The following response was written to address a very talented writer’s answer to a question posted on Quora. It was shared with the “Elephant in the Room” space for Republicans It deserves to be featured for how it skillfully dismantles any hope for the future of public healthcare by making unsupported false equivalences and by pretending that any proposed system would be subject to the same failures we see in other public healthcare programs. I posted this reply on Quora but feel certain it will be tagged for violation of the Be Nice Be Respectful policy.

Out of respect for the original author, I have redacted any references to their name.

Dear Quoran,

I have taken each of your comments and replied to them piece-by-piece to get a better understanding of the big picture. I noticed a pattern that is important to expose because it shows an effective, but dishonest means of discussing a topic. And I say “effective” only because people who agree with your overall point are likely to share it and it spreads support for your claims even though they are arrived at dishonestly.

The pattern you use is simple and easy to identify.

You make a blanket generalization (I think they call them Deepities) that on the surface seems undeniable, but when applied creates a feeling of cognitive dissonance that makes the reader uncomfortable. This is an important step because you want to comfort the reader with your new agenda.

You change the focus of the discussion to something that satisfies your goals but sounds enough like the original author’s intent to cover your real intentions. Though it’s not perfect, it seems reasonable. You now have the advantage because you have changed the topic to something you have gone over repeatedly and any response to your claim is going to seem unfounded or weakly framed.

This is especially true for the original author who now has the unfortunate duty of defending his belief by arguing your topic. It quickly devolves into the original author defending a belief that is secondary to his or possibly not his at all.

This provides a great platform where you are able to subtly plant digs against the author by using generalized pleas to logic that paint anyone who thinks differently in a bad light. After all, what idiot would support these new claims you are stuffing into the mouth of the original author? Who cares that the original author didn’t say what you claim, you are on a roll.

When someone calls you on your own topic, you deftly switch directions and employ the same strategy from another direction. It takes a considerable amount of dedication to avoid snapping your neck as you switch topics and claims in long, but beautifully worded comments. Fortunately, most of your intended audience lacks the ability to focus long enough to still be paying attention, but you get a certain joy from helping people to see it your way. I’ll demonstrate this more clearly in replies to your other posts in this thread..

Again, anyone trying to support the original premise is off guard and having to defend a position that was not theirs, to begin with. And don’t get me wrong, you are much more effective than most at doing this. You sound educational and gracious in your deceit, not the normal judgmental and oppressive tones you expect to see in this kind of partisan post.  

You do this over and over and in the end, it makes it look like what you had to say was reasonable. It willfully presents only part of the picture: your part and your picture. It fails to address the original issue.

I find this incredibly disheartening and I feel obligated to show you how you do this on the off chance that this is some incredible skill that you were born with or that you learned without self-reflection. If you are doing this on purpose, the rest of my post is not intended for your benefit. It’s to help others see through your arguments by exposing your unfair methods.

I hope to show how this divisive rhetoric serves the interest of successful conservatives at the expense of everyone else. Of all of the writers I have read, you definitely have the greatest skill and I was repeatedly drawn in. When I found myself agreeing with what you were saying, I wasn’t aware that you had completely changed the subject and nothing you said was applicable to the original discussion.

I was beginning to support the idea of a free market because it might be innovative and competitive. What I forget is that the free-market does not and will not ever support healthcare for all. But that’s not the subject at hand, your deceitful and formulaic answer is.

You hedge your bets repeatedly by setting the reader up to draw a conclusion that you never go so far as to make. You line it up and then use a broad generalization to smooth out any conflict. You use fear to manipulate your audience, you avoid direct attacks that would expose your bias, and you smooth everything out in the end, making you appear gracious, not deceitful.

So let’s look at how you employ this dishonest strategy to get people to agree with your point, not the original author’s:

The question is:

https://www.quora.com/According-to-Bernie-Sanders-all-Canadian-citizens-are-guaranteed-healthcare-and-if-they-come-out-of-a-hospital-they-dont-get-a-bill-Is-this-true

According to Bernie Sanders, all Canadian citizens are guaranteed healthcare if they come out of a hospital, they don’t get a bill. Is this true?

The answer to this question is not up for debate and there is only one correct answer. Yes this is true.

Now it is uncomfortable to answer this question as it is written because it could lead people to think that they don’t have to pay for the hospital visit. That is not true. But that wasn’t the question. Still, this is where your pattern is employed. You change the topic to make it sound like the question but really expresses the points that you want to convey. You basically refuse to answer the question as written, but instead attack the possible underlying presumption that healthcare is free. Bernie Sanders may have used this term loosely and some more profound linguists could defend against your argument but it wasn’t the original question.

Your response in full:

Breakdown:

Common sense tells us that Canadians don’t enslave doctors and nurses, so there is indeed a cost for providing healthcare. Some folks seem to confuse “not getting a bill from the hospital” with “free”.

Here is the generalization that appeals to reason (logical fallacy) that also makes the reader feel uneasy. Any reference to enslaving peoples is always effective—nobody wants to think about slavery, especially not our beloved doctors and nurses. Never mind that “slavery” nor “free” was part of the original question.

Now, rather than addressing the original author, you continue to appeal to the general notion that “some folks confuse…” This doesn’t come right out and say that the person asking the question is confused…because that is completely unfounded. It politely implies it, avoiding conflict and giving you the chance to deny having said anything about the question’s author.

You would have been more honest to state upfront: “I don’t want to answer that question because I’m afraid that my readers are too stupid to understand that “yes” doesn’t mean it’s free, it just means you don’t get a bill. Here’s the question I wish you had asked and my answer to it: “Are Canadians Guaranteed Free Healthcare?”

If Bernie were being a little more honest, he’d say that the difference is that instead of the hospital billing the patient (or his insurance company) directly, Canadians pay for healthcare through various forms of taxation. The patient doesn’t get a bill – the country does…the patient still pays, but it’s in the national budget, not a discreet invoice.

This is where your skills surpass most. Rather than directly attack the original author still, you instead shift blame to Bernie Sanders, endearing you with the readers that share your hatred of his position. You make a false claim that is not direct enough to be called a lie, per se, but it immediately paints your opposition as being dishonest when you have totally changed the topic. The information not mired in false judgment is spot on in support of your topic, I agree with what you say other than the lies about Bernie.

Before we continue down your path of deceit, let me make one point clear that I hope to reiterate throughout this long post:

• The details of the proposed public healthcare system have not been decided. Presumably, a model like the Canadian model will provide the basis for our system. But we have the advantage of being able to review Canada’s system as well as every other health system provided by every country in the world. Coupled with our vast resources, our wealth, and our American ingenuity, we can create a public healthcare system that avoids all of those pitfalls. Working together with free-market-advocates, we should be able to provide a public healthcare system that makes the most of the free-market without exposing so many people to lack of decent or affordable healthcare. The point is that the details conservatives point out as pitfalls can be avoided and if they spent as much time figuring out a way around those pitfalls as they do tearing down the idea of public healthcare in general, we would have the best healthcare in the world for 100% of the country, not just the 10% that can afford it.

Something similar Americans might relate to is the US public school system. In most places I’m aware of, you get to send your kids to school, and you don’t get a tuition bill from your local school district. You’re still paying tuition, but it’s spread around all of the taxes you pay.

This is really beautiful and I am not sure if this concept has been distributed like a giant conspiracy in a newsletter or receive it as a vision from Satan himself, but one thing for sure is that you can see it repeated almost word-by-word over and over by Republicans in every context. It is obviously not your ingenious invention because I have read this all over. It’s a de facto talking point for conservative underminers.

What this statement does is it creates an obvious false equivalence. You show your understanding of the current opinion of our failing education system without acknowledging how the current administration and others who support your point of view are systematically trying to destroy our public education system as well as the healthcare system in this country.

Like healthcare, you want education to be a profit-based free-market system. Such paragons of virtue like Betsy Devos have devoted their lives and their millions and millions of dollars in resources to undermine the public schools in favor of for-profit private schools.

Regardless of your hidden affiliation, you acknowledge that our schools are a mess. It serves your interest to associate the schools with public healthcare. Never mind that the idea of public healthcare has not been meticulously defined and since it is still in pre-conception, it could be designed to avoid the pitfalls of our public education system, You have already made the association and that’s really all you wanted to do.

Now you have intentionally opened a can of worms that has no resemblance to the original question at all. Brilliant. Now any liberal feels compelled to defend a) our public school system and b) the completely undefined public healthcare system. It’s not easy to defend something that hasn’t been defined yet, but again that’s your goal.

But those are all bonus distractions. The false equivalence is mostly about how these two concepts are funded. You know that public healthcare funded off local taxes would be the same shit show as our public schools. You realize that one of the few mandates of Bernie Sander’s goal is to avoid the unfair nature of locally-funded healthcare by making a federal healthcare system.

These two things are, by definition, opposites and cannot be evaluated as providing the same reasoning. You know this, but the association of locally funded schools being undermined by the administration makes federally funded healthcare supported by the administration seem dangerous. Who wants a public healthcare system as fucked up as Devos’ education system? Not me, not you…nobody.

And again, to bring this point home:

• The details of the proposed public healthcare system have not been decided. Presumably, a model like the Canadian model will provide the basis for our system. But we are fortunate to have a long history of every other public healthcare initiative used by almost every other country but the US to help avoid the problems in any one of them. We also have our history of failed attempts as well as successful attempts to provide socialized services on which we can rely to inform our plan moving forward. Coupled with our vast medical resources, our wealth, and our American ingenuity, we can create a public healthcare system that avoids all of the pitfalls of both the free market and the locally funded paradigms.

To go further, “guaranteed healthcare” is also a bit of a lie.

This is more of a lie than anything. You may not be guaranteed the highest priced solution for your healthcare needs and you may have a wait time, but there is no doubt that you can receive healthcare without receiving a bill just by being a citizen. There is no threat of being jailed for failing to pay taxes either, though I hear you flipping to page 87 of the Conservative Handbook, Taxes as State Violence chapter.

One of the reasons the Canadian system is less expensive than the US system is that patients get relatively limited ability to choose the treatments they get. You don’t get to pick and choose what treatments you get – the “machine” chooses according to their policies.

This statement is false but it speaks to the fear that uneducated readers feel about a monolithic machine designed to spit out a lottery of treatment decisions that may or may not be associated with your symptoms. “The Machine” tells you that you need to have your hand amputated and that is the only option you get even though you came in with a splinter. This is a tired trope of artsy sci-fi films that your intended audience will have never seen or never understood. And again, by insinuating, not actually making a direct claim, you can weasel out of it later.

Nothing less than brilliant how you slide this in to trigger the reader’s fear, further pulling them close to your seemingly protective point of view. After all, you only want to make sure that the ignorant reader isn’t victimized by public healthcare.

Regardless, this is just more information to help build a better public healthcare system.

• The details of the proposed public healthcare system have not been decided. Presumably, a model like the Canadian model will provide the basis for our system. But we are fortunate to have a long history of every other public healthcare initiative used by almost every other country but the US to help avoid the problems in any one of them. Coupled with our vast resources, our wealth, and our American ingenuity, we can create a public healthcare system that avoids those pitfalls.

Just as an example, let’s say you have an accident with a chainsaw and cut off a finger. The doctor might tell you there are three treatments: microsurgical reattachment that might cost $100,000, an advanced prosthetic that might cost maybe $10,000, or “stitch up the wound and be happy you still have nine working fingers” that might cost just a few hundred dollars. To me, “guaranteed healthcare” means I get to pick among these…it’s not worth all that much if what I’m guaranteed to is some suture and a few aspirins.

In case you weren’t afraid before, here is an example that shows how you will be dismembered by the Canadian healthcare system. You don’t have to come out and say it, but comments will reflect that you got your point across. Liberally will have to explain that you don’t lose a finger just to have public healthcare and your audience will still believe you.

The problem with arguing about how we predict a Canadian response to this particular example would turn out is that it doesn’t show any contrast. Show us how it would be better in our current system. If our system was identical (which it won’t be), we would suffer the same predicted fate. You imply, subtly, that currently in the US, you would be given all of the options that Canada would and then some. Not only that, but you’d get same day service and it would be free, not beaten out of you by taking your personal property through taxes. Canada wishes they had it this good, look at em scurrying across the border as illegals to take advantage of our superior healthcare services. This is your implication but it is laugh-out-loud funny.

I’ll go ahead and take the bait by engaging you on your hypothetical.

There are people in the richest country in the world who when they lose a finger in a chainsaw accident, find some rubbing alcohol and light it on fire to cauterize the wound because they cannot afford just a few hundred dollars to have the doctor sew it up. (Not true in Canada) They cannot afford to take the 5 different days off of work to go see the specialists at various locations in cities across the state. They cannot afford the hidden charges that will come up. Your simple aspirin, $500-literally. When you get the bill, a simple “few hundred” has become $2500 and because you failed to keep your appointments, you get billed $100 per missed appointment.

And the irony of all of this is that our government subsidizes hospitals to offset the cost of emergency services. When poor people can’t afford healthcare, they are guaranteed to be treated (poorly though) by an emergency room. They clog up emergency services making wait times to be seen in an emergency as long as 48 hours. And taxpayers end up paying a lot more than $2700 because the hospital adds administrative and collection fees before sending the bill to the government. What was a simple procedure is reported as a $20k procedure because that’s what they would charge an insurance company and the government spends your tax dollars to pay these outrageous prices.

And while you may think I am speaking in hyperbole, I am not. This is not an exaggeration. Let me give you a literal example along the lines of the example you provided:

My father has excellent coverage through Kaiser. He recently saved cutting his leg off by grabbing a runaway circular saw with his bare hand. He lost two fingers and cut through one but it was still attached. He went to the emergency room where they sewed him up and talked to him about his options.

Of course, as a woodworker for a hobby and a building inspector for trade, he wanted to be able to use his hands. He brought the severed fingers with him to the emergency room. They discouraged him from surgical reattachment because it would be problematic, they couldn’t do it in Cheyenne (where he lives) and it wasn’t covered by insurance, Furthermore, they couldn’t save the fingers even if he chose to go to Denver to have them reattached.

There was no prosthesis option available to him there, but they could refer him to a specialist in Denver. This also would not likely be covered by insurance and it would be nearly as expensive as the unavailable first option. The earliest appointment would be at least six months down the road and he would likely have to come up with the $20-50 thousand dollars upfront to have it done. Not to mention the 4-hour drive, overnight accommodations, etc. etc.

So he didn’t have the wealth of options you suggest that all Canadians would get. He had no options that didn’t involve considerable expense on his part and long waits. Because of the recent opioid scare (the pseudo-free-market in action), they gave him 2 ibuprofen, stitched up two finger holes, sewed the other finger down but it was purely cosmetic and would never function, and sent him on his way.

When he got the bill he was surprised to find out that after paying his $5k deductible, he still owed $1700 not covered by insurance. He was scheduled for a follow-up visit and physical therapy classes which he did not want. When he chose to go to neither, he was billed $100 per class by the hospital and not reimbursed by insurance.

My Dad had no option at this point to miss the 5K deductible because if he failed to come up with $5k, he would have been stuck with the full $20k cost of the emergency room visit. If he failed to come up with the deductible and to pay his debt off to the hospital and specialists, it would affect his credit and they would re-evaluate his coverage and likely be forced to cancel his plan. If he failed to make a payment ontime, they would not only cancel his coverage, they would take him to court and sue him for the remainder of the contract even even though he was not covered.

This was the situation from Kaiser support. My mother spent at least 5 hours per day for three weeks on the phone trying to get to the bottom of these extra charges when she finally got someone to tell her they refused to pay for the Ibuprofen given by the nurse in the Emergency Room. Kaiser claimed that hospitals know this: patients are required to get their medication through the pharmacy benefits provider, not the hospital in emergency cases. They told them that their pharmacy benefit provider had a prescription buyer that could negotiate a better price than $500/per pill so they refused to pay for it. They even implied that if she continued to harass them by calling repeatedly, they would have no option but to cancel their contract and she would pay for the entire $20k. The hospital later informed my dad that in addition to canceling his insurance policy, Kaiser would take him to court for the full cost of his contract though they had no obligation to pay for his medical expenses.

This was, of course, after my frail little 75-year-old mother goes down to the hospital with 2 Ibuprofen (200mg each) and told them to shove it up their ass. She then pulled all of the paperwork and pens off a rude woman’s desk while demanding to see the CMO. Fortunately, she didn’t seem menacing enough to get security involved and they eventually refunded both the appointment penalties and the $1000 for two ibuprofen. When my dad found out what had happened, he went to apologize. They were not the least bit upset. They explained that they were totally used to seeing irate patients–it is standard fare for hospitals in the United States.

In Canada, my dad would have received the same treatment but no bill. There would have been no wait in the Emergency room because they aren’t inundated by poor people who rely on emergency room services for primary care. He would not be fined for missing appointments and he would not have to pay for upcoming appointments himself. In fact, they probably would have had the physical therapists come to his house for follow up treatment at home—no bill, his option.  He would not pay any deductible and his total bill, paid for by the government, would have been less than $2000. His cost would have been covered by his taxes so he would have to pay $0 additional.

This is compared to the $5000 deductible, the additional $700 for xrays and a specialist to look at his hand, $1000 for 400mg Ibuprophen and $300 for missing appointments he declined. Total out of pocket expense: $7K (minus $1.3K after my mom kicked some ass) This is with excellent insurance that costs my dad about $800 per month. The hospital billed Kaiser more than 20k and undoubtedly used the $1300 they took off my parents’ bill to justify another $5k loss when they reported it to the government.

 So in consideration of the three options you provided:

If your insurance doesn’t cover the microsurgical reattachment, you would have to come up with the money yourself in Canada or the U.S. Both could be covered by supplemental insurance. This simply is not an option if it’s not available locally and to claim otherwise is dishonest.

In Canada, the prosthetic option could take 6 months to get the prosthesis appointment. The prosthesis, appointment, and followup adjustments and therapy would be covered by tax money and paid by the Canadian government. Your total bill would be 0$.

In the US, if you did not have insurance, or if it was not covered, you would have to pay for it all out-of-pocket by yourself. You would have to pay for the adjustments and physical therapy out-of-pocket. You would be required to show up at scheduled appointments or face fines. You would not be covered to take time off work and you would be responsible for lost wages. Since each of these levels of service is for-profit, they have incentives to charge you competitive pricing only if you have a referral to one of their competitors. Which you don’t. If insurance covers any portion of it, the prices are outrageous. Either way, you do not know what services you will be provided and cannot decline whatever services they provide in an emergency because you can’t afford them. You get what you get. Period. You end up with a surprise bill with outrageous charges that you have to pay out of pocket.

In the U.S., if you had insurance that WOULD cover it, you would still have to meet your deductible which could be anywhere from $500 for the most expensive insurance plan to $12k for the least expensive coverage. You would incur extra charges for every appointment you went to for at least $500/appointment. You would receive bills from specialists you did not know and you would be fined for missing appointments. You would still likely wait 6-8 months to get the treatment. You would spend countless hours on the phone arguing with your provider about what charges were for since you never get an itemized bill and therefore can’t tell if you are being charged fairly.

Because the total amount paid by the insurance company was more than $10k, you would be considered a potential risk and face problems making other claims moving forward. At any time you would lose coverage for being late on a single payment or for making claims in excess of your maximum coverage limit. The insurance company would file a lawsuit for the remainder of your contract even though your contract was canceled. There would be no appeal possible, regardless of whether the mistake was yours or the insurance provider. You signed the agreement.

Your next insurance provider if you were lucky enough to have two that covered your area, would charge you significantly more for insurance because you are obviously a risk.

If you lose or damage your prosthesis in Canada, it may take 6 months, but you will be given a new one without incurring any changes. In the US, you would have to go through the entire drama again and pay for another $10k prosthesis that would not likely be covered by insurance.

Regardless of your completely impractical example and how it shows that either you know these facts but are intentionally obscuring them or you simply do not know what you are talking about despite your supposed PhD in economics.  I need to make this point clear again:

• The details of the proposed public healthcare system have not been decided. Presumably, a model like the Canadian model will provide the basis for our system. But we are fortunate to have a long history of every other public healthcare initiative used by almost every other country but the US to help avoid the problems in any one of them. Coupled with our vast resources, our wealth, and our American ingenuity, we can create a public healthcare system that avoids these pitfalls and provides a better quality of comprehensive medical coverage to every citizen, not just the richest citizens who can afford it.

Before people start posting about how terrible the US system is compared to Canada, I’m not being critical of our friends to the North. Rather, the point is that while there are a lot of ways to allocate medical expenses, no system is capable of providing completely ungated service to consumers “for free”. Whether you control demand through rationing by price, availability or some other means, there are difficult choices to be made given today’s level of medical technology.

And despite the interruptions my post makes, by the time you finish your argument (which was not the topic asked), you realize that you have a group of scared readers that are clinging to your fears about the possible implementation of a yet-to-be-defined public healthcare system. They are all afraid they will have to give up a finger to get healthcare, that all of their wages will be appropriated by the government through taxes, that they will be paying for a system they won’t use, that the system will fund the free healthcare of illegals, that innovation will die, and that the government will torture you and take all of your material possessions if you have bad luck and can’t afford to pay your taxes. So, being as thoughtful as you are, you console them and make sure to unruffle any feathers without actually refuting any of the irrational fears you have just fed them. How gracious!

You summarize your completely off-topic rant by making a completely unsupportable new claim that puts demand at the center of the argument when before you were claiming it was supply or rather government funding. You started out saying that because the Canadian government pays for things, you get fewer options and longer wait times. Now you want to claim that it is because there is such high demand in Canada, you get longer wait times and fewer options unless you find a way to mitigate demand and making people wait for a long time is a good way to punish them for taking advantage of their healthcare system. None of this matters, does it?

We have the skills to take all of this unfounded hyperbole into consideration and plan around that. Furthermore, we have the resources that are missing in Canada, namely 11,800+ MRIs for example. In fact, as I point out in Part 2, if the problem with Canada’s health system is circumstantial and involves limited resources that we do not have here, all of your claims so far make no sense.

The systemic limitations that prevent Canadians from receiving fast resolution of their advanced medical conditions (not all medical conditions, just advanced care services like cancer) are not limits that we face and shouldn’t affect us. The availability of supplemental insurance solves many of these problems and being neighbors with the richest country in the world, you can also go for medical tourism if you have the funds. So no matter how you look at it, you are not being honest about your appraisal and you didn’t answer the question. All of your claims are completely unfounded if we work together to create a system that is not prone to these problems.

You fail to acknowledge that even if we cannot engineer around this minor problem in the Canadian model, Canda still provides a better quality of healthcare more readily to every Canadian than we provide to the majority of Americans at outrageous costs. And it certainly doesn’t take into consideration the fact that Canada takes care of all of its people, we don’t give a shit about the poor.A proactive universal healthcare plan would eliminate the current life-threatening bottlenecks in our emergency care facilities when the poor seek assistance for issues that primary care would normally handle.  And in case you are rich and want the extra fancy treatment for your advanced medical consideration, we can engineer that into the system where you pay for the fancy treatment.

The point is that you are raising concerns that if they were valid, should be considered when designing a public healthcare system. Perhaps if you were to put as much effort into supporting the public healthcare idea as you do in generating unfounded fear over it, we could leverage the free-market and still provide proactive universal healthcare to everyone in this country.

I apologize for the lengthy reply and for how long it took me to gather my thoughts. I still think you are being intentionally deceitful and that you know it, but feel that it is justified for your cause. I do still respect your writing skills and your ability to manipulate people and topics so effortlessly.

This is the first post for your answer. I have dismantled all of your claims in this thread and will post them as well. Be sure to read about how you conveniently use the bloated and unreasonable estimation of the national expenditure for healthcare to create fear of excessive taxation while also claiming that costs, not the estimate of costs are the problem.

And don’t miss my post about how the “greatest healthcare system in the world” operated by a pseudo-free-market is likely to put us in serious jeopardy and how this global pandemic COVID-19 clearly underscores the failure of a free market. Hint: profits don’t care about lives and it’s not profitable to have extra supplies available for the once-in-a-lifetime possibility of a pandemic. COVID-19 in America: Your Free Market at Work.