Medicare for None -- Sally Pipes: False Premise, False Promise

“Medicare for All,” were it subjected to truth in labeling criteria, would more accurately be named “Medicare for None.”  This is a point made early in Sally Pipes’ succinct but detailed analysis of the socialized medicine programs offered by Bernie Sanders and other Democrat POTUS candidates.  Her book, False Premise, False Promise: The Disastrous Reality of Medicare for All provides a chilling portrait of the much-touted socialized health systems in Canada and the U.K. -- programs plagued by doctor and hospital shortages, long waiting times, rationed treatment,  substandard care, and, on occasions, appalling bureaucratic callousness. 

Pipes begins her analysis, however, with a perceptive distinction between traditionally accepted rights and the assertion that health care is a right.  The former rights, she notes, only oblige people not to interfere with, for example, a person’s free speech or religious practice.  Non-interference is required as long as the exercise of those rights doesn’t restrict the rights of others, as it would if one yelled “fire” in a crowded theater.  These traditional rights are labeled “negative” because they “require others [including the government] to step aside and allow people to act independently.”

On the other hand, in the case of health care this “positive right” not only “gives us something,” it also “requires someone else to give it to us.”  And as Pipes illustrates in spades, defining “the criteria for positive rights . . . is tricky” -- a process that supposedly values equal medical care for all above, for example, the freedom of parents to pursue treatment for a sick child outside a nation’s socialized framework, thereby making mincemeat of the most prized of all American rights, life and liberty.  In short, residents of Canada and the U.K. forfeit a tremendous amount of freedom concerning the availability and quality of health care in return for a system designed primarily to offer an equal measure of care to everyone -- an arrangement Pipes concludes “is a catastrophe for the people forced to live under it.”  Thus, a “right” to health care is transformed into the obligation to accept and contribute to a system that often provides mediocre and sometimes appalling care.  

When analyzing specific “Medicare for All” proposals, Pipes notes that the program’s popularity disappears when folks discover it would totally do away with the private insurance held by 253 million Americans (mostly through employers) and would be far from free!  Sanders’ proposal adds at least 32 trillion to the federal budget over ten years and likely up to 60 trillion, since it “would prompt unlimited demand from patients.”  The latter figure represents a doubling of projected federal spending over the decade.  Add to that cost the inevitable hospital closures and doctor shortages tied to stringent government reimbursement rates as well as the dislocations caused by outlawing private insurance and you have the makings of a perfect societal storm.  But it would be a storm caused not by the quality of medical care (with which a large majority of Americans are satisfied) but rather by the cost of insurance.  Far from reducing insurance costs, Obamacare saw a doubling of premiums in the individual market between 2013 and 2017.  Meanwhile, employer-based family premiums continued to rise to over $20,000 a year in 2018.

The bulk of Pipes’ book describes the reality of socialized medicine in the U.K. and Canada, both statistically and via a number of gut-wrenching anecdotes.  Statistically, Pipes shows that the presumed monetary savings of socialized programs are largely illusory since significant costs are hidden in taxes and take no account of lost wages and productivity due to demonstrably inferior health outcomes.  Moreover, the typical assertion that the U.S. trails the U.K. and Canada in overall health rankings is also debunked by showing that those rankings don’t focus on specific health outcomes (e.g. cancer survival rates) but rather give inordinate weight to socialist programs and even fail to account for the different standards countries have for calculating “infant” mortality.  Additionally, those socialist-biased health comparisons don’t take into consideration non-health related factors (such as traffic accidents and crime) that significantly affect life expectancy averages.  When one compares like to like, U.S. life expectancy and infant mortality rates are comparable to or better than other advanced nations and, significantly, specific health outcomes for treatment are consistently better than their socialized counterparts.  

Pipes’ book would be persuasive but not emotionally compelling without its numerous vignettes that put a human face on an often less than human bureaucratic monstrosity.  Among others there is the tragic story of a single mother of two without a car in southeast Wales who called ahead to inform an emergency clinic that she would be a bit late bringing in her severely asthmatic five-year-old child since she had to make arrangements for an infant’s care and catch a bus.  Her 18-minute tardiness resulted in the doctor’s refusal to honor the appointment.   Instead, it was rescheduled for the next day.  That night the child had another asthmatic attack and died in the hospital.  Anyone reading Pipes’ book knows this tragedy is the direct result of doctor shortages that make a typical visit to a general practitioner in the U.K. last a grand total of nine minutes.

Then there is the case of young Charlie Gard, born August 4, 2016, with a rare genetic disorder that’s typically fatal.  His parents, however, wished to try an experimental treatment in the U.S. that wasn’t available in the U.K. and raised over a million pounds to give it a try.  The doctors caring for Charlie Gard, however, petitioned the government to remove him from life support, and it is the court, not doctors and parents, that has the last say in such matters.  Despite pleas from the Vatican and even assurance from President Trump that the U.S. would be “delighted” to help Charlie, “Charlie died in a hospice on July 18, 2017, after the court denied his mother’s request to bring her son home for his final hours.”  Another couple was arrested for kidnapping when they took their child to Spain in 2014 for a cancer treatment not approved in the U.K.  This story, fortunately, had a happy ending in Prague following a legal battle over proton therapy, a treatment available in the U.S. since 2001.  

Ironically, socialist medicine doesn’t mean the same care for wealthy and well connected individuals, as Canadian singer Micheal Bublé moved to California where his son was treated for liver cancer in 2016 at Children’s Hospital Los Angeles.  Even more egregiously, in 2010 Newfoundland’s premier traveled to Mount Sinai Hospital in Florida for minimally invasive heart surgery that he could have received in his own country.

Pipes ends with a series of proposals for making American health care more affordable, ideas that focus on Health Savings Accounts, tort reform, individually tailored insurance policies, and a government program to take care of the approximately two million folks who would not qualify for private insurance -- a small subset for which it makes no sense to socialize the entire health care system.  Overall, Pipes’ book is predicated on the hope that Americans won’t give up their access to quality medical care if they know that the “free” care they are promised will cost almost as much as the 17% the U.S. now devotes to health care and will result in vastly increased waiting times, fewer treatment alternatives, massive dislocations, and restricted or no access to expensive drugs -- all without the default option employed by thousands of Canadians, treatment in the United States. 

Richard Kirk is a freelance writer living in Southern California whose book Moral Illiteracy: "Who's to Say?"  is also available on Kindle    

Primal Screams: How the Sexual Revolution Created Identity Politics

Contrary to previous belief, wolves aren’t solitary creatures that naturally roam in random packs but are rather, like most animals, familial beasts whose behaviors assume pathological characteristics when those domestic bonds are broken.  That observation, reiterated with reference to other species, is the biological starting point for Mary Eberstadt’s insightful exploration of the social and political consequences of the recent and monumental disruptions in American family structure that she terms “the Great Scattering” in her book Primal Screams: How the Sexual Revolution Created Identity Politics.

Eberstadt’s focus is on the way divorce, absent fathers, shrinking family size, and the sexual revolution of the 60s has produced an environment that radically undermines traditional answers to the question “Who am I?” -- a question typically addressed by reference to a child’s father, mother, siblings, and sex.  In addition, since basic social skills are obtained vis-à-vis parental and familial examples, absent fathers and non-existent siblings make learning how to interact civilly with the opposite sex (or to respect one’s own) extremely difficult.

The rise in “identity politics,” therefore, is linked by Eberstadt to the social and especially familial disruptions that make answering the “Who am I?” question highly problematic.  The negative consequences of the sexual revolution (primarily contraception technology plus the destigmatization of non-marital sex, abortion, single-parent homes, and, to some extent, pornography) are provided abundantly by the author.  They include the clearly detrimental effects of fatherless homes (“a literature as well-known as it is stoutly ignored”) and various studies that document a large increase in self-harm and loneliness, including morose statistics on elderly folks (4,000 a week in population-dwindling Japan) who die alone without relatives and are only discovered by neighbors due to the odor coming from their residences.  The author links these and other sociological data to a desperate cri de coeur that amounts to a primal scream: “Who am I?”

As surrogates for the basic familial answers to that question, ethnic, erotic, racial, and sexual identities have been asserted with a vengeance, especially against those seen as oppressors.  Eberstadt notes that the “first collective articulation of identity politics comes from a community [black women] where familial identity was becoming increasingly riven” and constituted “a harbinger of what would come next for everyone else.”  In the previous year, 1976, “the out-of-wedlock birth rate for black Americans had just ‘tipped’ over the 50 percent mark.”

The “infantilized expression and vernacular” of identity politics also points to a regressive “mine, mine!” toddler mentality.  Young adults screaming at speakers they imagine threaten their sexual, racial, or ethnic identities (e.g. Christina Sommers and Charles Murray) or even at friendly faculty members offering criticism of Yale’s detailed “cultural appropriation” guidelines for Halloween costumes is typical behavior -- tantrums that go hand in hand with “safe spaces” on campus, “those tiny ersatz treehouses stuffed with candy, coloring books, and Care Bears.”  Such childish exhibitions point to a primitive psychological deficit that corresponds with studies about identity-formation in children of divorce or of those having no father at all.  

Eberstadt notes, furthermore, that after the sexual revolution, women were expected to be more like men and were praised for achieving sexual liberation (no strings sex), physical prowess comparable to men, or corporate CEO status.  Those women who assumed traditional maternal roles were correspondingly disparaged.  Men, on the other hand, received a steady dose of blame for “toxic masculinity” while those without fathers in the home had additional reasons to reject their biological heritage.  Lost in this reshuffling were familial models, via parents and siblings, to teach girls how to understand men and boys how to treat the other sex.  But were women, who now had the sole legal voice on abortion, naturally constructed to approach sex as men might?  And were men deprived of a father or an opposite sex sibling likely to approach females with the same respect and reticence as previous generations of men did whose families were large, intact, and often schooled to view women as, in some sense, sisters in a religious community?  And what about the impact of the sexually saturated culture that offers graphic, often violent, pornography with the click of a mouse?   

Eberstadt observes that the #MeToo movement exposed what perceptive observers already knew, that the dissolution of the family has led to profound ignorance not only about the opposite sex but also about one’s own sexual nature.  Even men who “identity” as women (or vice versa) are presumed to be the gender of their choice and treated as victims entitled to whatever athletic competition or locker room they choose.  Meanwhile, protestors against this biological conflation are relegated to the status of bigots.  The identity movement has gone so far that the feminist icon Martina Navratilova who protested against transgender competitors was all but excommunicated by its political mob -- a state of affairs that provides a stark example of the revolution consuming its own “in a spiral of scapegoating and social destruction that no one seems to know how to stop.”

Eberstadt concludes as follows: “Identity politics is not so much politics as a primal scream.  It’s the result of the Great Scattering -- our species’ unprecedented collective retreat from our very selves.”  Though the author’s analysis of the primacy of nature and the family is instructive, her persistent attempt to separate that nature from politics, at least for purposes of discussion, is destined to fail.  One of the three responses to her work included in Part Two of her book illustrates this point.  Though politics isn’t the only reason for “the Great Scattering,” the left side of the political spectrum clearly facilitated and encouraged it with gusto.  Thus, Columbia Humanities Professor Mark Lilla’s rejoinder to Eberstadt's book is overwhelmingly political and ignores completely the role of nature in family fragmentation and the divisiveness of identity politics.  Instead, he blames everything bad on “Reagan individualism” and capitalism -- a predictable response from a partisan for whom deterministic Hegelian ideas about History (with a capital H) are embraced with ardor and for whom the importance for most conservatives of unifying cultural institutions (family, community organizations, and religion) is completely ignored. 

That said, Eberstadt’s very compact work is well worth reading for the significant insights it provides into the relationship between family dissolution, the devastation wrought by the sexual revolution, and the puzzlingly infantile extremes to which any reasonable version of identity politics has been taken.

 Richard Kirk is a freelance writer living in Southern California whose book Moral Illiteracy: "Who's to Say?"  is also available on Kindle