Author Archives: Scott Gurvey

Medicare for All: The Possible Dream

Oh, “The Impossible Dream”. How were we to know that David Brooks, a true compassionate conservative torn asunder by the Trump led takeover of the Republican agenda, is a Luddite at heart?

New York Times columnist Brooks is one of my favorite writers. I never miss a column. And I never miss his Friday joint appearances with liberal syndicated writer Mark Shields on the PBS NewsHour. Brooks usually writes from a unique perspective, but his recent effort branding Medicare for All “The Impossible Dream” seems to have been written from the Twilight Zone.

The Blank Slate

“If America were a Blank Slate,” Brooks writes, “Medicare for all would be a plausible policy, but we are not a blank slate.” The problem, Brooks goes on to explain in detail, is that Medicare for all would require vast segments of America to “transition”, and that would, according to Brooks, be unacceptably disruptive.

The devil is in the details and in truth, as Brooks admits, we don’t know just what Medicare for all means or how we would plan to get there. He tends to cherry pick the proposals to focus on the most disruptive versions. But there is nothing in the history of this great nation to suggest that we will be unable to face whatever challenges the endeavor might raise.

A little history

In 1781 the thirteen American colonies, having taken up arms against their British masters and declared their independence from Great Britain in 1776, took pen to Tabula rasa and wrote the Articles of Confederation. In that document “the Delegates of the United States of America” set forth the rules to govern their joint enterprise and with that, a nation was born.

The British surrendered in 1783, and the United States struggled to reconcile the Articles of Confederation with the needs of the infant country. They couldn’t do it. Thank history they did not throw up their hands and declare the Articles must remain in force because it would be too disruptive to transition to something else.

That something else was the “Constitution for the United States of America”, written in 1787 and approved by enough states to put it in force in 1788. The nation has amended that document, in some very disruptive ways, in the years that have followed. These changes were often the result of change in the society, and sometimes the result of technological change which rendered provisions impractical or obsolete. Each time we “transitioned”.

Medicine is always changing

Medicine is especially adept at transition, a direct result of research and technological advance. We put the entire profession of “leech wrangling” out of business when physicians stopped using bloodletting as a treatment. We created an entire industry with the discovery of antibiotics and the development of pharmaceuticals. We forced medical practitioners to transition to an entirely new paradigm for surgical procedures when we required through regulation the use of sterile environments. Doctors, patients and insurance companies all had to transition in response to these advances, and we are the better for it.

Brooks chooses one of the most radical transition plans, that of Senator Bernie Sanders, to make his point. If instead you take Medicare for all to mean exactly what it says, it leaves room for private insurance to offer Medicare Advantage and Medicare Supplemental Plans, as well as Medicare Drug Plans. Companies can sponsor these plans as they do now to offer an attractive employee benefit.

Yes, the Mercatus Center Center study shows a tremendous increase in the amount of money which will flow through the federal government as a result of the transition to Medicare for all. But the study also says that the total cost will be somewhat less than the cost of the current system, where payments come from patients, employees and insurance companies. How did Brooks fail to mention that?

One of my best friends has just retired, selling the medical practice he co-founded nearly four decades ago.  He told me that even with Medicare paying less than private insurance for some procedures, the back-office cost of processing a claim, that is paperwork, telephone follow-up and appeals for the frequent denials of coverage, was 20-25% for a patient with private insurance and 2-3% for a patient covered by Medicare. With that amount of bureaucratic waste, plus the profits made by private insurers, the total cost of healthcare per person is likely to go down and the amount that is actually spent on medical services is likely to go up.

It is no surprise that, as reported by a Kaiser Family Foundation survey, if told “Medicare for all would eliminate private insurance and raise taxes only 37 percent of Americans support it….” The question is loaded. Try telling them that they would save more in health insurance premiums, co-pays and other healthcare costs than the amount of the tax increase. Try telling them they will, judging by the results in other countries, live longer, their children will be less likely to die of childhood disease and mothers will be less likely to die in childbirth. Now ask them if they are willing to make the transition.

Oh, Canada

One more point, this business about median wait time for an appointment. I have a Canadian friend who lives in Montreal and had hip pain. Her orthopedist had been watching it for years waiting for the point where a replacement was indicated. Finally, they decided the time was near and they put her on the waiting list for the surgery. It was a six months wait, which they had anticipated. One morning that same friend’s husband felt a sharp pain in his chest. He went to the emergency room and had triple bypass surgery that afternoon. Yes, there is a wait for elective surgery. But medical care is not compromised in a case of emergency.  My Canadian friends are very happy with the healthcare they have and wouldn’t trade it for the American system for anything.

This nation has been adjusting, and transitioning, since the day it was born. I’m sure it can handle this challenge. Although, if, as Brooks suggests, we went back and undid “that whole American Revolution thing,” we’d have the British healthcare system. On average they live longer than we do. And spend less money on healthcare while living it.

Post Oscars

So. Its over. What did you think?

It wasn’t as long as some. And frankly, I didn’t miss the host. Besides, any show that begins with a trialog featuring Tina Fey, Amy Poehler and Maya Rudolph is an instant hit in my book. Why can’t we have these three host every event from this day forward? TV Shows, shareholder meetings, weddings, Bar Mitzvahs, etc. You get the idea.

Special recognition must be given to  Randy Thomas. “Never seen her,” you say? Probably not. But you’ve heard her. Ms. Thomas is the voice-over talent and announcer who for the last ten years has introduced presenters and vocally escorted winners to the stage with information about previous nominations and wins. For this hostless Oscar ceremony, Ms. Thomas was a star.

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Favorite Movies

Oscar season brings out the annual comparison of favorite movie lists and I figure we may as well play the game together. I’ve become so compulsive on this subject that when asked about my top ten I can quickly produce a list of a couple of hundred films and about fifty television series. The secret is that I’ve built a home server system to hold files from my DVD collection so I don’t have to search through boxes of discs to find a favorite when I’m in the mood.

So click the more button to see my list. This game only works if you play along.

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Journalism? When Pigs Fly!

I could never have anticipated this post. In fact, I can see myself sitting in my journalism class alongside my friends, Marc, Mark and David, Alanna and Lori, and my professors, Isaacs, Patterson, Wood and Friendly. What I wonder, would have happened if I had predicted that 45 years later I would write, and publish where anyone in the world could see it, a commentary containing a reference to a “dick pic”? Never have received my degree, probably.

For those of you who have been on the far side of the moon, shielded from any electromagnetic radiation emanating from earth, a quick recap. Jeff Bezos, who the style books demand must be referred to as, “Jeff Bezos, the richest man in the world,” on first reference, woke up one morning to find himself on the front page of the National Enquirer.

bezos-enquirer-div

One generally finds the Enquirer at the supermarket checkout, where it might come in handy if the store is out of toilet paper. This issue featured the details of Bezos’ impending divorce, along with pictures of Bezos and a woman, not his wife, who he was reportedly seeing.

In spite of the headline, I am not going to argue that this report is not journalism. The press has a special place in the history of the United States. It is the only occupation specifically protected by the Constitution. The framers who wrote that document knew exactly what they were doing. They had employed the press to spread the word, sometimes false, about British abuse of colonialists. That helped fan the flames of insurrection. In fact, I’ve often thought the British might have won the Revolutionary War if they had just confiscated every printing press in America.

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The Name Game

Calling another kid by an unflattering nickname is a habit most of us left on the grade school playground. Of course, Donald Trump is not “most of us.” Donald Trump seems to take a particular delight in coming up with a derogatory nickname for people he is not too fond of. “Crooked Hillary” is just one example.

Some of the people he attacks don’t take the bait and engage him in this fashion. I admire them. I don’t think I would capable of that much self restraint. If a punch in the nose wasn’t an available option, and the guy is of course surrounded by Secrete Service agents, I’d at least resort to the obvious retorts. “Donny Draft Dodger” is a good fit. And “Pussy Grabber” would work for an adult audience.

But I am happy to see two of our most recently announced candidates for the Democratic nomination for president in 2020 have found a way to meet the Trump insults forcefully, while stopping short of my tendency to stoop to his level.

Massachusetts Senator Elizabeth Warren, a frequent Trump target, took a broadside from the Tweeter in Chief after she made her announcement:

Not only did Trump employ his usual nickname for Warren, “Pocahontas”, he took a direct shot at her unfortunate claim of being Native American, something for which she has apologized repeatedly. To that he adds a reference to the campaign TRAIL. The capitalization has prompted critics to charge he is referencing and trivializing the “Trail of Tears”, a series of forced relocation of Native Americans which drove the Natives from their historical lands and cost thousands of them their lives. In his defense, some of his supporters have argued that Trump is not knowledgeable about this history and so could not have intended to make light of the tragic events. Think about it. Using ignorance as a defense.

Without resulting to direct name calling herself, Warren called out Trump for posting tweets she said are “racist” and “hateful.” And at a campaign rally in Iowa she added, “Here’s what bothers me, by the time we get to 2020 Donald Trump may not even be president.” “In fact”, she added, “he might not be a free person.”

Warren is not the only one drawing a barb from Trump. Minnesota Senator Amy Klobuchar recently announced her candidacy for president in the middle of a typical Minnesota snow storm. From the comfort of the White House Trump tweeted:

I could do a whole hour explaining the difference between climate and weather and how Trump just cannot see the difference. We already know he melts in the rain and can’t operate an umbrella. So instead we’ll just let him play the ignorance card again and move on to Klobuchar’s classic response:

Once again a candidate proves she can give even better than she gets, making her point without resorting to the name calling that passes for debate.

And debate is what we need in these troubled times. Debate on the issues of the day and the policy choices we must make. Night after night in 2016 Donald Trump led the evening news by saying the most inflammatory thing he could think of while his opponents, trying to stick to civil discourse and policy based argument, got far less coverage if any. And the media is already at it, focusing its attention on Warren’s claims of native heritage, asking if Klobuchar is too tough a boss, if California Senator Kamala Harris is black enough and does New York Senator Kristen Gillibrand know how to eat chicken.

It would be nice if in 2020 voters demanded better of the news media, and of all the candidates.

Me Academy. Pick Me.

Dear Academy of Motion Picture Arts and Sciences:

I respectfully submit my name for your consideration as the host of the 91st Academy Awards broadcast. I know you’ve had some difficulty filling this role. In fact, your track record in this area is pretty shaky. It’s another nice mess you’ve gotten yourself into!

Its hard to understand why finding a host for the movie industry’s biggest night, and one of the highest rated television broadcasts of any year, should be so difficult. But the rumor mill says many very big names in the entertainment industry turned you down this year. Oscar, you have a problem.

This year’s announced choice, comedian Kevin Hart, withdrew. Those darn social media posts from the past just keep coming back to haunt you. What you got here is a failure to communicate. I’m gonna make you an offer you can’t refuse.

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Winners. Losers. 2020.

We’ve done it. We’ve survived Election 2018. And of course there are winners, losers, and implications for 2020. A few, in no particular order.

We the People. Tough call here. On the one hand, we won. We decided that an unconstrained government is not a good thing and we restored at least the potential for a check and balance for the next two years by putting the House of Representatives in the hands of a different party. We also turned out in record numbers for a midterm. Can we keep it up?

On the other hand, we proved once again that we are a deeply divided nation. Moderates lost to partisans. The future for bipartisanship seems as bleak as before. Race remains the greatest dividing issue. Even a geography based solution involving the dismemberment of the nation doesn’t seem practical as the divide is between urban and rural residents, not between states or regions. The election of 2018 was decided in the suburbs. 2020 may be decided there too.

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