The hypocrisy of the AMA (and other elite organizations like the NYT)

November 2, 2021 • 9:15 am

I call your attention to my post yesterday on the apparent metastasizng wokeness of the American Medical Association (AMA) in its new Medspeak guide, “Advancing Health Equity: A Guide To Language, Narrative and Concepts.” That guidebook, full of new medical euphemisms, was an almost unbelievable display of wokeness, so outré that it was funny—except of course that instantiated what’s happening in every college, every venue of mainstream media, and every professional and scientific organization in America. In fact, one of my friends who reads this site wrote me this assessment of the AMA pamphlet:

 I honestly think that the woke are minting new Republicans by the hour. We’ll be back to Trump, and then we can really kiss our collective ass goodbye.

Indeed. You don’t have to be a rocket scientist to see that!

But lest you think the whole AMA has gone woke, have a look at this article from The Hill (click on screenshot):

It’s pretty much what it says it is: the AMA President doesn’t want a “Medicare for all” system. Maybe for poor people (though they already have one), but President Dr. Patrice Harris says this:

The president of the American Medical Association (AMA) criticized “Medicare for All” as a “one-size-fits-all solution” on Wednesday, but acknowledged that some doctors, particularly younger ones, support the idea.

“We just don’t think a one-size-fits-all solution works,” Dr. Patrice Harris told The Hill when asked about a Medicare for All, single-payer system.

“And so, we believe that there should be choice for patient, choice for physician, and there should be a plurality of available options, but absolutely having a strong safety net,” she added in the interview at the group’s national advocacy conference in Washington.

Of course a “plurality of options” means different forms of medical insurance and that in turn means that doctors get to keep their high salaries and prestige. (I’m not of course implying that all doctors have this notion.)

Dr. Harris adds:

But attitudes among doctors could be changing. Asked if younger doctors are more open to single-payer, Harris said, “I’ve seen that, I’ve witnessed that.”

“I think there are folks of all, you know, age ranges and specialties that might support that,” she added. “But again, that’s the beauty of the AMA and our democratic process and our value of diverse thoughts and opinions.”

In other words, Harris’s sense of “diversity” is not the one we’re used to: she means, “Let a thousand insurance companies blossom,” which of course is good for the well-being of doctors, but not perhaps of patients who are well off or who have job-provided medical care. In fact, the article admits that:

The American College of Physicians, the second-largest doctors group after the AMA, made waves in January when it endorsed single-payer health insurance, as well as a public option, as ways to achieve universal coverage.

The rest of the health care industry, including hospitals, drug companies and insurance companies, remains strongly opposed to single-payer, though.

Many doctors worry that the payment rates under Medicare for All would be insufficient, given that Medicare currently pays lower rates than private insurance does.

This is about salary and prestige that some doctors are insistent on keeping. “But,” you might be asking yourself, “how can the AMA be against single-payer insurance and yet issue a document that is ultra-woke in prescribing the language to use?”

Well, how doctors use language to conform to current ideology doesn’t affect their wages, does it? Instead of coining euphemisms, if they really cared about the well being of poor people and minorities, they’d be lobbying Congress for “Medicare for All.”

The point, as Batya Ungar-Sargon suggests in her piece below on Bari Weiss’s site, is that Wokeness is not mainly a race issue but a class issue, one largely promulgated by privileged and well-off white people who use it to buttress their self-esteem while simultaneously propping up a meritocracy from which they benefit. That, after all, is what the AMA seems to be doing.

Click below to read Batya’s article. She’s an opinion editor at Newsweek and has a new book out, Bad News: How Woke Media Is Undermining DemocracyRead also Bari Weiss’s introduction to her article.

Now Ungar-Sargon is concerned with journalism and not medicine, but there are parallels. Journalism was once a middle-class profession, but has risen to an elite profession whose practitioners are not only uber-woke (at least in the Left media), but also pretty well off (she gives some salaries).  Not all of them are white, but you already know that wokeness is promulgated primarily by the white folk that own and manage the MSM. As Ungar-Sargon says, “Once working-class warriors, the little guys taking on America’s powerful elites, journalists today are an American elite, a caste that has abandoned its working class roots as part of its meritocratic climb. And a moral panic around race has allowed them to mask this abandonment under the guise of ‘social justice.’”

And here’s her argument. The more I think about it, the more I think it does explain how elite organizations such as the AMA and NYT can at the same time promulgate big-time wokeness and yet try hard to keep their position as members of the “elite.”

. . .Wokeness perpetuates the economic interests of affluent white liberals. I believe that many of them truly do wish to live in a more equitable society, but today’s liberal elites are also governed by a competing commitment: their belief in meritocracy, or the fiction that their status was earned by their intelligence and talents. Today’s meritocratic elites subscribe to the view that not only wealth but also political power should be the province of the highly educated. Still, liberals see themselves as compassionate and progressive. And perhaps unconsciously, they sought a way to reconcile the inequality that their meritocratic status produces with the compassionate emotions they feel toward the less fortunate. They needed a way to be perpetually on what they saw as the right side of history without having to disrupt what was right for them and their children.

A moral panic around race was the perfect solution: It took the guilt that they should have felt around their economic good fortune and political power— which they could have shared with the less fortunate had they cared to—and displaced it onto their whiteness, an immutable characteristic that they could do absolutely nothing to change.

This is how white liberals arrived at a situation where instead of agitating for a more equal society, they agitated for more diverse elites. Instead of asking why our elites have risen so far above the average American, they asked why the elites are so white. Instead of asking why working-class people of all races are so underrepresented in the halls of power, white liberals called the working class racist for voting for Trump. Instead of asking why New York City’s public school system is more segregated than Alabama’s, white liberals demanded diversity, equity, and inclusion training in their children’s exorbitantly priced prep schools.

In other words, wokeness provided the perfect ideology for affluent, liberal whites who didn’t truly want systemic change if it meant their children would have to sacrifice their own status, but who still wanted to feel like the heroes of a story about social justice, who still wanted to feel vastly superior to their conservative and even slightly less radical friends.

This clarifies a lot of things, including the fact that wokeness is highest at the most prestigious universities: places like Harvard, Princeton, and Yale. It explains why many of the white Woke are obsessed with trivialities like policing languages, art installations, and other behavior, and don’t really get out there in society and actually help poor people.  It’s why they can get away with dismissing the poor and working class as racists because so many of them vote for Trump.

I don’t think (nor does Batya) that this is the sole explanation for fulminating Wokeness. But I think she’s got a handle on one reason, and an important one.

 

68 thoughts on “The hypocrisy of the AMA (and other elite organizations like the NYT)

  1. If we are calling the woke out as having voted for Trump are we not confusing and comparing different issues. A problem with all of these things is it often becomes apples and oranges. The AMA is simply a corrupt and bigoted group like many others. They pretend to want good health care for all but there is nothing in their actions that show this. Coming out against a single payer system and in favor of insurance companies simply shows the hypocrisy. They love money and all they get from the stock market more than they like their patience. The fact that health, or what there is of it in America, is more expensive than damn near anywhere on the planet does not bother the AMA anymore than it bothers republicans.

    1. The AMA is a lobby group for doctors. They are merely representing the interests of their members who pay dues to them. If they represented the interests of anyone else, the dues-paying members would resign, just as you would resent your trade union (if you are in one) if it behaved in an excessively conciliatory manner toward management or the public. The AMA, like all lobby groups, pays lip service to the “public interest” insofar as that is necessary to get its message heard, “soft power” if you like. If you have “hard power” (like an Ontario Teachers’ Union) then you don’t need to worry what the public thinks of you.

      The challenge for the AMA, and all other medical membership lobby groups, is that interests of doctors today are not all aligned. Younger doctors (now heavily female and not always the major breadwinner in the family) have often taken salaried positions which, depending on how the money flows to the entity that pays them, may be less sensitive to the business aspects of billing the third-party payer(s) for as much as you can get. Older doctors, typically male and principal breadwinners, are more likely to be in traditional independent fee-for-service practice which is not a salary in the wage-earner sense. Income rises and falls with the state of the business. These doctors are highly sensitive to reimbursement rates (fees) and fear the monopsony power of single-payer systems which would drive down those fees. That is, after all, the whole point of single-payer systems: to make free health care for all affordable to the taxpayer. If you are the only buyer, you get to set prices. Nothing wrong with that from the point of view of the public or patients. Everything wrong with it from the point of view of traditional fee-for-service doctors, whom the AMA represents. Even if a doctor is a salaried employee of a hospital, the ability of the hospital to pay that salary will be affected by medical reimbursement levels, a fact that not all salaried doctors are aware of when they start. (As residents they were paid from another pocket altogether and were too busy and tired to think much about fees.) If the doctor is payed a salary from a source independent of billing, as in a civil service position like in the VA, only then is a medical income totally divorced from prevailing fee levels. So the AMA has to make mealy-mouthed statements like “plurality of insurance companies” to avoid alienating too many of any one dues-paying faction. If the fraction of doctors who belong to the AMA is as low as a poster said yesterday (12%), it can’t afford to lose many.

      The AMA’s historic opposition to any form of insurance is the old unreconstructed AMA that we foreign observers have come to know and reflexively love to hate, much like the NRA. I don’t doubt that the language guide reported yesterday is a clumsy attempt to paint themselves in false makeup while remaining gold-diggers at heart.

    2. Remember that when the NHS was set up, there was great opposition to it from the British Medical Association (BMA), particularly from the better-paid specialists rather than the GPs who often treated their poorer patients for free. The Minister responsible for it in Attlee’s Labour government, Aneurin Bevan ended up guaranteeing the specialists such generous terms that he declared he “had stuffed their mouths with gold.” Seventy-some years later, the gold has long gone, and British hospital consultants are paid poorly compared to colleagues in other countries. So while the AMA is motivated by money first, like any other union they are obliged to look out for their members’ interests. I regard a publicly-funded healthcare system as the only civilised way to run things, with a small private sector to satisfy those patients and those doctors who demand what it offers. I’ve worked in both the British NHS and the Canadian ‘medicare’ system, and the NHS generally works better, in part because the option of private care is available there, and is illegal in Canada. Wealthy patients pay to get their surgeries done quickly, making the waitlist shorter for those doing it on the NHS. And consultants are obliged not to let private work detract from the NHS work, in fact those who do private work have to offer extra time to the NHS to do it!
      https://www.bma.org.uk/advice-and-support/private-practice/working-in-private-practice/consultants-and-private-practice

  2. Journalism was once a middle-class profession, but has risen to an elite profession …

    Time was, journalism was the bastion of guys (in those days journalists were almost all men) from blue-collar backgrounds with (at most) high-school diplomas, who had worked their way up through the ranks from beat reporters at this nation’s then-numerous morning and afternoon daily newspapers.

    Today, in its upper echelons, journalism is the province of those with elite educations. Hell, even sportswriters got college degrees nowadays, some of ’em.

    1. I think that ignores about half of journalism, the extremely-low to nonexistent pay half. The people who create the content for local rags covering music, cultural events, etc. The bloggers. The witnesses to events who take cell phone videos. Instead of *rising* to elite status, it’s more of a split into rich and poor, elite and underclass. Kinda like the economy at large.

  3. “Wokeism” (both fundamentalist and totalitarian) is rapidly becoming the official ideology of the most important centers of power in this country, including corporate America. The apparatchiks of this new “woke” nomenklatura (whether in the academic world, in the media, in Big Tech, or in DC’s permanent bureaucracy) have nothing but contempt for the majority of working-class Americans, who were formerly dismissed as “deplorables” and are now denigrated as “extremists”” or “terrorists”.

    1. It’s certainly trying to become the official ideology but it is far from doing so and will peter out eventually. Corporate American and Political America won’t really adopt it as it is is just too ridiculous. They will be shamed and bullied into making small Woke gestures but will immediately balk at anything that makes an impact on their main interest. In the case of Corporate America, that’s making money. With Political America, it’s staying in office.

      1. For the abundant evidence pointing towards the ever-increasing intensification of this madness in the most powerful corporations (as well as the richest investment banks) in the land, aside from the reporting of Chris Rufo (who provides numerous screenshots of internal documents from whistle-blowers), one can consult two recently-published books, Stephen Soukoup’s The Dictatorship of Woke Capital and Vivek Ramaswamy’s Woke, Inc: Inside Corporate America’s Social Justice Scam. Both books are well-argued and well-sourced.

        1. Chris Rufo is a well-known player on the Right whose theme is to make Wokeness into an existential threat. He’s even admitted it. I’m very much against Wokeness and CRT but there’s no way it measures up to all the nastiness the Right is cooking up these days. Best to keep some perspective.

  4. Isn’t it funny that Medicare-for-all would disproportionately benefit Black and Brown people, and provide a concrete way to ensure greater racial equity in terms of access to affordable, quality health care, and the Docs are against it?

    1. Yes. Here in Canada, our Woke federal government ordered last summer that all flags at federal buildings be lowered following the discovery of many unmarked graves on the grounds of former Indian Residential School sites. The story is awful, and the graves probably include many kids who were neglected or murdered.

      But last Friday, the same Woke government (recently re-elected) quietly announced it would appeal a judicial order to pay financial compensation to child survivors of the Indigenous foster care system (the direct descendant of the shuttered IRS system). So too bad about your kids, here’s some flags, but no money. It’s the woke equivalent of thoughts and prayers.

      1. Not a single one of those graves is thought with any evidence to have been a murder. They were all buried in cemeteries which have disappeared into the overgrowth due to decades of neglect by their indigenous custodians.

        The appeal of the Human Rights Tribunal award you are referring to is a principled objection on legal grounds to overstep by the Tribunal. It is in the public interest of Canada that the appeal is to go forward.

        The public interest includes more than what makes enormous sums of money flow to indigenous advocates. The flag business is woke hypocrisy. The appeal is principled. We are on opposite sides here, obviously.

        I think we should both stick closer to the subject of the original post, at least this early in the thread. 🙂

        1. Les, you’re new around here, so I’ll cut you some slack. But it’s not cool to tell other commenters what they can say.

          1. I’m sorry and I apologize to you and to our host. I didn’t mean it that way but that’s a reasonable interpretation of what I said. So I accept the criticism and will learn from it.

  5. The real origins of Wokeness go back to the late 20th Century corporate style, where you cut your employee’s pay, get rid of their pension, cut his or her health benefits, and violate labor laws to keep out unions, and then re-name them “Sanitary Engineers” to make them feel better.

    The only difference now is that if your for unions, better wages, and health care, they call you a white supremacist. Every one even 1 cm left of the Democratic Establishment is now a far right Neo-Nazi White Supremacist extremist, starting with the Bernie Bros.

  6. Jerry: Well, how doctors use language to conform to current ideology doesn’t affect their wages, does it? Instead of coining euphemisms, if they really cared about the well being of poor people and minorities, they’d be lobbying Congress for “Medicare for All.”

    Batya Ungar-Sargon: In other words, wokeness provided the perfect ideology for affluent, liberal whites

    Exactly. I also believe this, and Democrats constantly pretending they wanted to do something for normal people but always come short, will backfire again. From USA Today:

    U.S. News ranked international turnout by percentage of Voting Age Population – a measure of turnout specifically among individuals of voting age in their respective country – among OECD countries in their elections from 2015 to 2020. With nearly 56% VAP turnout, Americans appear toward the bottom of the list. — source

    Also a glimpse, why:

    The president of the American Medical Association (AMA) criticized “Medicare for All” as a “one-size-fits-all solution” on Wednesday, but acknowledged that some doctors, particularly younger ones, support the idea.

    In a typical manner for the USA, the “one-size-fits-all solution” is pure propaganda. How could there be any “fits-all” solution to medical situations from cancers to a broken bones to hormonal imbalances? A medical system for all is about a broad insurance system for everyone. The point of an insurance is to be prepare for situations you don’t know in advance.

    You can still have private for-profit-schemes next to it, e.g. as Germany has, for instance. This is made for people who earn a lot, or who have ways to insure their future in other (ostensibly more profitable) ways.

  7. Ungar-Sargon’s thesis seems to be that white elites have embraced Wokeism as a diversion from taking actions that really help the poor. Their goal is to maintain their elite status in society. She makes a lot of assertions, not backed up by empirical data. She doesn’t address the fact that Biden’s human infrastructure package, a series of measures that would be of extreme help to lower income persons, is opposed almost unanimously by the most unwoke element in society – the Republican Party. The Democratic Party, in Congress at least, is dominated by Woke sympathizing progressives that want a massive spending program to help the poor. The decidedly unwoke, such as Joe Manchin and the Republicans, are blocking it.

    Ungar-Sargon’s assertion that journalists once were mostly working class folk and now are white liberal elitists is essentially meaningless. Does she mean street reporters, opinion writers, or editorial boards? Each of these groups may have different interests. Moreover, as is the case in the piece, she provides no evidence.

    The AMA has been a traditionally conservative medical lobby group. It is not surprising that it opposes medicare for all. Maybe it has even embraced Woke terminology as a diversion. But, whatever its motivation, it’s not a liberal elite organization. It is a conservative one. And, as Professor Coyne has noted, many of them probably voted for Trump. It would be interesting to see a poll of the medical profession to find out how many doctors voted for Trump that belong to the AMA as those who don’t.

    The thing to keep in mind that white elites, regardless of their Woke tendencies, are not ideologically the same in their economic beliefs. Being a white Woke sympathizer and supporting measures to help the poor are not at all incompatible. The progressives in Congress are a strong example of this. I view Ungar-Sargon’s article as nothing more than a hit piece against liberals.

    1. What did they bring out to stop Bernie in 2020 and 2016? The woke squad.

      Is there anything “left” about racial reductionism? No, pleas for racial solidarity are always used to over-ride class solidarity, e.g. to get people to support politicians who harm their economic interests. What we have invented with wokeness is a replication of the same social function (to protect class stratification) that used to be served by white supremacy.

      1. Bernie wasn’t stopped in 2016 and 2020 by “the woke squad”. He was stopped because the majority of people who voted in the Democratic primaries wanted somebody else to be their nominee. Bernie’s supporters assume that there are vastly more of them than there really are and he would be able to just walk into power if it were not for a vast conspiracy by the establishment. The reality is that most Americans simply didn’t want him.

        1. More might support Bernie’s ideas if he didn’t call himself a “socialist”. Yes, I know he’s a “Democratic Socialist”, or something like that. He doesn’t know how to sell his ideas, just like pretty much the whole Democrat party. That all said, I’m not really a Bernie fan but it is more due to his inability to win than his actual ideas.

    2. Historian: Creating a culture where the community gives everybody a lifetime of enough money and resources to live comfortably without requiring them to make any useful or valuable contribution to the community in return will probably hamper the community from thriving. How are people who have few marketable skills or much of a sense of responsibility to the community going to survive in a prolonged disaster? What kind of culture of entitlement will that transmit to their kids and grandkids? Where will the inventors and entrepreneurs come from, immigrants? Your better system is in place in complacent first world countries across the Atlantic that haven’t invented much of importance for a hundred years or more. But they provide more guaranteed services to their residents than our country does so that may well be enough of a trade off for many. I prefer a hybrid system that provides a real safety net for the needy while encouraging all who are able to excel and contribute to their families, their communities and the world. But then, I’m an old fart.

      1. The question of what elements constitute a thriving society is a discussion well worth undertaking, but it is not the subject of my comment. My goal was to point out that some white liberals sympathetic to Wokeism, many in Congress, have proposed measures that they believe will help the poor. Whether the components of the Biden proposals (including significant tax increases on the rich) will actually have a salutary effect on the lives of the poor and society as a whole is another issue that can be discussed. The issue at hand here is the motive of these people. Clearly, these white liberal else believe they will have a very positive effect on both the poor and society in general. Hence, in contrast to Ungar-Sargon’s thesis, at least some white liberal elites are not using Wokeism as a diversion from helping the poor. I doubt that the same can be said for white conservative elites.

        1. Historian: thank you for your thoughtful response to my comment. I was reacting to your endorsement of the social spending in the Build Back Better reconciliation package and your seeming critique of folks who didn’t embrace its provisions. Yes, the provisions will help the poor. And the well off. The package is a give away to the people considered part of the Democratic coalition. That is not a problem but it is a feature of the package you discussed. And the entitlement mentality that underpins the package was the basis for my thesis that creating a culture that expects community support without a commiserate contribution is not the best strategy for human evolution.

  8. It was revealing all along that this passion for “equity” was so prominently displayed at that hot-dog egalitarian institution, the pinnacle of the new nomenklatura, Harvard. Its graduate school of education celebrates its own mission as follows: “…the new competencies detail our goals for what all students should know and master by the end of their time at HGSE, from reflective self-work to interpersonal and group dialogue, as well as the ability to identify and analyze systems of power and threats to equity.”

  9. The “physician choice” argument against a proper healthcare system in the US is so ridiculous. As far as I know, no one is proposing a law against private practice. There will always be choices and probably not just for the rich. Most of those choices will need to be reasonably priced in order to compete.

    1. It is really another one of many republican lies about health care. When you are in bed with the lobby, the money and all, you are stuck doing the republican thing — make up shit. Medicare covers millions of people and how many MDs refuse medicare people? Almost none. It is almost the only thing that keeps small town hospitals operating. How many people refuse Medicare at 65? I sure don’t know any. I do wish I could stop the commercials and emails and phone calls telling me to call right away and find out what services you are missing. They do everything they can to make you think you are talking to Medicare, when all they are is Insurance companies scamming for business. The money they are spending in this scam would run a small country and then some.

    2. In my country, apart from the right and opportunity to consult a physician privately, people have the right to choose their general practitioner, and the public health care fund will pay him based on his registered patients. The same way, pregnant women can choose in which maternity ward to give birth. Of course, the choice is not perfect (some people live in places where there is only 1 practice), but methinks AMA is inventing problems out of thin air.

      1. I agree. Whatever changes are proposed for our healthcare system, it will make some people unhappy. It’s pretty much a certainty. We saw this when Obamacare was being introduced. Obama famously promised , “If you like your health care plan, you’ll be able to keep your health care plan, period.” It was obvious to most intelligent people that that can’t possibly be true. Insurance companies are independent operators. Some will change their products such that some will lose their insurance. Progress always has costs.

        What we really need is smarter voters.

        1. That last sentence contains the core of so many of our problems, now and (probably) forever. It’s why I fear much more for the state of our public, K-12 education system(s) than our healthcare, our infrastructure, our journalistic institutions, our universities, or the rest. Nothing of quality grows in undernourished soil.

        2. Like Robert, I underscore your last sentence. It reminds me of something Maureen Dowd wrote, to wit, “The occupational hazard of democracy is know-nothing voters.” Our ship of state here in the USA has foundered on this hazard.

  10. My guess is that white folk embrace Wokeness, rather than provide real help to the poor and disadvantaged, because they’re lazy rather than to prop up the power structure. They just aren’t that organized or diabolical. Woke activists have provided them a relatively easy and cheap way to appear virtuous.

  11. View this analysis from the viewpoint of Plato. You will find it completely familiar. Elites proclaiming and protecting their power, but tossing tokens of empathy to those in the dark at the back of the cave.

    Plato spawned Kant, who spawned Hegel, who spawned Marx. Woke is the child of a deliberate decision to change tactics from “class and economics” to culture wars.

    The notion that “…Woke is not mainly a race issue but a class issue.” Yes, it is ‘class,’ but fought on the cultural front.

  12. If Wokism is a religion, it very much resembles Roman Catholicism, which manages to have a poor carpenter as its founder yet has built up massive amounts of wealth and institutional power. The elites of the Catholic hierarchy can live in opulence on the backs of hardworking people, yet at the same time profess to be perfectly inline with the teachings of Jesus.

  13. In the corporate world, examples of Ungar-Sargon’s thesis abound to the point of comedy. Christopher Rufo reports on mandatory training programs, filled with Kendian clichés and directed self-flagellation of the serfs over their “privilege”, at such hotbeds of egalitarianism as AT&T, Walmart, and CVS Pharmacies. At the last firm, the outgoing CEO received compensation ~600 times that of the median employee. Wait a minute: maybe the woke term “Diversity” really means diversity of pay levels.

  14. I am familiar with both systems. A very good example of the single payer system in the US is the VA. Staff pays are predictably low. But that doesn’t mean quality of care is any better: it is worse. That is why the only veterans who go there are the ones who can’t afford anything better.
    Other countries using a single payer system, unfortunately, have created no utopia. Anecdotes abound of how many years you have to wait in Canada or the UK to see a specialist. What is factual is that many in those countries still go for a “private” insurance even though, technically, they already have coverage. And they pay for it through higher taxes, which everyone pays for, not just the super rich.
    To he sure this doesn’t mean the system in the US is efficient or that no modification is needed. But a step as radical as switching to UK’s NHS requires closer study than merely presuming it will benefit everyone outside the system, turning it into a zero sum “health-care worker v everyone else” paradigm.

    1. Sure nobody thinks Canada is a utopia. But that’s not what the single-payer system means. As Wetherjeff said here yesterday, “it means that no one has to decide if having chemotherapy is worth losing their house [and no] one has to face bankruptcy to give their kid heart surgery.”

      Anecotes abound that the Canadians who are complaining about this are wealthy boomers with a bad hip waiting to get a hunk of titanium. Their medical problems are sympathetic but not life-threatening. Their dilemma is deciding whether they should sell the cottage or sell the Jaguar in order to pay for surgery at the Mayo Clinic instead of waiting for surgery in Canada.

      1. Every Canadian I know (in engineering, several industries) in the USA has retained their Canadian citizenship in order to be able to access Canada’s Medicare. Every one of them.

      2. I can state from personal experience that having a “bad hip” is no joke. Try not being able to sleep for months on end due to the pain (leaving aside the other impacts to all the rest of your life).

        My hip replacement was as close to miracle as I’m likely to experience in my life.

        1. Word. Everyone dies, so saving lives is always saving them for later. But minimizing suffering is always worthwhile, and everyone can suffer, even those with tremendous privilege.

          And I can sympathize with that pain-induced sleep trouble. It’s been 20 years and failed back surgery, which came after several failed, less invasive attempts for me. I would happily become a full cyborg, honestly.

    2. The wait-time argument is crap. We’ve got that problem in the US too, for as long as I can remember. Most current example, a good friend had a back problem. Went to see his doctor, who sent him to a specialist. The specialist couldn’t see him for 8 months. Just last month, about 4 months to go to see the specialist, the problem in his back became an emergency that required emergency surgery and has left him with loss of feeling and loss of function from one side of his lower back down one leg to the toes, a condition from which he might recover some function and feeling over the next 1 to 1-1/2 years of therapy. If he had been seen promptly the emergency could have been entirely avoided and he would not be paralyzed in one leg.

      For every anecdote about people in countries with single payer like healthcare systems that hate their healthcare there are hundreds of anecdotes about people that love it. Or more. It gets even worse when you look at real data instead of anecdotes. It’s no contest. Single payer like systems are far superior to whatever you want to call what we’ve got going in the US.

      With the possible of exception of the wealthy. But then, the wealthy can afford to go wherever they want for healthcare and there will always be medical providers to cater to that niche. Just like there are all around the world today, including in countries that have single payer like systems.

      And let’s not bring out the old canard that the US has always made all the advancements in medicine that the whole world benefits from, and that that engine of advancement would be lost if we went to something like single payer. No and no. The US has certainly done its share, but plenty of advances come from other countries, and I’ve yet to hear a convincing argument for why changing to a civilized healthcare system would necessarily entail a loss of advancement. It’s supposedly just something that is self evident and everybody knows it.

      1. Yes, we pay 2X to 3X what the rest of the developed world pays for health care, and we get worse outcomes overall.

        Medical bills are the #1 cause of personal bankruptcy in the USA.

        People (even middle class people like me) live in fear (or at least anxiety) about medical coverage/bills. It shapes major choices in their lives.

        People stick with jobs they hate just to retain health care coverage. (Industry loves this (and I’m not anti-industry by any means).)

        I am in favor of a single-payer system for the USA and I vote that way and I write to my elected officials.

        It’s a big ship and it will be hard to turn. Obamacare was a first, smallish step. We can do better.

        1. Medical insurance should not be tied to employment. The reason it is lies with previous government intervention in the economy during WW2. The solution is very simple: Allow everyone to fully deduct medical expenses, including insurance payments, from their income tax, just as corporations can.

            1. It is so where I live. Everyone having a regular income is health-insured, and the money goes into the public health care fund. Government insures minors, pensioners, and unemployed people (the latter for a certain period). From every legal income up to the maximum insurance threshold, a percentage is taken for the health care fund. If you want and can afford it, you can pay an additional insurance. For most people, however, it is more practical to pay out of their pockets what is not covered by the health care fund, while generally relying on the safety net provided by it.

          1. Compulsory health insurance is tied to workplaces so that the insurance company can set rates actuarially without being exposed to adverse selection. The healthiest people would try to decline the insurance and take the premiums as cash wages instead.

            People who are healthy enough to be working are better risks than random members of the population. If you try to buy health insurance as an individual, either as a non-worker or a sole proprietor of a business, the insurance company guesses that you are signing up because you know something about your health that it doesn’t, and will set the premium to cover that risk, or deny you altogether if you admit to a pre-existing condition. The individual mandate in ACA was supposed to address this.

            That’s why I really do like single-payer so much. No one plays the adverse-selection game. Everyone is signed up to the same payer. But it does mean you have to cover the entire population: in for a penny, in for a trillion. It’s a big pig for the python to swallow and you must have cost controls applied to users and providers or the python will choke. But no one likes to be the subject of cost controls. Ouch. People fight more vigorously against specific losses about which they are highly knowledgeable than they do for over-all vaguely understood gains — it’s a lot like climate change. Even the elimination of the insurance companies, which seems like a great idea, gets push-back from the shareholders, employees, and suppliers of these large corporations. So it takes a lot of state power to make it work.

        2. We certainly do pay higher Healthcare fees than most of the world. That, though, is a very complex reality, and not entirely due to the Healthcare system itself. Case in point: we also have the world’s highest obesity rate. You think that’s got nothing to do with our Healthcare expenses?

      2. Absolutely not true. I don’t know what you have seen or experienced but where I have been, you could have a same day specialty appointment (from urgent care to office) the same day if necessary. And that is the whole point-in the US, providers need to compete over patients, so they have to be as accommodating as possible; in Canada, UK etc, they are salaried so they don’t care.

        1. What’s not true HL? You think I made up that story? Or do you mean more generally? If you truly think that people in the US never have to wait for long periods of time for medical services you are deluding yourself. In case you’re unsure, I’m a USian and I have more than 5 decades of experience with our healthcare system.

          Sure, you could get a specialty referral appointment the next day in the US. I’m sure you could in Canada and lots of other places too. You’re trying to make a case that single payer type medical systems always have a significant problem with long wait lists compared to the US. That is wrong.

          Compete over patients? Medical care in the US is not a free market, it is a thoroughly gamed market. Providing the customer with the best care experience at the best price in order to win more customers is not a primary factor in medical providers’ competition for patients. Not that it’s primarily the providers that are at fault for that, but the reality is Buyer Beware.

    3. There are sound economic and social-policy reasons for prohibiting private payment (from insurance or out-of-pocket) for services provided for free in a single-payer system. Put everyone in the same lifeboat and they are all incentivized to make sure it doesn’t leak. Canada is, however, the only OECD country that does have a truly single-payer system. All others permit or strongly encourage their citizens to purchase supplementary private insurance. They do this through tax incentives or by allowing hospitals and doctors to preferentially treat the more lucrative patients with private insurance. If you can’t afford any private insurance at all, you still get free emergency care and will not be bankrupted by a serious illness or injury. But your choice of doctor or hospital for management of a chronic illness or an elective quality-of-life problem will be limited either by fiat or by the market, depending on the country. And to prevent the insurance companies from leaving the market because of adverse selection, the incentives to buy insurance so as to avoid the free system have to be so strong that nearly everyone does. The system has to decide through negotiation whether people covered by insurance use it for all their care, leaving the free system only for the destitute, or if the insurance companies can decline payment for services or providers available in the free system. Obviously the premiums are higher and the taxes lower under the former rule than under the latter. I have tried to figure out how these blended systems even work — they sound as if they should be unstable but they are the rule and not the exception. Canada is the exception.

      From the ideologically communitarian point of view which I share, Canada clearly made the right call in banning private payment. And yes it was bitterly opposed by doctor groups à la the AMA (before my time.) It did not deliver as much cost control as imagined, though. Physician fees are regulated through monopsony power and hospitals are given global budgets from provincial ministries of health. Yet the government has not been able to control volume of services provided (except through occult rationing by queue) because this would entail politicians saying No to patients. Since medical science is always discovering new insurance-subsidized treatments that don’t face price resistance or even much cost-benefit analysis on their way into the market, the end result is to give ever more of everything to everybody. As long as it lasts.

    4. No, the VA is national health service model like England, with public providers. Medicare expansion contemplates a single payer national health insurance like Canada.

      The point is Canada, U.K., even places like Germany (with private insurance and private providers but national cost controls) pay 10-12% of GDP on health care. America pay 18% of GDP on health care, and we don’t even have universal access, and you have medical bankruptcy and the rest of it.

      The Democratic solution to all problems is open-ended Federal subsidies, based on the false right wing idea that subsidizing something creates more of it. Subsidizing something without cost controls means you pay more for what was created. Obamacare is a blank check to insurance companies, Pell grants are blank checks to universities. There is no means to contain health insurance costs in the American system, so it will just continue to bloat until it eats up the rest of the economy.

      The US has the #1 health care system in the world, at least for Return on Equity for market participants. But it is expensive, inefficient, and inhumane, and is the primary reason many manufacturers end up in Canada and the the US when they want to open a plant.

  15. “doctors get to keep their high salaries and prestige”

    In my opinion: Good doctors mostly do deserve a high salary and social prestige.

    Absent those, many of the people with the time and skills needed to complete medical school, residency, board examination, etc. will choose other fields — for the compensation (monetary and social).

    My best friend from high school was a medical doctor. He’s smarter and more hard-working than I am. He did not get his first “real job” doctoring until he was 32 years old. That is a huge lost opportunity cost, not to mention the direct costs of completing all that training.

    On top of that, after he got the “real job”, he had to work horrendously long hours and he had to be on call regularly, such that even his “off hours” were often taken away in the name of duty to work. And, he had to spend long hours in documenting his work for medical records, outside of clinical hours. (I often saw him doing this on his weekends “off”.)

    On top of that, doctors live under constant the threat of malpractice suits (and we know that: 1) Physiology and other human bodily factors vary and some people are going to have bad outcomes, regardless; and 2) Law suits need not be well grounded in facts in the USA.).

    He burned out in his 50s and retired early. Luckily, he was paid well enough to afford to retire and still have choices in life — and he and his wife deserved that.

    It’s unclear to me how the medical profession will attract excellent candidates in the absence of excellent compensation. Those kind of people have lots of other options in life.

  16. Medicare is a very poorly run system that should not be expanded. The book “Overcharged” (https://www.cato.org/Overcharged) provides a great deal of data supporting that view as well as providing alternatives.

    The worst thing the AMA does for medicine in this country is arbitrarily limit the supply of doctors. They should not be the sole gatekeepers of who can practice medicine.

    1. I agree that professional organizations such as AMA should not be allowed to limit the supply of doctors. Such organizations unscrupulously stand for the interest of their members against those of patients, and of young would-be doctors.

  17. If the AMA were primarily a physician’s professional association, their funding and expenditures would look very different than they do.
    Their largest source of income is from licensing the CPT Coding system, which none of the docs I know are particularly fond of.
    Their largest expense is employee compensation, including very lavish executive pay.

    Most docs are not members, and many of the members are med students. Perhaps it’s adoption of woke ideology is a symptom of decline from a representative of physician’s interests. Really, the woke stuff seems unlikely to affect either their CPT income stream or their executive compensation.
    And they get to do all of this while hiding behind a cardboard cutout of Marcus Welby, M.D.

  18. Canadian here. I believe the gov’t is there to create the infrastructure for the country to be able to develop and maintain a decent economy with decent results of varying degrees for the participants in that economy. I wish the US left would talk about single payer as an infrastructure issue. Roads to get people to work is seen as infrastructure, why is health-care not seen as infrastructure? Infrastructure has a somewhat neutral meaning, why not make voters see universal health-care as an infrastructure issue like people in the US see inter-state highways as an infrastructure issue?

  19. I grew up in Australia, NZ and Japan. It always amazes me how little Americans understand about how how med costs are done in other rich countries. Where doctors, btw, are paid a lot and have mega prestige.

    D.A., J.D.
    NYC

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