Heartland Daily Podcast: Debating Medicare for All (Chris Talgo and Pamela Gronemeyer, MD)
The above is a one-hour debate on health care alternatives, including Medicare for all. To be clear, I support MFA, and understand that Bernie Sanders, controlled opposition, is put in place to prevent it from ever coming to be.
As always, I don’t expect that you will take time from your schedule, busy or otherwise, to listen to something just because I did. So I am going to summarize this hour-log podcast.
Aside: I was drawn to Heartland Institute because I regard their work on the climate change hoax to be top-notch. They have assembled both scientists and science to counter every alarmist bell rung the Chicken Little crowd. They have also seen through the ruse, understanding that climate change is a false front, a green curtain behind which lurks dictators who want to control every aspect of our lives.
However, I get goose bumps as I listen to or view some of their other work. They are “free market” advocates as a solution to every problem, presuming that such a thing even exists and would be effective if allowed to flourish. I was dismayed that, at Heartland’s Thirteenth International Conference on Climate Change this year, they allowed time to Montana’s Jennifer Fielder, an advocate for transfer of Federal lands to the various states, a recipe for privatization. She says such a plan only allows more access, oblivious to the fact that access to federal lands is ubiquitous, rarely denied. I was invovled in that battle back in the 90s, and came up with the catchphrase “Keep Public Lands in Public Hands,” which turned out to be effective. It has been stolen and used by others, to this day. (It was not copyrighted.)
Enough about that. I dabble with Heartland on the Climate Change side, but otherwise am not trucking with them.
The debate above between Talgo and Gronemeyer is civil and respectful, as all debates should be. I wish they had brought forth someone with a broader point of view than Gronemeyer, who missed many opportunities, but I don’t think that was intentional. Heartland seems to be comprised of sincere and honest people. Very few have the courage to take a stage with a sharp and well-versed opponent, and she did it, so kudos.
Here are Talgo’s major points – I am tempted to say that as he spoke he was sitting beside a Kool Aid dispenser, but I don’t use the expression “drinking the Kool Aid” since I did my work on Jonestown, finding it to be fake. That’s too bad, as it is a useful expression.
My rebuttal is in italics.
Medicare for All is a “government takeover of the health care system. It is a reimbursement system for hospitals and doctors. Medicare as it exists now allows free choice of doctors and hospitals. It does not require pre-approval of procedures. Medicare sometimes balks on a charge as duplicative or, for various reasons, not covered, but when that happens it is the doctor or hospital, and not the patient, that suffers.
Government intervention in the health care system has created all the problems we experience. Do you remember the “preexisting conditions” regime where millions of people were denied health care? That came about because of insurance companies. When one company decided not to cover people with a certain condition, all other had to follow due to adverse selection. The high cost of health care is due to many factors, but one is that insurance companies only pay a portion of bills, which results in doctors and hospitals doubling, even tripling their charges just to get what they need, and endless cycle. Another factor is high overhead, as doctors and hospitals must hire staff just to sort through various companies’ forms, coverages, hoops and bureaucrats. Talgo’s statement is wrong.
Auto insurance works because it is a free market approach, while health insurance is not. Auto insurance indeed works, and it does not hurt that government mandates coverage. But it works because claims are infrequent in terms of the number of drivers and vehicles. That insurance model indeed works, as the minimal individual burden is shared to cover catastrophic events for a few. I tend to agree that health insurance, if we must have it, should be catastrophic coverage, while we rely on ourselves or associations for minor matters. It might work better if government mandated universal coverage, as it does in Switzerland, which uses private insurance and controls costs while covering everyone.
Medicare for All is a wealth distribution plan where the rich pay for the poor and working classes. Talgo needs to take a look at where government revenues come from … the shared burden of FICA and income tax in effect places a similar burden (in terms of percentage) on all who work. Those who do not work for wages only pay the equivalent of what workers pay as they enter the highest brackets. And let’s not even get into the matter of the ability to create money, the illusions of deficits and national debt. This post is already long.
Government is bureaucrats, private sector not. I tend to agree that bureaucrats are like Lilliputians, and that we have too many of them. Honoré de Balzac referred to bureaucracy as the “giant power welded by pygmies.” Private insurance companies are crawling with them. I argued to no avail with Humana about a surgical tooth extraction they refused to cover (shortly before dumping Humana), and was told that were it a true surgical procedure, Humana would have had to approve it in advance. In other words, a clown with a business degree is looking over the shoulder of doctor. Not that I honor doctors. That’s another story.
Obamacare was a takeover of the health case sector by government. I need to get caught up here, as there have been court decisions, and I sense that the private mandate is gone now, but Obamacare was written, shepherded and passed by Liz Fowler, a Wellpoint executive who fronted for the insurance companies that pushed it through. It was a disaster, to be true, with its exclusions, and MOOPS (max-out-of-pockets) (currently $15,800 for a family) and higher premiums and people running and hiding rather than seeking coverage. The insurance industry did that to us using its tool, Barack Obama.
Due to Trump, the VA is referring people to doctors and clinics and hospitals outside the VA system. VA has always done that. It makes sense to rent someone else’s expensive and rarely used specialist or equipment rather than purchase it.
Medicare for All will cost $30 trillion in the coming ten years. There are a number of studies on this matter. But this much is certain: We currently pay $3.5 trillion annually. Over ten years, that is $35 trillion. Is the $30 trillion number Talgo uses merely an assumption that all health care costs become tax expenditures? I cannot see it any other way. It flies, however, in the face of real expenditures in countries that have “single payer,” which is what MFA is. Canada’s system, which covers everyone up there, costs 60% per capita of what we pay even as we exclude 30 million people. I am sensing sensational scare tactics here. MFA should, over time, reduce health care expenditures per capita.
Monopolies lead to high costs and poor service. I tend to agree, and think that Talgo is not seeing that our health insurance industry is in effect a monopoly, or oligopoly, but I repeat myself. Indeed prices are out of hand. Service is an open question, as I’ve never experience bad service on the health care end, just in the insurance products we must purchase.
Here is one point made by Gronemeyer: The best health care begins at 65. That has been my experience.
Not discussed here: The American way of health care with its unnecessary and invasive, even abusive procedures; holistic and dietary alternatives to doctors and hospitals, the vaccination regime, the PSA. Zika, and AIDS and other hoaxes; cancer and its treatments … I am not oblivious to any of this and welcome comments from others more schooled in these matters than me.
The Talgo/Gronemeyer exchange was courteous and each person is sincere and intelligent. I only wish Gronemeyer was better on her feet, and that Talgo would get away from the free market sugary drink dispenser.
Piece of Mindful 
Just got done reading this when I flipped over to your site.
https://fee.org/articles/i-was-a-physician-at-a-federally-qualified-health-center-heres-why-i-no-longer-believe-government-health-care-can-work/
What I find most interesting about your views of governmental run institutions is your past career, which worked with federal rules and regulations.
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That article you link to is strictly anecdotal.
I find direct primary care to be appealing, in that most medical problems do not need to be run through either private insurance or Medicare. But for those that do, in case you did not read the blog post above or listen to the debate that I linked to, physicians generally find it easy to deal with Medicare, while private insurance companies require more paperwork and things like advance approval for procedures that Medicare does not. (In the debate on a couple of occasions, Talgo confuses Medicare and Medicaid, the latter acknowledged by all to be underfunded. But what are you going to do? Private health insurers want nothing to do with poor people.)
That, and, you know, I’ve known you for like twenty years now, and for those twenty years have been suggesting to you that if you want examples of government-run or single-payer or regulated private insurance systems that work, go to any other country in the world. Any-other-country-in-the-world. You’ve never looked at even one, except perhaps through your Kool Aid-stained free market glasses.
The last country to abandon the private health care model was Taiwan. They used as a model for their new system Medicare, not ours, but Canada’s, also called Medicare. It’s in place now and running smoothly, and Taiwan will not be returning to our system, ever.
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I looked at Canada’s system, even talked to Canadians. The ones I talk to complain mostly about the wait times and not the quality of the care.
If their system was so good why did 52,000 leave their country for care south of the border?
“In 2014, more than 52,000 Canadians received non-emergency medical treatment outside Canada. Physicians in British Columbia reported the highest proportion of patients (in a province) receiving treatment abroad (1.6%). The largest number of patients estimated to have left the country for treatment were from Ontario (26,252).”
“Across Canada, neurosurgeons reported the highest proportion of patients (in a speciality) travelling abroad for treatment (2.6%). The largest number of patients (in a specialty) travelled abroad for internal medicine procedures (6,559).”
“One explanation for patients travelling abroad to receive medical treatment may relate to the long waiting times they are forced endure in Canada’s health care system. In 2014, patients could expect to wait 9.8 weeks for medically necessary treatment after seeing a specialist—3 weeks longer than the time physicians consider to be clinically “reasonable” (6.5 weeks).”
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The problems as I have seen exist mostly in Ontario, but I guarantee you that Canadians would not voluntarily switch to our system.
The mythical movement of Canadians south to get treatment here a little on the absurd side, as they would have no insurance and would have to fork over cash at our exorbitant prices. What I have read about, and it was some years back, was that Canadians do farm out certain procedures to American hospitals … those that require expensive machinery that has little demand. Something like that, where the Canadian system pays the freight, would make sense. If you would read the blog post above, you would note that VA does this, and then gets criticized for having patients seeking care outside the system. Same deal.
You put quotes around your statements but do not cite the source.
By the way, more than a few Americans go to Mexico for care, Costa Rica for dentistry. And you did not address the fact that Canada covers ALL its citizens. Why, if we tried that here, why, I would bet we would have waiting lines.
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Link for leaving Canadians. https://www.fraserinstitute.org/studies/leaving-canada-for-medical-care-2015
Huffpost has something similar at https://www.huffingtonpost.ca/bacchus-barua-/canada-health-care_b_9646872.html
You seemed to avoid my original premise that your experiences with the rules and regulations of the federal tax systems were beyond reproach.
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The tax system is very complex. I am not thrilled to have made part of my living because I could negotiate parts of it where others could not. You do what you do, and that sort of thing was in my skill set. I retired in 2017, never again to look at that stuff. I might even pay someone else to do our return this year.
I don’t venture to HuffPo more than three or four times a year at most.
Are you ever going to actually read the post you are commenting on?
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52,000 is not a large number, and again, these people coming to this country are uninsured when they get here, and have to pay cash, retail. There has to be a reciprocity agreement at work.
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“The (American) Health Care System” is an oxymoron — unintended, of course. Profiting from population reduction, mass destruction of our God-given immune system, and prescribed/induced drug addition is hardly worth its cost to consumers. We’re long past the point where the parasite cares about the host’s survival. AI will take the wheel. Trust “white coats” at your peril.
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I avoid doctors and use a PA, but even there I get pushed to get vaccinations. My last appointment was just this month, and I was advised to see a urologist due to a PSA over 4. I am thankful … to me … that I took time to be my own patient advocate and got up to speed on PSA, a meaningless number. Had I followed advice and seen a urologist, I would likely have had a biopsy which would have revealed, possibly, something 65% of asymptomatic men my age have … prostate cancer. But urologists are people with hammers, and older men with prostate cancer are nails. I would have endured the biopsy, possibly a prostatectomy followed by incontincence and all the expensive solutions therewith and impotence, ditto. In other words, while I am aging, had I followed advice, I would have turned the corner and officially had become an old man. Most prostate cancer is best left alone. If it is aggressive, it will get me, so be it. But the PSA test tells me absolutely nothing. As part of my exam I had a DRE, and it was AOK from that vantage point.
We are headed this Sunday to the Dolomites and a rigorous forty mile hiking trek (with comfortable refugios at the end of each day – don’t get me wrong, we do not suffer). It is my intent to be healthy and active until I die. I wish this for everyone.
Your views on health care are noted, and I find them a little overstated … that is, not all medicine is useless, not all surgeries are unnecessary, not all medical personnel engaged in mass destruction. They do very good work on injured people, setting bones, healing wounds, draining cysts, joint replacements, stuff like that. My wife had knee replacement years ago, and it was a godsend. Six months after we hiked the Grand Canyon with another couple, she too having had the same surgery. Opening me up, removing the prostrate, destroying my quality of life … not in the cards. As I told my PA, something is going to get me, none of us get out of this crazy life while healthy, and it could be now or twenty years from now. I did not tell her that the prostate business is a racket. I need her in order to continue my ability to get temazepan, which helps me do something that I’ve been troubled with all my life, sleep.
Actually, I think my clock is on the European schedule. Maybe I belong over there. I am just now rereading Ellul’s 1960 tract, Propaganda, and in it he says that in the wake of WWII, that country (Italy) made a conscious decision not to do any more propaganda on its population. That’s a book written a long time ago, maybe not so anymore, but I wonder if the reason I find the country so delightful and its people so charming is that.
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Wow … takes me back decades. The arguments you present are based in the “I made it on my own” premise, no help, no infrastructure, no luck, no privilege. You are the beneficiary of a large wealth machine, you get to participate, brought some talent to the table, maybe inherited wealth too. Others less fortunate need things they cannot afford, so as a society of good and decent and humble people, we set up a health care structure so no one is left out. They don’t get private rooms, fancy meals, private nurses. Most of what we need can be accomplished by free clinics. People who abuse their bodies die sooner, cost less. Hard fact. You want them alone in a gutter, others of us think perhaps there but for the grace of God go you or I.
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In 1913 the Federal Tax code was 400 pages, todays code number over 74,000. That’s what tyrannical governments do eventually, infiltrate very aspect of your life restricting your freedom. Total control of all your health decisions is a fruit ripe for picking.
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It has long been understood that you don’t like paying taxes. None of us do. If you followed this blog closely, you’d find work on the tax code, how the FICA system punishes working people, how we essentially have a flat tax system when FICA and Income Tax are combined, and how Bill Clinton (as if) managed to do what everyone else failed at – to reduce Social Security benefits dramatically. In other areas you’ll find a theory that, since the Federal Government controls the currency, it can make as much as it wants, and that further the National Debt and deficit are illusions. In this scenario, the income tax is merely a means by which demand is contained, and inflation kept to a minimum.
The number of pages in the tax code ought not to concern you. Which of them have you read?
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Temazapan is a mild sedative, and I take only a half dose. It puts me over the hump. That and being on a European schedule tells me I need to live there and not here. (Only half serious there.) I don’t have a guilty conscience. It is crap beyond my control, things that make me hyper alert … so I’d appreciate it if you would back away from the psychoanalysis, please. We all got our issues. It is what it is.
You seem somewhat black/white. If not that, this, no middle ground. I do not like paying taxes. Here at the local level they pay for roads and bridges and law enforcement – are you one who imagines the private sector makes good firefighters, saving this house but not the one next door? Private fire fighting, like the private health insurance, cannot work unless it is regulated and forced to privide universal service. There are no blanket solutions, life is not like that.
At the Federal level it is different, as there they control the currency and can produce as much or little as they wish. They are constantly haranguing us with fear of deficits and national debt to prevent programs they fear, single payer one. The deficit and debt are not real, and can be eliminated at will. They must control inflation, and use taxes for this purpose, to keep our spending power down. I sat once next to a banker at a luncheon, and he told me the whole Buy War Bonds program during WWII was a hoax needed to get money out of circulation, since there were so few goods to buy.
Single payer, a government system,works. Private auto insurance, a market solution, works.,
I don’t like all of that. I am not a statist, do not wear hobnail boots or goose step. I cherish freedom, which I have enjoyed to a large degree being self employed, avoiding the chains of the boss and groupthink. Life is a mixture of colors, many delightful, some gray and tedious, taxation one I cannot avoid … cannot live off the grid. Sorry.
If by chance your comment went to moderation, and I think it did, I did not do it and freed it up as soon as I saw it there. You are not in any way censored, free to comment as you wish. If a comment goes to moderation, I have no control. I do not know why. Just be patient. It will appear in due course, the wait longer as we travel about Europe in the doming days, often out of wifi reach.
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Black/white thinking abounds. I favor single payer health care because it works in other countries. I detest our insurance system because it has led to millions of uninsured people and extremely hgih prices.
Where else have I shown your alleged “statist” tendencies? It appears I must be all or nothing, which makes you guys … zealots.
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Columbia is in the same time zone as New York City … just trying to figure out what time happy hour is at the bars. You’re surely writing while atop a barstool. How else can I explain your nonsense?
By my calculations … 6:30. Yep.
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I have Medicare and a very expensive $156 monthly charge for a United Health Supplement F that was sold to me as no co-pay, no deductible….I am having to appeal several charges that medicare deemed unnecessary. They said if the doctor ordered the lab work it is covered…color me “pissed off”
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I could be wrong, but it seems to me that if Medicare deems a procedure unnecessary, then you don’t have to pay. It is on the doctor or clinic to know this stuff. Don’t look to the supplemental … it is only there to pay the 20% when Medicare does the 80%. Supplementals are huge profit centers for insurance companies.
Hope this helps. A little.
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