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OCTOBER 17, 2021



Hour 1

"The Public Option Is the Wrong Approach to Healthcare Reform"

Dr. Lee Gross     


Hour 2

"The Real Afghan Tragedy"


Lawrence M. Mead     


About Dr. Lee Gross

Dr. Gross is the President of Docs 4 Patient Care Foundation and Owner of Epiphany Health
The Public Option Is the Wrong Approach to Healthcare Reform

July 28, 2021

Several leading members of Congress are preparing hearings to promote a “public option”— a government insurance program that would in time replace private insurance. As a doctor, I share the urgency to reform healthcare, but, in my experience, the public option is the wrong approach. Centralized bureaucracy, like the public option, is too costly, slow, and restrictive to keep pace with medicine and serve patients well. Instead, we must modernize our healthcare system by reforming outdated rules and red tape that come between patients and doctors. 

This debate comes at a time of incredible possibilities for the future of medicine. New treatments and technologies are rapidly developing that can revolutionize care—from innovative surgery practices that 
reduce costs by 70%–90% with excellent outcomes to simple blood tests that detect cancer very early while still treatable. 

Too often, however, advances are delayed and kept out of patients’ reach by America’s bureaucratic and expensive healthcare system. Rather than fixing these problems, a new government insurance program would compound them.  

Public option proponents claim it would simply give anyone the choice to opt-in to a government-run insurer. But the costs would not be optional: The public option would cost $800 billion in its first 10 years and 
require middle-class households to pay over $4,000 in new taxes annually. 

It would be understandable to spend more if everyone got access to quality care, but the public option would fail to realize that goal.

The public option would adopt the payment formulas used by Medicare and Medicaid. Given the financial strain already facing these programs, Medicare and Medicaid reimburse healthcare providers at low rates. Medicare pays providers about 40% less than private insurance, which can make it difficult for enrollees to find doctors willing or able to participate in the system—one reason 
more seniors are turning to private-sector Medicare Advantage plans. Medicaid reimburses even less, and one-third of providers do not accept it. 

By adopting these payment methods, the public option would likewise leave its enrollees with restricted access to care as many doctors and medical providers would decline its coverage. 
One in five rural hospitals were already in financial distress prior to COVID-19. Providers like these would struggle to cover losses of accepting public option patients if reimbursed at low rates.   

The public option would also restrict the services and technologies are covered. Medicaid is nearly 
four times more likely to deny an insurance claim than private insurance. Medicare is slow to cover new technologies—for instance, taking a decade longer than private insurance to cover disposable insulin pumps. And, given the public option would likely pay low reimbursement rates, some healthcare providers would cover losses by raising prices for people with private insurance causing higher premiums. 

Making matters worse, taxpayer subsidies would make the public option artificially cheap, while its payment formula would inflate private insurance costs. Rising costs would then drive private insurance plans out of the market. One study found the public option would leave 
14 states without any private insurance plans after a decade

America needs better healthcare reforms—easing costly bureaucracy, rather than masking costs with subsidies and new layers of red tape. While big proposals like the public option grab headlines, healthcare is undermined by a thicket of little-known but hugely consequential barriers. Policymakers should focus on modernizing these outdated rules, giving doctors and patients flexibility and easier access to affordable care. 

For example, America should build upon successful temporary reforms necessitated by COVID-19. For one, policymakers eased telehealth restrictions, such as allowing all Medicare beneficiaries to use this service. Studies have found 
38% of medical visits can be conducted via telehealth, like many mental health services or consultations about drug interactions. Telehealth sessions cost $50 on average compared to $176 for in-person meetings.

Similarly, during COVID-19, states waived Certificate-of-Need (CON) laws that require providers to get government permission to expand facilities or add equipment like MRIs—even for services shown to be safe. Since the approval process is slow, waiving CON laws 
saved 100 lives for every 100,000 residents by allowing providers to adapt quickly. Both CON law and telehealth reforms should be made permanent. 

Policymakers should lift restrictions on Health Savings Accounts to help people pay for care.  Doing so would allow people set aside tax-free income for healthcare costs. Today only one in ten Americans are allowed to open an HSA, if they have certain high deductible plans. Instead, any person who wants an HSA should be allowed to have one. HSAs can reduce out-of-pocket medical expenses by up to 40% and encourage price transparency among providers.

There are numerous other reforms that provide patients with more choices and control over their healthcare. From modernizing the FDA to allow more drug imports from countries with regulatory processes we trust, to making it easier for qualified doctors to practice across state lines, reforms like these enjoy broad support. A recent poll found 
69% of Americans prefer reforms like HSAs—that give doctors and patients more flexibility and do not require tax increases—compared to the public option.

As Congress debates the future of healthcare, they should reject the bureaucratic approach of the past and instead lift barriers that keep prices high and come between patients and doctors.


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"The Real Afghan Tragedy"

Lawrence M. Mead         

About Lawrence:

Lawrence M. Mead is Professor of Politics at New York University and the author of "Burdens of Freedom: Cultural Difference and American Power". He’s also host of the "Poverty and Culture” podcast.

The Real Afghan Tragedy                                            

September 23, 2021                  

The greatest tragedy of Afghanistan is not that the United States was defeated but that the Afghan government collapsed.  America will recover from this retreat from empire, but “failed states” are a much more serious problem.  Regimes are crumbling in much of the Middle East, Central America, and Africa.  Afghanistan is only the most extreme case.  Government failure has triggered the waves of immigrants now beating upon the West.

Experts and commentators tend to blame state failure too simply on obvious misrule.  Supposedly, governments fail because despots or oligarchs serve only themselves.  So they should allow political rights and hold elections.  But in these countries, there is often no middle between misrule and mayhem.  As Iraq and the Arab Spring showed, allowing open politics may just sap whatever authority a regime has, producing only chaos.  Changing rulers or holding elections usually changes little.

The deeper problem is cultural.  With few exceptions, only Western countries have made free government work.  That is because only they combine individual rights with equally strong commitments to the rule of law and government by consent.  This combination empowers regimes to rule while also keeping them honest and accountable.  The West thus reconciles freedom with order, as very few other societies have managed.

In the non-West, cultures are generally more passive, less individualist, and strongly deferential to authority.  Morals are less principled, more dependent on what one’s own associates expect.  So the civic culture is far weaker.  Corruption becomes accepted, thus weakening public authority, until officials can no longer command their territories.  Governments may appear to resist all challenge, but they are actually far weaker than the freer, more civic regimes of Europe or America.

The Taliban might seem more formidable than the Afghan regime it toppled.  But they too will probably govern more in form than substance.  For in the non-West, all authority structures, including Islam, remain largely external to the people and thus insecure.  Only in the West have public norms migrated from outside to inside the self.  Only this generates the moralism of our culture—strong insistence that government “do the right thing” and resistance to corruption and misrule.

Thus, despite its dedication to freedom, American government is the strongest the world has ever seen.  Washington has the resources and legitimacy to project power far beyond itself.  The huge Air Force transports that carried out the recent airlifts from Kabul are symbols of that power.  The hapless Afghans running beside the planes, struggling to get on board, reflect a powerless society that failed to advance even after two decades of American intervention.

Of course, many people in poor countries believe in freedom.  Many have been educated in the West, where they learned American values.  They want the United States to promote democracy in their countries.  Afghan women, particularly, fear losing the rights they gained from two decades of the American presence.  But these elites are typically isolated.  The rest of their societies is far less willing to challenge the authorities.  Political activists typically must look for support far more among foreign observers and journalists than among their own people.  Democracy must wait until local cultures become more moralistic themselves.

After World War II, the European empires were dismantled, and it was naively assumed that the “new nations” would steadily converge on Western models of good government.  But most have not.  From the moment the Europeans left, governmental quality in most of these countries declined.  Now millions of their citizens are risking their lives to escape to the West.  Not poverty or inequality but government failure is the greatest tragedy of the non-Western world.

Western efforts to promote democracy abroad have mostly failed.  Our policymakers have simply ignored the cultural preconditions of freedom.  Today the West must promote civility, not in its former colonies but at home, among the Third World migrants who are now crowding into “lifeboat America” and Europe.  Runaway immigration could well overwhelm the individualist culture that generated Western wealth and power in the first place.  Through migration, the non-West might finally defeat its past conquerors.  That is far more to be feared than the fall of Kabul.


Our guests today comes to us from:

Stephen Manfredi

Manfredi Strategy Group, LLC

1478 Kirby Road, Suite 1000

McLean, Virginia  22101

202.222.8028 mobile