HEALTH MATTERS: Zakaria dreams the impossible dream!


Part 2—Endorses "single-payer:"
Could Donald J. Trump, the American president, ever support "single-payer?"

Everything is possible! And last Friday, in the Washington Post, Charles Krauthammer said he could imagine that very thing. For background, see yesterday's report.

For Charles, single-payer is a lousy idea. For Fareed Zakaria, Donald J. Trump supporting single-payer seems more like the so-called impossible dream—the dream which, like the famous engine, maybe just possibly could.

In last Friday's Washington Post, Zakaria and David Ignatius wrote their own columns about health care. Ignatius said we should be embarrassed by the "high cost and poor care" provided by our health system.

Before the week is done, we'll suggest that we liberals should be embarrassed by discussions like the one Ignatius provided. Today, though, let's focus on Zakaria's impossible dream.

Zakaria dreamed the impossible dream. Ridiculous headline included, he laid it out like this:
ZAKARIA (3/31/17): Until recently, Trump got health care right

The recent Republican debacle on health care could prove to be an opportunity.
It highlighted, yet again, the complexity of the U.S. system, which continues to be by far the most expensive and inefficient in the advanced world. But President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent.


Trump has now taken up the call to repeal Obamacare. But until recently, health care was actually one of the rare issues on which he had spoken out, before his campaign, with remarkable consistency. In his 2000 book "The America We Deserve," he wrote:

"I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses. ... We must have universal healthcare. ... The Canadian plan ... helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. ... We need, as a nation, to reexamine the single-payer plan, as many individual states are doing."

Trump was right on this issue for much of his life. He has now caved to special interests and an ideology unmoored by facts. He could simply return to his convictions, reach out to Democrats and help the United States solve its health-care crisis.
All edits, save one, by Zakaria. That's the way his column began and ended.

As with Krauthammer, so with Zakaria. He seemed to imagine Donald J. Trump embracing single-payer!

That said, Zakaria's column struck us as phantasmagoric. We refer to his assertions about Donald J. Trump's "core convictions" concerning health care.

Does Donald J. Trump really have "core convictions" on the topic of health care? Zakaria seemed to say that Trump has been "consistent" and "right" about health care "for much of his life."

But alas! In support of this claim, Zakaria cited a passage from a 17-year-old book, a book which was written when Trump was considering an earlier White House run in a reform-minded party. He cited no other evidence in support of the apparent claim that Donald J. Trump has long held a "core conviction" about single-payer.

To what extent does Donald J. Trump have any such core convictions? Zakaria failed to note the ludicrous statements about health care persistently made by Candidate Trump during last year's campaign.

Presumably, the candidate only said those ridiculous things because he'd "caved to special interests and an ideology unmoored by facts." But his statements went all over the place. Together, they made little sense.

Does Donald J. Trump hold "core convictions" about universal health care? We'd say it's possible, but only in the sense that everything is. We see few signs that Donald J. Trump has core convictions about much of anything in the policy realm. We don't know why Zakaria would include health care on this puny list.

At any rate, Zakaria's piece accompanied the column in which Krauthammer imagined Trump embracing single-payer. Last Friday was Health Care Day in the Washington Post, and a day of exceptional dreams.

It was clear from Zakaria's piece that he himself supports the idea of single-payer. More precisely, he supports the idea of single-payer or of something equivalent.

As Ignatius did in his own Friday column, Zakaria said we spend too much on health care—far more than the better-run developed nations. In this passage, he detailed their obvious smarts, as opposed to our own dysfunctions:
ZAKARIA: Every advanced economy in the world has...adopted some version of a state-directed system for health care. Consider the 16 countries that rank higher than the United States on the conservative Heritage Foundation's Index of Economic Freedom. All except Singapore (which has a unique state-driven approach) have universal health-care systems that can be described as single-payer (Medicare for all), government-run (the British model) or Obamacare-plus (private insurance with a real mandate that everyone opt in). Hong Kong, often considered the most unregulated market in the world, has a British-style government-run system. Switzerland, one of the most business-friendly countries, had a private insurance system just like the United States' but found that, to make it work, it had to introduce a mandate.

While producing a CNN documentary on health-care systems around the globe, I was particularly struck by the experience of Taiwan, another free-market haven. In 1995, 41 percent of its population was uninsured and the country had very poor health outcomes. The government decided to canvass the world for the best ideas before instituting a new framework. It chose Medicare for all, a single government payer, with multiple private providers. The results are astonishing.
In his own column this day, Ignatius said we should be "embarrassed" by our system's high costs and poor results. Zakaria was saying much the same thing.

Zakaria seems to think that sensible developed nations will "adopt some version of a state-directed system for health care." We are inclined to agree. In the passages we've posted, he twice endorses "single-payer" (among other possibilities). He twice equates "single-payer" with "Medicare for all."

We think that turn of phrase can serve as a gift to us liberals. It lets us consider the way our self-impressed tribe's ineptitude has kept our nation locked in the startling health care mess Ignatius and Zakaria (euphemistically) describe.

We raised the question yesterday; we raise it again today. What does it mean when we liberals refer to Medicare as "single-payer?" In what sense are we proposing "single-payer" when we propose "Medicare for all?"

We'll repeat our judgment from yesterday. We'll guess that very few liberals could explain why we call our nation's Medicare program a form of "single-payer." In this, as in just about every thing else, we liberals—like Those People in Oklahoma—often have no freaking idea what we're talking about. We the liberals rarely have the first freaking earthly clue.

In reality, the lunacy of our health care system extends well past "embarrassing." This lunacy has lived, for decades now, in the womb of our self-impressed tribe's dumbness, ineptitude, laziness, incoherence.

We liberals! Along with just about everyone else, we're among the dumbest people on earth. Despite this fact, we tend to be sure of our greatness. We saw this reflected in yesterday's post by Kevin Drum, in which a highly advantaged person who 1) supported the war in Iraq and 2) told us on a weekly basis last year that Candidate Clinton couldn't lose (he knew this because Professor Wang said) found a way to kick down at much less advantaged people Over There.

Those People! They displayed their dumbness, and their hearts of darkness, by voting for Donald J. Trump!

Our liberal tribe loves kicking down; as with every other tribe, it's deeply bred in the bone. We kick down at the hillbillies, and at the Okies too. As we do, we fail to notice the world-class cluelessness we ourselves, and our ridiculous leaders, have brought to the health care pseudo-debate for the past many years.

It's the oldest story known to the race; it accompanied our crawl from the swamp. Our own tribe is smart and good. Theirs is evil and dumb.

In fact, our own liberal tribe has been tremendously dumb through the years. Inevitably, as part of the package, We're completely unable to see this.

In accord with the oldest of prehuman laws, We can't see the dumbness of Us. Instead, We believe in the greatness of Us, and We enjoy kicking down Over There.

Tomorrow: Ignatius seems to sound off

While we're at it, riddle us this: Why is our Medicare program called "single-payer?" We can't exactly say.

While you're at it, tell us this: Why were all those "flat tax proposals" described as flat tax proposals?

In recent years, such proposals seem to have gone the way of the dodo bird. But why were they ever called flat tax proposals?

Did you ever see our underwhelming, lead-exposed leaders ask?


  1. So, now it is "kicking down" to accurately report that many Trump supporters voted for him because he was going to build a wall? I didn't see Drum mention the word Hillbilly once.

    And Drum is a doody-head because he thought Hillary was going to win, just like everyone else thought -- because it was inconceivable to us that Russian meddling would hand our election to an idiot?

    Somerby is off his gourd. Now he is quibbling over what to call a health care proposal based on extending medicare. He thinks the people who would pay don't understand that they would be paying.

    Is he kicking down at us when he claims we are too stupid to realize that we pay for Medicare? I pointed it out myself last week in comments.

    Why is it OK for Somerby to kick down at us liberals but wrong when anyone points out the stupidity of conservatives -- who continue to do more and more stupid things every day?

    Ignatius apparently said the same thing Somerby has said -- that we pay more and get less for our health care dollar than other countries do. But there is something terribly wrong with Ignatius's column, so Ignatius is a bad guy, even though he is saying the stuff Somerby has long called for -- but apparently imperfectly. Phooey on you, Somerby.

    1. I agree with you. Somerby was spot on during the Clinton and Bush/Gore years with his critique of the media. But now, his critique has ballooned into "liberals are the dumbest people on earth." That's way too broad, Bob, and highly unhelpful.
      And, I don't control who msnbc or the NY Times employs, nor do I slavishly follow their opinions. And I try to be a decent, compassionate, well-informed liberal/person.

  2. Why do we call the earth round, a globe, when it isn't actually round?

    Lead-exposed minds want to know!

  3. Why do we call our country a democracy when it is actually a republic?

    Lead-exposed minds want to know!

    1. Actually, it is a democratic republic.

  4. Why do we call a prairie dog a dog when it is actually a rodent?

    Lead-exposed minds want to know!

  5. Why do we call Somerby a liberal when he is actually a wolf in sheep's clothing?

    Lead-exposed minds want to know!

  6. "Zakaria twice equates "single-payer" with "Medicare for all.""

    Please don't provide this information. We prefer to think that all such delusions are due to the awful influence of the Russian puppet Bernard Sanders.

  7. Yet another example of Bob Somerby attacking someone for doing exactly what he himself does.

    Here's my edit of Somerby on Zakaria:

    "That said, Zakaria's column struck us as phantasmagoric...

    Does Donald J. Trump really have "core convictions" care?...

    But alas! In support of this claim, Zakaria cited a passage from a 17-year-old book... He cited no other evidence in support of the apparent claim...

    Just yesterday Somerby wrote:

    "We cheer our Harvard men as they mock and name-call working-class women in rural Kentucky."

    Alas, Somerby has cited no evidence of anyone cheering. He has given no example of any Harvard man mocking or name calling any working class woman in Kentucky.

    Bob Somerby is a phony, self righteous hypocrite. That said, he is verbose and repetitive.

  8. Did Drum support the 2003 Iraq War?

  9. Bob Somerby continues his long march towards getting to the point:

    [QUOTE] We raised the question yesterday; we raise it again today. What does it mean when we liberals refer to Medicare as "single-payer?" In what sense are we proposing "single-payer" when we propose "Medicare for all?"

    We'll repeat our judgment from yesterday. We'll guess that very few liberals could explain why we call our nation's Medicare program a form of "single-payer." In this, as in just about every thing else, we liberals—like Those People in Oklahoma—often have no freaking idea what we're talking about. We the liberals rarely have the first freaking earthly clue. [END QUOTE]

    How about this, instead of putting "Medicare for All" on a bumper sticker why don't we go with NPR's phrasing instead [LINK]:

    [QUOTE] What Is A Single Payer?

    A single payer refers to a system in which one entity (usually the government) pays all the medical bills for a specific population. And usually (though, again, not always) that entity sets the prices for medical procedures.

    A single-payer system is not the same thing as socialized medicine. In a truly socialized medicine system, the government not only pays the bills but also owns the health care facilities and employs the professionals who work there.

    The Veterans Health Administration is an example of a socialized health system run by the government. The VA owns the hospitals and clinics and pays the doctors, nurses and other health providers.

    Medicare, on the other hand, is a single-payer system in which the federal government pays the bills for those who qualify, but hospitals and other providers remain private. [see bolded passage below]

    Which Countries Have Single-Payer Health Systems?

    There are fewer than many people might think. Most European countries either never had or no longer have single-payer systems. "Most are basically what we call social insurance systems," says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who has studied international health systems. Social insurance programs ensure that almost everyone is covered. They are taxpayer-funded but aren't necessarily run by the government.

    Germany, for example, has 135 "sickness funds," which are essentially private, nonprofit insurance plans that negotiate prices with health care providers. "So you have 135 funds to choose from," said Anderson.

    Nearby, Switzerland and the Netherlands require their residents to have private insurance (just like the Affordable Care Act does), with subsidies to help those who cannot otherwise afford coverage.

    ...As far as countries that have true single-payer systems, Anderson lists only two: Canada and Taiwan.

    Would Medicare For All Be Just Like The Existing Medicare Program?

    No, at least not as Sanders envisions it. Medicare is not nearly as generous as many people think. Between premiums (for doctor and drug coverage), cost-sharing (deductibles and coinsurance), and items Medicare does not cover at all (most dental, hearing and eye care), the average Medicare beneficiary still devotes an estimated 14 percent of all household spending to health care.

    Sanders' plan would be far more generous, including dental, vision, hearing, mental health and long-term care, all without copays or deductibles (which has given rise to a lively debate about how to pay for it and whether middle-class families will save money or pay more).... [END QUOTE]


    1. Not pithy enough? How about this slogan from Physicians for a National Health Program?:

      [QUOTE] What is Single Payer?

      Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.

      Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

      The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay.

      Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.

      The Expanded and Improved Medicare for All Act, H.R. 676, based on PNHP’s AJPH-published Physicians’ Proposal, would establish an American single-payer health insurance system. [END QUOTE]

      Chart [LINK]

      FAQ [LINK]

  10. Wow, is Bob naturally obtuse or does he spend hours every day honing this skill? I vote both. Hey Bob! Get out a pencil, because this is complicated. When an entity (let's say a doctor) bills Medicare, he/she receives a payment from the entity known as Medicare. Medicare is the single payer that writes that check. Now, if it is necessary, underline the words Medicare and single payer and study that sentence for a few hours if necessary. Get back with us when you've got it figured out. I told you it is complicated. Take your time.

  11. I saw a recent poll that showed public support for "Medicare for all" well outdid support for "single payer". Somerby is correct, proponents need to speak in a way that is advantageous to their argument by clarifying the terms. A change this dramatic and this important is going to require a major sales pitch.


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