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Hard and Complicated Aren’t Synonyms

2011 August 12
by Ian Welsh

The chart above is my second favourite chart. It’s a chart of per capita health expenditures over the last forty odd years and what I want you to look at is Canada and the US. You’ll see that at one point Canada actually spent more per capita than the US, then over less than a decade our costs dived to about 2/3rds of yours and then started paralleling your costs again.

What happened in that time period is that we went to single payor universal health care. Since then our metrics have been as good, or better than the US, with the exception of waiting times for optional surgery.

Now this isn’t actually a post about healthcare, it’s about language.

Specifically I’m sick of the idea that “the US doesn’t have any simple problems.”

Actually, many of the US’s problems are simple, and health care is just one of them.

The problem is the use of simple as a synonym for easy; and hard as a synonym for complicated.

See, stopping smoking isn’t complicated. All you have to do is… not smoke. But it’s hard as dickens, which is why so many people fail to do it.

Now a lot of US problems are like this and health care is one of them. The US spends about 16% of its GDP on healthcare, clocking in at 2 trillion. Changing to a single payor universal system will slash about a third of that. Savings: about 650 billion dollars. Everyone knows this who isn’t paid not to know it – every other country in the world that has universal health care pays about a 1/3 or less than the US and when Canada switched, its costs dropped by a third.

This isn’t complicated. But it is hard. It’s hard for the same reason that quitting smoking is hard, or that losing weight is hard – that 650 billion dollars extra is something the US is addicted to. That money pays for jobs and profits at insurers, drug companies and to hospitals and to some doctors.

That’s a lot of money, and the people who are currently making a living, or a huge profit from it, don’t want to lose it. So they’ll fight tooth and nail to not end the gravy train. The 20% to 30% administrative margins in health insurance companies as opposed to the 2% to 3% margins in Medicare are money that someone is getting. The price is that 50% of bankruptcies are caused by medical costs; that 43 million Americans are unemployed and that American companies like Ford and GM have huge medical costs that companies like Toyota don’t have.

So it’s not complicated to fix US healthcare – just go to comprehensive healthcare, probably modeled after France or Germany (who do as well or better on practically every metric), and voila – no more uninsured, much fewer bankruptcies, improved competitiveness and 650 billion dollars in profit and administrative costs that could actually be used for productive enterprise. Hard, because a lot of people make a lot of money from the status quo. But not complicated.

The US has a lot of problems like this. The debt and the deficit can be fixed by simply increasing tax rates and closing loopholes. Raise marginal rates on the rich, who can definitely afford it, end preferences for unearned income (which is taxed at half or less the rate of your paycheck) and make it so that corporations and people are taxed at the highest applicable tax rate on all their income so they can’t try and hide some of it overseas and get a lower rate, and you’d be back on track.

Or – to put it even more simply, don’t spend more than you bring in. It’s simple, and the Bush administration, after the Clinton administration had put the budget back on track, simply decided to max out the credit cards to give the rich tax breaks.

Social Security – simply get rid of the cap on contributions at 100,000 and it’ll be in the black. Heck, even without doing that it’ll be decades before it can’t pay. This one isn’t even simple, it’s just “there is no problem”.

Prison Incarceration – the US has more people per capita in jail than any other nation, edging out Russia back at the turn of the century. This is largely a result of draconian anti-drug laws, yet drug consumption hasn’t gone down, indeed, quite the contrary. When you do something for 30+ years and it doesn’t work, the answer isn’t to do it harder, the answer is to stop doing it. Get rid of mandatory sentencing requirements, 3 strikes laws and stop putting people away for possession of any but the worst drugs. Legalize marijuana. Legalize most opiates. Legalize mild forms of coca so people can get their kick without crack or cocaine. The prison population will drop, drug use won’t go up significantly, and the steady assault on your civil liberties will slow down (the war on terror was just the war on drugs on crack, really.)

One could go on like this for quite a while, including in foreign policy (stop supporting authoritarian regimes because you’re scared of regimes with popular support) and economics (restructure the economy so that making things makes more money than playing securities games) and education (don’t tie school money to property taxes). The solutions in many cases are clear and they aren’t complicated. But they are hard because many people benefit from the way things are done now. But one shouldn’t confuse hard and complicated and one shouldn’t think that just because someone is mainlining pork today they have a right to mainline pork forever.

(One also shouldn’t confuse logistically complicated with conceptually complicated.  We live in a society which is very very good at logistics.  Walmart, FedEx, UPS, the US military and many other organizations are logistical wizzes.)

When I look at America what I see isn’t a nation with problems it can’t solve, instead what I see is a nation with problems it won’t solve and what I see is a lot of people to whom the status quo is really good (including most Congresscritters) who try and sell Americans that there’s nothing they can do.

Politics is about fixing problems. Anyone who tells you that simple problems are complicated and can’t be solved, but only managed, needs to be kicked out of office. Because the one thing I’ll tell you is this – problems you don’t actually try to fix, don’t get fixed. Losing weight is hard, but if you never try, you’ll never succeed.

Cutting health insurance companies and drug companies off the gravy train will be hard. But if you don’t do it, you’ll never have good universal healthcare.

Your choice really. America has everything it needs, still, to choose life and a renewal of the American dream. But I wonder if it will, or can. Every great nation has its period in the sun come to an end, and in almost every case, it’s internal rot that brings them down. America has renewed itself in the past, does it have the guts and the integrity left to renew itself one more time?

(This is a re-post of a post originally published May 14, 2007. Some minor changes have been made.)

16 Responses
  1. August 12, 2011

    Would it be indelicate of me to applaud?

  2. August 12, 2011

    I have to ask: what is your first favorite chart?

    Speaking of health care, the individual mandate was struck down today by an appeals court.

  3. August 12, 2011

    I’m glad the appeals court struck down individual mandates, although the pro-corporatist SCOTUS may see it differently and trot out the dubious interstate commerce argument.

    Ian this is a great post, as you must know. Actually I was looking for it a while back, but here, not at FDL. You don’t address the question of false consciousness and the many questionable ideas that scores of educated middle class folks hold, although I imagine you have elsewhere–

    You know, like how true single payer would make healthcare costs skyrocket, how privatizing government functions saves money and is a net plus for society, and tax cuts for the wealthy creates jobs.

    (Speaking of which, Dmitry Orlov has a great one-liner: “Our system excels at creating jobs– in places like China and India.” I paraphrase.)

  4. StewartM permalink
    August 12, 2011

    Changing to a single payor universal system will slash about a third of that. Savings: about 650 billion dollars. Everyone knows this who isn’t paid not to know it – every other country in the world that has universal health care pays about a 1/3 or less than the US and when Canada switched, its costs dropped by a third.

    Though I think that copying Britain as well as Canada would be the best solution for the US. Have a National Health Service equivalent of network of government-run hospitals and clinics (a “VA for all” network) where any necessary medical procedure is always free.

    Private hospitals and clinics would continue to exist, and people could choose to go to them instead of the government ones.That’s where the single-payer insurance system comes into play, the reimbursement cost for private deliverers would then be based on how much it cost the government-run service to do the same procedure (if procedure X costs the government hospital $5000, then the reimbursement for a private hospital would likewise be $5000).

    Private hospitals or clinics could charge more than the reimbursement they got. But cap any responsibility for out-of-pocket expenses incurred at private facilities to something reasonable (say, $1000 maximum a year per person), to prevent a two-tiered health care system from coming about (one for rich people, one for poor).

    The advantage of having the government-run system in addition to single-payer would be that it would give the single-payer insurance system hard data on what any given procedure actually costs to perform. It would also compete against private deliverers, offering a free public alternative. Both of these would mightily work to drive prices down.

    I am not in favor or any system of highly regulated private insurers/providers, because while other countries with a stronger sense of the common good pull this off, I doubt that the US with its history of companies prying off encumbering regulations via constant lobbying will hold over the long run.

    StewartM

  5. August 12, 2011

    @StewartM:

    I am not in favor or any system of highly regulated private insurers/providers, because while other countries with a stronger sense of the common good pull this off, I doubt that the US with its history of companies prying off encumbering regulations via constant lobbying will hold over the long run.

    I agree, but I’ll raise you. (Suspending thoughts on what might be possible here in the U.S. of A. for the moment).

    I dislike the availability of any private services as a complement/alternative to public services, because it creates a dual-tier of quality of service (this includes schools and any other public utility you can think of, with the further caveat that I am limiting this to essential services.) Besides the distaste I have of giving monied people better quality access (weak point), it is also true that the monied are more influential in setting policy, and their incentive to provide decent minimum standards for the rest of us drops precipitously.

    Like what happens if you can afford to send your kid to private school. Do you really care about the quality of your neighborhood public school?

    Just putting it out there. I know that’s anathematic to our meritocratic culture, but I like to think that I’m not being overly idealistic…

  6. StewartM permalink
    August 12, 2011

    Petro

    I dislike the availability of any private services as a complement/alternative to public services, because it creates a dual-tier of quality of service (this includes schools and any other public utility you can think of, with the further caveat that I am limiting this to essential services.)

    Oh, I understand and concur with the sentiment, and recognize the danger.

    But that’s why I stipulated that even if one did go to a private provider, there should be a limit to what you’d be liable for out-of-pocket (say, $1000 a year maximum per person). That way you’d mitigate against the chances of “gold-plated” medical care providers catering only for the rich arising, because a private provider still couldn’t charge much more than the reimbursement fee. The idea that if a medical emergency occurred, it wouldn’t make much difference to the patient, no matter how poor, which hospital–public or private–he/she would go to. The nearest, even, if private, would be OK.

    (I’d also stipulate that no provider can turn away any patient, period, or refuse treatment, by law).

    As for the private alternative to public services argument in general, my reason for continuing a private alternative is to provide competition to the public sector. I think that such competition can be a good thing. I think if done right, the system I advocate would drive for-profit providers out of business, and health care would be delivered either by the government or by private but not-for-profit providers (i.e., religious institutions, humanitarian institutions, etc.). The latter (with county hospitals and the like) actually delivered much of America’s health care pre-1970 before the profiteers moved in.

    -StewartM

  7. August 12, 2011

    @StewartM:

    Thanks, all good points. Another point is the the problem of potential black marketeering, which would bring its own set of problems as well. What’s to prevent some pirate doctor(s) from providing an upscale version of the back-alley (penthouse suite?) clinic – taking bribes for extraordinary care? My idealistic stance would require a pretty strong and intrusive State… better to regulate than prohibit.

    I think I’ll go back to punching myself in the face. ;)

  8. August 12, 2011

    That money pays for jobs and profits at insurers, drug companies and to hospitals and to some doctors.

    While it would definitely cut down on the need for administrative people, single payer might actually make the medical professional job market bigger. There are a lot of people in America who are just not in the system right now. Making it possible for them to get medical care without going bankrupt ought to mean there’s a greater need for medical services, at least at the primary care level.

  9. August 12, 2011

    But to get to your more basic point – yes, this is one of the frustrating aspects of American politics these days. The needs of the politicians, and their sponsors, outweigh the needs of everyone else.

  10. jcapan permalink
    August 12, 2011

    “(including most Congresscritters) who try and sell Americans that there’s nothing they can do”

    … or that it’s really complicated. Or that the two sides can’t possibly agree. To paraphrase Janis Joplin–”it’s the same fucking side man!”

    Those who benefit the most from the status quo have taken over both parties. They collect our tax dollars, funnel them to their patrons, all the while propagandizing us. Misdirecting our anger. Not to mention that they’ve willfully raped education except for their own, who are indoctrinated to protect the machine. Most study the law, which teaches them one ring above all others–deceit, for profit.

    So, the best and brightest are steered into the institutions of power, the rest of us left to auto-didactic scraps, which reach us at different ages. And the few who come to any level of critical thinking, any political consciousness, stand divided. Alienated from a repellent mainstream society, they mistrust themselves, question if there’s something remiss in their own make up, so set aside they are–and they often can barely stomach their peers, sensing the same disenchantment, the same alienation. Thus, theyre hardly prepared to go into the trenches to preach the gospel to those who are even worse off, the proles. When we need to be of a piece, we set upon one another. It’s the easier path.

    Add to all of this that other propaganda device, the media, as sophisticated as anything Kundera or Orwell ever described. And finally the opportunity at any point to simply sell out:

    CYPHER
    You know, I know that this
    steak doesn’t exist. I
    know that when I put it in
    my mouth, the Matrix is
    telling my brain that it
    is juicy and delicious.
    After nine years, do you
    know what I’ve realized?

    He shoves it in, eyes rolling up,
    savoring the tender beef melting in
    his mouth.

    Ignorance is bliss.

  11. August 12, 2011

    “the question of false consciousness” a brilliant segue to Guy Debord’s ‘Society Of The Spectacle.’

  12. Bernard permalink
    August 12, 2011

    this is such a wonderful post. i am glad to have read it. it was so true then as it is now. Gotten much worse for the poor.

    the riots in London are a forewarning for America,once things escalate after the end of teh safety net FDR created on this date. August 12th. America has been given a wake up call of what possibly comes our way. the same economic/political insanity used to cover the Theft by the Rich on the Society as a whole. will Americans be interested/afraid of the fact that we are on the same path. the same type of Idiot Behavior. Pretending. all this Moral Outrage. lol

    how bad will things have to get before they wake up here. i always think of George Carlin’s American Dream video on Youtube and wonder how much more does it takes. How bad does it have to get. a lot worse, i gather.

    with equally insane and flat-outright acceptance of and complicity with the theft by the Banks and Congress, along with similarly convenient “feigned” outrage at the looting!! How dare those rioters get angry and riot about their life!! (their worth as humans). with the Banksters like Goldman Sachs, Bank of America, JPMorgan and the men behind them who steal and take everything, buying Congress in particular. These Anti-social Looters who bought your Senator or Representative to rewrite the laws. Now Banks can do anything cause it is not illegal. when you write the laws, you can steal and it isn’t illegal anymore.

    as we can easily see the results of. crumbling society from the top to the bottom. nothing to tie it together any more.

    if the Big People aren’t Jailed for stealing and robbing us blind, “Little People” will do the same. ignore the rule of Law . just like the Rich do. No one holds them accountable, no one is jailed, or stripped of all assets. nothing that hurts or stops them from further pillage and rape.

    now the Rule of Law is finished.
    nobody respects/fears the Law anymore. the Police, as highlighted by the example of Fox/Murdoch and the London Police, are owned and merely doing their Masters work. all those involved work together for the same goal. Profits. Focused and Determined and Successful.

    Welcome to the Lord of the Flies, a Darwinian existence. what an irony.

    easier prey gotten that way.

    the Rule of Law is gone and now we have the Rule of Men, very very Rich Men.

  13. StewartM permalink
    August 13, 2011

    Bernard:

    if the Big People aren’t Jailed for stealing and robbing us blind, “Little People” will do the same. ignore the rule of Law . just like the Rich do. No one holds them accountable, no one is jailed, or stripped of all assets. nothing that hurts or stops them from further pillage and rape.

    One of the most egregious violations of human rights in the US is jailing of poor men (and a few women) for not being able to pay child support. We’ve re-established debtor’s prisons.

    This arose from the efforts of misguided feminists and self-anointed “child advocates” based on the very few examples of well-off men not paying child support. Ergo, the Bradley Amendment was passed as a rider in 1986 which stripped judges of discretionary powers on child support, automatically kicking when the child support is past due. The law *expressly* forbids judges from taking into account an individual’s particular case (unemployed, sick, imprisoned, whatever) and moreover does not allow them to lower payments or relieve debt when a person cannot pay due to circumstances beyond his control.

    Examples of men being jailed for not paying child support include:

    Being in a coma
    Being a captive of Saddam Hussein during the first Gulf War
    Being imprisoned, even being imprisoned wrongfully
    Being medically incapacitated
    Of course, losing their job and having no income
    Medical reasons–people have *died* in jail from untreated medical conditions while being jailed for being unable to pay child support because they were too sick to work.

    All this monstrosity was justified because of a few high-profile cases of well-off people not paying child support (a doctor, a pro athlete, etc).

    But–returning to your point–did this jailing of all these mostly poor men achieve at least some of its purpose? Did those few rich slackers end up having to pay?

    Well, apparently not all of them:

    http://tpmmuckraker.talkingpointsmemo.com/2011/08/tea_party-backed_rep_walsh_lists_no_child_support.php

    To the tune of $117,000, mind you. The elites still flaunt the law; only the poor get punished, and unfairly and inhumanely and senselessly at that. We have one law for the poor, and one for the rich.

    Mandos–a number of threads back, we had this discussion about feminism. I started to write a reply detailing some of my objections to at least some strains of feminism in action, in particular the MacKinnon-Dworkin variety. One of Ian’s objections that I share about the left in the US, not only strains of feminism but part of the gay rights movement and others as well, is its willingness to abandon its allies and acquiesce or even promote things which are fundamentally “anti-progressive” in order to achieve its own particular perceived set of goals.

    I believe that progressivism is about advancing human rights, be they individual, sexual, social, or economic. Throwing poor men in jail to try to get a few rich men to pay child support isn’t “progressive”. Advancing censorship isn’t progressive. Advancing neo-prudery in order to “protect children” or protect women isn’t progressive. We do not advance if we go forward two steps in one area and then backward two steps in another. We must advance as a group.

    -StewartM

  14. Ian Welsh permalink*
    August 13, 2011

    I support equal rights, and women’s rights, but I have no time for most women’s groups. They are just another special interest at this point (and often even not that, given how they betray their own constituents) and I grant them no more legitimacy than any other special interest.

  15. Ken Hoop permalink
    August 13, 2011

    And I suspect most all of them tell their flock to believe Mullen when he lies that the surge is working in Afghanistan.

  16. August 15, 2011

    The problem is the use of simple as a synonym for easy; and hard as a synonym for complicated.

    Dear lord, I make this point to people over and over again and it just never seems to sink in.

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