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Americans’ Self-Contradictory Views of Socialized Healthcare

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On December 3rd, Gallup bannered “Government Favored to Ensure Healthcare, but Not Deliver It” and reported that 57% of Americans say “It is government’s responsibility to see that all have healthcare” but only 40% of Americans want a “government-run” healthcare system to be available to everyone who wants it. In other words: many Americans want other Americans to be forced into corporate and non-profit — privately run — healthcare. Lots of Americans are irrationally rabid against any sort of socialism, even the democratic types of socialism that exist in many European countries such as Sweden, where the quality of healthcare has been proven in international studies to be superior to America’s, and where the per-person cost of healthcare is around half as high as in America. The healthcare industry and its executives and its lobbies and its paid-off politicians have plenty of libertarian fools in America who, by their political participation, make life worse for all other Americans by effectively blocking socialization of the healthcare function. Gallup’s December 3rd poll also found this mental illness, libertarianism, to be especially common among Republicans: Whereas 65% of Democrats endorse universal availability of a government-run healthcare system, just 13% of Republicans do. So, Republican voters are terrific for the drug companies and the rest of the ‘health’care (actually sickness) industries.

Gallup has polled Americans on many questions about healthcare policy. One poll they published 16 May 2016, titled “Majority in U.S. Support Idea of Fed-Funded Healthcare System”, reported that 58% of Americans wanted “Replacing the ACA [Obamacare] with a federally funded healthcare program providing insurance for all Americans.” Only 37% opposed it. A tiny 5% had no opinion. Perhaps that was a high-water mark for the American public’s support of socialization of the healthcare function in America.

On 20 November 2014, Gallup headlined “Majority Say Not Gov’t Duty to Provide Healthcare for All” and reported that, “For the third consecutive year, a majority of Americans (52%) agree with the position that it is not the federal government’s responsibility to ensure that all Americans have healthcare coverage. Prior to the start of Barack Obama’s presidency in 2009, a majority of Americans consistently took the opposite view” (that it’s not government’s responsibility to see that all have healthcare). But if it’s “not the federal government’s responsibility to ensure that all Americans have healthcare coverage” (presumably meaning for all basic healthcare, but not for vanity medical services such as “tucks” and other non-health-related medical services), then even life-saving medical care, and also essential preventive care (which lowers overall medical costs), will be available only to people who can pay for it; other people will just have to die, unless they can find someone (perhaps a relative) who is willing to pay. Of course, this type of system — the “Greed is good” system — will also mean that people die young and that disability-rates, and associated incapacity at work, will be high, and all of this will lower economic productivity. Welcome to the United States! (Of course, it’s lots better than places such as Honduras.)

Is it likely that majorities really do want single-payer, but not from the government? Hardly: a gratuitous addition of stockholders’ profits into the costs for providing essential and economic-productivity-enhancing healthcare services that everyone should have access to if it’s really needed (lawfully prescribed etc.) won’t just distort the incentives to medical-services providers (and so reduce both health and economic productivity), but it will also waste the money of medical consumers (government or otherwise). But what about having ‘non-profit’ firms provide the single-payer services, instead of the democratically accountable government doing that? Non-profits cut out profits, and so eliminate the distortions that stockholders’ wants introduce into the providing of any services (wants such as stockbrokers have, who pump the investments that pay them the highest commissions, which necessarily harms their investors). However, the top executives even of ‘non-profit’ firms can pay themselves whatever their friends who sit on their board of trustees will approve; and so a ‘non-profit’ provider, too, can be, at least to that extent, a scam. (And, of course, in an entirely free market, there is no regulation, and therefore scams will be routine; so, only crooks would want that, anyway. But all the propaganda in the U.S. praises “a free market.”)

These are reasons why the countries that have the highest life-expectancies, and therefore the best health-outcomes, are the same as the countries that have socialized basic healthcare services, paid for normally entirely through taxes and provided to all citizens as a basic human right instead of as a privilege that’s available only to individuals who can afford it. (Of course, “tucks” and such get charged extra to the patient.) The United States has by far the costliest health care in terms of not only what Americans pay for it but in terms of healthcare costs as a percentage of GDP, and yet the U.S. has the lowest life-expectancy of all OECD countries; the U.S. has the most-free-market healthcare, and also the worst healthcare, among all of the economically developed countries — all (except the U.S.) of which provide guaranteed basic healthcare services to all citizens: essential services free as a right, not charged as a privilege. America’s combination of the worst healthcare plus the by-far-costliest healthcare is no coincidence; and healthcare profits in America are the world’s highest; so, the present American system is terrific for those stockholders (whose firms hire the lobbyists and their politicians who write America’s healthcare-laws). Because basic healthcare in the United States is a privilege instead of a right, the U.S. is the only economically developed nation that does not have universal coverage, health insurance for 100% of its citizenry, healthcare as a guaranteed right instead of dependent upon the patient’s ability-to-pay. When Barack Obama entered the White House, the uninsured rate was 14.6%; when he left office it was 10.9%; the insured rate when he started was 85.4%, and it was 89.1% when he left office. His repeated promises of “universal coverage” were blatant lies. His plan was in no way designed for “universal coverage”; that promise was a lie from the very outset.

In the OECD’s “Health at a Glance 2015” (which covers 44 nations), the United States scored at or near the bottom for almost all indicators of healthcare-quality, including: Life expectancy, Access to care, Quality of care, Doctors per capita, and Hospital beds per capita. We were by far the highest on Pharmaceutical expenditure per capita. Oddly, three nations, Czech Republic, Slovakia, and Hungary, were exceptionally high in both their heart-disease death-rates and their cancer death-rates; plus their life-expectancies were even lower than America’s, and their most carefully medically calculated measured “Quality of care” rankings were also generally as bad as the United States. However, in the latest calculated year, which is shown there, which was 2013, “Health expenditure per capita” (p. 165) was U.S. $8,713; Switzerland $6,325; UK $3,235; Czech Republic $2,040, Slovak Republic $2,010; and Hungary $1,719. So, America’s was over four times as high as the healthcare costs of some of the other countries in its class — i.e. in the overall worst class. Generally the top-performing nations were: Japan, Finland, Norway, Sweden, Italy, and Switzerland. Switzerland was the second-highest in cost-of-care ($6,325), right below the United States. Norway was third-costliest, $5,862. Sweden was fifth-costliest, $4,904. Japan was 14th-costliest, $3,713. Finland was 17th-costliest, $3,442. Italy was twentieth-costliest, $3,077. The average OECD cost for all the 44 nations was $3,453, which was less than half of America’s obscene $8,713. Whether Obamacare changes any of those U.S. rankings is too early to tell. However, the U.S. is such an extreme “outlier” so that our healthcare system would need to be replaced root-and-branch in order to be competitive with any other nation’s in terms of delivering value-for-the-money, instead of rip-off (which is its existing outlier status — unparalleled by any other country’s, for delivering lousy value). It is so bottom-of-the-barrel, that it is below the barrel. This is by far the world’s most-free-market healthcare system, but our government spends more per-capita on it than do other nations’ governments that pay almost all of their citizens’ healthcare costs. Wow! In fact, as shown in the chart “9.3. Health expenditure as a share of GDP, 2013 (or nearest year)” on page 167 of that OECD report, the U.S. is the only country where the private sector pays more of the nation’s healthcare costs than does the public sector, the government. America is a libertarian’s paradise. No other nation comes anywhere close to that degree of non-governmental providing of the healthcare function. Every other nation has socialized the healthcare-function to a vastly higher extent than the U.S. has. That’s how corrupt America is.

Lots of other countries are more corrupt in the pettier forms of corruption such as bribery, but perhaps few match America’s higher-level, and far more complex, systemic corruption. It benefits only the super-rich, and their lobbyists and other agents.

Investigative historian Eric Zuesse is the author, most recently, of They’re Not Even Close: The Democratic vs. Republican Economic Records, 1910-2010

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Americas

Wendy Sherman’s China visit takes a terrible for the US turn

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Photo: Miller Center/ flickr

US Deputy Secretary of State, Wendy Sherman, had high hopes for the meeting in China. At first, the Chinese side did not agree to hold the meeting at all. The reaction had obvious reasons: Antony Blinken’s fiasco in Alaska left the Chinese disrespected and visibly irritated. This is not why they travelled all the way.

So then the State Department had the idea of sending Wendy Sherman instead. The US government actually needs China more than China needs the US. Sherman was in China to actually prepare the ground for Biden and a meeting between the two presidents, expecting a red carpet roll for Biden as if it’s still the 2000s — the time when it didn’t matter how the US behaved. Things did not go as expected.

Instead of red carpet talk, Sherman heard Dua Lipa’s “I got new rules”. 

That’s right — the Chinese side outlined three bottom lines warning the US to respect its system, development and sovereignty and territorial integrity. In other words, China wants to be left alone.

The bottom lines were not phrased as red lines. This was not a military conflict warning. This was China’s message that if any future dialogue was to take place, China needs to be left alone. China accused the US of creating an “imaginary enemy”. I have written about it before — the US is looking for a new Cold War but it doesn’t know how to start and the problem is that the other side actually holds all the cards

That’s why the US relies on good old militarism with an expansion into the Indo-Pacific, while aligning everyone against China but expecting the red carpet and wanting all else in the financial and economic domains to stay the same. The problem is that the US can no longer sell this because there are no buyers. Europeans also don’t want to play along.

The headlines on the meeting in the US press are less flattering than usual. If the US is serious about China policy it has to be prepared to listen to much more of that in the future. And perhaps to, yes, sit down and be humble.

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Why Jen Psaki is a well-masked Sean Spicer

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When Sarah Huckabee Sanders showed up on the scene as White House Press Secretary, the reaction was that of relief. Finally — someone civil, normal, friendly. Jen Psaki’s entry this year was something similar. People were ready for someone well-spoken, well-mannered, even friendly as a much welcome change from the string of liars, brutes or simply disoriented people that the Trump Administration seemed to be lining up the press and communications team with on a rolling basis. After all, if the face of the White House couldn’t keep it together for at least five minutes in public, what did that say about the overall state of the White House behind the scenes?

But Psaki’s style is not what the American media and public perceive it to be. Her style is almost undetectable to the general American public to the point that it could look friendly and honest to the untrained eye or ear. Diplomatic or international organization circles are perhaps better suited to catch what’s behind the general mannerism. Jen Psaki is a well-masked Sean Spicer, but a Sean Spicer nevertheless. I actually think she will do much better than him in Dancing With The Stars. No, in fact, she will be fabulous at Dancing With The Stars once she gets replaced as White House Press Secretary.

So let’s take a closer look. I think what remains undetected by the general American media is veiled aggression and can easily pass as friendliness. Psaki recently asked a reporter who was inquiring about the Covid statistics at the White House why the reporter needed that information because Psaki simply didn’t have that. Behind the brisk tone was another undertone: the White House can’t be questioned, we are off limits. But it is not and that’s the point. 

Earlier, right at the beginning in January, Psaki initially gave a pass to a member of her team when the Politico stunner reporter story broke out. The reporter was questioning conflict of interest matters, while the White House “stud” was convinced it was because he just didn’t chose her, cursing her and threatening her. Psaki sent him on holidays. Nothing to see here folks, move along.

Psaki has a level of aggression that’s above average, yet she comes across as one of the most measured and reasonable White House Press Secretaries of the decade. And that’s under pressure. But being able to mask that level of deflection is actually not good for the media because the media wants answers. Style shouldn’t (excuse the pun) trump answers. And being able to get away smoothly with it doesn’t actually serve the public well. Like that time she just walked away like it’s not a big deal. It’s the style of “as long as I say thank you or excuse me politely anything goes”. But it doesn’t. And the American public will need answers to some questions very soon. Psaki won’t be able to deliver that and it would be a shame to give her a pass just because of style.

I think it’s time that we start seeing Psaki as a veiled Sean Spicer. And that Dancing with the Stars show — I hope that will still run despite Covid.

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As Refugees Flee Central America, the Mexican Public Sours On Accepting Them

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Authors: Isabel Eliassen, Alianna Casas, Timothy S. Rich*

In recent years, individuals from Central America’s Northern Triangle (El Salvador, Guatemala, and Honduras) have been forced out of their home countries by extreme poverty and gang violence. While initial expectations were that the Lopez Obrador administration would be more welcoming to migrants, policies have slowly mirrored those of his predecessor, and do not seem to have deterred refugees. COVID-19 led to a decrease in refugees arriving in Mexico, and many shelters in Mexico closed or have limited capacity due to social distancing restrictions. Now that the COVID-19 situation has changed, arrivals could increase again to the levels seen in late 2018 or 2019, with overcrowded refugee centers lacking in medical care as potential grounds for serious COVID-19 outbreaks.

Mexico increasingly shares a similar view as the US on this migration issue, seeking ways to detain or deport migrants rather than supporting or protecting them. For instance, Mexico’s National Immigration Institute has been conducting raids on freight trains to find and detain migrants. Public opinion likely shapes these policies. In the US, support for allowing migrants into the country appeared to increase slightly from 2018 to 2019, but no significant majority emerges. Meanwhile, Mexican public opinion increasingly exhibits anti-immigrant sentiments, declining considerably since 2018, with a 2019 Washington Post poll showing that 55% supported deporting Central Americans rather than providing temporary residence and a 2019 El Financiero poll finding 63% supportive of closing to border to curb migration.

New Data Shows the Mexican Public Unwelcoming

To gauge Mexican public opinion on refugees, we conducted an original web survey June 24-26 via Qualtrics, using quota sampling. We asked 625 respondents to evaluate the statement “Mexico should accept refugees fleeing from Central America” on a five-point Likert scale from strongly disagree to strongly agree. For visual clarity, we combined disagree and agree categories in the figure below.

Overall, a plurality (43.84%) opposed accepting refugees, with less than a third (30.08%) supportive. Broken down by party affiliation, we see similar results, with the largest opposition from the main conservative party PAN (52.90%) and lowest in the ruling party MORENA (41.58%). Broken down by gender, we find women slightly more supportive compared to men (32.60% vs. 27.04%), consistent with findings elsewhere and perhaps acknowledgment that women and children historically comprise a disproportionate amount of refugees. Regression analysis again finds PAN supporters to be less supportive than other respondents, although this distinction declines once controlling for gender, age, education and income, of which only age corresponded with a statistically significant decline in support. It is common for older individuals to oppose immigration due to generational changes in attitude, so this finding is not unexpected.

We also asked the question “On a 1-10 scale, with 1 being very negative and 10 very positive, how do you feel about the following countries?” Among countries listed were the sources of the Central American refugees, the three Northern Triangle countries. All three received similar average scores (Guatemala: 4.33, Honduras: 4.05, El Salvador: 4.01), higher than Venezuela (3.25), but lower than the two other countries rated (US: 7.71, China: 7.26) Yet, even after controlling for general views of the Central American countries, we find the public generally unsupportive of accepting refugees.

How Should Mexico Address the Refugee Crisis?

Towards the end of the Obama administration, aid and other efforts directed at resolving the push factors for migration in Central America, including decreasing violence and limiting corruption, appeared to have some success at reducing migration north. President Trump’s policies largely did not improve the situation, and President Biden has begun to reverse those policies and re-implement measures successful under Obama.

As discussed in a meeting between the Lopez Obrador administration and US Vice President Kamala Harris, Mexico could adopt similar aid policies, and decreasing the flow of migrants may make the Mexican public respond more positively to accepting migrants. Lopez Obrador committed to increased economic cooperation with Central America days into his term, with pledges of aid as well, but these efforts remain underdeveloped. Threats to cut aid expedite deportations only risks worsening the refugee crisis, while doing little to improve public opinion.

Increasingly, the number of family units from Guatemala and Honduras seeking asylum in Mexico, or the United States, represents a mass exodus from Central America’s Northern Triangle to flee insecurity. Combating issues such as extreme poverty and violence in Central American countries producing the mass exodus of refugees could alleviate the impact of the refugee crisis on Mexico. By alleviating the impact of the refugee crisis, refugees seeking asylum will be able to navigate immigration processes easier thus decreasing tension surrounding the influx of refugees.

Likewise, identifying the public’s security and economic concerns surrounding refugees and crafting a response should reduce opposition. A spokesperson for Vice President Harris stated that border enforcement was on the agenda during meetings with the Lopez Obrador administration, but the Mexican foreign minister reportedly stated that border security was not to be addressed at the meeting. Other than deporting migrants at a higher rate than the US, Mexico also signed an agreement with the US in June pledging money to improve opportunities for work in the Northern Triangle. Nonetheless, questions about whether this agreement will bring meaningful change remain pertinent in the light of a worsening crisis.

Our survey research shows little public interest in accepting refugees. Public sentiment is unlikely to change unless the Lopez Obrador administration finds ways to both build sympathy for the plights of refugees and address public concerns about a refugee crisis with no perceived end in sight. For example, research in the US finds public support for refugees is often higher when the emphasis is on women and children, and the Lopez Obrador administration could attempt to frame the crisis as helping specifically these groups who historically comprise most refugees. Likewise, coordinating efforts with the US and other countries may help portray to the public that the burden of refugee resettlement is being equitably shared rather than disproportionately placed on Mexico.

Facing a complex situation affecting multiple governments requires coordinated efforts and considerable resources to reach a long-term solution. Until then, the Central American refugee crisis will continue and public backlash in Mexico likely increase.

Isabel Eliassen is a 2021 Honors graduate of Western Kentucky University. She triple majored in International Affairs, Chinese, and Linguistics.

Alianna Casas is an Honors Undergraduate Researcher at Western Kentucky University, majoring in Business Economics, Political Science, and a participant in the Joint Undergraduate/Master’s Program in Applied Economics.

Timothy S. Rich is an Associate Professor of Political Science at Western Kentucky University and Director of the International Public Opinion Lab (IPOL). His research focuses on public opinion and electoral politics.

Funding for this survey was provided by the Mahurin Honors College at Western Kentucky University.

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