If You Can Keep It!

 In November 2024, the American voters who voted decided that democracy wasn’t  worth the effort.

 We kept our democracy for just short of two hundred and fifty years. But now we are losing it day by day. The majority voted for an autocratic oligarchy. For many, the distrust of government and traditional institutions that keep the country on an even keel was overwhelming. Too many felt left out of the resurging economy, like their moral upbringing was questioned beyond an acceptable level, or just wanted a change. They went for a leader who promised them a better life, who came out fighting at an assassination attempt, and convinced them that the opposition was corrupt. Only one party had a message that resonated at the kitchen table, and their candidate was an expert at producing shows, events, and merch that sold.

 Somewhere along the way, the nation decided that what used to count doesn’t anymore. There was a time when the slightest dalliance by a pol would end a career. It happened to members of Congress mayors and city council members.

 A minority of voters selected a person judged in a court of law of sexual harassment and the leader of a company convicted of cheating on loan applications and tax returns. It no longer matters. We elected a person who urged his followers to attack the capitol and interrupt the counting of votes on January 6, four years ago, people who harmed police officers trying to protect our temple of liberty. It doesn’t seem to matter. MLK asked us to judge people by their character. In America, character has always counted. It doesn’t anymore.

The once and new president has marshaled the angst and fury of the left-outs and the fly-overs and created a form of populism that is popular these days. National populism seldom works. David Brooks says, “Today’s populist ire is directed not at the European establishments living across an ocean but at the American ones on the East and West coasts. Democrats are mistaken if they think they can rebuff Trump by howling the words “fascism” or “authoritarianism,” or by clutching their pearls every time he does something vulgar or immoral.”[i]

I dissent.

Authoritarianism and oligarchy are precisely the factors that can take our democracy down. Democracy isn’t quick and easy and not always efficient but it is better than whatever is in second place.[ii] The opposite of quick and easy governing is never a good outcome.

 Over the last couple of centuries, when high schools taught civics and comparative government, the basic assumption was that America would never be a communist country, an autocratic country, or an oligarchy, so classes concentrated on how to make democracy work best. Well, now what will they teach?

Germany once elected an up-and-coming new chancellor. It took him less than three  months to turn the country into an autocracy that quickly invaded most of Europe and killed millions of Jews. How can such things happen?

They happen easily and often quickly. The elected leader of a strong movement begins by ignoring the institutions that weld the nation, cowers the legislature to their bidding, rules by fiat, finds scapegoats for all their supporter’s perceived troubles, and sends the military to harass the people. Then they forge a justice system that goes after people the leader doesn’t like, shouting about and shutting down the free press. Then they decide who is a good citizen or a bad citizen and continue lying  to the people until the lies are the accepted norms.

These things happened on the first day of the new presidency.

Over a thousand insurrectionists, convicted and sentenced in courts of law, were pardoned on Day One. Civil rights programs were outlawed on Day One. The army was sent to the border on Day One. Executive orders were issued to ignore the Fourteenth Amendment to the Constitution on Day One. The country was pulled out of the World Health Organization on Day One. Hundreds of Executive Orders were issued on Day One that changed the country. Inspectors General were fired so that there would not be anyone to ensure that agency heads followed rules, procedures, and laws.

At the inauguration ceremony, the oligarchs who supported the incoming president were given better seats than the incoming cabinet nominees. Many of the oligarchs have conflicts of interest because of their business dealings with the government. Some of them can’t get proper security clearance to conduct their mission. One of them has an office in the executive office building.

Among the oligarchs that influence the new administration is Peter Thiel, a significant contributor to the new president’s campaign and former employer of the new vice-president. Thiel has said, “I no longer believe that freedom and democracy are compatible.” Some suggest that he has simply bought into the idea that the president will die in office and the vice-president will take over or be the next president in four years. In either case, his monetary contributions will put him and his other Silicon Valley oligarchs in control and their investment will have paid off.[iii]

Many cabinet nominees have no experience running large organizations or experience in the areas they are expected to manage. Their reputations run from avowed unhinged to sex offenders lacking even a modicum of required experience. Yet they will be approved because the senators in the president’s movement are afraid the movement will primary them or they and their families will receive death threats, a common practice on the part of the movement’s base.

Too many people believe the lies told to them about America’s state of affairs. We have been told that the economy is bad when it is one of the best in the world. Inflation is down, unemployment is extremely low, and infrastructure construction is on the upswing.

Immigration is a serious problem. There is no way that a nation can assimilate millions of refugees each year. But the lies that are told about refugees being sent from hospitals for the insane, or from prisons can’t be substantiated. But the lies are good for ending affirmative action programs designed to level the playing field for everyone. Making America great again smacks and smells of a return to when white males ran the world, all of course in the name of Christian Nationalism.

Ben Franklin told us, “You have a Republic if you can keep it.” Millions of people have decided that neither is that important.

We have to ask ourselves if we are the land of the free anymore? Time will tell.

We have to ask ourselves if our democracy can stand? Maybe … despite all evidence to the contrary this last week.

We have to ask ourselves again, why did the voters do this?

Is the price of eggs and gas reason enough to decimate the world’s longest-running democracy? Is an uncontrolled southern border enough to try autocracy?

Are we willing to throw in the towel on a world order that has kept us free since 1945?

Are we willing to cede our free government to the wiles of a few oligarchs who control the information flow around the world and decided to discontinue fact-checking in the name of free speech?

I think the country will survive, but it won’t be the free or democratic United States we once knew. 

It doesn’t have to be this way.

 

 

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[i] David Brooks, How Trump Will Lose, New York Times, 01/23/2025.

[ii] Winston Churchill paraphrased, House of Commons, November 11, 1947

[iii] Trump’s First Week: The Real Story, Robert Reich, 01/26/2025

Kill the CEOs!

Insurance companies take a large risk that their income from premiums will exceed the amount they pay out to doctors, hospitals, and other medical providers for their services. They lower their risks by denying coverage as often as possible.

In most of the civilized world, healthcare systems provide coverage for whatever the doctor orders. In many countries, there is no charge for healthcare at the point of use or minimal copays. Our Medicare plan for older Americans is remarkably similar to what is available for everyone in most counties.

It is common knowledge that the healthcare system in the U.S. is broken. OECD ranks us last in healthcare availability and outcomes.[i] Millions of people can’t afford medical care except in emergency rooms. Millions of people can’t afford health insurance. Our life expectancy is 76.4 years compared to 80.4 years for OECD countries. Our infant mortality ranks thirty-third out of thirty-eight countries. We have the highest levels of diabetes. We spend twice as much on healthcare than any other OECD country and have worse results. There is plenty of blame to go around. Prescription drugs are expensive, and hospitals are costly and getting more expensive as hedge funds buy them up and reduce staff and departments to increase profits. Too often the U.S. healthcare system isn’t so much about healthcare as it is about profit. So let’s shoot the CEOs?

Brian Thompson, the CEO of UnitedHealthcare, was shot in the back while walking to an investor information meeting. The assailant evidently believed that shooting a CEO would improve healthcare. It won’t. The assailant has two degrees from an Ivy League school and comes from an upper-middle-class prominent family, who went missing for a month before the shooting. He should know better. Shooting someone isn’t an acceptable way to express anger. It is not justifiable under any circumstance. It never was. But that was then and this is now.

A study by the University of Chicago indicated that only seventy-eight percent of those surveyed blamed the assailant totally. Sixty-nine percent said that denial of coverage by insurance companies was to blame, and seventy-six percent blamed the general inequality of wealth or income. Axios reported that in a survey of one thousand voters, seventeen percent said that the killing of Brian Thompson was acceptable or somewhat acceptable. Shockingly, forty-one percent of those 18-29 said it was at least somewhat acceptable.

The assailant, Luigi Mangione, received loud applause when he was mentioned on TV. Axios said that the public's veneration of Mangione “Revealed a deep distrust of the health insurance industry and its treatment of patients in need of critical care.”[ii]

The day after the killing, Andrew Witty, the CEO of the parent company of UnitedHealthcare, wrote an opinion piece in the New York Times in which he said that he and his colleagues were trying to make sense of, “The unconscionable act and the vitriol that has been directed at our colleagues.”[iii] Yes, the deliberate and planned shooting was an unforgivable act. The vitriol should not be unexpected.

Mr. Witty went on to note that, “No one would design a system like the one we have. And no one did. It’s a patchwork built over decades.” He is right. It is a system that doesn’t work, it shouldn’t work and shouldn’t exist. Nothing changes without change. A highly educated friend of mine recently wrote to me, “I knew the U.S. healthcare for us old folks was broken but since coming here (nursing home) I realize how very bad it is.”

Mr. Witty was correct, the system is broken. You can’t expect different results if you keep on doing the same thing over and over again. Change requires change.

But will we make the needed changes? We just elected a president who has appointed people to responsible positions who want to do away with the parts of the system that work. They have convinced a large segment of the country that easily available and affordable healthcare is a bad thing. They want to tear apart Medicare and Medicaid which provides basic coverage for millions and millions of older people and low-income people. They don’t see good healthcare as a basic human right. They are wrong.

So what would be a good start to improving the healthcare of Americans? What would be a good start to make our healthcare as good as that of other nations? We could start by agreeing that everyone should have good healthcare. The rub is that it is hard to get people to agree on the definition of good healthcare. Then we could try to agree that everyone should have affordable access to good healthcare.

If we could agree on those two things it would open the floodgates of strategic options related to how we pay for healthcare, how we provide it, and how we use the system.  My thought is that we try to determine how we will pay for healthcare before we redesign the system. Everyone agrees that healthcare is expensive, but it doesn’t have to be so much. Hospital services, for example, have risen 269% since the year 2000.[ii] That suggests that some of the costs are increasing because the for-profit hospitals feel that they can raise the prices with impunity.

The price of drugs in the U.S. is extremely costly compared to the rest of the world. For example, the cost of the new drug for weight loss, Ozempic, is $936 in the U.S. It is $93 in the UK and $83 in France.[iii] Most users don’t pay full price if they have insurance. Other countries negotiate prices directly with manufacturers or have national groups that determine the price. The manufacturers tell us they could not afford to develop new drugs if prices were constrained, but they do it for other nations. The U.S. and Australia are the only two countries that allow drug manufacturers to advertise. Eli Lilly spends $1.0 billion on advertising each year and Pfizer averages $3.7 billion for advertising. They spent $9.3 billion and $10.7 billion respectively for research. Simply outlawing pharmaceutical advertising would save the system billions of dollars. Allowing negotiation for prices would reduce the cost of drugs by more than a third. Outlawing for-profit hospitals could lower those costs by at least half. A single-payor funding plan would eliminate billions of dollars that flow into insurance company profit streams. The point is that affordable healthcare for all citizens will require a massive disruption of the current system.

If we designed a system that wasn’t a patchwork of random methods and regulations we might do away with healthcare for profit. We might find ways to reduce by half the cost of healthcare if more people were healthier because they can afford preventive care. We might find ways to reduce our child mortality rates and increase our life expectancy. We might be able to provide prenatal care to all who need it. We might reduce the number of people who don’t seek medical care because of the cost. Killing CEOs won’t change the system. What will change the system is a nation of people who believe that good affordable healthcare is a human right.

Imagine a nation whose people’s health is as good as the rest of the world. We could be that nation someday.

 

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[i] The Organization for Economic Cooperation and Development is an international organization that provides economic information from one hundred countries.

[ii] Axios, 12/27/2024

[iii]Andrew Witty, New York Times, 12/13/2024

[1] Nonpartisan research organization at the University of Chicago

[1] Bureau of Labor Statistics, 2024

[1] Shawn Radcliff, Heartline, 7/31/202 13

 Nonpartisan research organization at the University of Chicago

[ii] Bureau of Labor Statistics, 2024

[iii] Shawn Radcliff, Heartline, 7/31/202 13