“Those People”

If there is any lesson to be learned from the current pandemic, it is that the U.S. population has suffered unnecessarily because we have stubbornly refused to do what every other modern Western nation has long done: provide universal health care.

Not only have we resisted any version of a single-payer system, we’ve thrown five million plus people off health insurance during this pandemic. And the “very stable genius”–our idiot President–has weighed in on a Supreme Court case challenging the Affordable Care Act, asking the Supreme Court to strike down a measure that provides health insurance to some twenty-three million Americans.

During a global pandemic.

So what accounts for America’s outlier status? For decades, the accepted answer to that question was some form of our individualism or our devotion to a market economy. But that excuse never really held water, because–as most of the world’s market economies understand–some areas of the economy are simply not suited to market transactions, which require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the proposed transaction.

That clearly does not describe medical services.

The real answer–the real reason American government has been so unwilling to provide universal health coverage–is the same reason the rest of our social safety net is both inadequate and deliberately punitive, constructed to “weed out” anyone who can’t adequately demonstrate both need and moral worth.

I receive Paul Krugman’s newsletter (no URL of which I am aware) and awhile back, he addressed the real reason for our disinclination to offer medical care and basic sustenance to all our citizens:

Non-American friends sometimes ask me why the world’s richest major nation doesn’t have universal health care. The answer is race: we almost got universal coverage in 1947, but segregationists blocked it out of fear that it would lead to integrated hospitals (which Medicare actually did do in the 1960s.) Most of the states that have refused to expand Medicaid coverage under the Affordable Care Act, even though the federal government would bear the great bulk of the cost, are former slave states.

The Italian-American economist Alberto Alesina suddenly died on March 23; among his best work was a joint paper that examined the reasons America doesn’t have a European-style welfare state. The answer, documented at length, was racial division: in America, too many of us think of the beneficiaries of support as Those People, not like us.

There’s a significant body of social science research that confirms Alesina’s thesis.

Americans are finally grappling with the institutional racism that has distorted our society. Unlike the civil unrest of the 60s, we’ve seen significant white participation in the Black Lives Matter protests. There is finally widespread–although certainly not universal– acknowledgment of America’s “Original Sin.”

It is also finally dawning on the “chattering classes” that America’s social problems are interrelated–that the reason Grandma doesn’t have health insurance might have something to do with the fact that Grandpa and his friends have always believed they are intrinsically superior to “those people”–people who definitely don’t deserve access to services funded by Grandpa’s tax dollars.

They’re willing to forego health insurance and other benefits of a social safety net if that’s what it takes to ensure that “those people” can’t take advantage of them.

America: where we cut off our noses to spite our faces–and call it “freedom.”


  1. Right on. So, WHO KNEW that racism still serves as the primary cause of enormous national disparities with respect to accessing: education, health care, housing, employment, financial services, fresh food, Representation in government, fair treatment under the law and depiction in popular media??

    I mean who knew besides every person of color in America? And maybe a few million nervous white liberals?

    We all knew. Every last one of us. And there is never a better time to own it, deal with its horrific legacy and begin to vanquish it from our land than the here and now.

  2. If our neighbors and our community is not healthy and safe, we are not healthy or safe. There is no ivory tower powerful or isolated enough to protect you. Remember who grows food for you.

  3. it is decades too late to try to undo the damage done by Nixon’s and the Republican’s repeal of the law preventing health care from becoming a “for profit” business. Any “plan” to pay for Medicare-for-all/single-payer health care has no solutions for undoing our current situation. “Health Care System” is a misnomer of the worst kind because it refers to actual life-and-death of all people for financial reasons to further enrich that “system”. We cannot worm our way out of this any more than we can worm our way out of the racist foundation this country has been supporting since its inception. Those same ships which carried original settlers to our shores also carried indentured servants who worked to buy their freedom in this new country. Nor can we rid this country of dependency on the corporate system due to Citizens United or the religious infusion in the form of laws at local, state and national levels, brought about by evangelicals and upheld by the Supreme Court.

    All of this goes back to yesterday’s blog and the fact that everything in our lives; including health care and our sex lives, are part of that “political question” we exchanged views on yesterday and in many past blogs. Trump sending in unidentified “federal agents” in phony “police” garb to “protect” the city of Portland, OR. is his “firing on Fort Sumpter” which resulted in the Civil War.

    “Americans are finally grappling with the institutional racism that has distorted our society. Unlike the civil unrest of the 60s, we’ve seen significant white participation in the Black Lives Matter protests. There is finally widespread–although certainly not universal– acknowledgment of America’s “Original Sin.”

  4. If it were not for the border closure to protect the citizens of Canada from the far more prolific incidence of infections among Americans, my wife and I would be enjoying our shoreline property in Ontario. The per capital infection rate in the USA compared to Canada is dramatic. Is it just coincidental to contrast the national public health policies of both countries that share the same cross Continental border? Canada has a form of universal healthcare. I recall vindictive criticism of Canadian healthcare during the last national election cycle and how the new President was going to build a far superior health plan to make America great again. Oh I guess the alternative fact cult would say we are among the greatest … if you flip the chart upside down, of course, we are right up there with Brazil and Venezuela. The facts are, our nation and way of life have underlying health issues our public health officials have warned us about but politicians refuse the challenge and will to address in a more effective manner.

  5. Health care is just one of the facets of our society where race determines who is included and who is not. As long as we continue to exclude part of our population from the benefits of our social and economic scheme, we will be a nation divided. And then we should not be surprised when those excluded for hundreds of years eventually retreat into a world of their own, where the laws, mores, and traditions of the majority no longer apply.

  6. The scariest word in the English language is taxes. As soon as the electorate hear that word, they are convinced the person uttering it is a commie, a socialist, or a liberal. Heaven forbid we ever let someone like that into a position of power! We won’t approve new taxes for schools. Why should we approve new taxes for healthcare, especially when WE don’t get sick?

    Until Americans realize we are all in this mess together, we won’t accomplish much of anything in the way of a social safety net.

  7. I failed to refer to verified facts to support a position while criticising the ‘alternative fact culture’ in our national political landscape.

    “The U.S. has had about 15 times as many confirmed new cases, per capita, as Canada over the past week and 12 times as many as Hong Kong or Europe.” Reported by CDC and WHO.

    For all the claims we hear attributed to our self-claimed greatness, the facts are not only appalling … they are scary if not embarrassing. Very stimulating and thought provoking post, Sheila.

  8. the reason,greed,why would the ones who run healthcare allow the investor,who is also the runs this game to give one iota to help,anyone..same as with a living wage,those numbers on wall street everynight are the reason why.ive talked with a few who have investments,they never given a single thought of the worker for such publically traded entity,why they dont have a living wage.its given to investors. then as insult,see those numbers climb in a fallout of jobs, its because im seeing the greed of keeping those numbers infalted. the price of meat,since we must abide to export trade contracts,its them,before the domestic market. order a dominos pizza,i got about 70% of the pepperonis.. same with freel shakes,new cups,smaller,same price,etc..
    on and on. i went on a price check at wallys,no doubt,being help hostage while we succeed in proxy to give covid45 and his mob more votes.those numbers on wall street are making him votes while the stock market,(his economy) is lying its assoff…the SEC and FED are going along for,the ride.mnuchin must be in paradise,foreclosures to be had, he runs a ponzy scheme, gets to kick the races to the curb, with trump,agrees with mcconnel on getting reelected at any ones,cost. lets not agree with the above,and ignore how germany handles this,they have nationalized healthcare,paid by GDP profits,the covid came in january,everyone laid off recieved 80% of their pay,through their the employer..just recent,last week, the eu, has made a mandate to give buisness their needs,now…its about 850 billion., imagine,we just allowed 5 trillion to bail the big banks,publicly traded corps and buisness to have a carnival on the tax payer,us, so they can guarantee trump is the king when novembers election is,well,demonized..now,where the hell is America? investor before customer,what else..

  9. Today it is all about the Money. Our “Health Care” system is based upon – >> Who can Profit off of sickness, disease or accidents. We have had for several years running attempts in House and Senate to pass a a Medicare for All into law.

    H.R.1384 – Medicare for All Act of 2019 has 118 co-sponsors this time around all Democrats. It is notable that Nancy Pelosi is Not a Co-Sponsor. If there ever was a time for Medicare For All, it would be now.

    At some point the bills for Covid treatments will become due. Then the other piece that is related to our Profit based Health Care will become engaged – The Bill Collectors. I suspect at some point, if it is not already happening the Medical Establishment will demand that the Government (read tax payers) subsidize them, after all we cannot have the stockholders take a hit or the CEO’s.

  10. Fixing the US healthcare system is extremely complex – we are where we are. Look how long it took to get the ACA and it is far from perfect. The “public option” and other fixes are likely on the way should the DEMS take over. The pandemic has been a sad blessing to accelerate such progress.

    Once the above have been successfully implemented, thoughtful heads can develop next steps toward universal health care. It is likely to be a hybrid; but as long as all have access to affordable quality care…does it matter?

  11. Lester,

    I disagree that fixing our health care is all that complex. The Medicare software, firmware and hardware are all in place and tested. What is missing is the political will. In the 1930s, FDR and the Democrats in Congress put forth a bill that would increase our naval power significantly. The Republicans, of course, went berserk. Their slavish devotion to the market failed to grasp that defense spending isn’t a market place.

    With health care, or education, why is competition supposed to be the saving grace? Who would want to go to a hospital or see a doctor that was the most “economical”, though the odds might increase that they would die? Does that mean that doctors and hospitals should have a survival index to lure in new customers? How does one suppose that would work today?

    In education, it’s the same non sequitur. You cannot measure a school’s excellence until the graduated students are 10 years older… if you’re using the idiotic Republican model for public expense: When do the students become productive enough to further enrich the 1%?

    Screaming “socialism” is a dead-end trope. Those that scream the loudest are indeed the greediest, and LEAST social beings among us. They simply don’t care about you, me or anybody else. THAT, plus the racism inherent in the “fragile” white populace, is why we are so backward in developing our civilization.

    As long as Republicans are allowed to govern at any level, nothing will change for the better. As with all other societies that operate the way Republicans do, we will fail, and our once great nation will collapse in a heap. I wonder what the younger generations think about that idea.

  12. Vernon,

    WADR – 30 years of working on complex cultural/organizational change in the business world inside companies with no toxic internal divide suggests that you are a bit naive. Real transformation of complex systems doesn’t come from silver bullets (even via violent revolution) or wishful thinking.

  13. Patrick,
    Excellent comment!
    And, you would figure that we’ve reached the age of enlightenment, LOL. Unfortunately, the age of enlightenment was also called The Renaissance, and it seems nothing is moved much past that point.

    This “great” country of ours, was the biggest consumer of slavery in the history of this planet. And, you have a large segment of the population that wishes it would be back to that point again (Tom Cotton)!!! Kind of one of those back to the Future Fiasco’s.

    My great grandfather’s brother was a miner and so was his son, they were working in a mine down in Texas. As the shift was changing, some boulders on the rubble heap broke loose and came down on top of the shift leaving the mine. The white miners were taken to the local hospital, the ones that lived. My great-grandfather’s brother and his son were considered “colored” and had to go to the colored hospital. That was 12 hours away by train. So, they had to wait for the next train, and then take the train ride 12 hours to the colored hospital. They didn’t arrive at the colored hospital alive. Things haven’t changed much!

    Manifest Destiny was the huge driver in using indigenous Brown and black African slaves to do most, not all, but most of the dirty work. And considering non-whites were considered only three-fifths human, those lives were disposable. Beasts of Burden received better care then people of color. Can anybody tell me what’s changed?

  14. Lester,

    Thanks for your careful analysis. After over 25 years as a manufacturing projects engineer, I found that systems that are in place and able to operate similar functions is NOT all that complex. Check out the Cleveland Clinic model for how they pay their medical and support staff.

    To your point, though, I didn’t mention the power of the lobbyists who are ever so eager to make money off the sick. So, please don’t lecture people about their relative sophistication to your overarching knowledge of everything.

  15. Vernon – respectfully appreciate your process view – but it ain’t the process, it’s the people and culture. And, just because the Cleveland Clinic can do something, that doesn’t mean the whole US will suddenly replicate it (or get the same results).

    We are of and by the people – not the process.

  16. Vernon, I would agree with your comment @ 10:10 am. There is also Medicaid out there. Some states have made accessing Medicaid equal to running a Marathon with obstacles and high jumps thrown in just to make it difficult.

    There are examples all across Western Europe, Japan and Australia to look at concerning how the their systems work. It is not rocket science where we would be building a rocket that has never been built before like the Saturn V Rocket in the 1960’s.

    Single Payer or Universal Healthcare cannot happen over night. Like the space program it can happen if planned and staged correctly.

  17. Yes, racism is plainly a drag on adoption of single payer, but so is classism. White hillbillies, meth gobblers, the imprisoned, the influence of the rich and investors and shareholders in healthcare corporations, libertarians, right wing Republicans (and not a few Democrats) – the list is long.

    I used to lunch on occasion with an insurance company underwriter. He educated me on the math of large risks and secondary coverage for insurance companies and, among other things, told me that in general the larger the risk pool the cheaper the premium, which fit in well with my rationale for universal single payer. There are other reasons, of course, ranging from the economic (no medical bankruptcies) to more efficient output by a healthly workforce who are not living in fear of a cancer or other wipeout of their lifetime savings.

    Any massive change in systems will involve us with problems heretofore unknown, of course, but when I think about our failure to adopt single payer I think beyond the usual culprits here set forth. I ascribe at least some of resistance to its adoption to those who support our unnecessary and hyper-inflated military budgets in the race to corral taxpayer dollars, so which is more important, single payer universal coverage or a few more aircraft carriers and/or fighter planes to add to ouralready overcrowded arsenal. You be the judge; I’ve made my judgment.

  18. Racism is the dead end to nearly every road to progress our country has traveled.

  19. ML,
    You’re absolutely right about universal health care not happening overnight. My only point was that the infrastructure is in place awaiting the political will to implement it. The industrialized world is replete with successful examples and models that we could cherry-pick for the best elements of each. THAT action requires the political will that is absent from Republicans everywhere who are paid by the lobbyists of both the hospital industry and the health care insurance industry. The insurers know their jobs and obscene profits will disappear. The hospital don’t, right now, know how to best operate as a non-profit. Again, there are models and examples around the world that would accelerate our changeover…but for the lack of political will.

    All that other stuff, Lester, is trying to separate fly crap from pepper.

  20. A truly enlightening show airs on CNN called The United Shades of America….I am learning a whole lot about the true history of this country and how the African slaves were part of the building of the country…see 1619 Project. The implicit biases that white people exhibit to any non-whites is more dominant that many realize. Black Wall Street, Redlining, black farmers, all subjects on this show have really opened my eyes to many things. Yes, Yes, Yes, we need universal health care, but until we eliminate the us vs them faction, this country is going to continue going backwards, not forward, especially with the help of the current administration!

  21. Monotonous – :Please clarify the thrust of this this statement:

    “H.R.1384 – Medicare for All Act of 2019 has 118 co-sponsors this time around all Democrats. It is notable that Nancy Pelosi is Not a Co-Sponsor.”

    As Democrat Speaker of the House may we not assume that Ms Pelosi sponsors the bill by signing and forwarding it to the Senate for bicameral support?

    And may we assume that the GOP Senate will block moving the liberal bill to the GOP President in an election year to spare him the VETO to kill it if the VETO risks being overridden?

    Support enhancing Social Security and Obamacare, Medicare for All, especially now during the pandemic.

  22. Of course Medicare is not an entitlement. You and I have been paying for it every working year of our lives and for those who last long enough, we continue to pay all of the years we use it as a fruit of our labor.

    What if to that bill for working stiffs we add the cost of current health care as well? The problem is that most people don’t want to recognize that there would be no change in their outgo because they already pay for health care and health care insurance either hidden in their compensation or deducted from each paycheck.

  23. I read an article in Time magazine that I believe is spot on when it comes to why our health care is so horribly expensive including the consolidation of hospitals, expensive salaries of doctors , the way pharmaceutical companies rob us of needed medications with exorbitant prices, and the administrative costs of hospitals. They did not include marketing costs.

    But though much of this volume of Time magazine was based on inequities due to racism, they failed to address this in their editorial.

    This just supports the statement that when we ignore the needs of any one group of people, we all pay in the long run.

  24. A few points

    First, Sheila is right. Racism is the number one, two, and three cause of our lack of a social safety net, including healthcare.

    Second, we should remember that for parts of the safety net (not necessarily healthcare – that I think is almost all skin color), it was also the other “other” — those German, Irish, Chinese, Jews, Italians, Poles, etc.

    Third, if racism started this mess, money is certainly a motivation for keeping it going. (Disclosure, my IT contract customer is Kaiser Permanente, so I benefit from “the system”)

    Finally, ML is right. Single-payer won’t happen overnight. You have to eat a cow one bite at a time. Remember the rollout of the ACA web site or the 2008 Obama campaign’s new “stress-tested” phone app – it crashed within 30 minutes. “Inventing” single-payer is one problem; scaling up is another.

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