The Shadow Safety Net revisited

America’s lack of universal health insurance is baffling to much of the world. Even here, many are struggling to understand why voters so dependent on insurance delivered by the ACA would support a candidate who plans to dismantle that program. It isn’t actually that tough to understand.

A post at Forbes revisits the premise of “socialism for white people” as a way to understand public attitudes toward the social safety net. This adage is worth repeating: When it seems like people are voting against their interests, I have probably misunderstood their interests.


  1. I think it’s really cool how the ideas and experiences of everyone on this blog, including the host’s, are woven together into a tapestry of knowledge, with many ideas appearing again and again from different sources, unintentionally, showing how many of us are on the same wavelength.

  2. Just a brief comment about the “National Health” systems I am familiar with (UK and NZ) and the years I spent in the USA

    The US system may be better for multimillionaires but for the professional engineers that I worked with who had an excellent health plan I’m not so sure
    I know it’s a small sample but too many of my US buddies have died of what I would have thought of as preventable illnesses

    My UK buddies – don’t seem to be dropping at the same rate – or even close to it and I know a LOT more people in the UK

    1. Duncan, I am a Professional Engineer myself. You are correct in that it is a small sample. However, I believe that it is typical of the American health care system. There is a strong tendency to not get regular medical care or to seek help until a problem is acute. Also even though the insurance is good for people with good jobs (though maybe not so good as in the UK or NZ), there have normally been additional charges, so people tend to put off routine medical and diagnostic care. I believe that there is a macho thing regarding seeking medical care. Without being sexist, let’s accept that engineering historically is a male profession. Regardless, I believe that Americans have a strong tendency to not obtain routine medical and preventative care, that could prevent acute problems later. Obamacare by making preventative care essentially free and requiring that all policies meet certain basic requirements, helps in that regard. However, that has in turn increased the basic cost of health insurance, thus generating much opposition.

      I am in the process of reading The Healing of America, by T R Reid (2008), which Mary has strongly recommended. Though, I hesitate to draw any conclusions based on having read less than half the book, one thing is clear and that is: the American health care system leaves a lot to be desired even with Obamacare. The ACHA will only make things worse.

      1. Tutta – I have no idea whether people in other industrialized countries take better care of themselves. I do know that men in particular have a macho attitude towards care. I also know from myself, my family, and observation, that the tendency to not care for one’s self has a tendency to start having repercussions around the age of 50-55. Not coincidentally that is also the age at which the costs of individual health insurance, if available, begins to increase substantially. For those without employer based health insurance, those premiums become a burden and the likelihood of going without also increases. Finding a good job at that age becomes considerably more difficult. That means easily treatable conditions can and are ignored. They can then become acute driving up costs. Finally, at the age of 65 when Medicare becomes available the costs of treatment can be considerably higher.

        For that reason, having nearly free preventative care is important. Over time, the tendency to ignore easily treatable conditions should lessen and the overall health of Americans would hopefully increase.

        Bobo – thanks for the links. I have downloaded the transcript and will read it. I also intend to watch the documentary.

        Basically, my general thoughts are that Basic Health care should be universally available at a minimal cost to the individual. For certain segments of the population the public should bear the cost. How to best achieve universal care in the US is a question, I have not answered for myself yet. Most likely a mix of policies will be the solution we finally select. I do believe that the ACA is a step in the right direction, though it does have problems. As other nations have found, constant tweaking will probably be required.

    2. My husband is also a P.E. He worked for one of the big oil companies until he semi-voluntarily early-retired.

      They had a number of wellness programs aimed at their employees. There was a huge workout center in Houston and the company paid for a gym membership when he moved to NM. There were yearly health screenings offered at work as well as flu shots in the fall.

      That said, my husband managed to have cancer, a stroke and a heart attack at an early age. His blood work, blood pressure, and weight were always in the acceptable range. The only predisposition he had was a mother with heart disease. (It goes without saying that being married to me could only be positive for his health!!! 🙂 )

      My own theory as to why people are healthier in foreign countries has to do with lifestyle. A lot of the engineers here in the States are put under a lot of stress, work longer than normal hours and might not get as much exercise as they should.

      There was a completely different attitude toward work when we lived overseas. Employees got more vacation and they actually left work at quitting time. People did more walking and depended on their cars less. Spending time sitting in Houston traffic is not exactly soothing to the soul.

      1. Objv,

        Yes in the US engineers are under a lot of stress and work extraordinarily long hours. As a consequence exercise is neglected. I found that to be true in my career. Personally, I found that once I obtained the P.E., the stress and hours went up considerably. Finally, after being let go from one position at around the age of 50, I decided to limit the hours as much as possible.

        However the long hours and the stress are fairly typical in the US for people in professional positions. It is also becoming common for people in non-professional positions. That was not the case when I first began working professionally in 1974. My partner has a niece who obtained a MBA. Initially, she worked for a consulting firm, then at Amazon for a short while. Now she works for Boeing and is much happier. She also has a life, again.

        I have no experience with overseas work, but from what I’ve read, I believe your comments to be the case.

  3. Chris, rereading your thoughts on the “Shadow Safety Net” was good. Last week I participated in a Value Engineering study for the US Army Corps of Engineers. It was one of the most depressing experiences that I have had in some time. The study was to develop suggestions for improving the design for replacing the downstream navigation lock gates at a dam on the lower Columbia River. The gates went into operation in 1954, are at the end of their serviceable life, and there are risks of failure leading to a catastrophe or shut down of the entire navigation system on the river. The study itself was conducted in Walla Walla, WA; a fairly prosperous agricultural community in Southeastern WA.

    The depressing part was that the entire study team except for an approximately 30 year old female administrative assistant, was composed entirely of white, mature, middle class men. Except for myself, they all voted for Trump and bemoaned the state of American industry, in that big massive machinery such as used in 1954 is no longer manufactured in America. Rather the same functions are accomplished differently. They were bad mouthing the state of health care, they were critical of the transportation systems, they decried the retirement systems, and so forth. They were negative about just about everything. Basically in a larger sense, they were complaining about the fraying of the Shadow Safety Net.

    I was immensely cheered when I returned to Seattle where there is generally a positive attitude towards life, with considerable diversity of races and ethnic groups, ages and a diverse mix of families.

    I found it ironic that the project I was working on went into operation in 1954, when the employer based health care tax deduction began, starting the “Shadow Safety Net.” I am old enough to remember conditions for the white working class in 1954. It was not a panacea. There were constant struggles to get by and to pay the bills. For many families keeping food on the table was difficult. Industrial accidents were common and medical care was rudimentary by current standards. but things were much better than during the Great Depression so people were more optimistic. That was the midpoint of the post WWII baby boom.

    I believe that there is a connection between the current negativity of many white, mature, middle class, American men and Trump’s victory. Similarly there is a relationship between the optimism and positivity, with a corresponding can do attitude of the coastal enclaves and the major metropolitan areas supporting Hillary. I suspect that 21st Century Corporations congregate in those areas, because of that attitude. Likewise, the political inclinations of the populace of those areas reflect that positivity. These things seem to form a positive feedback loop in the metropolitan areas, whereas a negative feedback loop is formed in the rural areas. The Democratic Party needs to develop ways of communicating an optimistic message to the white, mature middle class segments, while still supporting the more disadvantaged segments. FDR was able to do it, for his time. How to do it at this time is the BIG QUESTION.

      1. Chris, I might mention that the USACE design team individuals were generally in their 40’s and were fairly progressive in their design thinking. My role was to review the electrical and control systems. The proposed design uses a 21st century control system and modern electrical systems. For this project final installation, testing and commissioning during a 16 week period is critical and imperative. I was able to suggest some methods of streamlining installation and construction. My ideas seemed to be well received.

        Part of the electrical system must remain in place until the upstream gate is replaced sometime during the late 2020’s. The current and original electrical system is dangerous and not necessarily reliable. I was able to suggest a means of making it more reliable and safe.

        That is the difference of which I spoke. I try to be positive and look ahead, even though I am over 70, as contrasted to the other members of the team. My point is that this attitude and outlook tends to spill over into politics and I believe the prosperity of the metropolitan areas. Somehow, the NEGATIVITY needs to be overcome. Trump only reinforces it. I only hope that a leader capable of doing that will emerge; at this point that will most likely be from the Democratic party. This period out of power for the D’s, could allow that to happen. Historically that has been the case for both parties.

  4. 45 issues executive order requiring all federal agencies justify their own existence within the next 180 days before he brings out the hatchet:

    So, six months left of any sort of useful government then. Good to know. This reflects on earlier observations that his slowness to fill federal positions is not a bug, it’s a feature.

    In other news, here’s an 84 year old woman in small town Georgia who’s not racist, she’s just Registering Anxiety Centered In State Taxation:

  5. OK, so back to the topic at hand (socialism for white people). Here’s a book by a black man (Wake Up White People, You’re Getting Screwed Too!) explaining to middle class whites what rich people are up to. I think I like his response better than the black people who voted for Trump that Chris mentioned a post or two ago – not that their frustration isn’t perfectly understandable.

    I read a lot of political commentary that basically says – not always nicely, either – the Democratic Party should concentrate on its urban base and give up on the rural whites that will never vote for it. I don’t think the Democratic Party should give up on anybody. They do need to stop sucking up to big money and start doing right for the middle class – including those who don’t vote for them now.

      1. Lettuce celebrate with a Caesar salad – and an Orange Julius as our just desserts.

        (I’m hiding the steak knives …. I haven’t met my $6000 deductible yet …. can’t afford any stabbing injuries.) 🙂

      2. Et tu, Brute? Hey, stop brutalizing my Caesar salad. I like my word salads crisp. And, Tutt, I thought I made it clear that I prefer to say that I fritter away my time – not kill it.

        Happy Birthday to your dog, Bobo. You picked a good birthday for her. I was amused that some friends I know brought home a dog yesterday and named it Pi.

        I’ve been having dog troubles. My daughter’s dog ran off after a bunny last Friday and we haven’t seen it since. I’ve been spending my time out looking, posting posters, and visiting shelters.

  6. With Republicans still scrambling about, it’s understandable if it hasn’t caught as much attention, but it’s been quite remarkable to see just how quickly the right has been piling on Speaker Ryan, whose political capital seems to be dissipating faster than an ice-cream cone under the sun.

    More specifically, it’s worth considering if this wounded political animal hasn’t been singled out for elimination by Bannon, whose own Breitbart ever so conveniently just turned out an “exclusive” story of that time when Ryan said he wouldn’t defend Trump, “now or in the future” to quote his own words.

    As if that weren’t enough, a WH internal report also just so happened to release numbers today, saying that a whopping 26 million people, not 24 as per the CBO, would lose their insurance.

    That’s either quite the number of coincidences or a coordinated strategy intended to throw Paul Ryan under the bus.

    And pardon me if I’m venturing just a bit too far into conspiracy theorizing here, but I also think it interesting how Sen. Cotton also let slip just the other day how if House Republicans voted for Ryancare/Trumpcare, the House majority could be at risk in ’18. And goodness knows nothing spurs politicians to turn against each other than believing that their jobs are at risk. Needless to say, there’s no proof that Bannon was behind that, but one also can’t help but wonder if Cotton wouldn’t be more comfortable with a Speaker more in line with his own ways of thinking.

    Quite a bit of political intrigue and potential backstabbing going on today, I must say.

    1. Interesting thoughts. I am quite convinced that Bannon is participating in quite a bit of intrigue. I know that Ryan and he do not see eye-to-eye on a lot of things, and that Ryan could be considered a threat to Bannon. Flynn was a threat to Bannon’s power and look what happened to him. Others could be as well. I fully think that Bannon is busy consolidating power and is very possibly the most dangerous man in the Trump administration.

      I know little about him, but the little I have read indicates that he wants to “deconstruct” the government and then rebuild, no doubt so that Bannon will benefit.

  7. The White House has a “Share your Obamacare Story” page (for ‘victims’ of Obamacare). Go ahead. Share your story:

    I shared the part where the Medicaid expansion of the ACA saved me $4000 after a tonsilar abscess sent me to the emergency room and I had to get it drained. Will suck to know that’s gone for people of similar situations that happened to me. Too bad for them for living at the wrong time I guess.

    Next item on the discussion:

    The CBO mathed it out and people’ll turn out worse off under the American Health Care Act than before the Affordable Care Act ever passed. We get all the crap of the ACA, with all of the crap that came from having no options before it! Hooray, the GOP has officially chosen the worst of both worlds!

    Tomorrow’s news: 45 starts complaining about Congressional bureaucracy and committees and starts pressuring that the CBO be removed.


    Via MassDem on that Reason #492 Reagan’d hate Reagan’s Succubus Heir:

    “an interactive map from the Kaiser Foundation. You can see whether your county is predicted to lose or gain health insurance subsidies, and ballpark by how much, if the ACA is replaced by Trumpcare.

    First off, shit design, as it makes all red what counties SAVE money under the AHCA and all blue what counties lose, so you think the angry color is bad for you but it’s actually good.

    Anyway, once you hit my income, the map is awash in red. Which doesn’t actually cheer me up. Firstly, because it comes in the form of a tax refund rather than a subsidy, so I still have to make it through the year paying full price for that shit. And secondly, because I can barely afford the shit insurance I have right now (with $4000 deductible and 50% copays), so if the price goes up there’s nothing less for me to buy. The tax credit becomes beside the point, and if I can’t afford insurance NEXT year, then of course the price can be raised on me, so I could get a raise and still not afford the insurance the year after that, in perpetuity.

    Keep in mind I make double the national average personal income and slightly over the national average household income. Yeah, fucking tell me to my face other people can afford it. I’m a super frugal dude, have zero debt, save for emergencies and retirement, and make more than the average household, and I can barely afford shit health insurance.


    Reminder that single payer healthcare saves 98% of American citizens money, shaves off a third or more of administrative costs, decreases fraud, makes health consumption data publicly available for entrepreneurs to compete for better standards, has zero deductible, zero copay, covers prescriptions, and lowers the costs of prescriptions anyway:

    (Numbers are for New York but derived from national studies).

    So anyway, have a nice night ladies and gentlemen. Remember: ‘we’ voted for this.

      1. Vox has a good piece on this. SAvings accrue to wealthy, to young and middle aged. The poor, elderly in long-term care, the disabled, will be hurt the most. I’ve got several articles saved on this plan but waiting to see what happens next. The biggest problem is how many people will lose coverage, CBO estimates 24 million by 2018 and 52 million by 2026, while saving $337B….Sweet trade off right? That is if the lives of real people don’t matter to you.

        Creigh – This article has your name on it. Enjoy.

  8. “Maybe if [my great aunt] didn’t have her sons, she would have had to depend on Social Security”

    This is actually what got me started thinking seriously about economics. Back in the day, Reagan told us that Social Security needed to be reformed “because it was running out of money.” After some thought, it became apparent to me that Social Security’s problem was that our generation wasn’t having enough kids. Money was at best just a symptom of the real problem.

    1. Another question that I often think about is to what extent a family care should care for its members before transferring their upkeep to the government.

      I know many sons and daughters who have the financial resources to care for their elderly parents, but the parents themselves are low income enough to qualify for Medicaid.

      I personally think kids, and not the government, should care for their parents if at all possible.

      I don’t know if we should be held responsible for the lifetime upkeep of our siblings, though.

      On the other hand, receiving help from the government can keep an individual from becoming overly dependent on family and gives the person a measure of freedom.

      1. I have no siblings, so personally, if I’m going to be beholden to anyone, I’d rather be beholden to the vague concept of “government” and “the taxpayers” then to my cousin and his family.

        So, in this way, the government can be said to protect the freedom of the individual, so that is matters not whether the individual is part of a collective like the family.

      2. It’s a bit more complicated than the desire to care for a loved one – parent or otherwise. With older people, the care can become extremely difficult to manage in the home setting without adequate medical equipment. Since men usually are older than the women they marry or partner with, it is highly likely that women who are not as physically strong, will be managing physical challenges beyond her abilities. The problem gets even more difficult for couples in which one party has to work and cannot do both job and caregiver roles….have the income they need to maintain their families and get the rest they need to perform well at work.

        The best of all worlds is that we would all be healthy until we die peacefully in our sleep. That is not the real world most of the time. I agree whole-heartedly about keeping a family member at home as long as their care and the caregiver’s health result in a workable sitatuation. It can be a real struggle for many people who either lack the resources to manage the care at home or are physically unable to perform proper care. I know you’ve given of yourself to help your mother but not everyone is able to or wants to. What then? The cuts planned in the AHCA will impact medicaid by 25%. One of the chief expenditures of Medicaid is long term nursing home care. What happens to these old, sick, frail people if no one is there to help or no one wants to help within their family circle?

      3. I didn’t take offense but was trying to explain the difficulty some people (especially women) have in being caregivers at home. You gave up several years of your life for a mother who gave you life. I’d say that was very special and I know those years hold beautiful memories for you.

      4. Mime, I was thinking more in financial terms. I think if the kids are well enough off to afford to pay for their parents’ care, they should do so, versus putting the parents on Medicaid, even if the parents are low income and qualify for Medicaid.

  9. I understand what you are saying, Chris, but I do not for the life of me understand the fix: those jobs are not coming back to the Rust Belt.

    Automation has in large part been responsible for the disappearing working class jobs. And, soon, office workers will be replaced with automation. My own small company has grown much larger in terms of marketshare and territory, but without adding additional staff, because we rely on automation and smarter systems to handle the increased work load. We are making our staff do more by focusing on building computer systems to handle repetitive tasks better than a human can.

    Why does the Rust Belt voter feel that his or her job will come back to them just because Trump says to trust him and only him?

    1. “Why does the Rust Belt voter feel that his or her job will come back to them just because Trump says to trust him and only him?”

      Because he’s been told over and over again for forty years that his job was eliminated because government regulation, and the people who are arguing otherwise are those stupid nerds from high school who never worked a day in their life and left the hometown to go dress like a girl in some liberal coastal city.

  10. That’s a great article, Chris. But one of the reasons I’m hopeful that Medicare for all (the only plan that works, and that we’ll eventually get to in a few decades once several million more Americans die unnecessarily) will come to be, is that even white socialism isn’t enough to fix the fundamental market failures of a private insurance system.

    Firstly, the subsidy is now large enough that it’s no longer ignored. It’ll be chipped away. The first chip was Obamacare’s tax on “gold-plated” plans, which was sold as a tax on rich people working on Wall St. but actually hits a ton of union members. Eventually, that upper limit will be lowered.

    Secondly, since wages are stagnant, the automatic subsidy increases that you mention (tax credits leading to higher subsidies as your income increases), are no longer present, and so less and less of your increasing health care costs are being subsidized. Which means a bigger share comes out of your already stagnant wages. Tax credits are a great deal when your wages rise faster than the cost of the service being subsidized. But when the opposite is true, it’s better to just have the service paid for and let the government deal with the rising costs.

    Thirdly, you don’t mention the increasing risk of falling out of white socialism. Compared to the days of lifetime employment, people lose their jobs at the drop of a hat. And especially older (>50) people have an increasingly difficult time finding a new comparable one to replace it. Employer-based benefits are great when the employers only discriminate against minorities and women but are happy to keep around white males who are old, or have outdated skills, etc. But that’s increasingly no longer the case.

    We’ve already as a society decided we don’t care what happens to minorities and poor families. But white socialism is having increasing troubles solving the enormous problems of providing health care to white, middle class people through a market-based program. IMHO, that’s when the tide turns and people will finally do the right thing (albeit probably still for selfish reasons).

    1. And the losses until that light goes on will be huge. Think of the disincentive reduction in health coverage means for all the professionals working in this arena? For the incentives to create new medical equipment that medicare won’t pay for and most people can’t afford, for the research into new cures and treatments and vaccines, and, and….

      Read Doug Muder’s post. it’s beautifully simple. I’ll repost the link:

  11. It all boils down to the fact that what has been around for a long time is part of the woodwork and taken for granted, and what is offered as a brand new safety net is seen as charity. Social Security and Medicare were also considered charity at first, and now they’re taken for granted.

    1. In the days of the hunter-gatherers, we have the first recorded human system of redistribution. These people are considered primitive by today’s standards yet they were able to work out that survival was co-dependent. It’s unfortunate that the modern era has gained so much sophistication and lost so much common sense.

      1. We haven’t lost that sense of cooperation. In fact, it has grown stronger. Just look at the highly sophisticated and very advantageous system of white socialism we enjoy today.

        People don’t oppose changes to this system because they hate welfare. They oppose changes because they feel those changes would disadvantage them. And for a lot of those voters, they are right. We protect the existing system because it benefits a lot of people and those people are more politically powerful than the people who would benefit from a change.

      2. Ah, but there are always winners and losers in any re-distribution. Today, our advanced communication simply makes it more obvious. The flaw in current thinking is that too few understand the benefit of a shared economy. Look at the incessant focus by Republicans for even more tax cuts to the upper classes. How much money is enough? It seems to me that when your focus is to resent sharing of resources, it becomes a filter that doesn’t allow you to understand its value – and, there is value, even as there is abuse.

      3. Pride does play a role. My elderly widowed great-aunt, who was Mexican-American, became eligible for Social Security in the early 1960s, and she wanted no part of it, saying “I don’t need the government to support me. That’s what my sons are for. They can support me in my old age.”

      4. I’m pretty sure it was pride on my aunt’s part. Maybe if she didn’t have her sons, she would have had to depend on Social Security (grudgingly), but I know in my culture/family, people do thumb their noses at government support, unless it’s the kind that’s taken for granted.

      5. “They oppose changes because they feel those changes would disadvantage them. And for a lot of those voters, they are right.”

        That’s just the thing: for a lot of Trump’s voters, Obamacare *helped* them. I can see upper middle class voters not liking Obamacare. I can even see the coal miner voting for Trump because he wants his mining job back. But that coal miner despises Obamacare *regardless* of whether he ever gets his job back. Why is that?

      6. Do you think it’s possible that the reason miners “hate” Obamacare still despite jobs not materializing for them is that hope dies hard? Too much Fox News; too much denial of reality; too little preparation; too much fear of a future without an income and too much pride to accept that fate awaits.

      7. “But that coal miner despises Obamacare *regardless* of whether he ever gets his job back. Why is that?”

        There was that article shared here awhile ago about the post-New Deal rise in far right attitudes that was written in like the 60s or whatever. Sorry I’ve lost track of it. It brings up points that have thus been mentioned and pointed out quite a few times in contemporary articles dealing with this phenomenon.

        The two main groups most likely to take on this attitude are the near poor, and the recently poor. So for instance, ‘working class whites’ are just about one caste level up from truly impoverished. Settled first generation and second generation immigrants tend to be particularly anti-immigrant.

        What happens for them is, they’re still struggling against all the pressure from the top, but they see aide and resources being given to the people below them. So from their perspective, they’re working hard for very little, and the people below them are rewarded for working little. From a healthcare perspective, that poorer person is getting Medicaid, whereas I have to pay a huge premium for high deductible insurance that only offers 50% copay and disappears the second any of the words ‘out of network’ seem to emit from my breath.

        So why should that poor person who never works get Medicaid?

        Of course the answer liberals would tell you is that everybody should get Medicaid. But what the Republicans promise you is that if everyone gets Medicaid, you’ll lose your job and be poor like the poor people who live off of Medicaid. Better to get rid of Medicaid so that the poor people will work for their health insurance.

      8. Part 2:

        Why are the ‘working class whites’ near poor instead of completely impoverished?

        Because as white people, they have access to the white social safety net. So there are impoverished white people, but poverty disproportionately affects people of color. The coal miner believes if we stopped paying for Medicaid, he’ll get his coal mine job back. The black person never had a coal mining job, and never will.

        The white coal miner isn’t racist, he just benefits from racism, see? Republicans aren’t racist, they’re just registering anxiety centered in state taxation.

      9. Aaron, you’re on the right track. I instinctively cringe when I hear the term “single payer system” because I think “socialized health care,” which to me suggests “charity hospital,” and a resulting overall decrease in the quality of health care.

        If you’re from the Houston area, it’s like being told that we’re all going to have to go to Ben Taub Hospital for medical care.

        I am totally ok with expanded and more inclusive Medicaid, so that more of us have something to rely on in hard times, whether it’s temporary or long term, but the idea of our health system being one big Medicaid (aka “single payer”) implies low cost, low quality care.

      10. Aaron wrote: What happens for them is, they’re still struggling against all the pressure from the top, but they see aide and resources being given to the people below them. So from their perspective, they’re working hard for very little, and the people below them are rewarded for working little.
        Well-said interpretation. And of course, it’s easy for “rich liberals” to support more benefits for the impoverished, since they don’t have to struggle “like the rest of us working class folks”, and to accuse anyone opposed to more benefits for the impoverished of being racist.

      11. “If you’re from the Houston area, it’s like being told that we’re all going to have to go to Ben Taub Hospital for medical care.

        I am totally ok with expanded and more inclusive Medicaid, so that more of us have something to rely on in hard times, whether it’s temporary or long term, but the idea of our health system being one big Medicaid (aka “single payer”) implies low cost, low quality care.”

        I’m not sure how clear you are on this (if you’re writing ironically or earnestly) but for the record:

        single payer is about health INSURANCE, not health CARE. CARE is still privatized: doctors, hospitals, prescriptions, tech, equipment, suppliers, etc. Where single payer intervenes is in negotiating price, which can mean some types of drag on the overall healthcare system (however, private insurance also means some types of drag, so its a false inequivalence to say that only government paid insurance creates drags). And all of those prices and negotiations are now a matter of public record rather than private deals nobody has insight into.

      12. Aaron – Single payer vs Universal Healthcare….vs. Medicare for everyone….vs…..?

        You’re an excellent researcher so google health outcomes in countries throughout the world. It is clear that the free market quasi socialistic (medicare/medicaid/VA) system the US offers performs very poorly in health outcomes on a world-wide basis. And, that doesn’t even include a cost/benefit ratio….which I know you realize is obscenely disproportionate in America.

        Chris posted a link in Off Topic under my topic “Affordable Health Care, It’s Complicated” about France’s health care system along with some astute observations. (I have continued to post links there to good thinking on the health care subject just so there is a standing repository of information for interested parties to access…Thank you Chris for this platform.)The bottom line is that until America decides that Universal Healthcare (in whatever form) is our a national priority, we’ll continue to have these odious, partisan debates and more people will struggle financially and in poor health unnecessarily.

      13. By the way, I was specifically thinking of Ben Taub when I wrote that. My mother had to get care there once when my aging mother and father were uninsured. That place was a grim wasteland.

        Among the other adventures, the woman she shared a room with died. That woman’s abandoned bed stayed there, untended, unmade, untouched, for the rest of the time my mother was there, several days. It was a scary place.

      14. In this particular post I was writing totally in earnest. I guess I have a lot to learn about how the single payer system works. That may be one good reason people are unwilling to accept it — they don’t know all the details of how it works.

      15. I don’t know of a single health care system anywhere that is perfect. But from a cost and outcome as well as accessibility to care, there are many functioning models in other countries that America could model. The problem in America is that the free market approach conservatives favor is profit driven and when that is the basis for designing health care, there will be problems.

      1. EJ

        In my opinion, race has always been an issue in Europe as much, if not more than, in America. The difference is that in America the racially-disadvantaged people lived in the same cities as the White people; whereas in Europe there was salt water separating the two.

    2. “Social Security and Medicare were also considered charity at first, and now they’re taken for granted.

      FDR specifically set up Social Security to look like insurance (it isn’t, really, and the idea of a Trust Fund is merely an illusion, and FDR knew that) so that people would not feel like it was charity, would feel that it was something they had earned, and would defend from the political attacks that started immediately and continue today.

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