Matthew Holt

By the numbers, on single payer the Democrats are wussies

Matthew HoltNow before I explain why I say the Democrats are girlie-men, let me say three quick things.

1. I am not a supporter of Medicare-for-all, or Canadian style, single-payer (or anything primarily based on fee-for-service payment) although they are both clearly superior to the American status quo. (I am in favor of real universal insurance, but that’s different and less limited than just single payer).

2. It’s still only 50–50 that we’ll get any reform this year, and what we will get will basically be an expansion of one of the worst-designed government programs—Medicaid—mixed with some very modest regulation of the worst behavior of the private insurance companies. And with the exemptions to the individual mandate and for small business at best we’ll get to around 95% coverage—and that’s not counting the undocumented immigrants, who are about another 3–5% of the population and who will still get care and thus still have to be paid for somehow. And the likely Kennedy/Baucus compromise plan has no sustainable insurance payment structure that I can see.

3. The data is a little murky and all sides kinda cheat with polling data (and bankruptcy data too).

But imagine for a moment that Dick Cheney & George W. Bush had 60 votes in the Senate, a disgraced  opposition, and carte blanche to do what they liked because of a real national crisis (In other words a much better political situation than they faced in 2001 & 2003).

And imagine that there was a policy that their party’s supporters overwhelmingly favored.  Do you think for a moment that they’d be looking for compromise even if what they were doing was egregiously and clearly wrong in both terms of public policy and fairness? For instance, cutting tax rates on dividends to less than half what poor suckers who work for a living have to pay, even though the benefits went largely to millionaires and billionaires. Or even worse eliminating estate taxes, when the benefits went only to millionaires and billionaires.

Actually we don’t have to imagine. We know what Cheney/Bush did. They passed the legislation they wanted, and damn the rest of us. And then did it with way less political clout than Obama has—Bush didn’t even win the election after all in the way most of us understand (err…by getting more votes than the other guy).

Now imagine that there’s a policy that polls show at least 35% and (depending who you believe) perhaps up to 60% of all Americans want, and that the same polls show that a vast majority of Democrats want it. And of course Obama’s political situation is way stronger than the Cheney Administration’s was.

In that situation and if they had a different political philosophy, wouldn’t the Cheney Administration just ram through single payer?

So by the numbers, in not even considering the single payer option (not even Kennedy’s plan comes close), the Democrats are proving themselves to be wussies.

CODA: I changed one letter in one word of this piece so that the humorless crowd in the comments didn’t detract from the real offensive stuff going on here–50 million un and under-insured with no political will to do anything serious about it. But if the comments don’t make sense, my original defense is in there too.

Categories: Matthew Holt

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33 replies »

  1. We elected President Obama to get us universal health care and it has to be now while we have full control. We have to move fast because we may never have this chance again. All we need is the government option right now to get us eventually to the single-payer system, which is the best way to get the payments down to what the country can afford.

  2. Unfortunately we will probably not get a single payer health care system because most of our politicians and powers that be have been bought and paid for with donations, political contributions and lobbyist money by the insurance companies and anyone else that does not want single payer health care.

  3. If foresee explosive opportunities for gold-plated concierge care. Imagine gleaming private hospitals and clinics, staffed by the very best physicians and bristling with the newest medical technology. Sorry, only the wealthiest will be allowed to enter, because these health care palaces won’t accept government reimbursement.
    Who will enjoy this platinum card style care? How about high-end professionals, wealthy entrepreneurs, and pretty much anyone else with wads of dough. As for the poor schlubs who currently enjoy access to top quality medical care (ie, most of America), they’ll be consigned to urine-drenched waiting rooms, Dickensian hospitals, and an attention to care and customer service which would make only the Soviets proud.
    I hope all you out there who read this blog have put a bit of money aside for future medical needs, because if you don’t have cash (or a super fancy job title), you’re going to be screwed. SCREWED.

  4. Back to the issue of the current politics of healthcare legislation and why any attempt at reform that is beneficial to the ultimate payer – the patient as tax-payer or employee or direct-payer – never goes anywhere, below is a link to an article from the NYTimes.
    Apparently President Obama just read the recent essay by Dr. Atul Gawande about medical service spending in McAllin Texas (with comparisons to the delivery “model” and spending patterns at the Mayo Clinic and in Grand Junction Colorado).

  5. I’m guessing the plural of wuss would be wusses. Or you could just say wimps. That’s not too hard to spell.
    Does this mean I’m the second woman to comment on this post?
    Matthew, if I didn’t know you personally, I would think you are the biggest pig. If you use the p-word publicly again, I will likely smack you upside the head next time I see you on behalf of all of the offended women in the world.
    To avoid confusion, this is how I am defining the term (thank you urban dictionary):
    smack upside the head – to extend your arm so that your hand is below the back of a person’s head and thrust your hand upwards so that your palm hits them square in the back of the head

  6. Sigh… so sad to see Matt has missed out on the opportunity to explain away that what he *really* meant for the potentially offensive term “pussy” was that it was being deployed as an abbreviated form of the word “pusillanimous”. Thesaurus FAIL.

  7. your in trouble I just finalized plans for an intense breeding program, utilizing the latest in Octuples IVF and generous social saftey nets I’m pretty sure I can “conceive” 80-100 conservates a year, 18 years from now lets see you counteract that

  8. if youi believe strongly in Democracy then why did you not choose to live in one? We are a Republic, always have been, and if we hope to survive always will be. You might not like it but I would hope you atleast know what one is and when we have an election based upon our republic style of government and one party wins based upon the rules of an election for a republic you don’t snipe and claim the person didn’t really win becuase they loss under the terms of a democratic election. If we where voting in a democratic election then the results of popular vote would matter, we were not, and thus they do not. The left’s still bemoaning this fact all these years later is past old. Granted as a party you do love changing the rules post election but the ship has sailed, let it go.
    It was amusing to see the chickens come home to roost, when you build a coalition based on hatred of another group of peoiple this sort of political infighting is bound to happen. As a liberal you have lost half your vocabulary if your going to try and not offend members of your party. Being able to speak freely is enough of a reason to be conservative by its self.

  9. “Meaning” is in the eye of the beholder. So if you mean “weak, timid or unmanly,” why not use one or all of these words to make your point? You do yourself and the point you are trying to make an injustice by using words others find offensive or rude. And it doesn’t take innuendo or vulgarity to convey humor.
    Isn’t it striking that only one woman has posted comments to this blog — and it was to express outrage at the choice of words? This may be a first!

  10. I am not being offensive to women, cats or anyone other than Democrats
    Here is the definition from American heritage dictionary
    puss·y 1 (ps)
    n. pl. puss·ies
    1. Informal A cat.
    2. Botany A fuzzy catkin, especially of the pussy willow.
    3. Vulgar Slang
    a. The vulva.
    b. Sexual intercourse with a woman.
    4. Offensive Slang Used as a disparaging term for a woman.
    5. Slang A man regarded as weak, timid, or unmanly.
    I am clearly using this as #5 not #1, 2, 3 or #4.
    So I am saying that the Democrats are being weak or timid or unmanly, which they are.
    And I hope that pugnacious (as Wendell describes me as being) = fun, or at least engaging enough to keep reading. But I can tell you that this is nothing as offensive as there being 50 million uninsured Americans…

  11. Francis and Wendell,
    Sorry you guys don’t get it. I don’t care how brilliant the commentary. There’s no excuse for bad manners or bigotry.
    If you have something worth saying why not say it in language that does not offend or demean people in your audience? Then maybe they’ll all listen.

  12. Funny how we put so much attention on semantics, as with the word “pussies”, that we don’t even comment on the content of the blog. I agree with Wendell Murray that this is the voice that is consistent, not just with Matthew’s style, but his bold personality as well. If such words are really so offensive, then maybe we can use words like, “dick-head” and “asshole” and only potentially offend the other half of the population, assuming that part of the population even gives a “shit” in the first place.

  13. Good article in the NYTimes magazine on the mechanics of how healthcare policy is being handled between the Administration and Congress. Illustrates to me at least how substantive issues involved are essentially ignored. Not surprising I guess, but certainly disappointing. Inauspicious for any materially positive change to how the healthcare system operates, aside from expanded insurance coverage.
    Regarding Mr. Holt’s use of words, I do not use either the term “pussy” or “girlie-man” – there are certainly alternatives that sound better – but they seem consistent with his writing style and content which strike me as more pugnacious than the average. On the hand, I have so far found his opinions always worth considering regardless of tone or choice of words.

  14. Thank you Merle B. for your comment.
    Matthew, your misogynist and sexist terms are insulting. Your use of the words “pussies” and “girlie-men” devalues and disrespects 52% of the population; probably quite a few men are offended by your terms as well.
    I hope that you will dispense with this old boys club mentality, where men chuckle, jeer at, disrespect, and degrade women. Treat everyone with respect.

    ** 2.6 Million New Jobs,
    ** $317 Billion in Business Revenue,
    ** $100 Billion in Wages, and
    ** $44 Billion New Tax Revenues
    The press release is here:
    Here’s the study:
    Here is a clear definition of Single Payer healthcare:
    Single payer health insurance is a system by which the health care expenditures of an entire population are paid for through one source. 

    Distinctly different from socialized medicine (where the government owns and operates health care facilities) a “single payer system” is simply a financing mechanism.The government collects and allocates money for health care but has little to no involvement in the actual delivery of services. Care is provided privately at hospitals and clinics but paid for publicly. (From:
    It’s clear that single-payer is the solution, not only in terms of providing quality care for all, but also economically!

  16. 1. SEE the table comparing health and healthcare in the US with other countries here (you’ll be surprised):
    2. SEE the post: “Setting the record straight on Canadian healthcare”
    I lived in Canada for about 28 years.
    “I can’t begin to list how much better everything is in Canada compared to the health care disaster we all suffer from south of the border. Cradle to grave, there is never any question about whether they will do everything they can to treat you in a reasonable amount of time. . . .
    I could walk in to my primary care physician any time he was open. . . .
    My primary would even do house calls if you or your kid were too sick to make it in. . .
    If you had something so severe as to need more than what your typical primary could provide? Walk into the emergency room (or take the ambulance – they don’t ask if you have insurance first because that would be inhumane). . . “
    Read the rest here:
    3. JOIN the movement for Single Payer Healthcare Reform – EVERYBODY IN; NOBODY OUT.
    Find out more at these sites:;jsessionid=GKAARF0RSE0FWCQQPABCFEY

  17. Matthew, maybe I’m not cool enough but your language offends me, a man. I can’t imagine how the female readers of this blog feel about your choice of words!

  18. I agree with Mr. Holt that this is a case where Cheney-style dictatorship may be necessary to enact legislation that has at least some semblance to rationality.
    If the general public had some awareness of the facts about how the USA healthcare system works, even Republican politicians would push reform along the lines of single payer/insurer, but alas…
    I agree with the comments regarding Dr. Gawande’s article in The New Yorker: excellent and illustrative. I have been reading The Innovator’s Prescription by Clayton Christensen and two physician co-authors, an outstanding addition to many other excellent books on policy. The book uses the analytical framework that Prof. Christensen has outlined in other books and applied to sundry other industries. His perspective is unique and remarkably enlightening to my mind at least.
    Unfortunately, as anyone who takes the issue of healthcare system reform seriously, reality is what Mr. Holt notes – entirely in the never-never-land of Congressional politics where facts, analysis, etc. do not exist.
    I suspect Mr. Holt’s prediction of what will be enacted is accurate: worse rather than better than the current mess. The Medicaid comparison is accurate, I think. The effect of likely legislation will be to theoretically provide access to and financing for medical services to most USA citizens, if not residents, but it will continue the tiering of quality of services, i.e. the bulk of demand (those with chronic ill-health or severe, expensive acute conditions not to mention lower incomes) pushed onto too few physicians and public facilities and administered in the worst bureaucratic way – in any publicly-financed plan. All those with higher incomes and/or better health stay in private plans, which will continue to shift more and more costs onto the patient. No features that will reduce increases in costs much less reduce costs.

  19. The public is confused, and polling results depend very much on how exactly the medicare question is phrased. As long as there is no solid public pressure favoring SP, it is not going to happen, given the very solid lobby pressure.
    But I’d join interpreter and recommend Gawande’s article, or Maggie Mahar’s book. Just covering everyone in a fee for service system won’t do the trick. Almost all people commenting on this blog nuderstand that – the libertarian fellows want to do it with HSA, the progressive camp with various strategies. If I was in Obama shoes, I would hammer the point: cost control, effectiveness over and over and over, because otherwise, no system is going to work if we keep on doing the costly nonsense we are doing now (sure, SP could save us maybe 10-20%, but the rate of growth would be unchanges).
    And yes, the dems are pussies, not only with regards to healthcare.

  20. I’m afraid they’re right. It’s not party against party. It’s the insurance/drug industries and a symbiotic incestuous relationship with the whole damn US Congress. They got ’em all by the family jewels.
    They say money is the oxygen of politics. If health-care reform is done right one side effect should be less expensive elections because a lot of oxygen will be sucked out of the current system.

  21. As we’ve seen in Massachusetts, an overwhelmingly Democratic state, neither party appears to be interested in actually reforming anything. Time for viable third party candidates to start appearing…

  22. I couldn’t agree more. The Democrats aren’t interested in making a single-payer system a reality — let alone a truly universal health care system. They’re trying to make the insurance companies happy while throwing a few slops to working people.

  23. Not pussies, Matthew. Politicians that would sell even their first born for the right price. Big difference. Republicans haven’t cornered the market on sleaziness, you know.

  24. Matt did you really not know about the electoral college till after the election? They didn’t teach that in citizenship classes?

  25. Neither the republicans nor the democrats get it. Remedial reading for all interested is the Gawanda Report in the June 3 New Yorker, also featured on Wachter’s World Blog. Until there is an understanding of how the government caused this health care debacle with ludicrous and inferior policies over the 3 decades, health care will remain an embarrassment.

  26. “I am not a supporter of Medicare-for-all, or Canadian style, single-payer (or anything primarily based on fee-for-service payment) although they are both clearly superior to the American status quo.”
    Gee .. all the USA would have to do, to become Canada, is evict tens of millions of foreigners (legal and ILLEGAL) and refuse to pay a fair share of developing blockbuster pharms and new med-surg techniques. And refuse to erect a nuclear umbrella.
    Yup, becoming weak and submissive would do the job.