My Odyssey on Healthcare Reform

The debate about healthcare reform in the United States didn’t begin in 2009. It has been going on for more than 70 years. Although it’s forgotten by most Harry Truman’s Fair Deal included a provision for universal healthcare. That didn’t go much of anywhere and the discussion really began to heat up in the 1960s.

When the debates that culminated in the establishing of Medicaid and Medicare were going on, I supported something quite different, a system of clinics, run by the federal government, that would provide healthcare to needy seniors. Something else that has been forgotten is that before Medicare there were a lot of destitute or near-destitute seniors. I suspect that was a leftover from the Great Depression. Some areas of the country, particularly in the South, didn’t recover for a generation and the seniors of the 1960s had been adults in the 1930s and their lives had been blighted by the Depression.

There was a very simple reason for my preference. The United States had no experience in running a system like Medicare or Medicaid in which tax money was transferred in the billions to private providers but it did have experience in running a much more modest plan which seemed to be working and controlling costs at the same time: the VA system. Also, that plan wouldn’t have the spillover effects that Medicare has and which were obvious from its inception fifty years ago.

Such a system didn’t satisfy the ambitions of the progressives of the time (we called them “liberals” then) who really wanted British National Health. For reasons that have never been clear to me it was anathema to conservatives and libertarians of 50 years ago as well. A system of clinics to provide healthcare to qualifying seniors was “socialized medicine” but the VA hospital system wasn’t? The idea is beyond absurd.

In the 1970s I had the opportunity to live and work in Germany briefly, visiting France, Belgium, and the Netherlands. While there I learned that their systems didn’t lead inevitably to those countries becoming Soviet hellholes as most Americans seemed to believe and many believe still. For decades thereafter I supported a single payer system something on the order of France’s. That got nowhere and when Hillary Clinton bungled her opportunity to reform the U. S. healthcare system the door was once again closed on any sort of U. S. healthcare reform for another 15 years.

Shortly after the Congress began its annual exercise in kicking the can down the road called the “doc fixes” I abandoned my support for a single payer system. I have now concluded that the federal government is simply unwilling and incapable of controlling costs and any system in which costs are not controlled will inevitably collapse of its own weight. The present system, which I still find disrespectful to call “Obamacare”, is no exception. I think it will collapse for all of the reasons its critics have predicted but it’s still early days. By the time it collapses healthcare will comprise about 20% of the economy and the dislocation that collapse will produce is truly awful to consider.

So now I’m in despair. It’s far too late for a modest program capable of addressing the actual problems. Healthcare costs, inflated by Medicare, are simply too high. The U. S. is pretty obviously incapable of running a nationwide single payer system.

I suspect that workable reform must take place at the state level, as is the case in Canada and Australia, which will mean that some states will have state healthcare systems, some will have have state-based single payer systems, and some won’t have either one. Such an outcome is so unacceptable to both political parties that I don’t expect to see our system seriously reformed in my lifetime. The deadweight loss of our healthcare system will continue to grow, stunting economic growth in the other sectors of the economy, for the foreseeable future.

14 comments… add one
  • bob sykes Link

    My daughter has lived in Germany for 15 years and is enrolled in their health insurance program, a single payer system. They got it right. The Brits and Canadians screwed it up.

  • Germany’s system is a little more complicated than a single-payer system. They have a state-mandated and paid system with lots of little insurance companies. In a true single-payer system, at least the way most people use the term, there would be no insurance companies.

  • bob sykes Link

    True. But the German system works.

    However, she pays 30% of her gross income into Germany’s pension and health funds. She thinks she gets a good deal, but in recent years her health has been subpar?

  • My experience has been that the Germans obey rules. I think Americans by contrast are more willing to play fast and loose with the rules.

  • Andy Link

    I share your skepticism – I don’t really see a solution at present.

  • ... Link

    Forget this, I’m waiting to see what Schuler thinks is the biggest menace to America today: Opiod Induced Constipation or Diarrhea?

    (The correct answer is, of course, puppymonkeybaby. Don’t do the Dew.)

  • My wife watched the SuperBowl with rapt attention. It doesn’t interest me so I sat at my computer playing Dragon Age: Inquisition for the umpteenth time through.

    If opiod-induced constipation is a really serious problem in the United States, the problem of addition is significantly worse than I thought. Clearly, it’s bad–it’s a big reason for the uptick in suicides among white middle income women.

  • Andy Link

    I’m a life-long Broncos fan, so I watched with interest. The commercials this year weren’t so good IMO. My favorites were the baby doritos commercial and the weiner dogs running toward the ketchup and mustard.

    I haven’t played Dragon Age and probably won’t – I just can’t play them all. I’m trying to finish Fallout 4 right now and that is a huge time-suck.

  • Andy Link

    This was probably the worst:

  • ... Link

    Worst product, yes, but not the worst commercial.

    An interesting aspect of the Super Bowl ads is that some of the most entertaining ads leave you clueless about the product. Loved the ad with the sheep singing Queen. The ad might have been for a truck? Or speakers? Perhaps about buying property in Montana with an eight minute mortgage? Not sure, but I liked it.

    The best ad was the Avocados from Mexico ad, if only for getting Scott Baio off the street.

    And based off the ads and the music played over the stadium PA (meaning: NOT the halftime show), there hasn’t been any new music since Seal released “Kissed by a Rose” in 1994.

  • Ben Wolf Link


    I see multiple user reviews of Fallout 4 complaining there’s little to do outside the main questline and for that reason haven”t bought it. Is that not your experience?

  • Ben Wolf Link


    The provision in the ACA providing funding for local clinics appears to be one of the few parts going well. Do you think additional federal support for this is the best (or least worst) way forward?

  • Andy Link


    I really think it depends. A lot of reviewers spent 80 hours playing in a week or two and then complained about a lack of content. 80 hours is a lot for normal people and even there that’s focusing on the main quest while doing side quests. You can probably blow through the main story in about 24 hours played if you know what you’re doing and ignore anything else (which is pretty much impossible on a first-playthrough without looking up spoilers on the internet).

    So I think there is a lot to do, but once you are done with the side-quests you’re stuck with radiant quests which do get repetitive. If you like to explore in open world games then there are many hours of that. So I guess it depends on how you like to play and how much time you have. If you spend an hour or two a night playing and play it like most people do, then it will take a good month or two to complete and there will still be areas to explore. Plus, there will probably be a DLC by then.

  • Ben Wolf Link

    Andy, you’ve sold me.

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