What made the GOP debate last night so deadly dull was all the numerical “facts” candidates had memorized and spouted.  Those that weren’t totally false, lacked context (I know they were intended to deceive) but to me they also exposed the candidates as zero knowledge of  the structure and purpose of various governmental programs.  I’ll limit myself to one program, Medicare, and two candidates Paul and Carson.

PAUL: The question always is, what works better, the private marketplace or government? And what distributes goods better? It always seems to be the private marketplace does a better job.
Is there an area for a safety net? Can you have Medicare or Social Security? Yes. But you ought to acknowledge the government doesn’t do a very good job at it.

The main problem with Medicare right now is that the average person pays in taxes over their whole lifetime about $100,000. But the average person takes out about $350,000. We have this enormous mismatch because we have smaller and smaller families.

He’s repeating an article of faith among Republicans and neo-liberal Democrats, mixing some apples and oranges for the anti-abortion base, and also flipping the standard refrain of GOP voters on its head.

And what distributes goods better? It always seems to be the private marketplace does a better job.

Would Dr. Paul please produce the evidence that any health insurance provider has OA&G expenses as low as that for the portion of  Medicare that is exclusively managed by the USG.  He won’t because he can’t because in some areas government can and does operate more efficiently and at lower cost than the US private sector can.

We have this enormous mismatch because we have smaller and smaller families.

See, Medicare would be fine if Americans would only return to breeding like rabbits
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The main problem with Medicare right now is that the average person pays in taxes over their whole lifetime about $100,000. But the average person takes out about $350,000.

The “stand on its head part” is that the public as been led to believe that they have paid for Medicare through their payroll tax.  Hence,  beneficiaries scream, “I paid for it.”  It’s not true.  It was never true and the program was never designed for that to be true.

Workers and their employers pay into an insurance program that covers the hospitalization costs for existing Medicare beneficiaries.  Actuarially,  a little bit more than a “pay-go” tax rate would have required, and that excess for over the past fifty years has resided in the Medicare Part A Trust Fund.  In the past few years, Part A has been running an annual deficit and if this continues will require an adjustment some years from now.

Now I’d also like Mr. Paul to provide evidence of any insurance company for any insured risk that pays out an average of 3.5 dollars to the beneficiary for every dollar collected from the beneficiary.  Can’t be done.  Insurance company’s pure loss ratios over a number of years are less than or near 100%.  (And the ACA health insurers are at 80-85% loss ratios.)

Medicare Parts B-D funds come from general revenues and beneficiary premiums.  The reason for this is that flat taxes, like Medicare payroll taxes, are regressive.  It’s smart public policy to establish programs that everyone has an investment in.  It’s also smart to pay for it based on ability to pay.   It’s not smart politics not to remind the “tax cut” folks that they are asking to reduce funds for Medicare.            
Moving along to the second physician in the GOP clown car —

CARSON: Well, first of all the — the plan gives people the option of — of opting out. But I think they will see a very good option here. You know, the annual Medicare budget is over $600 billion. And there are 48 million people involved — 40 million, 65 and over, and 8 million other.

Divide that out. That comes out to $12,500 for each one. Now, I can tell you there are a lot of private-sector things that you could do with $12,500, which will get you a lot more than you get from this government program.

And that’s really a theme of a lot of the things that I’m talking about. How do we utilize our intellect rather than allowing the government to use its, quote, “intellect,” in order to help us to be able to live healthier and better lives?

We’ve already covered the extremely low administration costs of Medicare, but other than that who the hell does Dr. Carson think is receiving Medicare disbursements?  Approximately  $12,000/year/beneficiary?  Government operated hospitals and clinics, government employed doctors and pharmacists, and government owned drug manufacturers, medical device manufacturers, etc.?  As the vast majority of the US medical providers/suppliers are private, and therefore, collecting most of the $12,000/year/beneficiary, why would they provide more for less if given the whole shebang?  If they’re so smart, why are they charging so much on a per capita basis for US senior citizen health care?  An amount that would bankrupt the universal health care program in any other country with such a program.  (Let’s also not neglect to note that those countries provide care for a senior population that is 15% to over 20% of their total population and not the piddling 13% that exists in the US.)

Is it at all possible that the primary problem with Medicare (and all US health care) is that the private sector demands too much money?  That it can’t do the job as well as government does in the UK or the highly regulated providers/servicers do in other countries?  Oh sure, the medical school cost of physicians, nurses, etc. doesn’t get embedded in the health care costs of UHC countries because the governments pick up that cost, but throwing that into their numbers wouldn’t change the disparity in US per capita health care costs and theirs by much.  (And I doubt that med school in those countries costs anywhere near what it does in the US.)

Phillip Longman in The Best Care Anywhere details how government health care can surpass that of the private sector.  And let’s be fair, the population served by the VA isn’t representative sample of the Medicare or general population.  They have more special medical needs, higher rates of PTSD and other psycological issues, and while in service were exposed to more and more various toxic chemicals than the general population.  It’s not inexpensive, but a portion of the cost should be billed to the Pentagon and included as part of the cost of the dumb wars the US has engaged in since 1963.

Will end with a video of Dr. Alexa Canady telling her story as the first US AA female pediatric neurosurgeon.  Dr. Alexa Canady is worth listening to, unlike Dr. Carson.

Update

Bill Moyers & Company, Mike Lofgren: The GOP and the Rise of Anti-Knowledge

English unfortunately doesn’t have a precise word for the German “Fachidiot,” a narrowly specialized person accomplished in his own field but a blithering idiot outside it. In any case, a surgeon is basically a skilled auto mechanic who is not bothered by the sight of blood and palpitating organs (and an owner of a high-dollar ride like a Porsche knows that a specialized mechanic commands labor rates roughly comparable to a doctor).

How could such a useful word not exist in English? Too many fachidiot dictionary guardians or too many fachidiots among those from which new words emerge and come into usage.