Richter Scale

What Ails America on Health Care?

11 theses on what an undemocratic and unnecessary mess the world’s supposedly leading democracy finds itself in.


  • Paul Ryan has a cold and cynical distaste for a government that would be "for, of and by the people."
  • Why is there a lack of courage and resolve on the part of the Congress to take on Big Pharma and the insurance industry?
  • For decades, American people have served as economic laboratory rats for Big Pharma.

1. Paul Ryan is an ideologue first and foremost. He fundamentally does not care about people. He has a cold and cynical distaste for a government that would be “for, of and by the people,” a goal that is yet to be reached in the United States, despite Lincoln’s best efforts.

2. Ryan is actually worse than Trump because he would remove virtually all progress in health care. Trump doesn’t really care – so his lackadaisical attitude is less harmful than the determined one manifested by Ryan and, even worse, The Freedom Caucus members, who have even less ability to compromise than Ryan.

3. Those opposing health care reform of any kind, whether Obamacare or not, are ultimately doing so because they do not want those people to have a healthy life.

In the Ryan/Ayn Rand tradition of utter, human-despising libertarianism, the welcome(!) reality is that the sooner that people die who suffer from chronic disease, often beginning with unhealthy lifestyles in childhood, the better it is.

4. Indeed, from a purely financial perspective, it is far more cost effective and cheaper for the federal government to let them die.

In that regard, the “good” news is that the United States already leads the developed nations in a truly perverse way: Americans’ longevity has already shrunk in comparison to other leading economies.

5. Of course, Mr. Ryan (he would probably plead Catholicism) and The Freedom Caucus would probably deny that allegation publicly, but what they say in their private chatter is bound to be different.

They view any human and/or social matter via the Procrustes bed of the national budget, perplexingly in a very short-term perspective, though.

6. Their conception of small government – a government that is in the hands of and benefits only the rich, the Kochs, etc. — inevitably leads to no funding for preventive care and other basic health benefits, which prevent chronic disease and lead to better longevity.

Their conception of government hangs not just the poor, but also middle class, out to dry. It supports concierge-style health services for the rich – and bake sales (to pay for outrageous hospital bills) for everybody else.

7. Rising health care costs are the crux of the concern. This is true for (fiscal and political) conservatives, as well as for the people in general.

What is NOT being addressed with regard to costs is the lack of courage and the lack of resolve on the part of the Congress to take on Big Pharma and the insurance industry.

8. The Obama administration sadly lacked that will, too. He and his team had a soft ball approach to controlling costs.

That is never going to work as long as health care in the United States is centered in the marketplace with wholly inadequate government regulation.

9. Hard though it is to imagine when viewed from the perspective of civilized countries, but the Republicans approach is truly out of this world.

Their solution is to take benefits away from the people who need them, NOT to take profits away from the industries that feed the U.S. Congress with campaign contributions and lobbying. Talk about RICO-style self-dealing.

10. No other leading industrial nation refuses to negotiate drug prices with the pharmaceutical industry.

For decades, the American people have effectively served as economic laboratory rats for Big Pharma and, stupidly, falling for the lines about “competition” and “the free market” (there is, by the way, no such thing). In short, they have let themselves be taken for a phenomenal ride.

11. The health insurance industry played nice during the Obamacare negotiations, though it is safe to say that the White House and Democratic Congressional staffers at the time did yeoman’s work just to keep them at the table.

What the insurers did was to agree to what was in their interest (i.e., taking in more customers with government subsidies) – and, purely temporarily, restraining themselves with regard to raising premium costs. So, predictably enough, when the going got rough, some insurers withdrew from the “marketplaces” and all of them raised premium prices.

Hey, that’s the free market at work, folks!

America, have you had enough of it yet?

Editor’s note: Terri Langston spent a quarter century of her career in the foundation sector working on laying the groundwork for a rational, affordable and equitable health care system in the United States, mainly focused on state-level reforms.

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About Stephan Richter

Director of the Global Ideas Center, a global network of authors and analysts, and Editor-in-Chief of The Globalist.

About Terri Langston

Terri Langston is senior editor at The Globalist.

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