What We (Don't) Talk About When We Talk About Healthcare

Anytime anyone talks about a single payer system in the United States, you'll usually find people on two opposing sides of the practicality of such a system. 

I say usually, because there's now apparently a third group- what I guess you could call a sort of "progressive realist."  These are the people who claim to completely believe in the idea of socialized medicine, but who've committed themselves to the all-important task of gently telling the people who want to bring it about that they're full of shit.

Paul Krugman, economist and recently outed snob, bashed the Sanders healthcare plan in an article in the New York Times called Lack of Power Corrupts (it should be noted that Krugman is renowned for being an major figure in economic opinion pieces, and I assume he's also renowned for naming said pieces in the snobbiest way possible.) You can read the whole thing here, but what I find to be the most infuriatin is this line in the fourth paragraph:

"You don’t have to be a corporate hireling or a Hillary shill to be taken aback when a Democratic campaign endorses economic projections that are even more outlandish than the Republican fantasies you were ridiculing just the other day."

Now, of course, Krugman is doing his due diligence. First of all, even acknowledging the plausibility of any Clinton opponent would put this man at odds with himself. Krugman has worshiped the male Clinton presidency's economics since its inception. Considering that this president was in office during the greatest economic expansion in 40 years, it's not hard to do- all you have to do is forget that his presidency overlapped the massive expansion of the internet, and be able to conveniently forget that when Clinton overturned Glass-Steagall he laid the groundwork for one of the most destructive economic collapses in the history of the planet.  

(It would also be convenient to forget the GOP plan for healthcare, the long and short of which is somewhere between jack and shit.)

The second part is that Krugman understands the fine line Sanders is walking with his policy, so much as that Sander's knows today's political audience doesn't do well with multi-part arguments. Sometimes it takes time to explain things, such as how a single-payer healthcare system could drive costs down. Sanders knows his opponents are smart enough to cut him off between “we would raise taxes on people” and the “but we would end up saving those people money.” 

Krugman sees that if Sanders wants to convince people his plan could work, he has to work with the time he's given.  He has to give the outlines, then point towards countries that save themselves tons of money and hope we're smart enough to put the pieces together. 

But never mind if it works. If it isn't stated explicitly, in one sentence or less, it's no better than any bat-shit crazy plan that Trump has put out, right?

Here's my question: why are we even talking about this?

I'm seriously asking, because I don't think we know anymore. You can hear progressive economists like Robert Reight (and 170 others) argue the minutia of policy and the economic effects they would have, and you can hear basically fucking anybody on Fox News talk about the economic disaster it could become. 

We can (and are about to) talk about how on a case-by-case basis it's incredibly difficult to determine whether or not a socialized medicine system like [insert literally any other first world country here]'s would have on people's real, actual, day to day lives when it comes to finances. 

“People would lose! People would win! Some people would lose, some more important people would win!”  Whatever.  You could spend a whole day reading about the politics of Sander's plan or the benefits of Obamacare, and I think that by the time you were done, you'd probably have less certainty about your position, regardless of where you started. 

What's the point?

Do we need socialized healthcare? Could we afford it? Who would pay for it? Who would stand to gain, or lose?

I'll spoil this for you- until we answer the following question, there's really no point in talking

about anything else.

Is healthcare a right?

Nobody wants to be put into the position of defending the answers of “yes” or “no” or “it depends,” but it's something we need to decide, otherwise, you're either a. never going to see a policy enacted that you think is economically or morally justified and/or b. never going to hear the end of this policy debate/partisan circle-jerk.

Let's make the question easier. Is healthcare a public good? We're now talking about the most affordable, most effective healthcare as being the same as the right to an education, or a right to being safe from intruders, or the right to have somebody show up to stop your house from burning down.

Plenty of people, and now apparently a self described “progressive policy serious-person", are more than willing to dodge the question- to them, the more appropriate question involves the cost thereof. I understand that before we decide how to make something work on a federal level, we need to figure out how to budget it.  "Fail to plan, plan to fail" kind of thing. 

Or is discussion out of the question entirely?   Reality may have a liberal bias, but in our political climate, facts don't matter, unless you're a billionaire who needs to skew public opinion with very specific facts for the sake of policies that benefit you and the .05% of Americans like you. Otherwise, who gives a shit about what's real-  Say anything with enough confidence in a presidential debate, and you'll get the backing, especially when you're running against a world class bunch of wimps and liars.  Ask Trump.

But here's what I don't understand. The reason we have fire departments and police officers, the reason we have a criminal justice system, or the reason we collectively pay money towards maintaining bridges and roads and buildings so that they don't collapse, isn't just because we can afford them. Fire-fighters are trained to protect people. Police officers are trained to shoot people who would kill others. There's a publicly funded criminal defense system in every single county in the United States who would prosecute anyone who was charged with murder, attempted murder, kidnapping, assault, whatever. Clearly, the idea is to prevent injury or loss of life. For some reason, in these cases, we prioritize the life of human beings over the discussion of how much protecting that life costs.

Despite the fact that we don't bother to measure the value of humanity, we control the costs of public goods just fine.  Instead of having any number of police stations that people could choose to pay to protect them, we have one per city, county, and state.

Since there's no competition, and there's no profit margin, the cost is as low as it can go. Same with firefighters, and prosecutors, and trash collectors. These are public goods we determine are the most conducive to our survival, therefore, they are excused from any sort of profit battle. They're things we need, not things we want, so we put them in another pile. There's a word for that, and it's kind of a bad word: Socialism.

And yet, in one particular aspect affecting the possibility of loss of life or injury, namely, medicine, we're completely OK forcing people to pay for it themselves.

It's like we've collectively said “We all know that it's possible that fires, murderers, the weather, or most accidents can kill any one of us. Let's pitch in and make sure that if a house or building catches on fire, or if a tornado hits, or of somebody kills somebody else, or a building is going to crumble, somebody will attempt to rectify the situation. A person shouldn't have to pay for that as an individual, because it's something we all need.

“However, should you add the word 'cancer' to any part of that paragraph, then that person is on their own. Fuck 'em.”

What we're really talking about is the difference between dying from cancer or dying from a fire. What's the difference? They're all socialist policies.

The only answer, really, is the price.

That's why we need to decide. Because if the price is enough to stall you, then you're really asking how much any human life, including yours, is actually worth. And if that discussion sounds like a shit sandwich, consider that it's only the first of many, because if we're going to go through this with health care, then we might as well talk about all of those other pesky services we've decided are public goods. If we're simply going to ignore the morality argument, but we still want to talk at all, then we need to talk about the practical aspects of public goods. Are all goods unnecessary?

Perhaps. If we truly want free-market solutions, then for the sake of consistency in our rhetoric we now need to abolish all government, because even having a government is a public good.

In one of the weirdest pieces I've ever read on the subject, it's said that socialism means force, and force is wrong.  Truly free markets don't need force- if a better service is available at a lower price, then people can get that service instead.  Through plenty of these decisions, the invisible hand of the market will provide the lowest costs for the highest standards of service.  The only way anyone could cheat the system is with the help of the government.  It's that simple, right?

Well, simply put, fuck that. 

Force is society's way of keeping us from destroying ourselves. The only reason we don't kill each other over the last tickets to a Deadpool premiere is that we've decided that we need people trained to prevent that sort of activity. Do you really think that's wrong? Sometimes you have to give up some liberty for security.

Look at it this way- you were able to publish that article on the internet. Now all Al Gore jokes aside, without massive investments from the United States, the internet as we know it wouldn't exist. You're using a tool created by socialist policy to say that nothing good comes from socialism.

What I never understood about the free-market, anti-socialist crowd was that many of seem completely fine with spending public money lots of other things. Tell them we need to spend money on the military, or policing the corrupt unions, or making it more difficult to spend money on abortions, and they'll chalk it up to a star-spangled necessity. 

But here's the thing we have to realize eventually- even these services are socialist as well. And at this point, considering how easy it is to figure out exactly what “socialism” means, you have to figure that some of them are completely OK with ignoring the definitions of words in the English Language for the sake of maintaining their positions.

The point is that we are completely OK with using certain allocated resources for the sake of price control- in a private system, the vast majority of people wouldn't be able to afford their own security, or their very own trash service, or their very own fire service. 

If you're one of the 100,000 or so people in the United States who could afford this, well, I'm sure that sounds great. That would certainly keep those evil socialists out of your lawn- but what it probably wouldn't keep out would be an army of screaming people who haven't eaten in days because there's no longer any government subsidized food- let alone somebody who could harvest and transport the food. Probably a good thing; any working transportation would have been torn to scraps of what could be bartered, meaning that some poor fuck would have to walk the food all the way to you. Or they would, if it wasn't practically a mathematical certainty that they'd get robbed and murdered within a day because we decided those pesky government paid police didn't need to take any of our tax dollars away.

Can we just ask the politicians directly?  I'd love to hear Ted Cruz or Trump explain why spending a trillion dollars belonging to the collective United States on a war in a foreign territory somehow evades the technical definitions of “socialism,” but giving somebody a public option for healthcare somehow doesn't. Five bucks says they don't make it 30 seconds without trying to change the subject to 9/11.

But I guess not talking about it is sort of the point. Some things we glamorize and value, such as capabilities for violence and making our gasoline powered-machines even louder, and some things we like to look down on and present as evidence that our culture has lost its self sustainability, even though it's all socialism, according to the language we're all using to talk about it. 

But I get it. It's a lot more psychologically satisfying to look at people who have lost everything they'll ever own to medical bills, and blame them for misplacing their priorities- they should have been working harder to get a better job so that when they got cancer it didn't send them and their families into a cyclical hell of debt and sadness. “I pay for health insurance, because I'm [Insert any adjective here, so long as it isn't “I happen to be in a position where I can afford it.]"

Before there was a police department, there was probably a large, angry collection of people who looked at the problem of people getting robbed and decided that the victims were to blame. Never mind that people can “choose” to get robbed in the same way they “choose” to get cancer. 

 I'm strong enough to defend my goods and my family, so why aren't you? Why should my tax dollars go to defending people who won't even have the decency to defend themselves? This is socialism! We're forcing people to pay for a police service, and force is wrong!

Here's one of my least favorite sentences ever- let's do some math. According to the CDC, these are the 10 highest causes of death for Americans in 2015.
Heart disease: 611,105

Cancer: 584,881

Chronic lower respiratory diseases: 149,205

Accidents (unintentional injuries): 130,557

Stroke (cerebrovascular diseases): 128,978

Alzheimer's disease: 84,767

Diabetes: 75,578

Influenza and Pneumonia: 56,979

Nephritis, nephrotic syndrome, and nephrosis: 47,112

Intentional self-harm (suicide): 41,149

You might notice that a common theme, and that theme has a lot of names. Some prefer “natural causes,” some prefer “diseases.” I personally prefer “shit that has nothing to do with terrorism.”  Call it what you want, but at least call it a problem.  And if the goal is to prevent loss of life, then we either have to start spending collective money on health services or invent some sort of hand-held weapon or ICBM we can use to kill diabetes.

But let's look at this another way. Maybe somebody who's reading this really doesn't care that people are dying from things we can prevent. Fine, then. Let's talk about the practical aspects of keeping people alive.

According to data from The World Bank, the United States spent 17.1% of its GDP on healthcare spending. That equates to roughly 2.867 trillion dollars. By comparison, Italy, which was ranked the 2^nd healthiest country by Bloomberg, spends about 9.1% of its total GDP on healthcare. (Simply put, Italy has a mixture of public/private healthcare, roughly the equivalent of a very popular public option.) It should be noted that the United States is ranked 33^rd healthiest, according to that same study.

So forgive me for extrapolating, but hear me out: If we were to spend the same percentage as Italy, we'd save ourselves something along the lines of 1,324,676,187,000 dollars. That's more than the entire cost of the war in Iraq, in one fucking year. That's more than 4000 dollars for every single person in the country.

In review, that means if we implemented the exact same system they have in Italy, and spend the same percentage of our money, it means we'd be healthier, and we'd all be, on average, 4000 dollars richer. Is there any better reason to do anything?

This is the infuriating part about listening to people drone on about the unreality of a Sander's health-care plan. Maybe the numbers don't add up (they do). But if the plan sucks, but the goal attainable (per the dozens of countries that currently pull it off) then we're all under at least some variety of obligation (morality, fiscal sense, whatever) to figure out how to make it work.

And so, Krugman, to quote John Hartigan: "Breathe steady, old man.  Prove you're not completely useless."


Sam Wellborn lives in Austin, TX, and is going to watch Deadpool again.  Follow him on Twitter, or email him what you'd do with $4,000 at swellbo@gmail.com

Five Things You Need to Do to Outlaw Abortion

For a moment, let me talk to the wonderful and rational anonymous strangers who have opinions on the internet, so that we might engage in a nice, warm, friendly conversation:

Abortion! 

Since the Supreme Court decision on Roe v. Wade in 1973, there's been a never ending series of protests and arguments both for and against the Courts decision to a level that's unprecedented. There hasn't been a single more divisive case in the history of the Supreme Court (with the exception of Twilight: Edward v. Jacob, of course.)

Speaking of divisive, while I'm not pro-life, I'm definitely pro-discourse. I want a world in which civilized discussion determines important things like policy, morality, and whether crunchy or smooth peanut butter goes best with PB&J's. Discussion with well constructed arguments is a critical means of discerning right from wrong.

Unfortunately, when it comes to abortion, discourse breaks down almost immediately. This is partly because of the passion of the parties involved, but mostly because these two sides aren't just in opposition over the legality or morality of the act- they believe they're dealing with completely different scenarios. One side feels they're protecting the privacy and freedom of choice for women, who they feel need protection from the collective. The other side feels they're protecting unborn children, who they feel need protection from their mothers. We can't even decide what we're going to argue about. Good luck trying to win that argument, from either side.

I'm pro-choice. You might not agree with me, and I sincerely think that's awesome. I hope you voice your opinions! However, if you want Roe v. Wade overturned, then you have to convince people that it needs to be overturned, because that's the only way you're going to elect enough Presidents to nominate enough Justices who can be appointed by the correct ratio of Congress to overturn the ruling (barring an unexpected ruling on HB2 which, for the record, is absolute horseshit.)

And believe it or not, I'm here to help. So, if I may, I'd like to present the five things that pro-life people need to do to propel the discussion in any meaningful direction.

1. Acknowledge that you need to present an argument.

First things first: I respect your emotions.

I'm not going to pretend that this isn't something to get passionate about. If you believe that abortion is murder, then you're probably absolutely furious that it's happening at the rate it's happening, and that not enough people seem to care. However, you have to bury these emotions, because they're not helping your cause. Elevating emotions in arguments never works as it's intended to.
In order to convince somebody of something, the very first step is to separate the topic from any 

emotional involvement, because emotions won't help you.

I understand this is incredibly difficult. For some people, that's demanding the impossible- trying to hide their emotions would be like losing a part of themselves. But you have to understand that people who are pro-choice decided their position via their own logic and emotions, and, like you, they might think their opinion on the matter is an extension of who they are. Separate the discussion from anger, use logic, speak at a reasonable volume, and frame the discussion so that people are arguing points in a case. If your opponents feel like they're defending their arguments, and not themselves, you can at least get people to acknowledge you, if not listen to you. And getting somebody to talk to you is the first step to convince them of anything.

In a way, presenting an argument is a lot like trying to make a sale. You have a prospective client and you want them to do something. Now read this quote from forbes.com:

Sales coach and author Wendy Weiss, also known as The Queen of Cold Calling, says too many salespeople make fundamental mistakes early on. “Dedicate more time to the process upfront,” she says. “Salespeople are so fixated on the end result—closing the sale—that they neglect the important initial steps.”

You need a logical case to support the claim that abortion isn't morally acceptable; a sales pitch, if you will. If you want to change enough people's minds, you have to start here.

The next step is hearing the counter offer...

2. Acknowledge the social benefits of abortion.

First, this is not the same as saying that, as a whole, abortion is good for society. But it does mean understanding that, in specific ways, abortion has benefited many people in profound ways. For instance, look at this chart:

As Steven D. Levitt pointed out in Freakonomics, legalizing abortion drastically reduced violent crime rates in the US.

You can read more about it here, but the gist is basically this: when women were able to decide whether or not to give birth to children while they were in poverty, it decreased the number of poverty stricken adults in 18-22 years after the Court's decision. Fewer people in poverty means less crime, which is that big downward slope you see in that chart up there.  See how around 1994, or 21 years after Roe v. Wade, that chart starts dropping?  It's not a coincidence. 

Now, if you're trying to outlaw abortion, than your job isn't to disprove this statement, because objective data doesn't work in your favor. Unless you can argue people into believing a false reality, then you don't want to go this route.

No, your job is to convince people that even though there was a drop in crime, it wasn't worth it. This sounds daunting, but it might be easier than you think, because a very sound argument against the reduction in crime is basically this: A thirty percent reduction in crime isn't worth it if the cost is the murder of millions of people. 

That's what the argument boils down to, right? Abortion, according to the pro-life crowd, is murder, and murder is wrong. Murder has to be wrong- no society can function if the quickest, most efficient way to manage a disagreement or solve any problem is to kill another human being.

However, in order to prove that abortion is murdering a human being, you have to...

3. Determine the logically consistent point in which a fetus becomes a person.

I'll admit it: I'm not sure this is even possible.

The most common point listed by the pro-life crowd is at the “moment of conception.” The problem is that “conception” takes a lot more time than a moment. 

This is probably the biggest difference in the mindset of the pro-life and pro-choice people. A fetus, at any given point between the development of the male sperm or female egg, all the way until the exact instance the umbilical cord is cut, is either a human being- a separate entity that deserves the same rights as every other human being- or it's just another collection of cells in the human body. Without the exact definition of when a fetus becomes a human, we're at the “different scenarios” problem I mentioned earlier: one person thinks an abortion is murder, and another person thinking an abortion is as controversial as a haircut. There is literally no way to debate any issue under these circumstances. If you try, you'll lose. That's why you need a logically consistent definition of when humanity occurs.

This is the hardest obstacle any pro-life person will have to overcome. When does it happen? At what week? At what point in development? Is it when the sperm meets the egg? Hopefully not- even in a successful pregnancy, eggs are fertilized by sperm, and a lot of those don't end in pregnancy, because they don't stick to the lining of the uterus.

Is it when the fertilized egg sticks to the lining of the uterus? I'd hope not- you'd have to investigate every single sexually active woman, to ensure that every single time she had sex it didn't end with the implantation of the zygote, and menstruation happening anyway. Because that happens all the time, and if that's when a fetus is a child, then it's murder, and in our society, we don't get to pick and choose which murders get prosecuted- that's arbitrary. That's not how society, or even the world works.

When it comes to arbitrary, you have to be careful. People can see through arbitrary designation. When you claim that a human being exists at a certain time, and somebody asks "Why then?" you need to give them backing, and not just because that's the time you picked. The only time “because I said so” works is when your trying to talk your kids out of using their crayons to color the cat, and ask any parent, they'll tell you the success rate of that is a coin flip, at best.

Like I said, I don't envy the position of the person who's trying to make this determination and defend it, but in order for your side to have any merit, it's something you have to do.

Maybe you don't want to think so specifically. Maybe you think that once a pregnancy is confirmed, that's it. It's a child. Since pregnancy is a very real, even likely consequence of intercourse, nitpicking the finer details of the “when” isn't really important. What's really important, you're possibly thinking, is that somebody who had sex should realize that this is what could have happened. If they understood the very real possibility of pregnancy, and had sex anyway, then they should be more concerned with protecting their own flesh-and-blood than nitpicking scientific semantics as an excuse to remove themselves from their responsibility.

Or maybe you think something similar, and don't care for me creating straw-men. Fine, I'll stop. The point is this: Remember, what we're talking about, what Roe v. Wade was talking about, isn't sex. It's abortion. So in order to continue the abortion discussion, you have to...

4. Only talk about abortion.

I've been told, I mean, I ABSOLUTELY KNOW BECAUSE I HAVE ALL OF THE EXPERIENCE, that sex is awesome. I've also been told that having sex with somebody you haven't married is immoral, and makes Jesus cry. (It might be worth noting that one person has told me all of those things, including the awesome part, sometimes in the same sentence.) There are a large number of pro-life people who see sex between people who aren't married as immoral. Virtually, all of these arguments are rooted in religious texts, and in said texts there are rules against actions or thoughts that a supreme deity of some variety doesn't want people to do. (The internet has told me that these are called “sins.”)

This fucks your argument up not once, but twice- the first way is that it creates an equivalence between abortion and sex.  People like sex.  It is, biologically speaking, the reason we do just about anything.  Secondly, taking this a step further, this also creates an equivalence between abortion and wearing mixed fabrics. And while cheap, scratchy polyester/cotton blends is definitely something worth burning in the streets, you can't convince somebody to ban something if they think you equate it to something that's utterly harmless. Hell, I'd even margin that many of the women who have received abortions did so when they had long hair- which in certain situations is a sin.

A sexy, sexy sin.

And we have to talk about the other people. You know the type. The LOUD people. They might be the guys in the YouTube comments section, saying things that are somehow nonsensical AND offensive.

Wait, what?

Or maybe, they're the guys who promise to cure people's cancer while they convince their financially troubled followers to buy them jets.

That's Robert Tildon, whose net worth is close to a billion dollars.  Him, and people like him, only want sex to happen between either 1. a married man and woman, or 2. a confused altar boy and a consenting priest.

These are the monsters who need people to follow the religion they preach in the way they preach it, and that means no sex for recreation- it's distracting from their profits. Make a few kids so you can leave behind somebody to support the brand, and that's all the sex we need from you, thank you very much.

None of these people help your argument. If you want to convince people that abortion is murder, then siding with any of these shitbags won't do anything but piss people off. And as I've said before, pissing people off isn't in the play book of convincing them that they're wrong about a certain issue.

While we're talking about what you should and shouldn't do...

5. Focus the argument against abortion, not abortion providers.

Recently, a grandjury indited the creators of a video that investigated Planned Parenthood, because when they were trying to convince Planned Parenthood that they were trying to buy baby parts using fake ID's, they were committing the crimes of falsifying identification and attempting to buy human organs.

This is important for a couple of reasons. The first is that it demonstrates how you are more likely to metaphorically kick yourself in the dick by trying to subvert logical arguments in favor of manipulating public opinions. The second is that it shows where the justice system currently stands on the notion of whether a fetus is a human being, because the people who made this bullshit video were charged for attempting to purchase parts, not people. That's an important distinction. They aren't charged with buying human beings.

And shouldn't the accused have protested this? You would think that if they really believed that a fetus is a human being, they'd ask the charges be elevated to human trafficking. The easiest way to prove that you don't really have a case is when you can change your terms for the sake of convenience.

Not only did they fuck up their own case, but they put a dent in the case of pro-life people everywhere. It's the same with the clown-shit Santa Claus lookalike who shot a bunch of people in Colorado Springs, or any person who decides to skip the conversation completely and go straight to violence.

It may not look like it, but you don't want this man as your spokesperson.

There's an old saying: “Violence isn't the answer.” I wish they would change that, because sometimes, violence is the answer, but only if you're stupid. Remember when you were a kid, and every disagreement ended with either a time-out or a fistfight? Do you remember anyone agreeing after that? I don't. I remember the people who were the most violent (sometimes this was me) getting punished, and the rest of the class moving on like nothing happened, except for occasionally giving a load of shit to the idiot who thought it was a good idea to fight somebody over a game of Pogs in the first grade. (Again, this might have been me.)

That's who we're talking about. The people who use guns and bombs are the children who could never win the war of words, which means that they were never able to get what they wanted, unless they wanted to hurt people (which is what I think we're all trying to stop.)

Don't be one of those people.

Like I said, I don't envy the position of the person who is in charge of putting the case against abortion together. You've got a lot against you; there's the current law, there's the ambiguous articulation of people who are trying to work on your behalf, and there's plenty of people who agree with you but are too goddamn stupid to do anything but get in your way.

But I understand where you're coming from. You, like most people, don't like abortion, and want it to end. That's fair, even though I think you're misguided. But it's not going to stop if you don't use the right tactics.

I won't say good luck, but I will say that by debating, you're doing the right thing.

Sam lives in Austin, Texas, and doesn't feel great about googling "human trafficking" and "abortion clinic shootings" in the same day.  Follow him on twitter, or email him at swellbo@gmail.com.