HEALTH CARE $$$$: Rose and his guests manufacture consent!

FRIDAY, JUNE 2, 2017

Part 4—Disappeared all the way down:
Ever so briefly, permit yourself to become a conspiracy theorist.

Imagine that a potent cabal is scripting American journalism. In service to powerful interests, they mandate what our major journalists will, and will not, say.

In theory, we don't live in that world. But if we did, very little would have changed on last Thursday's Charlie Rose program.

We refer to the nine-minute segment in which Rose and two well-informed guests discussed, or seemed to discuss, the question of health care spending. More specifically, they discussed, or seemed to discuss, the very high level of health care spending in these United States.

To appearances, our nation's level of health care spending isn't just high; it's crazily high. Back in 2005, Paul Krugman tried to create awareness of this problem in a series of columns in the New York Times, a well-known American newspaper.

Uh-oh! As if guided by an invisible hand, our journalists all seemed to know that they mustn't follow Krugman's lead in this area. From that day to this, remarkable data like these have persistently been disappeared:
Per capita spending, health care, 2015:
United States: $9451
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Finland: $3984
It's often said that "those French" have the world's best health care system. But how odd:

According to those OECD data, we spend more than twice as much on health care, per person, as the high-flying French! As compared with the French, $5000 per person per year disappears into the maws of our "health care system."

Amazingly, that's $5000 per person. That missing money accounts for the problem we've long had in providing universal health coverage. It also accounts, all by itself, for our annual federal deficits!

And yet, as if by the work of an invisible hand, remarkable data like those are persistently disappeared by our major news orgs and the people they employ. The American public is kept from seeing those startling figures.

With that in mind, why not take The Conspiracy Theorist Challenge? Ever so briefly, permit yourself to be a conspiracy theorist. You'll feel fairly sure that last Thursday's discussion just couldn't have been on the level.

Rose spoke with Ezra Klein and Peter Orszag, a pair of well-positioned, major insiders who know what they're talking about. And yet, their nine-minute discussion of health care spending had the sweet smell of a con.

(To watch the entire segment, click here. The discussion of health care costs starts at the 12-minute mark.)

As the conversation started, Klein said that our health care system is the worst in the world. He and Orszag quickly agreed on two other points:

Our health care prices are too damn high! And that's because, unlike every other developed nation, our government doesn't establish prices for health care procedures and products.

It took roughly ninety seconds for these basic points to be made. From that point on, an invisible hand seemed to control what was said.

For starters, Rose himself never posted or cited the data we've posted above. In turn, Orszag and Klein made no attempt to report the remarkable size of our overspending.

In that way, PBS viewers were treated like rubes concerning the remarkable size of this state of affairs. As is required by Hard Pundit Law, those remarkable basic data were ruthlessly disappeared.

Things got worse from there. Consider what else the boys said:

Uh-oh! As they continued, Klein and Orszag agreed on another remarkable claim. According to Orszag and Klein, the rest of the developed world is freeloading off our remarkable rate of spending.

Everyone else is freeloading on us! Fighting through one of Charlie's interruptions, Klein made this basic point first:
KLEIN (5/25/17): There is a more honest debate we could have be having in this country. There is a consistent, coherent and in some ways persuasive, I think, conservative case on this, that if you regulate prices, particularly in America, where we are the single largest market for health services, for pharmaceuticals, for medical devices, all of it—

ROSE: And the single largest sector of our economy, right?

KLEIN: —that you would hurt innovation badly. And no matter whether it be cheaper, it wouldn't be worth hurting innovation.

That is a fair argument. But what it implies is that the direction you are going is just more expensive health care. That America, in order to have this world-leading innovation, in order for the rest of the world to be able to free-ride off our innovation, which they do—conservatives are right about that—that conservatives need to be willing to put more money into the American health care system in order to be able to keep this going. It just costs more to do what we're doing.
Say what? According to Klein, the rest of the world is "free-riding" (freeloading) off our medical innovation. He seemed to say that our overspending is connected to this search for innovation, and that innovation would be harmed if we regulated prices, the way all others do.

Is everyone else freeloading off us? Orszag soon agreed:
ORSZAG: We do subsidize medical innovation for the rest of the world. The issue is how, and what kind of innovation. Because we have historically just paid for whatever comes along and so we paid for even very minor improvements. On average, the innovation has been miraculous. But there is plenty of stuff, high-cost, that doesn't really do very much.
Everyone's freeloading on us. Apparently, this explains, or helps explain, our very high medical spending.

That said, neither Orszag nor Klein suggested that we should take steps to end this freeloading—to distribute the costs of innovation across the developed world. Instead, Klein offered a familiar but highly misleading statistic—a statistic which tended to disguise the size of our overspending.

Orszag, in turn, played Pollyanna. Cheerfully, he described the best of all future worlds.

What statistic did Klein provide? Cheerfully, he said this to the people who can best be describes as "the rubes of PBS:"
KLEIN: I do not think American health care is going to be as cheap as in our competitor nations in any near-term time frame—

ROSE: Because of the absence of regulation.

KLEIN: No. Because of the absence of regulation, but even if you put it in today, path dependence is a very powerful thing. You would have a tremendous amount of disruption in the health care system if you tried to cut cost by 20 percent or 30 percent that quickly. So I would like to believe we could get it further down, and I think we can do a much better job than we are.
Good God! Our health care won't be as cheap as everyone else's in any near-term time frame. But over time, we might be able to lower costs by 20 or 30 percent!

Over time, we might be able to cut our costs that much! To the rubes of PBS, that may have sounded like a promising projection. But because they hadn't been shown the basic data, they didn't know that a 25 percent reduction, magically backloaded, would have left us looking like this back in 2015:
Per capita spending, health care, 2015 (with United States spending reduced):
United States: $7088
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Finland: $3984
We'd still be getting looted badly compared to everyone else! Because they'd been deprived of basic data, the misused "rubes of PBS" had no way to know this.

Klein had envisioned a magic trombone which didn't exactly blow. Up jumped Orszag, cheerfully casting himself in the Pollyanna role, as he'd also done earlier:
ORSZAG: I'm an optimist here. I think in ten years, we are going to have a health care system that is much more digitized, it's much more personalized, in the sense of not just something works on average, but works for you, Mr. Rose, or works for you, Mr. Klein, in which scheduling and billing is not as annoying and tedious as it is today.

And the good part of all the inefficiency that exists in health care today is that we can slow the growth rate, or even maybe reduce costs, but at least slow the growth rate of costs without harming the quality of the health care that people get by wringing those inefficiencies out. So I'm a big optimist here.

ROSE: Thank you. Thank you, Ezra. Thank you for joining us.
Yay yay yay yay yay yay yay! We can slow the growth rate of costs—and not only that! In ten years, scheduling and billing won't be as annoying as they are today!

So ended a striking discussion.

We can slow the growth rate of health care costs? All through this nine-minute discussion, an invisible hand had kept us rubes from seeing the baseline from which that slower growth rate would emerge.

Here's how our spending looks today as compared to the world's best system. In the face of this craziness, we rubes were told that our growth rate can slow!
Per capita spending, health care, 2015:
United States: $9451
France: $4407
As is decreed by Hard Pundit Law, Rose never let his viewers see those remarkable data. They drifted to sleep, unaware of the way they'd been conned.

In closing, let's make one key point. It's silly to think that our overspending is all caused by innovation. But that was the only explanation offered to Charlie's angels. The massive looting involved in this ludicrous scam went unmentioned, as always.

Beyond that, though, lies the larger problem—the problem of disappeared data. Pretending to be a conspiracy theorist, you might end up thinking this:

Chomsky describes this puzzling process as "manufactured consent." For whatever reason, elites present certain frameworks and facts while disappearing all others. Through this selective presentation, we the rubes are skillfully led to the desired conclusions.

In the realm of health care spending, our consent is manufactured through the startling data we never get shown. Those basic data, which are truly remarkable, get disappeared all the way down.

This lets the remarkable looting continue. As part of this important process, our PBS viewers get conned.

Soon, a doo-wop tape is playing, and they're asked for donations.

Tomorrow: Some comic relief


  1. Hi Bob, I tried to contact you via yahoo email, and it bounced back. Would like to inform you of documentary on broken media system. If you want to learn more, email me at Here is the trailer:

  2. I know there is been a lot of imitators and a lot of things said back-and-forth and the opposite both before, here and today and after, really for a long time now but it has come to the time to heed to the realization and make the declaration that yes it is true after all this time and all these words spilt and all the fuss about him and me and I say let bygones be bygones and let us realize once and for all, Bob is an idiot. People in the sticks never see Maddow. And right wing propagandists never put together YouTube videos showing her acting like a dick and spread it around. They don't ever talk about the deplorables comment. Liberal coastal elites and the inbred Trumpian farmers exist in completely separate worlds because of the Internet. I drink urine and blood. People imitate me. Everyone cares. My thoughts are celebrated. I am a great favorite. I will never die. Today the magic moment arrives. Everyone is cheering. Don't be confused by the other one. He stole the nym. Process the data. I will never die. The cat food. The radiator. Corby. The little bits of crayon. The melted pieces. The loving friends. All the things you wish you had.

    1. If you are a friend or relative of this person, please heed his cry for help.

    2. Lest anyone think different, that is not the real Greg. I am the real Greg so please address me here if you have something to say to me and I will address you back.

  3. Which is the bigger problem for Americans today: (1) crazily high health care costs, (2) global warming?

    Which do we as Americans have more control over as individuals: (1) crazily high health care costs, (2) global warming?

    What has everyone been talking about these past few days, because of the President's decision: (1) crazily high health care costs, (2) global warming?

    I don't care about crazily high health care costs. I care about global warming. Somerby keeps writing these columns to promote Bernie Sanders socialist worldview. Sanders didn't care much about global warming either.

    As an individual, there is quite a bit I can do to help combat global warming. There are things our cities and states can do, things our corporations can do. Fortunately, action does not depend on Trump and the federal government. Somerby could be part of the solution too. Obviously, he chooses not to be. The media has done a better job than Somerby in addressing global warming as a critical issue, perhaps the most critical issue facing us NOW.

    1. The only chance to for the United States to deal with the crisis of climate change rationally is for We the People to assert control over our political system. Currently the plutocratic class is in control of our government and media.That class has made a mission of undermining all democratic institutions in this country- and globally -so that, ever as soon as possible, it can capture more wealth and power for itself.

      The People will not become an effective political force dealing with a range of issues without, as their first steps, empowering themselves by eliminating the pall of economic insecurity they face in their day to day lives. An overhaul of the healthcare system is an obvious requirement for achieving this necessary state of broad-based economic security and such an overhaul could be in place within a decade.

      In the meantime we'll mark it down 11:18 AM, you can't be bothered with the petty concerns economics and politics, you're one of those serious sorts who are devoted to saving the planet by being an inspiration to others.

  4. Somerby said: "Our health care prices are too damn high! And that's because, unlike every other developed nation, our government doesn't establish prices for health care procedures and products."

    Except our government does establish prices for health care procedures and products. It does that by establishing amounts it will reimburse under Medicare and Medicaid.

    Aside from that, the government cannot intervene with price controls unless there is a national emergency, as during wartime. Changing that would change the fundamental nature of how our government interacts with business. We would no longer be a capitalist country but would become a government-managed economy, at least with respect to health care. People don't seem to want that.

    So how about having a real discussion about health care costs and the factors affecting them?

    1. The first step at fixing things is to reject the hold plutocratic sponsored neo-liberalism has over our politics and transition America back towards being a functioning social democracy. When FDR was inaugurated during the Great Depression we heard from people like you that there was nothing to be done about the cruelties of want the population was suffering through; that we were living in the best of all possible worlds; that economic busts were to be endured by the many as a just God's punishment for the economic booms enjoyed by the few; "that when the storm is long past, the ocean [will be] flat again."

      Nonetheless, in fits and starts, beginning with the New Deal, the country changed course and started managing its affairs as if it were the modern industrial society it was instead of pretending it remained an agrarian one. The wonderful result was a couple of decades of happy economic days. We should take a lesson from that history and give up on these fundamentalist incantations you're chanting.

    2. You should read an actual economic history of the depression and aftermath of WWII. Nothing FDR did ended the depression. It was the war spending that stimulated the economy enough to get us out of that bad time. No one reformed government. The president took upon himself war powers that were later overturned by the supreme court and limited by congress. He did things like busting unions and stopping strikes to ensure continued production, and he set prices. He also imposed rationing and quotas and directed materials toward war production, making laws about the length of hemlines on clothing.

      We could have enacted universal health care after the war, but we didn't. Why not? Countries in Europe were bankrupt and there was famine, relieved by the US. They could reorganize because they had our support. We went into debt to bail out Europe after fighting an expensive war. That's largely why we couldn't do what they did.

      Europe elected leftist governments because the right was associated with the Nazis. We fought the war with a leftist government so we went to the right afterward in order to return to normalcy. Your happy revolution is a figment of your imagination. The main changes enacted was social security and it was to enable people to feel less threatened by the events of the previous two decades.

      Poor people died during the depression. Relief efforts were inadequate. Look at mortality for that decade. Look at health stats for the cohort born during that decade. You have only the vaguest idea what happened in our country during that time period.

    3. U.S. GDP was at 60% of its 1929 size in 1933, the year FDR took office, eight years later it had returned to its peak level. Though he did expand employment through deficit financed job programs the scale of the effort ultimately was insufficient to match the emergency.

      FDR rejected Keynes' prescription that when the economy was suffering from high unemployment and unused industrial capacity the government should borrow and spend as the means to return it prosperity. In fact, the president blundered in 1937 causing the recovering economy to dip back into recession for a year by taking steps to reduce the deficit.

      Nonetheless, FDR took crucially necessary steps during his first two terms in office for the economy to recover from the Great Depression and for fairness to prevail in the long run thereafter by transforming the federal government's role in American economy and the political system itself. First and foremost he established the national belief that the federal government had the ultimate responsibility to make the economy work.

      At the policy level FDR and a Democratic congress took unprecedented steps to regulate banks and the financial markets. He overturned the Lochner labor law era by forcing the switch in time which saved nine guaranteeing thereafter courts would find in favor of the constitutionality of minimum wage, unemployment insurance, old age insurance, and worker protection legislation, and that labor had a right to organize.

      As to that last matter, despite the passage of the reactionary Taft-Hartley legislation after WWII, so powerful was the effect of New Deal's Wagner Act that labor became the core and driving constituency for American liberalism thereafter, into the 1970s.

      So profound was the societal transformation FDR wrought that, after a year in office, the next Republican to sit in the White House, Dwight Eisenhower, would write his brother with the concession that:

      [QUOTE] Now it is true that I believe this country is following a dangerous trend when it permits too great a degree of centralization of governmental functions.

      I oppose this — in some instances the fight is a rather desperate one. But to attain any success it is quite clear that the Federal government cannot avoid or escape responsibilities which the mass of the people firmly believe should be undertaken by it.

      The political processes of our country are such that if a rule of reason is not applied in this effort, we will lose everything — even to a possible and drastic change in the Constitution. This is what I mean by my constant insistence upon “moderation” in government.

      Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.
      [END QUOTE]

      As to the government debt issue you mentioned, post war American presidential administrations steadily paid down government debt as a percentage of GDP from 1947 until the Reagan years. Gilded Age ideology, not budget constraints, is the reason neither FDR nor Truman could achieve single payer healthcare.

      As for the social democratic policies western Europe adopted after WWII, they were a result not of American financial aid, rather they were steps on a continuum which began in 1848 and were first manifested by the policies of Bismarck in the 1880s and advocated for in more sweeping fashion, for instance, in the UK in the middle of WWII by the Beveridge Report.

      But what most powerfully drove post war western European politics was the fact that the working class had been pressed into service to fight two world wars in thirty years empowering its members to feel rightfully entitled to their exercise of democratic power and to social benefits from the state.


    4. ...continued

      BTW, Nazi Germany had an utterly depraved national healthcare system which, if anything, argued against any other state taking a role in that area of life.

      If it were in reaction to a regime that the role in healthcare expanded in various states in western Europe after WWII, it was in response to the recognized threat the appeal Soviet communism might have for the economically insecure in market based economies there.

  5. This is a valid issue that you should keep pounding away at, not the alleged condescension of some liberals to the so-called white working class.