Diatribes of Jay

This blog has essays on public policy. It shuns ideology and applies facts, logic and math to social problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear.

30 March 2019

Universal Health Insurance: Nine Points of Common Sense


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

Introduction
1. Health care is not health insurance
2. Health care in America is overwhelmingly private
3. Private medicine, health care and health insurance all exist in the United States and always will
4. The purpose and function of government-run “universal health insurance” or (badly named and ambiguous) “Medicare for All” is not to replace private health insurers, but to make sure that every American has the ability to pay for basic, necessary health care
5. What existing health insurers (and their lobbyists) really fear is not government control or restriction, but competition they can’t win
6. Even if outlawing private insurance did not contradict our nation’s fundamental values, there would be no practical reason to outlaw it
7. When universal public health insurance sets a floor on health-care affordability, there will be plenty of room for private insurers to dance on that floor
8. Our current non-system makes it hard to determine how much government-run health insurance actually costs
9. A better system would make health-insurance costs transparent, on both an individual and population-wide basis
Conclusion

Introduction

Nature abhors a vacuum. Pols abhor a vacuum of news, and some pols abhor a vacuum of news about themselves. Just so, ideologues hidden inside Trump‘s White House have taken this time, while we wait for Attorney General Barr‘s scrubbed version of the Mueller Report, to propose repealing and replacing “Obamacare” yet again.

So health insurance is again on people‘s minds. And we don‘t have many more important political things to think about as we wait for the full Report. So now is as good a time as any to turn our collective thinking to health insurance.

I’ve been writing about health insurance on this blog about at least since late 2007. At that time, then-candidate Barack Obama distinguished himself from Hillary Clinton by refusing to push a health-insurance “mandate”—forcing individuals who don’t want health insurance to buy it or pay a fine. In the ensuing dozen years, I’ve thought and wrote often on the subject, I hope with an ex-physicist’s instinct for simplifying and for quantifying only what can really be quantified. The best of my essays can be found here, here and here.

After twelve years of thinking, I’ve come to the conclusion that health insurance in America is perhaps the single most complex subject that pols have to deal with. It’s even more complicated than energy policy.

The complexity arises only partly from the propaganda and disinformation that interested parties spew daily, including the erroneous idea that optional universal insurance would be “socialism.” (According to the standard dictionary definition of “socialism,” it would not.) Most of the complexity comes from the way our system has developed, privately and organically, without anyone thinking about the big picture, let alone planning it.

As a result of that organic and somewhat “random” development, our national system of health care, including health insurance, is not a “system” at all. It’s a non-system, with programs like Medicare and Medicaid (and similar state programs) overlaid on a hodgepodge of for-profit, non-profit, local, state and federal programs and organizations. The organizations include a myriad of private, for-profit, non-profit and government doctors’ offices, hospitals, medical practices, medical laboratories, medical research laboratories, college, university and industrial research establishments and health services, and insurers.

All of these institutions, by and large, have separate charters, missions, rules, regulations, forms, procedures and computer systems. And most of these things are different from and often incompatible with each other. If a superior but perverse intelligence had set out to stymie every human rationalist, simplifier and organizer by creating an unsolvable puzzle, it could hardly have done a better job.

The result is unfathomable complexity. No one really “understands” the American health-care or health-insurance “system” at any level of detail. I mean no one. All we understand is that we Americans spend more on health than any other nation and mostly get worse (or no better) results.

When the numbers don’t add up, the best thing to do is ignore them. That’s what scientists do when their theory doesn’t match their calculations. Then the most fruitful thing to do is to go back to so-called “first principles”—basic things that you know make sense—and see what you can deduce from them.

That’s the purpose of this essay. Health insurance is so complicated that even honest and well-intentioned analysts often live inside separate bubbles of bogus “facts.” Maybe by starting with some simple, unassailable truths, we can start making some sense of our health-insurance debate. So let’s start with nine points of common sense that public debate over health insurance often neglects:

1. Health care is not health insurance.

Health care involves too many specialized professionals to fully enumerate. They include: physicians, postdoctoral researchers, physicians’ assistants, nurses, nurse practitioners, orderlies, phlebotomists, laboratory technicians, and all the various mechanical, electrical, electronic, chemical and computer scientists, engineers and technicians who invent, develop, produce, administer or distribute, repair and maintain medical and diagnostic equipment, drugs, protheses and medical devices. Health insurance involves mostly accountants and lawyers, with some help from computer specialists.

Health care and health insurance are two completely different industries. Their only real overlap is that the insurance helps pay for the care. Whenever a reporter or analyst uses the term “health care” in a discussion of insurance (other than to state the obvious payment purpose), his or her supervisor should rap some knuckles with a ruler.

2. Health care in America is overwhelmingly private.

The only clear examples of government-run health care in America are the Medical Corps of our various military branches, the Veterans Administration, a few (rare and emergency) interventions of the Centers for Disease Control and Prevention and some government-run (as distinguished from government-financed) Medicaid clinics. Some public universities also have student health services and teaching hospitals which are owned by government, but most are independently operated.

There is nothing in America like Britain’s National Health Service, which builds and owns hospitals and clinics and employs the doctors, nurses and technicians who work in them. Nor is anything like that contemplated here, even by the most progressive or radical of pols.

The most radical vision now abroad in America is a government-run system that would help pay for care, not own or run the institutions that deliver it. That’s why the term “socialized medicine” is not just inapplicable to what’s under discussion today. It’s a bald lie.

3. Private medicine, health care and health insurance all exist in the United States and always will.

No one—and I mean no one—is proposing to outlaw private care or insurance.

There will always be wealthy and other patients who want to get their health care directly from the source, without paperwork, and are willing to pay cash for it. Even Britain, which does have “socialized medicine,” has private doctors and hospitals that patients can see privately for separate payment. And there are also private insurers who will help pay their bills.

Three fundamental American values demand that we always make room for private health care and private health insurers. First, we are a society of liberty and free markets. If someone can make a buck by offering a non-scam service that people are willing to pay for, she should be allowed to do so. That’s the American way.

The second fundamental American value is progress. Medicine and medical science are always on the move, the more so in America than in most places around the world.

It takes time for both government and private insurers to assess, verify and eventually cover new drugs and devices and new medical procedures. In the interim, more adventurous private insurers can pick up the slack. Medical research will never stop producing new methods of diagnosis and treatment that are not covered by existing insurance, so there will always be room for supplemental, if not the most basic, private insurance. This is the area in which private enterprise can and must contribute most fruitfully.

The final fundamental value underlying private enterprise in health insurance is patients’ freedom. If private or public health-care providers offer care that government insurance doesn’t cover (or doesn’t cover completely) patients must be free to seek supplemental insurance to cover the bills for that care. That’s exactly what tens of millions of Medicare beneficiaries do today when they purchase “Medicare Supplement” insurance from big private companies like UnitedHealthcare.

Just so, American patients are and will remain free to purchase private health care for cash. I recently discovered a medical group in the San Francisco Bay Area that not only won’t accept Medicare patients. It won’t accept any health insurance at all. Apparently its doctors want to practice medicine and not push paper (or hire those who do), and the region in which they work is wealthy enough to support their kind of practice. More power to them: no serious pol is even thinking of outlawing what they do.

4. The purpose and function of government-run “universal health insurance” or (badly named and ambiguous) “Medicare for All” is not to replace private health insurers, but to make sure that every American has the ability to pay for basic, necessary health care.

Universal health insurance has one purpose only. It’s to let every patient pay for some minimum level of care that citizens of a modern, developed nation have a right to expect.

We Americans have never actually had any form of universal health insurance. That fact makes us “exceptional,” but not enviably. It makes us disgracefully exceptional.

When we finally do have universal health insurance, we will avoid people suffering and dying, when medical science could save them, in the richest country in the world. We will have far better public health and “herd immunity” than we do today. People who think they need not concern themselves with others will no longer take a risk that their cooks, nannies, maids, butlers and gardeners will bring pandemics home to their spouses and children.

Universal health insurance will pay for care only up to a specified floor level. It will not set a ceiling, far less allow the sky as a limit. Private insurers will always have the chance to sell insurance for care above that floor.

Of course the floor will change from time to time, presumably in an upward direction, as medical science advances. There will always be legitimate debate about what diagnostic and therapeutic costs ought to be covered universally, especially for new and untested technology. But there is now a general consensus that everyone who is sick or injured ought to be financially able to see a doctor, and that preventatives like vaccines, which protect both the individual and public health, ought to be universally available.

Recently a consensus has arisen that pre-existing conditions ought to be covered. Pre-existing conditions are problems that are most likely to recur, so no insurance can offer patients real assurance without covering them. Anything less is not “insurance”: it’s a sham.

5. What existing health insurers (and their lobbyists) really fear is not government control or restriction, but competition they can’t win.

Private health insurers will always have a place in America. But right now they have a dirty big secret. There are four reasons why government-run (or other nonprofit) single-payer basic insurance will almost certainly undercut the price for any insurance they can offer at the same level of coverage.

The first reason why a nonprofit single payer can beat private insurers is profit itself. A government-run, non-profit or cooperative system makes no profit. In contrast, Wall Street demands that private insurers make a profit, often of ten percent or more, before they can attract needed investment capital. Right out of the gate, that’s ten percent or more that government-run or non-profit health insurance can save consumers.

The second reason why a single payer can beat most private insurers on price is efficiency. Careful studies of foreign single-payer systems, such as Canada’s and Australia’s, show administrative expenses from 5% to 13% lower than those incurred by typical American private firms. Likely the difference derives from economies of scale, as the costs of accountants and computer systems are spread over larger numbers of insureds in government or non-profit systems.

The third reason why a single payer can beat a whole passel of private insurers on price is the intrinsic inefficiency of that passel. Virtually every insurer has its own contracts, rules, procedures, forms and computer systems. If a group of insureds, such as employees of a particular employer, use different private insurers, the employer has to hire and pay people to handle all the insurers’ different systems. The result is higher administrative expenses at the employer level than those it would need to handle a single insurer with a single set of contracts, rules, procedures, forms and computer systems.

The final and perhaps most important reason why private insurers fear competition from a government-run or non-profit single payer is the size of the “risk pool,” i.e., the total number of patients insured by any single insurer. Diseases and injuries seems to strike people at random. That’s in fact the whole reason for insurance: spreading the random loss over a lot of people, so that each pays only a small amount of the burden that a single patient with no insurance would bear if misfortune befell him alone.

Of course, when you increase the number of insureds, you also increase the chance that any one of them will suffer a particular disease or injury. But diseases and injuries can come in clumps, called “statistical fluctuations.” The bigger the risk pool, i.e., the more people insured, the less chance that a clump of misfortune will cause a big bump in premiums.

Take Wyoming, for instance. This year it has a population of some 568 thousand. But it also has some of the biggest coal mines in the nation, and therefore an increased risk (over the average non-mining state) of black lung disease—an expensive and nasty lifelong condition. If the people of Wyoming were included in a risk pool of the entire nation, or 326 million, the increase in premiums caused by black-lung risk would be reduced by roughly the ratio of the risk pools, or 0.568/326 = 0.0017. That’s a reduction of 574 times!

In practice, the reduction would be larger because private insurance plans in Wyoming, as in most other states, don’t cover every citizen of the state, but only the employees of a particular employer. Sometimes they cover even fewer: the employees of a particular plant or subsidiary.

As these four points suggest, private insurers have no realistic fear of being outlawed or expropriated. What they really fear is being done in by competition. And there are four specific reasons, backed by simple arithmetic, why that fear is reasonable.

What insurer’s lobbyists won’t tell you, however, is that their fear is reasonable only for universal basic health insurance, and only because they can’t compete on price. Private insurers will always have a wide-open field for supplemental insurance, including the “exotic” fields of new medical technologies not yet standardized or approved for universal insurance. There will never be a time when private health insurance is not needed, useful and profitable in the United States of America.

6. Even if outlawing private insurance did not contradict our nation’s fundamental values, there would be no reason to outlaw it.

Once a fair, basic system of “universal” public insurance has been established, people will flock to it without compulsion or restraint. There will be no reason to outlaw or even disadvantage alternatives. There are three reasons why.

First, for all the reasons stated previously, the public premiums will be lower for the same coverage than any private ones, if only because every private insurer has to make a profit, and government or cooperatives do not.

Second, a government-run insurer has little incentive to deny valid claims. In contrast, a for-profit private insurer has good reason: every claim denied avoids a direct hit to the insurer’s bottom line. The biggest worry of government claim processors is consistency: they don’t want to be accused of handling similar claims differently. Isn’t that just what you want in a claim processor?

Finally, marketing and promotion rear their ugly heads. Private firms are constantly striving to convince non-customers to become customers, customers of other firms to switch to theirs, and existing customers to buy more expensive insurance. All that promotion and advertising cost money, which is yet another reason, not discussed above, why private firms have to seek higher premiums for the same thing.

But there’s more to it than just cost. With something as important and personal as your health, you as insured want to be sure that your insurer is dealing straight with you. When it’s constantly trying to sell you something, it’s hard to have that feeling of confidence. That’s why I and every senior I know heaved a huge sigh of relief when we got old enough to enroll in Medicare. It was reassuring to feel that our insurer was just doing a boring job, not trying to sell us something and profit from us.

7. When universal public health insurance sets a floor on health-care affordability, there will be plenty of room for private insurers to dance on that floor.

In fact, politics will have a lot to say about where that floor is. For the purpose of universal health insurance is not to make sure that everyone has access to the latest or most expensive treatment. It’s to make sure that everyone has a basic right of access to the now-routine “marvels” of modern medicine. What constitutes a basic “floor” for which universal public insurance will pay will vary from time to time. The floor level will always be a matter of politics: no market principles can decide it.

There will always be means of diagnosis and treatment that are nascent, under test, under doubt, or (even if safe and effective) too expensive to give to everyone for free. Private insurers will have free rein to fund those means for people who can afford their premiums. And private patients rich enough to afford those means without insurance can always have them.

In the end, even people who can’t afford the means or insurance to cover them will benefit indirectly from the “experiments” that rich people or supplemental insureds support. Over time, those experiments will prove the benefits and reduce the cost of the experimental technologies.

Thus, in reality, as distinguished from conservative propaganda, public and private systems of health insurance fit together like hand and glove. They do today, and they always will.

Private insurers will have to be more nimble and forward looking than government, offering supplemental coverage to augment what we Americans consider basic health care. But they will have plenty of opportunities to serve their customers and make money, especially as “designer medicine” based on a patients’ individual DNA comes to the fore.

What private insurers won’t have is a way of making easy money by offering inadequate or deceptive insurance at “bargain” prices, at the cost of keeping our current non-system in force. That non-system is , after all, responsible for excluding some 45 million people from reasonable access to health care in what is still the richest nation, with the most advanced medical technology, in the world. As we encounter those 45 million in our daily lives, the thought that they can’t afford to see a doctor when they are sick—perhaps coming down with a budding pandemic—should give us all pause.

8. Our current non-system makes it hard to determine how much government-run health insurance actually costs.

Seniors like me know how much we pay each month for Medicare. For convenience, we can have our premiums taken out of our Social Security payments, so we never miss a payment.

But those payments don’t reflect the full cost of the insurance because the insurance is subsidized. So I know, for example, how much I pay to Medicare per year—$2,150, according to my latest Social-Security Form 1099. I also know that my payments, based on my income, are at the higher of two standard levels. That is, the premiums are progressive, and I pay at a higher rate than most.

But how much of my taxes should I allot to the cost of my Medicare? Should I just multiply my total taxes by the percentage of everyone’s taxes that go to Medicare? How do I account for the fact that federal income taxes, too, are progressive, so I pay them at a higher rate than the average taxpayer. Without official guidance, I haven’t a clue. (That’s just another reason why it’s impossible to determine how much health insurance actually costs us nationally, as asserted in Point 1.)

9. A better system would make health-insurance costs transparent, on both an individual and population-wide basis.

A better system would be transparent not only as to amounts, but also as to tax subsidies, so that everyone could see how much his or her government health insurance costs. Not only would that transparency promote honest political debate about the cost of health insurance and the attempt to reduce economic inequality through progressive premiums. It would also induce a faster natural, unforced transition to the government’s “universal” program by allowing patients to compare the real, total costs of government-provided insurance (including tax subsidies) with premiums offered by (presumably more expensive) private counterparts.

Conclusion.

See? In analyzing what is probably the most unnecessarily complex health-insurance system in our Galaxy, you can make some progress by reasoning just from first principles. What you can’t do is trust any of the numbers that various advocates for this or that bruit about today. There are just too many rigged accountings, too many caveats, too many qualifications and ignorable footnotes—which advocates ignore in their summaries. You can’t even trust your own Medicare premium today, because you don’t know precisely how much your health insurance or health care is subsidized by your taxes, or how much you ought to pay for supplemental private insurance for things Medicare doesn’t cover. And your own premium always seems to be going up.

But you can trust three general conclusions derived here. First, a single-payer system for universal basic health insurance will almost certainly drive average premiums for that insurance down. Second, such a system will make it possible—and far easier than our current non-system—to calculate what health care and health insurance in America actually cost. Finally, such a system will show conclusively how there will always be private health care and private insurance in America, and precisely what the private sector can do better than government.

Links to Popular Recent Posts

 For a discussion of how the West’s fall and China’s rise affect the chances of our species’ survival, click here.
For a discussion of what the Mueller Report is and how its release could affect American politics, click here.
For a note on the Mueller Report as the beginning of a process, click here.
For comment on the special candidacies of Beto O’Rourke and Pete Buttigieg, click here.
For reasons why the twin 737 Max 8 disasters should inspire skepticism and caution with regard to potentially lethal uses of software and AI, click here.
For my message to Southwest Airlines on grounding the 737 Maxes, click here.
For an example of even the New York Times spewing propaganda, click here.
For means by which high-school teachers could help save American democracy, click here.
For a modern team of rivals that might comprise a dream Cabinet in 2021, click here.
For an analysis of the global decline of rules-based civilization, click here.
For a brief note on avoiding health lobbying Armageddon, click here.
For analysis of how to save real news and America’s ability to see straight, click here.
For an update on how Zuckerberg scams advertisers, click here.
For analysis of how Facebook scams voters and society, click here.
For the consequences of Trump’s manufactured border emergency, click here.
For a brief note on Colin Kaepernick’s good work and settlement with the NFL, click here.
For an outline of universal health insurance without coercion, disruption of satisfactory private insurance, or a trace of “socialism,” click here.
For analysis of the Virginia blackface debacle, click here.
For an update on how Twitter subverts politics, click here.
For analysis of women’s chances to take the presidency in 2020, click here.
For brief comment on Trump’s State of the Union Speech and Stacey Abrams’ response for the Dems, click here.
For reasons why the Huawei affair requires diplomacy, not criminal prosecution, click here.
For how Speaker Pelosi has become a new sheriff in town, click here.
For how Trump’s misrule could kill your kids, click here.
For comment on MLK Day 2019 and the structural legacies of slavery, click here.
For reasons why the partial government shutdown helps Dems the longer it lasts, click here.
For a discussion of how our national openness hurts us and what we really need from China, click here.
For a brief explanation of how badly both Trump and his opposition are failing at “the art of the deal,” click here.
For a deep dive into how Apple tries to thwart Google’s capture of the web-browser market, click here.
For a review of Speaker Pelosi’s superb qualifications to lead the Democratic Party, click here.
For reasons why natural-gas and electric cars are essential to national security, click here.
For additional reasons, click here.
For the source of Facebook’s discontents and how to save democracy from it, click here.
For Democrats’ core values, click here.
The Last Adult is Leaving the White House. Who will Shut Off the Lights?
For how our two parties lost their souls, click here.
For the dire portent of Putin’s high-fiving the Saudi Crown Prince, click here.
For updated advice on how to drive on the Sun’s power alone, or without fossil fuels, click here.
For a 2018 Thanksgiving Message, click here.

Links to Posts since January 23, 2017

 permalink to this post

posted by Jay Dratler, Jr., Ph.D., J.D. @ 3/30/2019 02:33:00 AM   0 comments

28 March 2019

Has the West Had It?


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

Tribalism and nuclear weapons don’t mix. If we keep dividing our human species into inimical tribes striving for dominance by building yet more terrible weapons, eventually it will happen. Some not-too-foresighted leader will miscalculate. Rival leaders will agree to test their rival tribes’ “luck” in war, and all will lose, just as in World War I. Or a badly designed autonomous war system will start nuclear Armageddon faster than Boeing’s autonomous software could down two 737 Max 8s.

More than any other risk we know today, this sort of thing could fix our fate as a species. Half a millennium from now, if we survive, we should be far less divided by tribe than we are today. Or we might not be much of an intelligent species at all. We might have extinguished ourselves completely, or we might be slowly struggling, with renewed social and biological evolution, to bootstrap ourselves up from a radioactive new Stone Age.

If global warming is an existential threat, tribalism is a worse one. Everything about global warming will make tribalism worse: a struggle for resources, a backlash against hordes of migrants, economic and social disruption, and a tendency to blame other tribes for burning fossil fuels while we burn them ourselves. The more we humans argue and fight tribally among ourselves, the less effort we will devote to the energy conversion that we know we must make before our climate changes beyond recognition and oil and gas run out for good.

Once upon a time, the “West”—meaning all of us humans but Asians—seemed to understand the risks of unrestrained tribalism, if only unconsciously. The West invented democracy, in ancient Greek and Rome. The Romans let members of other tribes become citizens after serving in the Roman army. The Brits revived democracy in a modern form with Magna Carta. British and European colonialists eventually turned from brutally exploiting their colonized tribes to educating them in democratic values and science. The United States gave up its two war-won colonies—Cuba and the Philippines. After our species’ most terrible war, it took baby steps toward a world government with GATT, the WTO, the United Nations and innumerable economic treaties.

In these and may other ways, the West first bruited the idea of “citizens of the world.” For these enlightened members of our species, tribalism would be little more than an amusing relic of history and culture. It would provide diversity in cuisine, literature, language and music—a touch of cultural spice—in a nourishing meal of internationalism. Globalism would prevail in the workplace, in diplomacy, and in global challenges like ebola, energy and climate change, and the World Wide Web.

Now we are suffering an unprecedented, near-global tribal backlash. Three events in just the last week highlight it in stark relief.

The clearest example is Israel’s dancing on a pinnacle, as described by Tom Friedman in a recent must-read column. There Bibi is bent on forming a government of Israel’s most rabid tribalists, including a tiny racist, anti-Arab party. His apparent goal is to kill, once and for all, the dream of a “two-state solution,” with Israelis and Arabs living peacefully side by side. Instead, he’s moving toward annexing as much of the Arab West Bank as possible and leaving the rest and Gaza to fend for themselves.

Not only would this “solution” elevate one tribe and diminish the other. Due to the West Bank’s large population, it would eventually force Jewish Israel to choose between remaining democratic and inviting Arab citizens to join in substantial power, or developing something like tribal Apartheid and converting Israel into a theocracy like Iran’s. Friedman frets that this stark choice would sunder the global Jewish community, including America’s, into fierce tribes divided by ideology.

A similar choice faces Britain with Brexit. In fact, tribalism was a primary motive for this fiasco, which is even now dividing Brits and their visitors both by ethnic and ideological tribes. The bare 52% majority of Brits who voted for Brexit in 2016 wanted to lower the level of non-British immigrants and reduce the control that non-Brits have over British government. Their very motive for the whole fiasco was explicitly and unabashedly tribal.

The third big sign of a backlash of tribalism is the presidency of Donald J. Trump. If he’s not a consummate tribalist and bigot himself, he’s at least an actor of Academy-Award quality. More important, his policies are based on pure tribalism: the “Wall,” the obsession with “America first,” a fear of immigrants (especially non-whites and non-Christians), a desire to downplay foreign alliances, and a big push to unwind international cooperation in trade, diplomacy, and economic cooperation. His tariffs are just a start, reminiscent of the Smoot-Hawley tariffs that once help trigger the most terrible war (so far) in human history.

In each case, these outbursts of tribalism cast doubt upon the means by which the West has heretofore sought to reduce tribalism: science, technology, trade and democracy. Science and technology have increased the terror of war and the efficacy of social control, bringing George Orwell’s only imagined totalitarianism within practical reach. But they have not yet led to a noticeable improvement in empathy and international understanding.

A near-majority in both Britain and the United States blames trade and international cooperation, as well as tribal scapegoats, for its fall from grace. And democracy has taken a big hit in all three countries, as democratic leaders have been unable to square democracy with either the imaginary or legitimate grievances of large parts of their respective populations.

For its minuscule size, Israel is a powerhouse of science, technology and trade. Over the last decade, it has, for example, taken over generic production of the “miracle drugs” that I and most geezers take. It still deserves credit as the single most democratic state in the Middle East. But now it seems about to re-elect a leader (Bibi) who is not only eager to bow to raw tribalism, but whose very campaign may be a mere ploy to save himself from indictment and conviction for corruption.

Britain has no apparent corruption, but it sure has a lot of fuzzy thinking. Despite being world’s oldest continuously functioning modern representative democracy, it ceded control of its future to a popular referendum, on a complex question on which the people have no basis for deciding. That’s not democracy; it’s abdication. As for science, technology and trade, Britain’s proposed withdrawal from Europe will most likely render it a backwater in all three, as Europe once again assumes global leadership in fundamental science with its Large Hadron Collider and independent space missions.

As for the United States, what can we say? Trump as president is waging a propaganda war against science, technology, trade and democracy. He’s gone the Brits one better: instead of following a 52% majority, he has taken his cues from an angry 43% minority in unwinding the global community. He’s retreated to tribalism in its most base (pun intended) and vulgar form, undermining democracy with such demagogic calumnies as Mexican “rapists” and murderers, “invasions” of “caravans” of desperate women and children seeking refuge, and thousands of Hitlerian lies like “Only I can fix it.”

Are these sea changes in Israel, Britain and the United States? Or are they only temporary insanities? Time will tell.

In the meantime, there’s a nation having more than twice the population of all three put together, which has much to say about tribalism. It’s China.

Unbeknownst to most Americans, China has spent centuries fighting tribalism. It’s done so against greater odds and with more success than any other modern nation, including India, which suffers regular Hindu-Muslim pogroms.

There are still some 56 different ethnic groups in China, most with their own spoken languages. And with notable exceptions (in Tibet and Xinjiang) China has had remarkable success in unifying them into a uniform national culture that it claims as “Han” Chinese.

The linchpin of China’s unification has been its common written language. It has nothing like a Western alphabet. Instead, it uses complex ideographic characters called “hantsu” in Chinese (pronounced “hahnt-SUE”). China’s many Chinese dialects use the same written characters, but the sounds and pronunciations that go with them vary radically among the dialects. That’s why China has been trying hard to get all Chinese to speak Mandarin—the Lingua Franca of China—whatever else they may also speak.

There’s a big downside to the complex writing system. Each hantsu character can have as many as 24 strokes, as compared to 4 in the most complex Roman letters (E, M and W). To be literate, a scholar has to know as many as 3,000 hantsu, while an ordinary person has to know about 1,600 just to read a newspaper. Those high numbers compare to the Roman alphabet’s four maximum strokes and 26 letters.

As I’ve argued in a separate essay, this cumbersome writing system may delay mental maturation of students and impede abstract thought. But as a uniform national writing system in which every adult is invested through years of learning, it does much to reduce misunderstandings and tribalism throughout China. Today every schoolchild in China must learn Mandarin.

So China has made great strides in linguistic unification of its once diverse population. Mandarin has probably fostered that unification as much or more than does English in Britain and the United States. The differences lie in the respective governments’ tolerance of tribalism.

In Britain and the United States, people can say or write virtually anything they want. The only true restraints are revealing state secrets and inciting others to immediate violence. Thus Nigel Farage can rail against foreign immigrants and their undesirability as non-British, while Donald Trump and his supporters can bury us in lies about non-white people, foreigners, Muslims and their supposed criminal and violent tendencies. Trump and his minions have done exactly that, in winning elections, in fostering nativist tendencies, and in getting otherwise reasonable people to redirect their legitimate anger from inadequate government policy toward racial, ethic and religious scapegoats. Isn’t that just a milder form of what Hitler once did?

Which is the better way? At this early stage, an honest answer is that it’s no longer clear.

To see why, look at the results. Britain and Europe are cowering in exaggerated fear of migrants and terrorists. Their fear has made them resort to splitting up the EU—the second most distinguished repository of Enlightenment values after the United States. It has also induced them to follow crude authoritarian leaders in Italy, Hungary and Poland, just as we have in the United States.

Now consider Xinjiang, the mostly-Muslim Chinese province in China’s far northwest. As of 2017, it had a total population of 24.45 million, of which 58% (in 2010) were Muslims. That was a majority. Yet China controls this “majority-minority” population with Han immigration, strict policing and “re-education” of those deemed to have anti-social or terrorist tendencies. It also controls firearms strictly and censors the Internet strictly (everywhere in China).

As a result, in a province almost equally divided between “minority” Muslims and “majority” Han Chinese (elsewhere in China), China has had only a few, relatively minor terrorist attacks by Muslims in Xinjiang. Almost all have involved only knives and other hand weapons. There have, to my knowledge, been virtually no terrorist attacks by the dominant groups, whether Han Chinese or others.

In contrast, we have had several Islamic terrorist attacks by Muslims with advanced weapons. We also have had several fatal “backlash” attacks by white supremacists and “white nationalists,” including ones with firearms.

So which approach is better? Which better keeps minority terrorism under control? Which best suppresses majority terrorism like the old Ku Klux Klan’s? Which is better, forcible “re-education,” unchecked violent extremism, or war? Can we Americans be proud of what we have done so far, and all the lives and treasure we have lost and let be lost, in Iraq? in Syria?

The difference in trade is even starker. Under Trump and the realistic threat of Brexit, the Anglo-American leaders that once led peaceful globalism have all but abandoned it. In contrast, China is hard at work on its “Belt and Road” initiative, beginning with places most neglected by the West: South Asia, Latin America and Africa.

The places that China is cultivating need almost everything modern. So it’s quite possible that China could soon rely on them to replace America, Britain and even Europe as markets for its manufactured goods. Perhaps that’s China’s near-term economic goal.

If you look at what’s happening around the globe today, it’s impossible to ignore the facts. China is bent on upward growth and outward expansion and influence. America, Britain and Europe are turning inward and renouncing global influence. Israel, too, seems to be falling into the same dead-end trap, save for ever preparing for what might be a cataclysmic war.

Meanwhile, the West is busy producing a class of clueless, demagogic leaders who rile up and follow, not lead, their people. They prey on their people’s bald ignorance and most savage tendencies. At times, as in America, the leader’s only plausible motive seems corruption or self-interest.

The West’s media daily spew propaganda, trivia and tribalism and support extremism and terrorism by inciting vicious backlashes, almost as if they were the Communist dailies of old. Instead of serving their people, the “democratic representatives” now manipulate the prejudices and predilections of ordinary people who haven’t a clue.

Which is the better system? I wish I knew. I like America, Britain and Israel because they purport to share the social and moral values that I grew up with. For me, the Western Enlightenment planted the seeds of both human greatness and human happiness.

But if I ask which system, as it exists today, will allow our species to survive in an age of growing challenges from nuclear-fueled tribalism and fossil-fueled global warming, I’m not so sure. Isn’t survival the most important value of all?

Links to Popular Recent Posts

 For a discussion of what the Mueller Report is and how its release could affect American politics, click here.
For a note on the Mueller Report as the beginning of a process, click here.
For comment on the special candidacies of Beto O’Rourke and Pete Buttigieg, click here.
For reasons why the twin 737 Max 8 disasters should inspire skepticism and caution with regard to potentially lethal uses of software and AI, click here.
For my message to Southwest Airlines on grounding the 737 Maxes, click here.
For an example of even the New York Times spewing propaganda, click here.
For means by which high-school teachers could help save American democracy, click here.
For a modern team of rivals that might comprise a dream Cabinet in 2021, click here.
For an analysis of the global decline of rules-based civilization, click here.
For a brief note on avoiding health lobbying Armageddon, click here.
For analysis of how to save real news and America’s ability to see straight, click here.
For an update on how Zuckerberg scams advertisers, click here.
For analysis of how Facebook scams voters and society, click here.
For the consequences of Trump’s manufactured border emergency, click here.
For a brief note on Colin Kaepernick’s good work and settlement with the NFL, click here.
For an outline of universal health insurance without coercion, disruption of satisfactory private insurance, or a trace of “socialism,” click here.
For analysis of the Virginia blackface debacle, click here.
For an update on how Twitter subverts politics, click here.
For analysis of women’s chances to take the presidency in 2020, click here.
For brief comment on Trump’s State of the Union Speech and Stacey Abrams’ response for the Dems, click here.
For reasons why the Huawei affair requires diplomacy, not criminal prosecution, click here.
For how Speaker Pelosi has become a new sheriff in town, click here.
For how Trump’s misrule could kill your kids, click here.
For comment on MLK Day 2019 and the structural legacies of slavery, click here.
For reasons why the partial government shutdown helps Dems the longer it lasts, click here.
For a discussion of how our national openness hurts us and what we really need from China, click here.
For a brief explanation of how badly both Trump and his opposition are failing at “the art of the deal,” click here.
For a deep dive into how Apple tries to thwart Google’s capture of the web-browser market, click here.
For a review of Speaker Pelosi’s superb qualifications to lead the Democratic Party, click here.
For reasons why natural-gas and electric cars are essential to national security, click here.
For additional reasons, click here.
For the source of Facebook’s discontents and how to save democracy from it, click here.
For Democrats’ core values, click here.
The Last Adult is Leaving the White House. Who will Shut Off the Lights?
For how our two parties lost their souls, click here.
For the dire portent of Putin’s high-fiving the Saudi Crown Prince, click here.
For updated advice on how to drive on the Sun’s power alone, or without fossil fuels, click here.
For a 2018 Thanksgiving Message, click here.

Links to Posts since January 23, 2017

 permalink to this post

posted by Jay Dratler, Jr., Ph.D., J.D. @ 3/28/2019 02:09:00 AM   0 comments

24 March 2019

What Is the Mueller Report?


For brief descriptions of and links to recent posts, click here. For an inverse-chronological list with links to all posts after January 23, 2017, click here. For a subject-matter index to posts before that date, click here.

The media sphere is all agog. Long awaited and much discussed, the Mueller Report is finally done. It exists. It’s complete. It’s compiled and delivered.

We don’t know precisely what’s in it, but we surely know in general. It’s a compilation of evidence of our President’s lies, fraud, corruption, obstruction of justice, self-dealing, self-interest, gratuitous cruelty, incompetence, and treason. It’s a compilation of facts, as far as anyone can know them, prepared by Special Counsel Robert S. Mueller III and his team of experts.

Mueller and his experts spent the better part of two years gathering facts, interviewing witnesses, and preparing the Report. More broadly, they each have devoted whole careers to gathering facts related to crimes and wrongdoing in a fundamentally honest way. They are our nation’s foremost experts in fair fact-gathering related to wrongdoing.

Why does everyone want to see the Report? It’s detail is crucial.

Everyone with a pulse knows all the crimes and misdeeds of which Trump stands accused. Everyone has heard his oft-reported denials. But everyone with a brain knows that you can’t capture a story as complex or important as this one with puerile name-calling like “witch hunt!” or “collusion!” It’s a subtle story and a broad one, one that already involves “215 criminal charges, 38 indictments or pleas, and five prison sentences so far.” Already that’s more than in our previously most corrupt regime, Warren G. Harding’s.

Everyone understands that you have to tolerate some detail to know the truth. So what is the Mueller Report? Why has it, sight unseen, assumed the importance of a national oracle?

First of all, it’s a mirror. It’s more than an impressionistic reflection in a stream or pond, whose ripples and mud distort the view. It’s a clear and polished mirror that will show every wart and blemish in our sick society. It will show what wrong and evil we have accepted—day to day as standard operating procedure—for over two years. It will show how a substantial minority of the American people have come to accept Trump’s reported 8,158 lies and misleading statements as some “alternative” version of reality.

The Report is hardly a mirror for Donald J. Trump. He can’t see himself at all. If he looks in a mirror, he sees only his delusions of grandeur, which require the fuel of constant flattery and popular adulation to maintain. He sees only what’s in his own mind.

Instead, the Report is a mirror for all of us. It will show us how we’ve allowed our shining city on the hill to become a moral slum. It will show us, precisely and in detail, the level of corruption, filth and degradation that we have come to tolerate and accept as “normal.” It will let us see ourselves as we are, like Al Gore’s frogs in water, not noticing as it’s heated slowly to boiling.

The Report is a thermometer. It shows just how sick our society is, at its very top. Trump has claimed the mantle of the greatest president in our history. But how can that be? Can this man who threatens Kim with “fire and fury” and then sucks up to him, who cozies up to killers like Putin and MBS, really claim the wisdom, moral clarity and steadiness of Washington, Lincoln, Teddy, FDR, or Obama?

Most of us suspect that our culture and our society are ill, but we don’t know how gravely. Like a medical thermometer, the Report will show us in detail. It will give us some hint whether we have a mere cultural flu, from which we’ll soon recover, or a life-threatening illness.

The Report is a lie detector. There are lies and there are lies. Some are explicit and obvious, like the thousands the Washington Post has carefully tallied. Some, like the many that Michael Cohen has alleged, are mere nods and winks in the Mafia-like context of Trump’s tiny clan. The Report will highlight the subtler lies in the only way possible, short of mind-reading: the actions of Trump and associates. By their deeds ye shall know them.

The Report is a goad. Genuinely decent conservatives like David Brooks and Michael Gerson writhe in mental torment as they try to square their views of the moral universe with what our national government has become. Yet they do little more than wring their hands. Brooks, in particular, seems to have retreated from politics and found refuge in abstract moral philosophizing.

Sometimes it seems that people like these have come to accept the most corrupt, vile and incompetent leadership in our nation’s history as a necessary evil to preserve a rapidly disappearing “conservative” tradition. Gerson’s recent column went so far as to recommend continuing to enable and support a party that has abandoned all of its principles and become a monster’s plaything.

The Party of Lincoln abolished slavery, enshrined its Abolition in three Civil-War Amendments to our Constitution, took public lands to create land-grant colleges, built the Transcontinental Railway, and propelled our mostly rural, isolated nation toward global leadership. In contrast, Trump and his minions have gutted voting and civil rights, sought to put education back into self-interested private hands, procrastinated endlessly on infrastructure, and poured the nation’s substance into the pockets of the unworthy rich. The Report and its incontrovertible detail may, at last, goad decent Republicans like Brooks and Gerson—and many more—toward their own peculiar form of resistance.

Finally, the Report is a trigger. So many Republicans who claim to follow Trump have got to hate him in secret. He’s the biggest bully in the party’s and our nation’s histories.

Trump has insulted Republicans and given them demeaning nicknames. He’s subjected them to hazing and crude dominance rituals worthy of a sick college fraternity. He’s ridiculed their values and their efforts. He’s stolen credit for their hard-won successes in elections and their rare successes in public policy. He’s broken every rule by which they’ve led their public lives. He’s crossed a line that no honorable man—let alone a pol or diplomat—ought ever to cross: he’s insulted, belittled and ridiculed their families.

How long will so many Republicans continue to tolerate this personal debasement, not to mention debasement of their party’s values? As Nobel Laureate Dylan sung, the answer is blowin’ in the wind.

But the funny thing about bullies is how quickly the tide can turn against them. First one, then two, then many see the light. Then, all of a sudden, it’s “et tu, Brute?” Just so, without violence, the Report could trigger meaningful resistance among those with the most to lose.

If not, there is another possible future. Hitler’s real enablers weren’t the Brown Shirts—his violence-prone shock troops. They were just the muscle.

What really enabled the most violent and self-destructive regime in any developed nation were the German “elite.” The great German industrialists helped: the Farbens, the Krupps, the Speers, the Thyssens. So did men from noble families, such as the great general Rommel, whose support of the doomed regime led to his own destruction.

Non-college-educated people who work largely with their hands are the core of Trump’s “base.” They are not going to read the Report. Instead, they will slavishly credit their hero’s claims that the investigation was a “witch hunt” and that there was “NO COLLUSION!”

If Trump’s steady march away from democracy and toward dictatorship is to be stopped in its incipiency, our elite must put their shoulders to the wheel. Only they will read the Report, and only they have the power and influence to slow or stop our national degradation.

To do that, they must read the full text, in all its detail. To read it, they must have it.

The Report’s power as a mirror, a thermometer, a lie detector, a goad and a trigger lies in its detail. Apart from future secret leaks—for example, from Attorney General Barr’s office or from Congress—our elite can have access to that detail only to the extent Barr releases it to the public.

So whether those who can use the Report get hold of it now lies in Barr’s hands. For now, so do our nation’s future and its survival as a Republic.

Links to Popular Recent Posts

 For a note on the Mueller Report as the beginning of a process, click here.
For comment on the special candidacies of Beto O’Rourke and Pete Buttigieg, click here.
For reasons why the twin 737 Max 8 disasters should inspire skepticism and caution with regard to potentially lethal uses of software and AI, click here.
For my message to Southwest Airlines on grounding the 737 Maxes, click here.
For an example of even the New York Times spewing propaganda, click here.
For means by which high-school teachers could help save American democracy, click here.
For a modern team of rivals that might comprise a dream Cabinet in 2021, click here.
For an analysis of the global decline of rules-based civilization, click here.
For a brief note on avoiding health lobbying Armageddon, click here.
For analysis of how to save real news and America’s ability to see straight, click here.
For an update on how Zuckerberg scams advertisers, click here.
For analysis of how Facebook scams voters and society, click here.
For the consequences of Trump’s manufactured border emergency, click here.
For a brief note on Colin Kaepernick’s good work and settlement with the NFL, click here.
For an outline of universal health insurance without coercion, disruption of satisfactory private insurance, or a trace of “socialism,” click here.
For analysis of the Virginia blackface debacle, click here.
For an update on how Twitter subverts politics, click here.
For analysis of women’s chances to take the presidency in 2020, click here.
For brief comment on Trump’s State of the Union Speech and Stacey Abrams’ response for the Dems, click here.
For reasons why the Huawei affair requires diplomacy, not criminal prosecution, click here.
For how Speaker Pelosi has become a new sheriff in town, click here.
For how Trump’s misrule could kill your kids, click here.
For comment on MLK Day 2019 and the structural legacies of slavery, click here.
For reasons why the partial government shutdown helps Dems the longer it lasts, click here.
For a discussion of how our national openness hurts us and what we really need from China, click here.
For a brief explanation of how badly both Trump and his opposition are failing at “the art of the deal,” click here.
For a deep dive into how Apple tries to thwart Google’s capture of the web-browser market, click here.
For a review of Speaker Pelosi’s superb qualifications to lead the Democratic Party, click here.
For reasons why natural-gas and electric cars are essential to national security, click here.
For additional reasons, click here.
For the source of Facebook’s discontents and how to save democracy from it, click here.
For Democrats’ core values, click here.
The Last Adult is Leaving the White House. Who will Shut Off the Lights?
For how our two parties lost their souls, click here.
For the dire portent of Putin’s high-fiving the Saudi Crown Prince, click here.
For updated advice on how to drive on the Sun’s power alone, or without fossil fuels, click here.
For a 2018 Thanksgiving Message, click here.

Links to Posts since January 23, 2017

 permalink to this post

posted by Jay Dratler, Jr., Ph.D., J.D. @ 3/24/2019 10:17:00 AM   0 comments