Democrats Have To Expand the Supreme Court

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From Paul Waldman of The Washington Post:

Keep this image in your mind: Justice Amy Coney Barrett, standing with President Txxxx on a balcony at the White House, smiling in satisfaction as the crowd below them whoops and hollers with joy after Barrett was sworn in to the Supreme Court.

Barrett no longer needs to pretend that she’s anything other than what she is: a far-right judge, installed on the Supreme Court by a president who got fewer votes than his opponent and confirmed by a Republican majority that represents fewer voters than their Democratic colleagues, whose job it will be to do everything in her power to maintain minority GOP rule while carrying out a conservative judicial revolution.

That picture of Barrett and Txxxx reveling in their mutual triumph was so vivid that the Txxxx campaign literally turned it into an ad for the president’s reelection. A different person [Note: he means someone more like a judge] might have said, “Mr. President, it wouldn’t be appropriate for me to participate in such a nakedly political event.” But Barrett wasn’t concerned. She didn’t shout “MAGA 2020!” but she might as well have.

So now it is up to Democrats to recalibrate their understanding of just what is and isn’t appropriate — starting with expanding the Supreme Court as soon as they have the opportunity, which could come in January 2021.

This may be the single most important thing they have to remember: Their actions must not be determined by whether Republicans will complain.

Unfortunately, that’s how Democrats usually see things. If Republicans raise a stink — or even if they just assume Republicans might raise a stink — then Democrats shrink back in fear, lest the action they’re contemplating be considered inappropriate.

But by now they should understand that Republicans will say that everything they do, no matter how by-the-book it might be, is an egregious violation of propriety and good conduct. That’s how Republicans operate, precisely because they know Democrats are deeply concerned with whether processes are conducted in fair and reasonable ways.

But Democrats should listen to Sen. Mitch McConnell. Here’s part of what the Senate Majority Leader said Monday during the floor debate on Barrett’s nomination:

Our colleagues cannot point to a single Senate rule that’s been broken. They made one false claim about committee procedure which the parliamentarian dismissed.

The process comports entirely with the Constitution.

We don’t have any doubt, do we, that if the shoe was on the other foot, they would be confirming this nominee. And have no doubt if the shoe was on the other foot in 2016, they would have done the same thing. Why? Because they had the elections that made those decisions possible. The reason we were able to make the decision we did in 2016 is because we had become the majority in 2014.

The reason we were able to do what we did in 2016, 2018, and 2020 is because we had the majority. No rules were broken whatsoever.

To clarify, the dates McConnell refers to are when he and Republicans refused to hear President Barack Obama’s nomination of Merrick Garland (2016), changing the size of the court from nine to eight justices and then back again; the nomination of Brett M. Kavanaugh (2018); and Barrett’s nomination (2020). [Note: There is no way Democrats would have refused a vote on a Republican nominee in 2016, but that’s the kind of bullshit McConnell says when he wants to sound reasonable.]

“The reason we were able to do what we did 
 is because we had the majority.” It’s the rule McConnell has lived by: Whatever Republicans can do, they will do, if it gives them an advantage.

And he’s right that neither the Constitution nor the rules of the Senate were violated in any of those cases. Nor would it violate the Constitution for Democrats to say that just as Republicans changed the size of the court in 2016 (and as happened many times in the country’s early years), Democrats will now change the size of the court again.

They should do this not only to restore balance after the extraordinary actions McConnell and Republicans undertook, but also as part of a desperately needed effort to stop America’s slide into minority rule and restore something resembling democratic responsiveness to the entire system.

That goes along with eliminating the filibuster so the majority of senators can pass the agenda voters elected them to enact; granting statehood to the District of Columbia and Puerto Rico so the millions of Americans who live in those places can have representation in Congress; and passing a new Voting Rights Act that prevents GOP efforts to disenfranchise voters.

Whenever Democrats waver in their willingness to do what needs to be done to safeguard democracy, they should remember that McConnell is almost daring them to do it, precisely because he thinks they don’t have the guts.

“A lot of what we’ve done over the last four years will be undone, sooner or later, by the next election,” he said Sunday about Barrett’s nomination. “But they won’t be able to do much about this for a long time to come.”

But they can, and they should, no matter how much Republicans whine about it. If voters give them the White House and the Senate, they’ll have the legal right and the moral obligation to do so. Without it we won’t have a real democracy.

Unquote.

I still think adding three justices to balance the Court between Republicans and Democrats is a good idea. If President Biden creates a commission to study the matter, I’ll send them a postcard.

Five days.

Making the Supreme Court More (Small “d”) Democratic

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The fundamental objection to the Supreme Court’s powers . . . is that no one concerned to establish a democratic state would bestow on nine judges, appointed for life at the whim of the pre­sident, powers to determine society’s governing norms.

That’s from an Oxford fellow’s London Review of Books article about America’s Supreme Court, which now includes six Republicans (five of whom are Catholics) and three Democrats (one of whom is). The article continues:

Some progressives have begun to argue that the court’s problems can be fixed only if its powers are reduced. One possibility would be to introduce term limits for judges. This, though, wouldn’t limit their powers.

But the Constitution says federal judges “shall hold their offices during good behaviour”. That seems to mean term limits would require a constitutional amendment, which would be unlikely to pass when the Court is so unbalanced. Republicans wouldn’t agree to give up their big advantage.

Another suggestion is to change the voting rules on the court. Continental legal systems often require unanimity among the judges in all decisions. In the US, if the justices were unable to reach unanimous agreement, the lower court’s decision would be upheld. This already happens when an equal number of justices are in favour of and opposed to a ruling: the court can divide equally when . . . there are only eight members on the court, or when a justice recuses him or herself. A unanimity rule would not deprive the court of all its powers: between 1946 and 2009, 41 per cent of decisions were unanimous.

There is nothing in the Constitution that says how many votes are required for the Supreme Court to make a decision, so requiring a unanimous vote would merely require a new law, not a constitutional amendment. A Democratic president and Democratic Congress could easily make that happen, assuming a Democratic Senate got rid of the filibuster.

But it would mean that a single ideologue could exercise an outsized effect on individual decisions.

Some scholars propose a super-majority requirement, permitting one or two dissenters. That deprives the lone ideologue of ransom power, but it is also a conservative measure, entrenching the court’s existing decisions; the more controversial may never be overturned.

The proposal often mentioned is to enlarge the Court (so-called “court packing”). Congress and the President could add three Democrats, for example, creating a 12-member Court split evenly between the parties.

. . . When Franklin Roosevelt sought to pass progressive legislation during the Great Depression, the Supreme Court stymied his efforts by striking down key parts of the New Deal. In response, he resolved to appoint as many as six new justices. Roosevelt, for all his skills, was unable to get the measure through the Senate (though the court was chastened by his efforts). Pete Buttigieg revived the idea in his run for president, proposing an expansion from nine to 15 judges. There is no principled reason to settle on nine as the appropriate number of justices; the court initially had six, once had ten, and other Supreme Courts around the world often have more.

The author of the Guardian article thinks adding justices would be inadequate:

But ‘packing’ the court, even if it were politically feasible, still doesn’t address the problem of how to limit its powers. That said, the political confrontation it would generate might cause the justices to reconsider their attitudes to those powers. That would be no bad thing.

Chief Justice Roberts is apparently concerned that the Court’s right-wing activism may sometimes go too far. But depending on him or other justices to refrain from using all their power to carry out the Republican agenda is wishful thinking. Rather than waiting for the Republican majority to restrain itself, Congress should limit the Court’s powers. A University of Chicago law professor explained how last month in The Washington Post:

A new Democratic Congress could, for example, impose by ordinary statute a limit on the Supreme Court’s authority to declare federal legislation unconstitutional, permitting it to do so only by supermajority (say, 7-2) rather than the usual 5-4. In so doing, Congress would be using the same power it does to dictate how many justices constitute a quorum. This reform would implement, via voting rule, the sort of “clear error” approach to judicial review imagined by Harvard professor James Bradley Thayer in the late 1800s. Such a rule would permit a judicial veto in cases of uncontroversial constitutional violation (for example, an effort to reintroduce de jure segregation of schools or criminalizing the speech of political opponents) but otherwise require the court to stay its hand.

Alternatively, Congress and the president might (again by ordinary statute) “strip” the court of jurisdiction over constitutional challenges to specific legislation — the Green New Deal, for example, or HR1, the sweeping set of reforms first approved by the Democratic House in 2019 that includes establishing automatic voter registration, making Election Day a national holiday and ending partisan gerrymandering. (It could also strip its jurisdiction over whole areas of law, such as climate legislation). Here, Congress would be making use of its Article III power to decide what kinds of cases the Supreme Court may hear on appeal — the court has constitutionally mandated jurisdiction only over disputes between states and the like — as well as its authority to decide whether lower federal courts exist at all, and so what cases they are permitted to hear.

. . . The exact scope of Congress’s ability to strip jurisdiction remains controversial, and a recalcitrant court might resist. This is a situation in which additional sympathetic justices recently added to the court might be helpful; court packing, in other words, might pave the way for additional reforms. Whatever stance the court takes, the limits Congress may impose is a question that careful attention to the Constitution is unlikely to answer; rather, as with most of these disputes, the resolution would ultimately be political, as opposed to legal, with the political and judicial branches left to hash out a new status quo. As former dean of Stanford Law School Larry Kramer has observed: “The Constitution leaves room for countless political responses to an overreaching court” — including judicial impeachment, slashing the court’s budget, giving the justices onerous responsibilities or simply ignoring the court, as did Lincoln, after the Dred Scott case.

Conservatives made similar efforts at limiting the court’s authority in the 1970s and 1980s (backed by legal arguments from a young [John] Roberts, working as an attorney at the Department of Justice) — repeatedly introducing legislation to limit federal courts’ ability to adjudicate contentious cultural issues such as abortion and school prayer — and have made similar efforts since. Those efforts failed, in part because of a lack of support in the Senate, but one can imagine that a Democratic-controlled Senate might be exceptionally motivated to protect its potential legislative accomplishments from a hostile judiciary.

Given Republican rhetoric about unduly powerful courts, there’s a chance that at least some conservatives may embrace the cause of judicial disarmament (especially if liberal court-packing is the alternative). For both parties, of course, going down such a path would increase the stakes for who controls the political branches. Both sides would have to ratchet down the expectation that the Supreme Court would annul popular laws that they find distasteful — whether that means (on the right) a statute phasing out fossil fuel production or (on the left) a federal ban on affirmative action in higher education. In a democracy, however, that is exactly how things should be.

Unquote.

Seven days.

More Confirmation of Something We Already Knew

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From The Guardian:

The Republican party has become dramatically more [authoritarian] in the past two decades and now more closely resembles ruling parties in autocratic societies than its former centre-right equivalents in Europe, according to a new international study.

In a significant shift since 2000, the [Grim Old Party] has taken to demonising and encouraging violence against its opponents, adopting attitudes and tactics comparable to ruling nationalist parties in Hungary, India, Poland and Turkey.

The shift has both led to and been driven by the rise of Dxxxx Txxxx.

By contrast, the Democratic party has changed little in its attachment to democratic norms, and in that regard has remained similar to centre-right and centre-left parties in western Europe. Their principal difference is the approach to the economy.

The new study, the largest ever of its kind, was carried out by the V-Dem Institute at the University of Gothenburg in Sweden, using newly developed methods to measure and quantify the health of the world’s democracies at a time when authoritarianism is on the rise.

Anna LĂŒhrmann, V-Dem’s deputy director, said the Republican transformation had been “certainly the most dramatic shift in an established democracy”.

V-Dem’s “illiberalism index” gauges the extent of commitment to democratic norms a party exhibits before an election. The institute calls it “the first comparative measure of the ‘litmus test’ for the loyalty to democracy”.

The study, published on Monday, shows the [Republican Party] has followed a similar trajectory to Fidesz, which under Viktor OrbĂĄn has evolved from a liberal youth movement into an authoritarian party that has made Hungary the first non-democracy in the European Union.

India’s Bharatiya Janata Party (BJP) has been transformed in similar ways under Narendra Modi, as has the Justice and Development party (AKP) in Turkey under Recep Tayyip Erdoğan and the Law and Justice party in Poland. Txxxx and his administration have sought to cultivate close ties to the leadership of those countries.

The Republican party has remained relatively committed to pluralism, but it has gone a long way towards abandoning other democratic norms, becoming much more prone to disrespecting opponents and encouraging violence.

“We’ve seen similar shifts in parties in other countries where the quality of democracy has declined in recent years, where democracy has been eroding,” LĂŒhrmann said. “It fits very well into the pattern of parties that erode democracy once they’re in power.”

“The demonisation of opponents – that’s clearly a factor that has shifted a lot when it comes to the Republican party, as well as the encouragement of political violence,” she said, adding that the change has been driven in large part from the top. . . .

In western Europe, centre-right parties like Germany’s Christian Democratic Union and Spain’s People’s party have stuck to their commitment to democratic norms. By the same measure, Britain’s Conservative party has moved some way along the liberal-illiberal spectrum, but not to the Republicans’ extremes.

“The data shows that the Republican party in 2018 was far more illiberal than almost all other governing parties in democracies,” the V-Dem study found. “Only very few governing parties in democracies in this millennium (15%) were considered more illiberal than the Republican party in the US.”

The institute has found the decline in democratic traits has accelerated around the world and that for the first time this century, autocracies are in the majority – holding power in 92 countries, home to 54% of the global population.

According to V-Dem’s benchmark, almost 35% of the world’s population, 2.6 billion people, live in nations that are becoming more autocratic.

Unquote.

The Republican Party is also an outlier among major political parties by virtue of its repellent denial of global warming.

Eight days.

Our COVID Mortality Rate Is Down 85%?

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That’s a statistic in the news, but what does it mean? CNN reported this on Friday:

Friday’s case count of at least 80,005 surpasses the country’s previous one-day high of 77,362, reported July 16, according to Johns Hopkins University.
 
US Surgeon General Dr. Jerome Adams cautioned earlier Friday that hospitalizations are starting to go up in 75% of the jurisdictions across the country, and officials are concerned that in a few weeks, deaths will also start to increase.
 
The good news, Adams said, is that the country’s Covid-19 mortality rate has decreased by about 85% thanks to multiple factors, including the use of remdesivir, steroids and better management of patients.
 
According to CNN, the Surgeon General  made these remarks during an online discussion of global health policy at Meridian Global Leadership Summit. Meridian is a “non-profit, non-partisan diplomacy center” in Washington. I couldn’t find exactly what he said, either from Meridian’s site, the Surgeon General’s site or the Surgeon General’s Twitter account. The Center for Disease Control doesn’t seem to report a mortality rate.
 
Looking at statistics from The New York Times, however, indicates what the Surgeon General was talking about. Back in mid-April, the US was reporting around 2,200 deaths for every 32,000 confirmed cases. Now 800 deaths are being reported for around 68,000 cases. That translates into 6.9% of cases ending in death in April vs. 1.2% now, a decline of 83%. So it’s true that the mortality rate has dropped quite a lot.
 
This is confirmed by two studies reported by National Public Radio:
 
Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.
 
The article mentions other reasons the mortality rate may be dropping:
 
[Researchers] say that factors outside of doctors’ control are also playing a role in driving down mortality. . . . Mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients. . . . Keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, “staff are stretched, mistakes are made, it’s no one’s fault — it’s that the system isn’t built to operate near 100%”. . . 
 
This hardly means we’ve turned the corner on COVID-19, as one of the presidential candidates claims. A mortality rate of 7% is still high relative to other diseases. Serious illness is never a joy and even patients who survive COVID-19 sometimes suffer long-term effects.
 
In addition, two other numbers recently reported aren’t encouraging. The pandemic is causing significantly more deaths, either directly or indirectly, than are being reported:
 
In the most updated count to date, researchers at the Centers for Disease Control and Prevention have found that nearly 300,000 more people in the United States died from late January to early October this year compared to the average number of people who died in recent years. Just two-thirds of those deaths were counted as Covid-19 fatalities, highlighting how the official U.S. death count — now standing at about 220,000 [or 225,000] — is not fully inclusive [Stat].
 
One model predicts that the next four months will be especially bad in the US:
 
More than 511,000 lives could be lost by 28 February next year, modeling led by scientists from the University of Washington found.

This means that with cases surging in many states, particularly the upper Midwest, what appears to be a third major peak of coronavirus infections in the US could lead to nearly 300,000 people dying in just the next four months.

In fact the University of Washington warned that the situation will be even more disastrous if states continue to ease off on measures designed to restrict the spread of the virus, such as the shuttering of certain businesses and social distancing edicts. If states wind down such protections, the death toll could top 1 million people in America by 28 February, the UW study found [The Guardian].

Finally, the presidential candidate who doesn’t think we’ve turned the corner offered this timely reminder:

President Txxxx’s plan to beat COVID-19. 

Nine days.

Harry Truman’s Healthcare Plan and Our Current Sorry State

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What President Truman tried to do and where we are today, by David Oshinsky for The New York Review of Books:

“Bow your heads, folks, conservatism has hit America,” The New Republic lamented following the 1946 elections. “All the rest of the world is moving Left, America is moving Right.” Having dominated both houses of Congress throughout President Franklin Roosevelt’s three-plus terms in office (1933–1945), Democrats lost their majorities in a blowout. Some blamed it on the death of FDR, others on the emerging Soviet threat or the bumpy return to civilian life following World War II. The incoming Republican “Class of ’46” would leave a deep mark on history; its members, including California’s Richard Nixon and Wisconsin’s Joseph McCarthy, were determined to root out Reds in government and rein in the social programs of the New Deal.

One issue in particular became fodder for the Republican assault. In 1945 President Harry Truman had delivered a special message to Congress laying out a plan for national health insurance—an idea the pragmatic and immensely popular FDR had carefully skirted. As an artillery officer in World War I, Truman had been troubled by the poor health of his recruits, and as chairman of a select Senate committee to investigate the defense program during World War II, his worries had grown. More than five million draftees had been rejected as “unfit for military service,” not counting the 1.5 million discharged for medical reasons following their induction. For Truman, these numbers went beyond military preparedness; they spoke to the glaring inequities of American life. “People with low or moderate incomes do not get the same medical attention as those with high incomes,” he said. “The poor have more sickness, but they get less medical care.”

Truman proposed federal grants for hospital construction and medical research. He insisted, controversially, not only that the nation had too few doctors, but that the ones it did have were clustered in the wrong places. And he addressed the “principal reason” that forced so many Americans to forgo vital medical care: “They cannot afford to pay for it.”

The facts seemed to bear him out. Close to half the counties in the United States lacked a general hospital. Government estimates showed that about $11 million was spent annually on “new treatments and cures for disease,” as opposed to $275 million for “industrial research.” Though the nation claimed to have approximately one physician per 1,500 people, the ratio in poor and rural counties regularly dipped below one per 3,000, the so-called danger line. On average, studies showed, two thirds of the population lacked the means to meet a sustained health crisis.

The concept of government health insurance was not entirely new. A few states had toyed with instituting it, but their intent was to replace wages lost to illness or injury, not to pay the cost of medical care. Truman’s plan called for universal health insurance—unlike the Social Security Act of 1935, which excluded more than 40 percent of the nation’s labor force, mostly agricultural and domestic workers. Funded by a federal payroll tax, the plan offered full medical and dental coverage—office visits, hospitalization, tests, procedures, drugs—to all wage and salary earners and their dependents. “Needy persons and other groups” were promised equal coverage “paid for them by public agencies.”

People would be free to choose their own doctors, who in turn could participate fully, partly, or not at all in the plan. Private health insurance programs would continue to operate, with policyholders required to contribute to the federal system as well—a stipulation the president compared to a taxpayer choosing to send a child to private school. “What I am recommending is not socialized medicine,” Truman insisted. “Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.”

It did him no good. At the first Senate hearing on the proposal, Ohio’s Robert A. Taft, . . .  known to his admirers as “Mr. Republican,” denounced it as “the most socialistic measure that this Congress has ever had before it.” A shouting match ensued. . . . Taft retreated, but not before vowing to kill any part of the plan that reached the Senate floor.

. . .  A predictable coalition soon emerged, backed by pharmaceutical and insurance companies but directed by the American Medical Association, which levied a $25 political assessment on its members to finance the effort. At its crudest, the campaign pushed a kind of medical McCarthyism by accusing the White House of inventing ways to turn a brave, risk-taking people into a bunch of “dainty, steam-heated, rubber-tired, beauty-rested, effeminized, pampered sissies”—easy pickings for the nation’s godless cold war foe. “UN–AMERICAN SYSTEM BLUEPRINTED IN THE KREMLIN HEADQUARTERS OF THE COMMUNIST INTERNATIONALE,” read one AMA missive describing the origins of Truman’s plan.

Precious freedoms were at stake, Americans were told: when the president claimed that medical choices would remain in private hands, he was lying; federal health insurance meant government control; decisions once made by doctors and patients would become the province of faceless bureaucrats; quality would suffer and privacy would vanish. Skeptics were reminded of Lenin’s alleged remark—likely invented by an opponent of Truman’s heath plan—that socialized medicine represented “the keystone to the arch of the socialized state.”

The economist Milton Friedman once described the AMA as “perhaps the strongest trade union in the United States.” It influenced medical school curriculums, limited the number of graduates, and policed the rules for certification and practice. For the AMA, Truman’s proposal not only challenged the profession’s autonomy, it also made doctors look as if they could not be trusted to place the country’s needs above their own. As a result, the AMA ran a simultaneous campaign congratulating its members for making Americans the healthiest people in the world. The existing system worked, it claimed, because so many physicians followed the golden rule, charging patients on a sliding scale that turned almost no one away. If the patient was wealthy, the fee went up; others paid less, or nothing at all. What was better in a free society: the intrusive reach of the state or the big-hearted efforts of the medical community?

Given the stakes, the smearing of national health insurance was not unexpected. What did come as a surprise, however, was the palpable lack of support for the idea. For many Americans, the return to prosperity following World War II made Truman’s proposal seem less urgent than the sweeping initiatives that had ended the bread lines and joblessness of the Great Depression. Even the Democratic Party’s prime constituency—organized labor—showed limited interest. During the war, to compensate workers for the income lost to wage controls, Congress had passed a law that exempted health care benefits from federal taxation. Designed as a temporary measure, it proved so popular that it became a permanent part of the tax code.

Unions loved the idea of companies providing health insurance in lieu of taxable wages. It appeared to offer the average American the sort of write-off reserved for the privileged classes, and indeed it did. Current studies show that union members are far more likely to have health insurance and paid sick leave than nonunion workers in the same industry. . . .

At about the same time, popular insurance plans like Blue Cross emerged to offer cheap, prepaid hospital care . . . . In 1939 fewer than six million people carried such insurance; by 1950, that number had increased fivefold. In the years after Truman’s plan died in Congress, the government filled some of the egregious gaps in the private insurance system with expensive programs for the poor, the elderly, and others in high-risk categories, thereby cementing America’s outlier status as the world’s only advanced industrial nation without universal health care. . . .

[In the United Kingdom, the National Health Service] succeeded because the Labour Party won a landslide victory in 1945 in a country battered by war and facing a bleak economic future—precisely the opposite of the American experience. Opinion polls in the UK showed strong support for a government-run system offering universal, comprehensive, and free health care financed by general taxation. But the threat of a physicians’ strike forced Labour’s health minister, Aneurin Bevan, to scrap the idea of turning doctors into full-time government employees. . . .

The UK excels in universal coverage, simplicity of payment, and protection of low-income groups. While the NHS remains quite popular, it also is seriously underfunded: the UK ranks dead last in both health care spending per capita ($3,900) and health care spending as a percentage of gross domestic product (9.6) among the six European nations [reviewed in Ezekiel Emanuel’s book Which Country Has the World’s Best Healthcare?] The most common complaints . . .  concern staff shortages and wait times for primary care appointments, elective surgeries, and even cancer treatments . . .  “The public does not want to replace the system with an alternative,” writes Emanuel. “All the public wants is a fully operational NHS.”

By contrast, the US health care system—if one can call it that—excludes more people, provides thinner coverage, and is far less affordable. It combines socialized medicine practiced by the Department of Veterans Affairs, four-part federal Medicare (A, B, C, D) for the elderly and disabled, state-by-state Medicaid for the poor, health coverage provided by employers, and policies bought privately through an insurance agent or an Affordable Care Act exchange—all of which still leave 10 percent of the population unprotected. . . . “The United States basically has every type of health financing ever invented,” Ezekiel adds. “This is preposterous.”

And extremely expensive. America dwarfs other nations in both health care spending per capita ($10,700) and health care spending as a percentage of GDP (17.9). Hospital stays, doctor services, prescription drugs, medical devices, laboratory testing—the excesses are legion. Childbirth costs on average about $4,000 in Western Europe, where midwives are used extensively and charges are bundled together, but close to $30,000 in the US, where the patient is billed separately by specialists—radiologists, pathologists, anesthesiologists—whom she likely never meets, and where charges pile up item by item in what one recent study called a “wasteful overuse of drugs and technologies.” There is no evidence that such extravagance makes for better health care outcomes. The rates of maternal and infant death in the US are higher than in other industrialized nations, partly because the poor, minorities, and children are disproportionately uninsured.

For head-spinning price disparities, however, nothing compares to pharmaceuticals. Americans account for almost half the $1 trillion spent annually for prescription drugs worldwide, while comprising less than 5 percent of the world’s population. It is probably [i.e. definitely] no coincidence that the pharmaceutical industry spent almost twice as much on political lobbying between 1998 and 2020 as its nearest competitor, the insurance industry. . . .

Unquote.

Whenever the president is asked why he wants to eliminate the Affordable Care Act (which means people with “pre-existing conditions” would no longer be protected, among other things), he says he’s going to announce a beautiful replacement for the ACA “in two weeks”. Or “next month”. It’s always in two weeks or next month. Reporters never press him for details, because they know he’s full of crap.

Una volta un truffatore, sempre un truffatore (once a con man, always a con man).

PS:  Ezekiel Emanuel says different countries do different things very well, but if he had to choose his personal favorite, he’d pick healthcare in The Netherlands, with Germany, Norway and Taiwan in the running.