White House Chronicle

News Analysis With a Sense of Humor

Medicare for All Is the Wrong Fix for the Healthcare Crisis

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As Charles Dickens might have said, “It is the best of times in medicine, it is the worst of times in healthcare.” It is a time of great medical discovery with artificial intelligence, it is a time of the poorest outcomes for the sick.

One of America’s most distinguished pediatric cardiologists says the nation is in desperate shape with the end of Medicaid subsidies and the 28 million people — or almost 10 percent of the population — who lack insurance. The number is growing as people trade off the cost of insurance and prescriptions against rent, food and electricity.

Cardiologist Dr. Arthur “Tim” Garson Jr., a clinical professor at the University of Houston, College of Medicine, is keen to head off those who think the answer is Medicare for All.

“It seems to me that politicians of either party, especially those who are new to healthcare, say, ‘Medicare for All’ when they mean ‘universal coverage,’” Garson said, adding, “Coverage for all people is essential, but Medicare for All is only one way — and a terrible way.”

Garson, who is a former University of Virginia provost and an elected member of the National Academy of Medicine, said: “Let me be clear: Traditional Medicare works beautifully for 34 million of us. It’s easy, actually too easy, with essentially no pre-approvals for care. But that won’t work for 338 million people — allowing anyone to have anything.”

According to Garson, analyses that say Medicare for All saves money have it wrong. “We know that with no guardrails, care can go up 25 percent to 30 percent. They showed that in South Texas.”

Particularly, he takes aim at the Medicare for All Act of 2025, which is still before Congress. It contains coverage of everything from elective surgery to dental, hearing and vision care without copays or any cost-sharing, and eliminates all insurance.

The answer for the uninsured, according to Garson, is basic, tax-supported healthcare for everyone. That may not be enough for some, so private insurance must be permitted — a system he calls the “single safety net.”

That system operates in most of the developed world.

Behind Garson’s concern for those who go without insurance and who can’t afford prescriptions is a close-to-home tragedy. He helped save a toddler’s life and watched her grow over the next 19 years. Then, when her Medicaid ran out, she died because she couldn’t afford her sustaining prescriptions and was too ashamed to ask for help.

Garson shared a draft paper with me that explains the ruinous cost of Medicare for All and the basic healthcare he believes is affordable and achievable.

It states: “We spend more than twice the average of other developed countries on healthcare per person, and waste about one-third of the $5.5 trillion that we spend on healthcare — that’s about $1.6 trillion wasted. Yet, other countries provide healthcare for everyone.”

Garson isn’t advocating for a more expensive system. He says getting rid of even a portion of the waste can pay for perfectly adequate care.

I know a bit about the healthcare systems in three countries: England, where I used to be a beneficiary of the National Health Service, and where members of my family have used it since it began in 1947; France, where I received extraordinary care after a bad fall in Paris two years ago; and Ireland, where the two-tier system is praised by friends.

If people across the developed world can have the security of illness without going into penury, and they get that for half of what we spend on healthcare, what are we waiting for?

Garson thinks it will take a long time to eliminate the waste before America can move toward coverage for all.

I am not so sure. I think the effect of tens of millions without medical insurance could be dramatic. They will clog the emergency rooms where the law says they must get treatment.

In education, Garson notes, we have public schools and private schools for those who want them, so why not at the doctors’ offices?

I say that if your house catches fire, you expect to see the fire brigade. All of you.

Time to hear the fire bell in medicine. Many wonderful things are on the way with AI medical research. Everyone should get the benefits.

The ‘New Weather’ Reality Will Change the Nation, Defy Politics

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I have never done political consulting. So it was novel to me when a candidate in the midterms asked me what he should be worried about in 2027. I repeated what Harold Macmillan, British prime minister from 1957 to 1963, is believed to have said, “Events, dear boy, events.”

Actually, I had a little list of crises that I have been gathering and which will come to bear on the political establishment — and we the people. Topping the list is one that is already at hand: the climate, which I call the “new weather.”

We have had weeks of atmospheric disturbance resulting in catastrophic floods, power outages, flight cancellations, oppressive heat and fires. Weather disruptions have been the first or second stories on the networks’ evening newscasts, pushing back the news on the wars in Iran and Ukraine, as well as news from the White House.

Television stations like to tell viewers they have “news you can use.” The new weather is news that will abuse you. It knows where you live and it may call. It has called in Europe and across North America. It is a new reality.

The Southwest is parched and the Colorado River, that life channel, is running dry, severely affecting people in seven states. It also affects the food supply, as much of farming depends on the river’s bounty. Even Mexico receives some of the dwindling Colorado River water supply under a treaty with the United States.

Hundreds of thousands have lost power for hours or days, and others may be choosing between keeping the air conditioning on and spending on other necessities.

Sustained heat of over 110 degrees is a killer, and electricity for air conditioning is a lifesaver. Every year, more than a thousand people die of heat.

The Centers for Disease Control and Prevention reports the number of heat-related deaths nationwide. The worst year was 2023, with 2,325 deaths, as measured by death certificate analysis.

But heat-related fatalities are hard to collect. I would wager that the real death toll is much higher.

Liberal politicians will blame the fossil fuel industries — coal, oil and natural gas — for continuing to drive up greenhouse gas emissions in the atmosphere; conservatives will blame regulation and lack of infrastructure building. Local politicians will attack the data centers and the utilities.

President Trump has called global warming a hoax. But “say it ain’t so” doesn’t work when it is too hot for kids to play outside or streets are rivers, and when the flow of food from farm to supermarket is interrupted.

Huge infrastructure projects will be proposed at a time when there is a growing awareness that the budget deficit is out of control and there is no way America will grow out of it on its present tax trajectory.

If my candidate makes it to Congress, he will find it easier to say no to new expenditures than it is to say yes to new taxes.

Nonetheless, effective pipelines will be proposed to move water from water-rich areas to water-starved states. Some of those, like Texas, drunk on its recent Mecca-like effect on business, will have difficulty accepting that people won’t come if there is no water and inadequate electricity.

Heat, not economics, could curtail the North-to-Southwest flow of people, which has been the population realignment in recent years.

How to live with the new weather will definitely be a new priority that politicians will find difficult to address. It doesn’t fit behind a political slogan. It does favor infrastructure repair and enhancement, from boosting the electric grid to planting water-frugal crops to serious concern about where people live and how they pay their electric bill — a matter of keeping cool and staying alive.

But for the political establishment, other issues are forming, each competing with the weather for attention. For a start, there is integrating artificial intelligence into our economy without severe disruption, dealing with a broken healthcare system, and providing care that is beyond the reach of people facing higher prices for other survival services and products, like electricity and water.

Easier to say your opponent is a rascal, the other party is fascist or communist, and to worry about the use of AI on cellphones in classrooms.

We all have the weather to deal with, Democrat or Republican, and it is still an issue for governance.

Women Face Massive Layoffs as AI Use Spreads in the U.S.

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March is Women’s History Month and a time to take a look at how women are progressing, or otherwise.

Alas, the news for women in the United States isn’t good, and the future is foreboding as they are about to lose 6 million jobs to artificial intelligence. Work traditionally done by women — secretaries, receptionists, payroll clerks and customer service representatives — is likely to lose jobs. Except for healthcare, semi-skilled workers are the most vulnerable.

I must confess to a longtime interest in the women’s movement, particularly the path of women in journalism. In 1964, in New York, my first wife, Doreen, a stupendously gifted English journalist, and I created what we liked to believe was the very first women’s liberation magazine. Ms., co-founded by Gloria Steinem, didn’t launch until 1971.

Our magazine was “Women Now,” and we only got out one issue before we ran out of money. As I have said often, “It didn’t liberate any women but liberated all of our money,” which was utterly insufficient for the undertaking. However, I remained interested in the progress of women in society.

When I was at The Washington Post about six years later, I was elected president of the Washington-Baltimore Newspaper Guild. Women’s rights and their path in journalism were on the agenda, propelled as much by our talented business agent, Brian Flores, as by me.

The guild held conferences (including a national one in Chicago), formed study groups, and made the path of women an issue at the bargaining table. The Post’s editor, Ben Bradlee, asked if I was doing this “to improve my love life.” I wasn’t, and it didn’t.

Women could write themselves to glory, but it was a lot harder from the women’s pages or if you weren’t considered for reasons of your sex for a foreign assignment or war coverage. However, I think Marguerite Higgins, Martha Gellhorn and Dorothy Kilgallen were towering talents who circled above their contemporaries, male and female.

In the time I have been watching women’s issues, I have seen great progress and now backsliding.

I have seen progress in the numbers of women editors, film directors, board members and company heads. Yet many women are hired, I believe, because it is possible to pay them less, on the assumption that they will be supported by a partner or husband. The old thinking.

In the 1960s in Britain, jobs were advertised with one salary for men and another, a lower one, for women for the same work. In that sense, things have improved. But women worldwide are still losing ground in abhorrent ways. They encounter gender oppression, including honor killings in Muslim societies, female circumcision in parts of Africa, and femicide in some Caribbean and Latin American countries.

In the democracies, there is a backward movement for women as the bad ways of old are championed as “conservative” or “traditional.” Worse, reproductive rights have been scaled back or denied, and overt efforts to promote equality have been prohibited.

The unwelcome news isn’t at an end: Enter AI.

Several studies, including those by the United Nations and McKinsey & Co., conclude that women will bear the brunt of the first American AI-induced layoffs. This will be felt between now and 2030, and as many as 6 million women may have to find new jobs or quit the job market altogether.

In the years ahead, it is going to be harder for women than men as the first waves of what I call the “AI adjustment” hit the workplace. The political class needs to absorb this reality and to start thinking about the nature of work when AI starts snatching jobs by the millions.

So far, political talk has been to eschew the looming future — a future that, initially at least, threatens women most.

Women’s history is about to have a new chapter written.

Productivity To Surge with AI. Do the Politicians Know?

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There is every chance that the world’s industrial economies may be about to enjoy an incredible surge in productivity, something like the arrival of steam power in the 18th century.

The driver of this will be artificial intelligence. Gradually, it will seep into every aspect of our working and living, pushing up the amount produced by individual workers and leading to general economic growth.

The downside is that jobs will be eliminated, probably mostly, and historically for the first time, white-collar jobs. Put simply, office workers are going to find themselves seeking other work, maybe work that is much more physical, in everything from hospitality to healthcare to the trades.

I have canvassed many super-thinkers on AI, and they believe in unison that its impact will be seminal, game-changing, never to be switched back. Most are excited and see a better, healthier, more prosperous future, justifying the upheaval.

Omar Hatamleh, chief AI officer at the National Aeronautics and Space Administration, and author of two books on AI and a third in preparation, misses no opportunity to emphasize that thinking about AI needs to be exponential not linear. Sadly, linear thinking is what we human beings tend to do. To my mind, Hatamleh is in the vanguard of AI thinkers,

The United States is likely to be the major beneficiary of the early waves of AI adoption and its productivity surge if we don’t try to impede the technology’s evolution with premature regulation or controls.

Economies which are sclerotic, as is much of Europe, can look to AI to get them back into growth, especially the former big drivers of growth in Europe like Germany, France and Britain, all of which are scratching their heads as to how to boost their productivity, and, hence, their prosperity.

The danger in Europe is that they will try to regulate AI prematurely and that their trades unions will resist reform of their job markets. That would leave China and the United States to duke it out for dominance of AI technology and to benefit from its boost to efficiency and productivity, and, for example, to medical research, leading to breakthroughs in longevity.

Some of the early fear of Frankenstein science has abated as early AI is being seamlessly introduced in everything from weather forecasting to wildfire control and customer relations. 

Salesforce, a leading software company that has traditionally focused on customer relations management, explains its role as connecting the dots by “layering in” AI. A visit to its website is enlightening. Salesforce has available or is developing “agents,” which are systems that operate on behalf of its customers.

If you want to know how your industry is likely to be affected, take a look at how much data it generates. If it generates scads of data — weather forecasting, electric utilities, healthcare, retailing and airlines — AI is either already making inroads or brace for its arrival. 

PFor society, the big challenge of AI isn’t going to be just the reshuffling of the workforce, but what is truth? This is not a casual question, and it should be at the forefront of wondering how to develop ways of identifying the origin of AI-generated information — data, pictures and sounds.

One way is watermarking, and it deserves all the support it can get from those who are leading the AI revolution –the big tech giants and the small startups that feed into their technology. It begs for study in the government’s many centers of research, including the Defense Advanced Research Projects Agency and the great national laboratories.

Extraordinarily, as the election bears down on us, there is almost no recognition in the political parties, and the political class as a whole, that we are on the threshold of a revolution. AI is a disruptive technology that holds promise for fabulous medicine, great science and huge productivity gains.

A new epoch is at hand, and it has nothing to do with the political issues of the day.

Please Note: I will be hosting a virtual press briefing, which I have organized for the United States Energy Association, on the impact of AI in the electric utility industry on Wednesday, Oct. 2, at 11 a.m. EDT. It is open to the press and the public.

Here is the registration link: 

https://us02web.zoom.us/webinar/register/WN_BbE_VO1bRo2PuiVl6g8IzQ#/registration

Good Reason to Look at Health Care Anew

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Nothing is ever done until everyone is convinced that it ought to be done, and has been convinced for so long that it is now time to do something else. — F.M. Cornford

There are no simple solutions to complex problems — unless they’ve become so complex that only a simple solution will do. Welcome to health care and insurance in all of their complexity.

Engineers like to say that if a new machine of structure has too many parts, it’s not ready. Not a bad idea to keep in mind when creating a societal structure like health care. One should know where one wants to go; knowing what one doesn’t want isn’t a starting point.

I submit that the goal of health policy, stripped of its advocates, denigrators and rentiers, should be to get everyone insured for the minimum amount of money and best care result. Simple, eh?

Some aspects:

  • There ought to be enough money for the United States to have universal health care, not a patchwork — a crazy quilt with holes and weak seams. We spend 19 percent of our GDP on health care, but Germany and the Netherlands spend just under 12 percent of theirs on hybrid public/private, comprehensive systems.
  • Insurance is a probability game, ergo it’s not unreasonable to ask the able-bodied to pay for the sick.
  • Mandates are not alien to us. We are mandated to pay taxes, drive with licenses and even wear clothes.
  • The more people covered by insurance, the lower the cost to all.
  • There seems to be no good explanation in the public record as to why medicine is so expensive in the United States — so much more expensive than elsewhere on earth, under wildly different systems.
  • The United States is the only country that leans on employers to provide health insurance to employees and to administer the policy and deal with issues that arrive with disputes.
  • The cost of the service patients receive is opaque once a third-party payer is responsible: the insurer. The basis of a hospital charge is hidden from the patients and policymakers. The patient has little idea what a procedure costs and who benefits from the expenditure, including doctors who own imaging companies, testing labs and even operating theaters. At the time of delivery, as Norman Macrae noted in The Economist years ago, neither the doctor nor the patients has an interest in the cost.
  • Hospitals are burdened with emergency rooms that can’t refuse the uninsured and hide this cost by overcharging elsewhere.

For more than 30 years I operated a publishing business and provided health care for my employees. It cost. It cost in time. It cost in premiums. It cost in employee well-being because as the premiums (well before Obamacare) rose by 15 percent to 25 percent, I was forced to shop for providers — which meant, in many cases, new doctors for my employees every year.

After salaries, health care was the big expenditure. I thought I was in the publishing business, but I was also, reluctantly, in the health care business.

I was keen that people have the security that goes with not having to be frightened of getting sick or falling off a bicycle. Some of my employees were on a spouse’s policy as well as mine and didn’t tell me. One man, a printer, said he didn’t like to fill in forms, so he, his wife and three children just told the hospital emergency room that the family had no money. He wanted me to give him what I was paying the insurer so he could spend it.

None of the proposals now before Congress, nor those codified in Obamacare, address the fact that as a nation we backed into health care and created complex set of stakeholders — some of whom should leave the field.

For someone who has wrestled with health care as a provider, as in other things, I believe that if the purpose is not defined, you’ll get the wrong result no matter how hard you try.

The big questions Congress should be asking of the House Republican health care plan, backed by President Donald Trump, are: Will it save money? Will everyone be covered adequately? From my point of view, Congress is proposing to replace a monster with a monstrosity.

That’s no prescription for a healthy nation, free from fear of accident or illness. Time to grab a clean sheet of paper and start again, maybe check on what works around the world, if that isn’t too damaging to our self-esteem.

For InsideSources