“Legions of Half Truths, Prejudices, and Propaganda”: My Online Healthcare Reform Studies for MLK Week

The Martin Luther King, Jr (MLK) Human Rights Week is upon us and starts tomorrow. The University of Iowa theme customarily uses an MLK quote and this year’s is “Intelligence plus character–that is the goal of true education.” This is taken from “The Purpose of Education,” an essay he wrote in 1947 for The Maroon Tiger, the campus student newspaper of Morehouse College. One excerpt from it seems to fit my impressions about what I’ve been trying to do today, which is to try to find a way to make sense of the plethora of online articles about single payer systems and Obamacare that made me dizzy trying to resolve the political slants and rhetorical flourishes.

Education must also train one for quick, resolute and effective thinking. To think incisively and to think for one’s self is very difficult. We are prone to let our mental life become invaded by legions of half truths, prejudices, and propaganda. At this point, I often wonder whether or not education is fulfilling its purpose. A great majority of the so-called educated people do not think logically and scientifically. Even the press, the classroom, the platform, and the pulpit in many instances do not give us objective and unbiased truths. To save man from the morass of propaganda, in my opinion, is one of the chief aims of education. Education must enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction…

We must remember that intelligence is not enough. Intelligence plus character–that is the goal of true education. The complete education gives one not only power of concentration, but worthy objectives upon which to concentrate. The broad education will, therefore, transmit to one not only the accumulated knowledge of the race but also the accumulated experience of social living [1].

Maybe it’s not wise to try to research this using online articles, but it’s the most convenient. I was going to say that is sad, but most public libraries have computers now anyway. Recently, I’ve supported the single payer system promoted by the Physicians for a National Health Program (PHNP). I still do, but it’s usual for me to reflect and check other opinions in order to reach the most practical and reasonable conclusion.

I have racked up about 20 web pages in my journey today and I’ve been wary of colorful overstatements, understatements, and other provocative language as well. My search was triggered by the NPR article “GOP’s Go-Slow ‘Rescue Mission’ Plan to Rescue Obamacare,” published on January 14, 2017, by Susan Davis. In it, Davis says, “Broadly, there is a philosophical debate here about whether the federal government has an obligation to insure all Americans, or whether Americans should decide whether or not to have insurance.”

That reminded me of another MLK quote, which shows up a lot on the PHNP website, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” I didn’t see any mention of single payer in the Davis article.

But because I signed the petition  “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform,” I got an email message with link to an editorial published by the American Journal of Public Health in June 2016 written by PHNP single payer promoters. Their conclusion:

Despite the ACA, many serious problems remain in American health care. Uninsurance and underinsurance endure, bureaucracy is growing, costs are likely to rise, and caring relationships take second place to the financial prerogatives of health insurers and providers. A single-payer NHP offers a salutary alternative, one that would at long last take the right to health care from the realm of political rhetoric to that of reality [2].

I had plenty of questions about my choice to defend and support single payer in the form of the “Expanded and Improved Medicare for All Act,” H.R. 676. I found a slew of answers on the PHNP website at the Single Payer FAQ.

But there are also a lot of other web pages. One of them which pops up near the top of search pages, is obamacarefacts.com. There is a huge page comparing single payer and Obamacare. Scroll all the way to the bottom and what do I find out about the sources? There are only 3: Wikipedia, PHNP, and a Washington Post article from 2014. And I looked for a byline for the article but could not find one. The site is red, white, and blue and “Obamacare Facts” is advertised all over the place, along with links to sites where one can sign up for Obamacare. I got the sense that it was biased although there was a lot of information that looked like the authors were trying to draw a fair comparison between single payer and Obamacare. There was a broken link to a BloombergView article that I finally tracked down, written by Ezra Klein in January 2014. The title is provocatively titled, “What Liberals Don’t Get About Single Payer.” There are 1,114 comments. Here’s what Klein says about private insurance carriers, which are typically criticized as driving up the cost of health care by single payer supporters:

Insurers aren’t even where the big money goes. In 2009, Forbes ranked health insurance as the 35th most profitable industry, with an anemic 2.2 percent return on revenue. To understand why the U.S. health-care system is so expensive, you need to travel higher up the Forbes list. The pharmaceutical industry was in third place, with a 19.9 percent return, and the medical products and equipment industry was right behind it, with a 16.3 percent return. Meanwhile, doctors are more likely than members of any other profession to have incomes in the top 1 percent…

The dirty truth about American health care is that it costs more not because insurers are so powerful, but because they’re so weak…

A health-care system that followed international best practices would direct the government to set rates. Or it would let insurers band together and negotiate rates collectively — a practice called “all-payer rate setting.” But it wouldn’t need to eliminate private insurers. It’s good for consumers to have a choice of insurers, who have real incentives to innovate and devise better ways to keep customers healthy and costs down.

It’s health-care providers — not insurers — who have too much power in the U.S. system. As a result, they have the most to lose if health-care prices fall. But, as is often the case, political power flows in part from popularity. So politicians who routinely rail against for-profit insurers are scared to criticize — much less legislate against — for-profit hospitals, doctors or device manufacturers (though drug companies come in for a drubbing now and then). These are the people who work every day to save our lives, even if they make us pay dearly for the privilege.

See what I mean about the online resources being confusing? I’m definitely getting progressively less confident my education has prepared me, as MLK said, to be able “…to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction…”

Klein casts a shadow over the motives of doctors, maybe with good reason but then, what’s the perspective on the physicians’ side? For that I read the MedPage Today article by Joyce Frieden from January 27, 2016, “What Would Single-Payer Mean for Doctors?” The article begins by quoting well-known PHNP and other supporters of single payer who praise it. On the other hand, a dissenting opinion follows:

But it wouldn’t be all roses. “My colleagues and I think this is nothing more than a government monopoly and it would have economic consequences as any government monopoly would,” Robert Moffit, PhD, senior fellow at the Center for Health Policy Studies at the Heritage Foundation, a right-leaning think tank in Washington, said in a phone interview.

“Monopolies are bad because they are basically vast concentrations of economic power in very few hands,” he continued. “We are talking about the government controlling virtually everything because it will be the single provider of a particular set of services, and that means … every decision dealing with the system is not simply an economic decision or a medical decision, ultimately it’s a political decision.”

“You have to make political calculations, like how much you are going to spend, and when you get down to doctors and hospitals, what the reimbursement will be and will not be.”

Make sure you note that Dr. Moffit works for a “right-leaning think tank in Washington.” The article also quotes experts praising the “public option,” which PHNP experts criticize:

In another scenario, Senator Baucus, leader of the bipartisan “board of directors” who are working this out behind closed doors has suggested that the “public option” will be the chance to buy insurance through Federal Employee Health Benefit Program, something candidates Clinton and Obama discussed. These are (1) administered by the insurance industry and (2) way out of reach for the uninsured and underinsured, thus would at least require colossal government subsidy, way beyond the $600 billion “down payment.” Baucus also supports a “mandate” that criminalizes the uninsured.

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Incidentally, if you watched the CNN Town Hall discussion with Speaker Paul Ryan, the other night, you’ll recall he praised the Federal Employee Health Benefit Program (FEHBP). Wikipedia has several articles that I consider helpful and I saw one about the FEHBP. I thought it was worthwhile linking to that because it’s too complicated for me to summarize or paraphrase and because it seems to contradict the belief that competition amongst private insurers wouldn’t work to keep costs down.

At the risk of sounding even more contradictory about my support of single payer, I found another on line article “Single-Payer System: Why It Would Ruin US Healthcare,” by Leigh Page. There are 127 comments about this one. The subtitle of the first section is “Single-Payer Would Be Bad for Doctors.” Here’s an excerpt:

Michel Accad, MD, a cardiologist in San Francisco, says that because a single-payer system makes healthcare virtually free, “demand is almost unlimited,” and the government has to set limits on what will be provided. Dr Accad writes a blog called “Alert & Oriented,” which provides alternative views on healthcare systems.

Because the offer is so open-ended, Dr Accad says that single-payer systems in Canada, the United Kingdom, and other developed countries have to impose strict central planning. Rather than leave healthcare choices up to individual physicians, their patients, and free-market forces that could balance supply with demand, the government sets the rules.

The article also mentions long waiting lists in Canada as a major hassle which leads doctors and patients to travel to the U.S. The PHNP denies that this is a major problem and so did the AARP in 2012 in an article entitled “5 Myths About Canadian Health Care.” written by Aaron E. Carroll, MD, MS. There are 530 comments attached to this one. You can try reading this one but you might not tolerate the flickering and twitching the web page does. I encourage you to try reading the article itself, but I’ve excerpted the high points below:

“Myth #1: Canadians are flocking to the United States to get medical care.”–The author quotes a study on the topic that debunks it; Source: “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States,” Health Affairs, May 2002.

“Myth #2: Doctors in Canada are flocking to the United States to practice.”–“The Canadian Institute for Health Information has been tracking doctors’ destinations since 1992. Since then, 60 percent to 70 percent of the physicians who emigrate have headed south of the border. In the mid-1990s, the number of Canadian doctors leaving for the United States spiked at about 400 to 500 a year. But in recent years this number has declined, with only 169 physicians leaving for the States in 2003, 138 in 2004 and 122 both in 2005 and 2006. These numbers represent less than 0.5 percent of all doctors working in Canada.”

“Myth #3: Canada rations health care; that’s why hip replacements and cataract surgeries happen faster in the United States.”–“This has been debunked so often, it’s tiring. The St. Louis Post-Dispatch, for example, concluded: “At least 63 percent of hip replacements performed in Canada last year [2008] … were on patients age 65 or older.” And more than 1,500 of those, it turned out, were on patients over 85.

The bottom line: Canada doesn’t deny hip replacements to older people.

But there’s more.

Know who gets most of the hip replacements in the United States? Older people.

Know who pays for care for older people in the United States? Medicare.

Know what Medicare is? A single-payer system.”

“Myth #4: Canada has long wait times because it has a single-payer system.”–“Our single-payer system, which is called Medicare (see above), manages not to have the “wait times” issue that Canada’s does. There must, therefore, be some other reason for the wait times. There is, of course.

In 1966, Canada implemented a single-payer health care system, which is also known as Medicare. Since then, as a country, Canadians have made a conscious decision to hold down costs. One of the ways they do that is by limiting supply, mostly for elective things, which can create wait times. Their outcomes are otherwise comparable to ours.”

“Myth #5: Canada rations health care; the United States doesn’t.”–“This one’s a little bit tricky. The truth is, Canada may “ration” by making people wait for some things, but here in the United States we also “ration” — by cost.

An 11-country survey carried out in 2010 by the Commonwealth Fund, a Washington-based health policy foundation, found that adults in the United States are by far the most likely to go without care because of cost. In fact, 42 percent of the Americans surveyed did not express confidence that they would be able to afford health care if seriously ill.

Source: “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” Health Affairs, November 2010.”

On the other hand, my goodness, I found an article (why not?) that says almost the complete opposite, “If Universal Health Care Is The Goal, Don’t Copy Canada,” by Jason Clemens and Bacchus Barua in the Jun 6 2014 Forbes. This one had 66, 712 views. Are the authors biased against Canada? Clemens is the executive vice-president and Barua is the senior economist at the Fraser Institute in Canada.

One aspect of the health care debate in the United States that is, unfortunately, riddled with misinformation is the state of Canada’s single-payer health care system. Too often advocates of Canadian-style health care in the U.S. present limited or even misleading information about the true state of Canada’s health care system and worse, often times present the ideal of Canadian health care rather than its reality.

It’s first important to recognize that a single-payer model is not a necessary condition for universal health care. There are ample examples from OECD countries where universal health care is guaranteed without imposing a single-payer model.

Amongst industrialized countries — members of the OECD — with universal health care, Canada has the second most expensive health care system as a share of the economy after adjusting for age. This is not necessarily a problem, however, depending on the value received for such spending. As countries become richer, citizens may choose to allocate a larger portion of their income to health care. However, such expenditures are a problem when they are not matched by value…

As Americans struggle with determining the next steps for health care reform, whether that means continuing to tweak the ACA or “repealing and replacing it,” they should keep in mind that the success of any reform depends in part on the degree to which facts dominate fiction and ideology. Discussion of the Canadian model is worthy of inclusion in such a debate, but more in terms of “what to avoid” than as a model for reform. The reality of Canadian health care is that it is comparatively expensive and imposes enormous costs on Canadians in the form of waiting for services, and limited access to physicians and medical technology. This isn’t something any country should consider replicating.

Is there anybody out there who tries to think both/and rather than either or about this? Is it Laurence Kotlikoff who wrote “How a Sanders Medicare-For-All Plan Can Be Affordable and Appeal to Republicans,” published online in Feb 2016 Forbes? It collected 11,384 views. In it, he mentions the “Purple Plan” which is called that because it supposedly would appeal to both Democrats and Republicans because Blue and Red make Purple.

“Here’s a plan that Sanders, Trump, Clinton, Cruz, Kasich, Rubio, Bush, and Carson (Did I miss anyone?) should like. I won’t call it the Medicare for All plan, which Sanders would like, or the Medicare for None plan, which Cruz might like. I’m calling it the Purple Health Plan, a title reds and blues can both like since purple combines both colors.

If you go to wwwthepurpleplansorg, you’ll find that the Purple Health Plan has been endorsed by five Nobel Laureates in Economics and a slew of other top economists, none of whom has a political ax to grind. The plan has two hot-button words. One is single-payer, which Blues love and Reds hate. The other is voucher, which Reds love and Blues hate.”

OK, I’m almost done. I looked at a couple of other Wikipedia articles. One of them was “Single-payer healthcare.” Highlights are the failure of several individual states to either pass single payer legislation or implement single payer systems. What I like about Wikipedia is that they highlight sections that need expansion, need to be updated, or warn the reader that neutrality of a section is disputed. The last one marks the Wikipedia “United States National Health Care Act, which refers to H.R. 676, supported by PHNP.

This is probably the longest post I’ve ever written and it reflects how much I’ve thought about the issue of health care reform, especially today. I have not been saved from “…the morass of propaganda…” Paraphrasing MLK, it has been extremely difficult for me to think incisively and for myself, given all of the “…half-truths, prejudices, and propaganda” that litter the online information about health care reform. I am trying to think logically and scientifically about it but I’m besieged on all sides, including the press, by nonobjective and biased views.

If I’m to use my education to enable me to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction…shouldn’t those who purport to be educating me at least make an effort to try not to mislead me?

References:

  1. Kingencyclopedia.Stanford University.edu
  2. Adam Gaffney, Steffie Woolhandler, Marcia Angell, and David U. Himmelstein.  Moving Forward From the Affordable Care Act to a Single-Payer System. American Journal of Public Health: June 2016, Vol. 106, No. 6, pp. 987-988.
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