Part 4—Disappeared all the way down: Ever so briefly, permit yourself to become a conspiracy theorist.
Imagine that a potent cabal is scripting American journalism. In service to powerful interests, they mandate what our major journalists will, and will not, say.
In theory, we don't live in that world. But if we did, very little would have changed on last Thursday's Charlie Rose program.
We refer to the nine-minute segment in which Rose and two well-informed guests discussed, or seemed to discuss, the question of health care spending. More specifically, they discussed, or seemed to discuss, the very high level of health care spending in these United States.
To appearances, our nation's level of health care spending isn't just high; it's crazily high. Back in 2005, Paul Krugman tried to create awareness of this problem in a series of columns in the New York Times, a well-known American newspaper.
Uh-oh! As if guided by an invisible hand, our journalists all seemed to know that they mustn't follow Krugman's lead in this area. From that day to this, remarkable data like these have persistently been disappeared:
Per capita spending, health care, 2015:It's often said that "those French" have the world's best health care system. But how odd:
United States: $9451
United Kingdom: $4003
According to those OECD data, we spend more than twice as much on health care, per person, as the high-flying French! As compared with the French, $5000 per person per year disappears into the maws of our "health care system."
Amazingly, that's $5000 per person. That missing money accounts for the problem we've long had in providing universal health coverage. It also accounts, all by itself, for our annual federal deficits!
And yet, as if by the work of an invisible hand, remarkable data like those are persistently disappeared by our major news orgs and the people they employ. The American public is kept from seeing those startling figures.
With that in mind, why not take The Conspiracy Theorist Challenge? Ever so briefly, permit yourself to be a conspiracy theorist. You'll feel fairly sure that last Thursday's discussion just couldn't have been on the level.
Rose spoke with Ezra Klein and Peter Orszag, a pair of well-positioned, major insiders who know what they're talking about. And yet, their nine-minute discussion of health care spending had the sweet smell of a con.
(To watch the entire segment, click here. The discussion of health care costs starts at the 12-minute mark.)
As the conversation started, Klein said that our health care system is the worst in the world. He and Orszag quickly agreed on two other points:
Our health care prices are too damn high! And that's because, unlike every other developed nation, our government doesn't establish prices for health care procedures and products.
It took roughly ninety seconds for these basic points to be made. From that point on, an invisible hand seemed to control what was said.
For starters, Rose himself never posted or cited the data we've posted above. In turn, Orszag and Klein made no attempt to report the remarkable size of our overspending.
In that way, PBS viewers were treated like rubes concerning the remarkable size of this state of affairs. As is required by Hard Pundit Law, those remarkable basic data were ruthlessly disappeared.
Things got worse from there. Consider what else the boys said:
Uh-oh! As they continued, Klein and Orszag agreed on another remarkable claim. According to Orszag and Klein, the rest of the developed world is freeloading off our remarkable rate of spending.
Everyone else is freeloading on us! Fighting through one of Charlie's interruptions, Klein made this basic point first:
KLEIN (5/25/17): There is a more honest debate we could have be having in this country. There is a consistent, coherent and in some ways persuasive, I think, conservative case on this, that if you regulate prices, particularly in America, where we are the single largest market for health services, for pharmaceuticals, for medical devices, all of it—Say what? According to Klein, the rest of the world is "free-riding" (freeloading) off our medical innovation. He seemed to say that our overspending is connected to this search for innovation, and that innovation would be harmed if we regulated prices, the way all others do.
ROSE: And the single largest sector of our economy, right?
KLEIN: —that you would hurt innovation badly. And no matter whether it be cheaper, it wouldn't be worth hurting innovation.
That is a fair argument. But what it implies is that the direction you are going is just more expensive health care. That America, in order to have this world-leading innovation, in order for the rest of the world to be able to free-ride off our innovation, which they do—conservatives are right about that—that conservatives need to be willing to put more money into the American health care system in order to be able to keep this going. It just costs more to do what we're doing.
Is everyone else freeloading off us? Orszag soon agreed:
ORSZAG: We do subsidize medical innovation for the rest of the world. The issue is how, and what kind of innovation. Because we have historically just paid for whatever comes along and so we paid for even very minor improvements. On average, the innovation has been miraculous. But there is plenty of stuff, high-cost, that doesn't really do very much.Everyone's freeloading on us. Apparently, this explains, or helps explain, our very high medical spending.
That said, neither Orszag nor Klein suggested that we should take steps to end this freeloading—to distribute the costs of innovation across the developed world. Instead, Klein offered a familiar but highly misleading statistic—a statistic which tended to disguise the size of our overspending.
Orszag, in turn, played Pollyanna. Cheerfully, he described the best of all future worlds.
What statistic did Klein provide? Cheerfully, he said this to the people who can best be describes as "the rubes of PBS:"
KLEIN: I do not think American health care is going to be as cheap as in our competitor nations in any near-term time frame—Good God! Our health care won't be as cheap as everyone else's in any near-term time frame. But over time, we might be able to lower costs by 20 or 30 percent!
ROSE: Because of the absence of regulation.
KLEIN: No. Because of the absence of regulation, but even if you put it in today, path dependence is a very powerful thing. You would have a tremendous amount of disruption in the health care system if you tried to cut cost by 20 percent or 30 percent that quickly. So I would like to believe we could get it further down, and I think we can do a much better job than we are.
Over time, we might be able to cut our costs that much! To the rubes of PBS, that may have sounded like a promising projection. But because they hadn't been shown the basic data, they didn't know that a 25 percent reduction, magically backloaded, would have left us looking like this back in 2015:
Per capita spending, health care, 2015 (with United States spending reduced):We'd still be getting looted badly compared to everyone else! Because they'd been deprived of basic data, the misused "rubes of PBS" had no way to know this.
United States: $7088
United Kingdom: $4003
Klein had envisioned a magic trombone which didn't exactly blow. Up jumped Orszag, cheerfully casting himself in the Pollyanna role, as he'd also done earlier:
ORSZAG: I'm an optimist here. I think in ten years, we are going to have a health care system that is much more digitized, it's much more personalized, in the sense of not just something works on average, but works for you, Mr. Rose, or works for you, Mr. Klein, in which scheduling and billing is not as annoying and tedious as it is today.Yay yay yay yay yay yay yay! We can slow the growth rate of costs—and not only that! In ten years, scheduling and billing won't be as annoying as they are today!
And the good part of all the inefficiency that exists in health care today is that we can slow the growth rate, or even maybe reduce costs, but at least slow the growth rate of costs without harming the quality of the health care that people get by wringing those inefficiencies out. So I'm a big optimist here.
ROSE: Thank you. Thank you, Ezra. Thank you for joining us.
So ended a striking discussion.
We can slow the growth rate of health care costs? All through this nine-minute discussion, an invisible hand had kept us rubes from seeing the baseline from which that slower growth rate would emerge.
Here's how our spending looks today as compared to the world's best system. In the face of this craziness, we rubes were told that our growth rate can slow!
Per capita spending, health care, 2015:As is decreed by Hard Pundit Law, Rose never let his viewers see those remarkable data. They drifted to sleep, unaware of the way they'd been conned.
United States: $9451
In closing, let's make one key point. It's silly to think that our overspending is all caused by innovation. But that was the only explanation offered to Charlie's angels. The massive looting involved in this ludicrous scam went unmentioned, as always.
Beyond that, though, lies the larger problem—the problem of disappeared data. Pretending to be a conspiracy theorist, you might end up thinking this:
Chomsky describes this puzzling process as "manufactured consent." For whatever reason, elites present certain frameworks and facts while disappearing all others. Through this selective presentation, we the rubes are skillfully led to the desired conclusions.
In the realm of health care spending, our consent is manufactured through the startling data we never get shown. Those basic data, which are truly remarkable, get disappeared all the way down.
This lets the remarkable looting continue. As part of this important process, our PBS viewers get conned.
Soon, a doo-wop tape is playing, and they're asked for donations.
Tomorrow: Some comic relief