Speaker 1: It's great to welcome back to the program, Thom Hartmann, who is, of course,
host of the Thom Hartmann program, author of the Hidden History series.
The latest installment is The Hidden History of American Health Care Why Sickness Bankrupts
You and Makes Others Insanely Rich.
Great to have you back on, Tom.
Speaker 4: Thank you, David.
It's great to be here.
Speaker 1: So I've talked about this a little bit before.
Wendell Potter has written about this particular thing.
I'm going to ask you about Ouvea Rhinehart in his his last book wrote about it.
There was a point in time in the U.S. in the early 20th century where it was sort of looking
like we may be going in the direction of, if not a straight out single payer system,
something much more like what Germany and some other European countries have.
And that was short circuited.
And there are important political and historical stories to be told about that topic that maybe
as our entry point, what happened during that time that derailed that path for the United
States?
Speaker 4: Which are you talking about?
Teddy Roosevelt?
Nineteen.
Speaker 1: Twelve, right.
That I should clarify, because there's more than one or so Roosevelt in 12 and the period
between World War One and World War Two was relevant.
I mean, feel free to to jump in wherever makes sense to start the story.
Speaker 4: Yeah.
Well, you know, we've had multiple American presidents suggest this and and it has and
it's not like we didn't have a role model.
I mean, Germany got this an eighteen eighty four and it was tomorrow von Bismarck, who
is no flaming liberal.
He saw it as a way of strengthening Germany and been building an industrial policy and
mollifying the masses that, you know, for for a whole bunch of his own reasons that
were ultimately good for the country as well.
And and we've had a number of politicians who have tried to bring it about the thing
that blew it up back then, which is quite different from what's blowing it up right
now or somewhat different, was Frederic Hoffman and and the Prudential Insurance Company and
and or what was then the Prudential Insurance Company.
And and there's this whole program called Scientific Racism that even President Woodrow
Wilson, the Democrat, had bought into, as well as pretty much everybody else.
And that really started in the 17 nineties when Hoffman came over here from Germany.
He was a young man, married a southern belle down in Georgia.
He was an absolute genius with numbers.
He was the guy who working for for Prudentially, worked his way up to vice president.
He was the guy who figured out that there was an association between lugg lung cancer
and mesothelioma between smoking and and lung cancer, excuse me, between asbestos and metal.
Velia and he wrote a book about the association between processed food, diet and cancer, which
is still in print.
So he was a big deal at the time and he did the math on mortality and morbidity for white
versus black people and came to the conclusion influenced heavily by his wife.
And the environment in Georgia where he was living, came to the conclusion that black
people were so genetically inferior that if we simply denied them health care for a couple
of generations, it would, quote, solve the race problem in America because they would
all die out.
And he is plugged into a program that he had helped start called Scientific Racism, which
then led to eugenics in the 1920s that Hitler picked up in the nineteen thirties.
And that idea that if we simply deny health care to black people for a couple of generations,
it will cause them all to die out.
Or many of them, most of them not only animated the anti health care movement throughout the
early 20th century, it's the reason that Southern senators, the Democrats at the time the Dixiecrats
fought to have a 20 percent hole in Medicare in the 1960s because they felt that that would
make it very, very difficult for black people to get any kind of health health care that
they didn't want them showing up in white hospitals or white doctors offices, even if
they were over sixty five.
And that was that was the shtick.
I'm not sure if there's a specific other incident that you're thinking of that you'd like to.
Speaker 1: That's a lot of the one other is and I think it's it's Wendell Potter who wrote
about this specific element, which was that between World War One and World War Two, there
was a sort of renewed push for going in the direction of a single payer system in the
U.S. but but sort of for political posturing reasons, it felt and sounded to German at
a time when that was politically inconvenient and that that also created a roadblock at
another time where there was some momentum building.
Speaker 4: Well, for.
Kaufman actually wrote a series of pamphlets about that and gave numerous speeches saying,
I'm from Germany and he was a rabid anti-communist.
By that time I'm from Germany.
And this program that Bismarck started is really communism in disguise.
And you don't want this.
And I mean, he he became the principal spy.
He died in nineteen forty six.
He became the principal spokesperson throughout that period, basically from 1985 to 1940.
Nineteen forty five against a national health care policy is a principle argument was the
racial argument.
He also had the chops, the cred to say I'm a German, I was born in Germany, I lived under
that system sucks and you don't want it.
So those two things combined, you know, and there were obviously a lot of other people
who were echoing what he was saying.
Speaker 1: When you think about the situation now that we have with health care in the United
States, in terms of it as a for profit system, in terms of a system that that is contained
within states, do you have a sense that the most radical change to use that term?
Not pejoratively, but but but the most drastic change is likely to come from within individual
states that want to try different things?
Or do you believe that the most radical change is likely to come from the federal level down?
Speaker 4: I'm guessing it's going to happen from the states for two reasons.
One, because that's how it happened in Canada.
And and we're very culturally and politically similar to Canada and Saskatchewan.
Got this in the nineteen sixties, and then other provinces around them said, well that
really works well and it saves money, let's do that.
And it spread across the country.
And eventually the federal government got into the act and said, OK, we will backstop
you guys and offer some standards.
But every every province in Canada has their own different Medicare system that does cover
all of their people.
But some, you know, covered dental and some don't.
I mean, there's there's subtle differences between provinces we have in the United States
or both California and Vermont that have passed legislation turning their states in a single
payer states.
The problem that we have in the United States is one that I never really was able to find
out if this was put into law in order to prevent single payer or if it's just, you know, how
the clumsy aspect of how the laws were written.
But one of my best friends was the the head of health, education, welfare in Vermont when
the when Vermont decided to go single payer and they got the legislature to pass it, the
governor to sign it and everything.
And he was tasked with putting it together.
And what he found was that the federal law says that Medicare can go Medicare payments
can go through the Medicare system directly to Medicare recipients and Medicaid can go
through the state.
But it has to go to Medicaid recipients, but it has to go through a system that's basically
called Medicaid or the state version of it.
Different states, particularly for children, have their own little branded versions.
But there's very clear there's very clear definitions of how that money has to flow,
probably largely to prevent fraud or states making off with it.
But what it does what that means is that if Vermont was to go single payer, Vermont would
have to pick up the responsibility for all the people in the state over sixty five and
for all the low income people.
And there would be no federal funds available to them for that.
And so billions of dollars every year that come into the state would cease to come into
the state.
And all it takes to fix this so that our states can do single payer.
And like I said, we got two that are are primed and ready to go is a very small tweak in federal
law that blows the provides a waiver basically to Medicare and Medicaid to be able to provide
that money instead of to the recipients directly to the state with some oversight.
And that law, that change in law has been proposed in a number of times.
It's I believe it might have passed the House the last time around.
But that's that's the sticking point right now.
Speaker 1: Sometimes I'll hear different versions of the following argument as to why a system
that works in a country with five million people would not work in a country of three
hundred and thirty million people.
And it's some version of and I'm sure you've heard this because the United States has so
many more people or so much more diversity in the types of people.
You can't expect something that works in Norway to work in the United States now from like
a purely actuarial perspective in general, the bigger your risk.
All the more predictable your expenses are going to be, so mathematically, I don't really
understand that that argument.
What are the reasons why that's not a very good argument against such a system in the
United States?
Speaker 4: Well, let me boil that argument down for you, David.
It's essentially the same argument that John Stennis was made to southern Democrats were
making in the 1960s about why we need to have a 20 percent hole in Medicaid.
And basically what it is, is Norway doesn't have a lot of black people.
Speaker 1: That's what they mean by different types of people.
Speaker 4: That's exactly what they mean.
Yeah.
Speaker 1: Wow.
And is there I mean, this has been looked at is in general, is it right to say that
a much bigger risk pool overall makes for more predictable
Speaker 4: larger country, the more efficient and effective the single payer system would
be?
And I mean, the countries that have done it so far and done it well, Germany, I think
has what?
Fifty three million people France's is in the neighborhood of 40 is.
I mean, it's been a long time high school geography.
Yeah.
But, you know, the UK is I don't even I don't even want to guess what the UK is.
But, you know, none of these countries are 350 million people, but the entire European
Union is eight hundred and fifty million people.
And to the best of my knowledge, every country in the European Union has some form of a national
health care system.
The one exception being Switzerland, which mandates everyone to buy insurance, requires
the health insurance companies to be not for profits and the hospitals and and will pay
your insurance for you if you can't afford it.
So it's functionally the same thing, but their system is a little more of a kluge.
And as a result, they are they have the second most expensive system in the in the developed
world behind us.
But it's still not even close to us.
It's it's we're way up here in terms of what we pay and then Switzerland and then all the
other countries down here.
Speaker 1: Yeah.
On that note, you know, sometimes I will tell my audience about how you different countries
in Europe have different systems.
And for example, Germany system is not it's not what Medicare what we imagine Medicare
for all would be.
There's a combination and sometimes people are combining what the government offers with
some nonprofit supplemental.
France has a different system as well.
Are you?
I'm sort of agnostic in terms of exactly how it's set up if we get to universality and
affordability for everybody.
Do you think that it's a good thing to be open to looking at the different ways in which
different European and actually Singapore has a different system as well?
That's probably worth looking at as well?
Or do you think that it really has to be Medicare for all as envisioned by a contingent of those
in the Democratic Party?
Speaker 4: If you want to look at a country where it really works the best in the world
and there's no no debate about this, look at Taiwan, OK?
Taiwan has a pure single payer system.
And because of that, they have a national medical database.
And because of that, they were on January twenty first, the day after we got our first
covid case a year, a year ago, January, they got their first the day after they got their
first covid case and they were able to use that system to do contact tracing and testing
and kept their death rate for the entire year of covered.
The first year of covid kept it below two hundred people while Donald Trump lets five
hundred thousand Americans die.
That's that's a system that works really well.
I lived in Germany in the nineteen eighties when their health care system was still largely
ninety nine percent, really just a single payer system.
What happened and the reason why you're seeing all this so-called diversity, David, is that
in the eighties there was this major project launched.
It really was launched in nineteen seventy eight by Margaret Thatcher in the UK and but
by the 80s it had become a whole new governing paradigm that is sometimes referred to as
neo liberalism.
And its core tenet is that government can't do anything right.
As Reagan said in nineteen eighty eight January 20th of eighty one when he was inaugurated,
government is not the problem.
Government is the cause of the problems, not the solution to the problem.
And so as country after country adopted what are called neo liberal reforms, and as the
EU began to incorporate neo liberal policies into their charter, they required countries,
for example, not exceed three percent of debt in GDP, debt of three percent of debt relative
to GDP.
In any given year, et cetera, you know, the stuff that just brought Greece to its knees
during the crash in 2009, as that happened, more and more countries started.
You know, one of the biggest pieces of neoliberalism, of course, is privatizing government functions
on the assumption government can't do anything right.
It's why more than half of our power and water in the cities is not provided by for profit
companies, which is also why, you know, California burned and maybe three people died in the
Paradise Fire, which PG&E was convicted of.
And why the high tension lines down south going to New Orleans never got buried because
they had to pay their stockholders.
But anyhow, that that neoliberal infection was caught by a number of European countries,
most notably France and Germany and the U.K., I think to a large part succeeded in pushing
it away, which is kind of ironic because so much of this started with Maggie Thatcher.
But that's what you're looking at.
You're looking at experiments in bringing more and more so-called free market stuff
into health care.
And many of them are just not working well at all.
Speaker 1: Yes, that is an understatement, to say the least.
We've been talking about Tom Hartmans latest book, The Hidden History of American Health
Care Why Sickness Bankrupts You and Makes Others Insanely Rich.
Tom, I really appreciate you being on.
Of course, there's this whole other side of the book about the medical bankruptcy and
the profitability, which we should we should take up at another opportunity.
But I really appreciate you being on.
Speaker 4: Thank you, David.
Thanks so much for having me.