastards and providing a national plan, eliminating the wasteful insurance companies and taxing the rich to pay for it and NO, I don’t agree that we can’t tax them to pay for stuff but we also need to bring costs down including big pharma ripoffs, college education rackets and all the other overpriced services americans pay way more than other countries that don’t allow the gouging but in this country money and lobbyists talk and we all suffer for it….btw, how about the $4 trillion we spent on two unnecessary wars of choice…..what did we get for that….a bunch of dead and mamed kids to make the ruling class and wall street much richer

  15. Sam F
    January 18, 2017 at 05:50

    Another failure of national health care will be a major front likely to separate Trump from his lower middle-class supporters. They will see that they have been sold out to the rich with another marketing package. They will no doubt spread lies that cheaters are gaining benefits at the common expense, but obviously no one could gain unneeded benefits in health care.

    Another front will be unemployment statistics, already completely fake.
    Another front will be the secret wars for Israel, and secret wars against social democracies, likely to continue.

    However, they are stupid, and many admire gold and imagine that they will get some by agreeing to theft by the rich, even when they are the ones being robbed. Advertising and Hollywood worked fine for Reagan.

    The critical need is for a true liberal or progressive party to replace the Dems and exclude all but individual donations.

  16. Bill Bodden
    January 17, 2017 at 23:44

    Back in the late 1960s I lost a tooth to an abcess at a port in Southeast Asia. When I returned to San Francisco I got a quote on a bridge to fill in the gap. I had a trip to Britain already planned and didn’t have time to get the bridgework in San Francisco. When I was in Scotland I arranged with a dentist to have the bridge installed with my paying as a private patient and not using their national health plan. I don’t recall the numbers now, but my air fare combined with the dentist’s bill approximated the quote I got in San Francisco.

    Call that socialism or communism or voodooism or anthropomorphism or any other “ism” you want, but it certainly beats what we have here.

    Fortunately, we have a plus side to American health care in the majority of doctors and other medical personnel being so well-trained.

    • Bill Bodden
      January 18, 2017 at 14:13

      In fairness to dentists I should note a conversation I had with a dentist who told me that it is common for recent dental college graduates to have a tuition debt of $400K to $500K. Accordingly, it is understandable they feel compelled to charge high fees to pay off these loans. Education of doctors, dentists, nurses and others is another part of our dysfunctional health care system.

      • backwardsevolution
        January 18, 2017 at 16:58

        Bill – I’m not sure whether I read it here or not, but within the last two weeks I read an article about a dentist who travelled to foreign countries years ago, met with indigenous peoples, and while there he checked out their teeth. I believe he said in one tribe in Australia, out of 1,000 teeth he checked, he found ONE cavity. Same with the next tribe, and the next. Of course, as soon as these people started to eat a Western diet, cavities went through the roof!

        The Western diet is killing our teeth. It’s killing us with diabetes, high blood pressure, heart attacks. Great for the pharmaceutical companies, though! Very much a guarded secret. Much education and lifestyle changes need to occur before things get turned around. Huge lobbies make sure that the education trickles out. Too much money in keeping people sick.

        • Litchfield
          January 21, 2017 at 21:27

          I believe the doctor you are referring to was Dr. Weston A. Price.
          There is a foundation named after him that is a source of a lot of good reliable information on nutrition:

    • augie
      January 19, 2017 at 21:28

      that is a myth perpetrated by the billionaires for wealthcare and their whores in congress that other industrialized nations don’t have trained Doctors….that is a bunch of bullshit

  17. Bill Bodden
    January 17, 2017 at 23:28

    Hearings aids are another high-priced item that probably cost much less (or nothing to the patient) in more sensible nations with national health plans. Our local newspaper continually carries advertisements from audiologists that have purchased ads ranging anywhere from three or four column inches up to full pages that you can bet don’t come cheap. So, who pays for those ads?

  18. Joe Tedesky
    January 17, 2017 at 23:10

    “…. in order to pay out the compensation for Stephen Hemsley, the United Health CEO for 2014, nearly 4,000 families had to pay the full $16,351 amount for healthcare that year. In what sort of world should 4,000 families have to pay close to a third of their total income to a single individual simply for the pleasure of having health insurance?”

    Read the article…


    The linked article written by Chris Martenson is his response to why voters are fed up to their eyeballs with the system, and Martenson believes this is the explanation to why Donald Trump won the race to the White House. Read the article and review Matenson’s provided statistics where he shows how 4,000 families pay for a single healthcare CEO’s yearly pay.

    If those 4,000 families showed even the slightest interest in a Medicare single payer plan, our illustrious MSM would aire the concerns of 4 families who would loudly shoot the single payer plan down, purely because they don’t want to live in a communist country. Our American media would then drive this communist narravative to such a point of hysteria, that any viewer or reader upon hearing this would be throughly convinced that most of their fellow Americans don’t want a single payer healthcare plan, as much as they do. Anyone with the dream of one day having a single payer healthcare system, would give up their aspirations of this type of plan believing no one else wants it.

    Ever since Winston Churchill stood on Harry Truman’s porch and shook his fist at the Iron Curtain of Joseph Stalins, Americans have come to fear any, and all ideas of anything based along the lines of socialism. What’s even more disappointing is that most Americans don’t even know what socialism is. Often you will find that those who hate these ideas of socialized programs of any kind usually confuse these socialistic programs with Nazism, or a brutal form of Communism. This fear is more often than not confused with paying higher taxes, and it gives rise to worry about to much government control over life or death.

    Without an objective media, and up against one of Washington’s most influential lobby’s America will never have a Medicare Single Payer Healthcare System….this is my belief.

    • Realist
      January 18, 2017 at 03:37

      Ah, yes, Sarah Palin’s “death panels.” I remember them well. Many people actually believed that Obamacare had a provision for unplugging grandma’s ventilator.

      I’ve always been for “socialized” medicine, starting with full government support for every minute involved in training our cadre of new physicians so they don’t have to start out their careers being a half million dollars in debt, which they attempt to make up ASAP on the backs of their patients. I was aware of this problem forty years ago when my girlfriend attended medical school and I trained numerous future doctors as a professor in the biomedical sciences.

      The system I like best (even more than Canada’s single payer) is Great Britain’s NHS which other posters here have alluded to using even as American tourists in the country. A professor friend of mine had a heart attack while on sabbatical at a British medical school and received full treatment plus recovery time at absolutely zero cost to himself, an American citizen. This being uber-capitalist America, I would still allow private insurance alongside a national health service for those who would prefer to choose it. All would qualify for NHS care but could opt for a super-privileged private plan if they’ve got the cash to pay for it. When I had half my cancerous colon removed two years ago they placed me into a private room that had a view and the amenities of a suite at the Waldorf Astoria, totally unnecessary (and largely unappreciated by someone “out of it” for most of the time). Our standard best practice does NOT need to provide all those bells and whistles (my three-room suite actually included a living room larger than the one in my house next to three yuge picture windows overlooking the city–maybe for the whole family to sit around in whilst grandma slowly dies) except for someone who can cover the cost themself. We’d save a lot of money right there, as new hospitals (at least the ones in South Florida) are becoming more like luxury resorts than the germ traps (the sources of nosocomial infections) that you want to stay in for as short a time as possible. I’m not suggesting going back to huge open wards either, just facilities more reasonably appointed and priced like I recall from the 1950’s (but with the modern equipment).

    • augie
      January 19, 2017 at 21:26

      the problem is u never explain that the ONLY way out is single payer….BO tried and he was lambasted by not only the GOP but the billionaire for wealthcare insurance industry and demagogued by corrupt mainstream media and the hijacked tea party by Kock bros and dick armey so we ended up with the ACA (by the way, why does everyone call it obamacare…..subtle racism maybe???….don’t recall anyone calling medicare Johnsoncare), which is a system developed by the right wing think tank, the Heritage Foundation and passed by Mitt Romney in MA but oh, I forgot….since the black man in white house passed it, now it not their plan…..what a bunch of bullshit….the GOP have absolutely NO interest in fixing this mess but instead send more money to the billionaires in this rigged system….as Cong Grayson once said on house floor: GOP Plan for Healthcare…..Don’t Get Sick….and if you do, DIE Quickly.

      • Joe Tedesky
        January 20, 2017 at 10:24

        You are spot on augie thanks for the comment.

  19. Bernie
    January 17, 2017 at 22:37

    I remember reading that Trump came out in favor of single payer some years ago. Trump understands that single payer would help attract businesses to the U.S. It would lower the healthcare costs for employees and that is a significant cost.

    • augie
      January 19, 2017 at 21:14

      but he has to convince the fascist GOP….never happen

  20. January 17, 2017 at 22:21

    “…two-thirds of our health care is already paid for through the tax system. In fact, we pay more in taxes for health care in the United States than other nations pay for their entire health care system.”
    This is a ground for a class action lawsuit against the US government for the shameful penalties imposed on those who do not want to buy the racketeering “health” insurance (an open thuggery by the insurance corporations)
    Another stinky piece of Obama legacy

    • augie
      January 19, 2017 at 21:13

      ur an asshat…..don’t get sick

Comments are closed.