Je Vous Dis, Merde! 40: Successful Cognitive Debiasing in the US Healthcare Debate

On Wednesday 13 September 2017, Bernie Sanders introduced the Medicare For All act in the US Senate, with 15 co-sponsors.

The same day, he combined this with a cogently-argued, but also passionately-presented, op-ed piece published in The New York Times, “Why We Need Medicare For All.”

Like many, many others, I have also argued for Medicare For All, aka Universal Free Healthcare— in “Liberation From Fear in The Age of Trump 3: Healthcare Hell,” back in December 2016, in the immediate wake of the election of So-Called POTUS Donald Trump.

The basic arguments for Medicare For All are now all fully visible on the table of public debate, so I won’t repeat them here.

What I’m going to focus on is something more subtle, and, as it were, hiding under the table of public debate, where the little orange gremlins with big teeth and night-sticks live (see below), namely, the need for some serious and successful cognitive debiasing if the Medicare For All act is ever to be accepted and adopted by the American people.

Sanders stated nothing more than the unvarnished truth when he wrote this in his op-ed piece:

Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal.

But what he neglected to point out, are the two following equally unvarnished truths:

(i) It is a well-confirmed empirical fact that the American people are widely subject to the malign influences of propaganda and mind-control, as, for example, Brendan Nyhan and Jason Reifler have shown in “When Corrections Fail: The Persistence of Political Misperceptions,” and then Stephan Lewandowsky and his co-researchers have further elaborated and reconfirmed in “Misinformation and Its Correction: Continued Influence and Successful Debiasing”

(ii) It is a well-confirmed empirical fact that the primary source of propaganda and mind-control in the USA is the corporate-controlled mass media, as Edward Herman and Noam Chomsky have shown in Manufacturing Consent.

All that being so, then how can we, as woke progressives, working under the table of public debate where the big-teethed, night-stick-armed little orange gremlins live, rationally engage in successful cognitive debiasing, in order to undermine and reverse the malign influences of propaganda and mind-control by corporate-controlled mass media, as they try to seduce ordinary Americans into believing that what is self-evidently in their very, very best interest — Medicare For All — is in fact very, very bad for them?

Well, here is a simple summary, in graphic format, of general procedures for successful cognitive debiasing, borrowed from “Misinformation and Its Correction: Continued Influence and Successful Debiasing”:

OK. How can we apply these procedures specifically to the upcoming national debate about Medicare For All?

I have two basic proposals.

First, in view of the “continued influence effect” and the “familiarity backfire effect,” we can calmly and repeatedly present the following facts:

United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990.[5][6] Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of obesity, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, and homicides. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country, though notably Americans aged 75 live longer than those who reach that age in other developed nations.[7] A 2014 survey of the healthcare systems of 11 developed countries found the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity.[8]

Gallup recorded that the uninsured rate among U.S. adults was 11.9% for the first quarter of 2015, continuing the decline of the uninsured rate outset by the Affordable Care Act.[15] A 2004 Institute of Medicine (IOM) report said: “The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.” A 2004 OECD report said: “With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990.” Recent evidence demonstrates that lack of health insurance causes some 45,000 to 48,000 unnecessary deaths every year in the United States.[16][17] In 2007, 62.1% of filers for bankruptcies claimed high medical expenses. A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.[18]

Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States was at or near the top in infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and rates of disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.[7]

The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009).[24][25] According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008.[26] The United States had the fourth highest level of government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita: Monaco, Luxembourg, and Norway.[26] A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses.[27] Since then, health costs and the numbers of uninsured and underinsured have increased.[28] A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses.[18]

The U.S. pays twice as much as Canada yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. Currently, the U.S. has a higher infant mortality rate than most of the world’s industrialized nations.[nb 1][29] In the United States life expectancy is 42nd in the world, after some other industrialized nations, lagging the other nations of the G5 (Japan, France, Germany, U.K., U.S.) and just after Chile (35th) and Cuba (37th).[30]

Life expectancy at birth in the U.S., 78.49, is 50th in the world, below most developed nations and some developing nations. Monaco is first with 89.68. Chad is last with 48.69. With 72.4% Americans of European ancestry,[31] life expectancy is below the average life expectancy for the European Union.[32][33] The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).[34][35] In 2008 the Commonwealth Fund, an advocacy group seeking greater government involvement in US healthcare, then led by former Carter administration official Karen Davis,[36] ranked the United States last in the quality of health care among similar countries,[37] and notes U.S. care costs the most.[38]

United States ranks close to the bottom compared to other industrialized countries on several important health issues affecting mortality: low birth weight and infant mortality, injuries and murder, teen pregnancy and STDs, HIV and AIDS, deaths resulting from drug overdoses, obesity and diabetes, heart disease, COPD, and general disability.[39]

A 2004 Institute of Medicine (IOM) report said: “The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.”[40] A 2004 OECD report said: “With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990.”[41] The 2004 IOM report observed “lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States”,[40] while a 2009 Harvard study conducted by co-founders of Physicians for a National Health Program, a pro-single payer advocacy group, estimated that 44,800 excess deaths occurred annually due to lack of health insurance.[42]

(Source: “Health Care in the United States”)

Second, in view of the the “overkill backfire effect” and the “worldview backfire effect,” we can all calmly and repeatedly engage in conversations of the following form, where we’re the Y-folks —

X: “Medicare For All is socialized medicine, anti-capitalist, and anti-American!”

Y: “But isn’t Medicare, in general, a very good thing for those people in the USA who already have it?”

X: “Yes, but….”

Y: “So what would be wrong if everyone living in the USA had Medicare?”

X: “Well, I agree that it would have to be very good for everyone living in the USA, if it’s already in general very good for those people in the USA who already have it. But we can’t afford it!”

Y: “Yes, I understand where you’re coming from. But actually, that’s not correct. If Canada and many other liberal democracies can afford it, then so can the USA. Just read Bernie’s op-ed piece: he makes that point too.”

X: “Well, Bernie Sanders is a socialist, anti-capitalist, and anti-American jerk! And he’s too old to be President!”

Y: “Yes, I understand where you’re coming from. But isn’t Medicare, in general, a very good thing for those people in the USA who already have it?”

X: “Yes, but….”

Y: “So what would be wrong if everyone living in the USA had Medicare?”

X: “Well, I agree that it would have to be very good for everyone living in the USA, if it’s already in general very good for those people in the USA who already have it. But Bernie is a REALLY, REALLY BIG SOCIALIST, ANTI-CAPITALIST, AND ANTI-AMERICAN JERK! In fact, I think HE’S BEING PAID BY THE RUSSIANS! And he’s REALLY, REALLY TOO OLD to be President! And what if some of the people living in the USA who received Medicare turned out to be ILLEGAL IMMIGRANTS AND FOREIGN TERRORISTS, and then got to be HEALTHIER ILLEGAL IMMIGRANTS AND FOREIGN TERRORISTS? Just imagine all the damage they could do! And I heard that people in CANADA blah blah blah….”

Y: “Yes, I understand where you’re coming from. But isn’t Medicare, in general, a very good thing for those people in the USA who already have it?”

X: “Yes, but….”

Y: “So what would be wrong if everyone living in the USA had Medicare?”

[Repeat as needed.]

So in these two ways — also, at the same time, self-consciously remembering and fully taking to heart the basic principles of Grouchomarxist Lennonism — we can successfully cognitively debiase the American people and have Medicare For All.

And, as always, to anyone who seriously disputes the soundness of this argument,

Je vous dis, merde!

***

“Je vous dis, merde!” (literally, “I say to you: shit!” or more loosely, “You’re so full of shit!”) is a morally and politically defiant slogan invented and first published by an early 20th-century Catalan anarchist who used the nom de guerre “Miguel Almereyda.” Almereyda, who was murdered in a French prison in 1917, was also the father of the famous French film director Jean Vigo, who immortalized the same slogan in his breakthrough 1933 film, Zéro de conduite, aka Zero for Conduct.

Here is the seven-part platform of The Wake The Fuck Up! Party , aka The WTFU Party, aka Up Against the Wall, Philosophy-Fucker!, aka UAW/PF —

1. Universal Respect for Human Dignity (URHD):

· Human dignity is the absolute non-denumerable moral value of every member of humanity, and everyone ought to try wholeheartedly to treat everyone else in a way that is sufficient to meet the demands of respect for human dignity, especially including (i) alleviating or ending human oppression, and (ii) actively engaging in mutual aid and mutual kindness.

2. Universal Basic Income (UBI):

· Anyone 21 years of age or over and living permanently in the USA, who has a personal yearly income of $50,000.00 USD or less, and who is capable of requesting their UBI, would receive $25,000.00 USD per year, with no strings attached.

3. A 15-Hour Workweek for Understaffed Non-Bullshit Jobs (FHW-for-UNBJs):

· Anyone 18 years of age or older who is living permanently in the USA, who has completed a high school education, and is mentally and physically capable of doing a job, would be offered an eco-job, paying a yearly wage of $25,000.00 USD, for fifteen hours of work (three 5-hour days) per week.

Thus anyone 21 years of age or older with a high-school degree and who is also mentally and physically capable of working, would have a guaranteed yearly income of at least $50,000.00 USD if they chose to do an eco-job.

The rationale behind the three-year gap between (i) being offered an eco-job at 18 and (ii) beginning to receive their UBI at 21, is that every young adult who has finished high school will have the option of pursuing three years of part-time or full-time free higher education without credentialing, i.e., for its own sake, after high school, before making longer-term decisions about what I call job-work and life-work.

***

Here are a few more details about UBI and eco-jobs.

(i) The UBI is to be paid by a monthly stipend check.

(ii) Eco-job income is not taxed.

(iii) For all individual yearly incomes of $50,000.00 USD or under, no tax will be levied; hence for someone receiving their UBI and also doing an eco-job, no income tax will be levied.

(iv) For all individual non-eco-job incomes, for every $1.00 USD earned above the standard UBI of $25,000.00 USD, the monthly UBI stipend is reduced by 50 cents, until the recipient’s UBI is reduced to zero; hence for those individuals with yearly non-eco-job incomes equal to or under $50,000.00 USD, the maximum UBI + non-eco-job income sum is always $50,000.00 USD.

(v) For all individual yearly incomes over $50,000.00 USD, for every $10,000.00 USD earned, that surplus income is taxed at the rate of 1%, with the highest surplus income tax rate being 50%; hence the maximum surplus 50% tax rate starts at individual yearly incomes of $550,000.00 USD, and applies to all higher surplus incomes.

***

4. Universal Free Higher Education Without Credentialing (HEWC):

· Everyone would be offered, beyond their high-school education, a free, three-year minimum, optional (but also open-ended beyond those three years, as a further option), part-time or full-time universal public education program in the so-called “liberal arts,” and also in some of the so-called “STEM” fields, including the humanities, the fine arts, the social sciences, mathematics, and the natural sciences.

· For many or even most people, their HEWC would fall between (i) the end of their high school education at age 18 and the corresponding availability of eco-jobs, and (ii) the beginning of their UBI at age 21.

· But HEWC would be open to anyone with a high school degree, no matter how old they are, provided they are mentally and physically capable of doing the program.

5. Universal Free Healthcare (UFH):

· Every human person living permanently in the USA will receive free lifelong healthcare.

6. 2-Phase Universal Open Borders (2P-UOB):

· Phase 1: Starting in 2021, there will be universal open borders with Canada and Mexico, and everyone who moves across those borders and then claims residence in the USA, will receive temporary or permanent residence in the USA and also full membership in the system of UBI, FHW-for-UNBJs/eco-jobs, and UFH in the USA, with the precise number of new temporary or permanent residents to depend on the current availability of (i) adequate funding for UBI, eco-jobs, and UFH , and (ii) adequate living accommodation, in the USA, provided that all new residents also fully respect the human dignity of everyone else in the USA and elsewhere in the world.

· Phase 2: Also starting in 2021, the USA, Canada, and Mexico will collectively form a Global Refugee Consortium (GRC), with three-way open borders to any political refugee, economic refugee, or asylum seeker from anywhere in the world (aka “global refugees”), who will receive temporary or permanent residence in the USA, Canada, or Mexico, and also full membership in the system of UBI, FHW-for-UNBJs/eco-jobs, and UFH in the three GRC countries, with the precise number of new temporary or permanent residents, and the precise distribution of new residents among the three members of the GRC, to depend on the current availability of (i) funding for UBI, eco-jobs, and UFH , and (ii) adequate living accommodation, in the three GRC countries, provided that all new residents also fully respect the human dignity of everyone else in the GRC and elsewhere in the world.

7. Universal No-Guns (UNG):

· No one in the USA, including police, internal security forces of all kinds, armies, and intelligence forces of all kinds, has the moral right to possess or use guns of any kind, for any purpose whatsoever, because the primary function of guns is coercion, and coercion is immoral.

· UNG would be implemented by repealing the Second Amendment to the US Constitution in 2021 and then universally banning the possession or use of guns thereafter.

I’m also assuming that Universal Public Education (UPE) — universal free access for all human persons of any age to good public education up to the end of high school — already exists in most countries, and needs no further justification.

Where UPE does not already exist, it would automatically become a necessary part of the seven-part WTFU Party package, thereby making it a eight-part package.

***

Mr Nemo, Nowhere, NA, 15 September 2017

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