Dean Clough

June 23, 2023

Portico Darwin: Depart Las Cruces + US Health Care


<3 Minute Read
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Well, it's been a wonderful 12 nights here on the desert, and I'd be remiss if I didn't thank our hosts, the marvelous, if rather aged, Davis and Melynda Fladgate.  These two were kind enough to give us the complete run of their home for almost 2 weeks, whilst also tolerating my endless plays of M83's Fantasy poolside and even more endless Weissβier imbibing.  Speaking of which, a toast to our very gracious hosts:  thank you - it's been Textbook (and Killer!).

We depart from El Paso and head home to SF tomorrow evening. 

During our stay, we had a friendly debate here about health care in the United States, and the role that good ol' red-blooded American capitalism should or should not play in it.  As it happens, the hospital system at which Melynda works was purchased not very long ago by Apollo Global Management, one of the world's largest private equity firms. 

So the time would seem right to look at the results produced by the US health care system as compared to peer nations.

Just The Facts
The graphics below are from the OECD, for 2019, so they avoid pandemic distortions.  I do urge anyone doubting what follows to bring forth evidence that the OECD is biased in one way or another, and/or their data incorrect.

A basic fact to know and as most are aware already, America is unique amongst the members of the OECD in that it does not guarantee basic medical services for its citizens.  Many have pointed out that begs the question of whether health care is a right or a privilege in a wealthy society like ours?

I will highlight some key points afterwards, but stating that the health care system in the United States is the best in the world is not accurate.  At least if outcomes are considered.


As you can see, the US spends far more on health care, yet has worse results - in nearly every category.  And we fail in an area often cited as a strength of our current system by its defenders:  access to doctors.  We spend almost 3 times as much on healthcare per capita, yet only 65% of adult Americans - vs. 79% in all other OECD countries - can access a doctor when they wish.

Is It Really Capitalism?
I believe we can do better as a nation.  We just need to examine what is working and what isn't in other public health programs, including our own and those of our peer nations, and do something superior.  The tired old trope of "Do you want to wait 6 months for ankle surgery like they do in Canada and England?" doesn't get it done any longer.  Accepting what we have as the only thing possible is not good enough. 

Indeed, I am baffled at the reluctance to admit we're not getting our money's worth.  After all, isn't that a big part of capitalism, getting the most possible from the resources available?  If you're OK with free market capitalism in health care, why does that rule not apply here? 

For the record, I don't believe there's a place for much capitalism in health care, as it is far too different than any other good or service.  Having and treating an acute and/or chronic illness is different than picking a dish soap or landscaper for your home.  The purveyors of suds and lawnmowing want you to obtain as much as you can of what's on offer and the entire thing is relatively transparent, from branding to options to pricing.  The buyer is, or at least can be, highly informed on their purchase.  None of that applies when you head to a doctor.

And that's why relying upon market forces in health care can't work.

If you're concerned about loosing our edge for innovation in the medical arts in the absence of capitalism, consider our military.  There is zero incentive for private industry to build the world's finest nuclear aircraft carriers.  But they do, because the government pays them to do so. 

It could work the same in medicine.  The federal government could fund basic and advanced medical research, performed by private institutions.  In fact, I can point to a recent Republican administration's role in pushing for the blazingly fast development of a Covid vaccine as evidence this concept works.

Lastly, and something typically omitted by the free-market-no-matter-what folks when this subject arises:  no rational advocate for a public system wants to ban private doctors, hospitals or insurance.  So the wealthier and more fortunate among us can purchase whatever they wish.  The change is that everyone would get the same quality mental and physical health care the privately insured get now.

Like the citizens do now in every other country like ours. 

But let's not end on a down note.  It's been a great visit to New Mexico, and we've had a lovely time.  Which makes it all that much harder to understand why Davis has my bags packed already?


It's high praise indeed for Hunter Deuce when an artist the stature of my cousin Charles Clough pulls himself away from his myriad projects to give a nod of approval.  The famed painter clearly liked Hunter's Identity Politics rejoinder from Wednesday.

Great, Hunter Deuce - right on!

And Hunter's not done (is he ever?).  Seeking even more of the spotlight, Mr. Participation added this.

BTW, I cannot recommend Richard Rothstein's The Color of Law enough.  It delves into the history and formation of urban areas throughout the country, and how racism was codified into law when it came to the development and expansion of our cities from the turn of the century through the 1950's and 1960's.

Freeway development.  Zoning laws.  Veteran benefits.  Federally guaranteed loans to white people only.  And if you think the book focuses on places like the South, think again.  The book literally kicks off right here in the oh-so-progressive Bay Area with a study of the City of Richmond and other designated "colored" areas for black shipbuilders who had emigrated here for work to live in.
Thank you, Hunter.  

10 Seconds of Seriousness:  if this were required reading in schools, do you think there'd be a whole lot of people attempting to disenfranchise black Americans by rolling back voting protections established almost 60 years ago? 

Thank you to any one reading this newsletter.


Woo boy:  this is perfect for today's post and also for my final day poolside - in fact, it was cranked poolside here in Las Cruces when it first came out in 1999.  It is a Killer jam band album, but one where the songs are actually songs, and with only one longer then 6 minutes.  Here is one of Nick Pritzker's favorite bands Widespread Panic, and 'Til the Medicine Takes.

Oh, why not, and it's a great bonus for those of you that made it this far.  Have a great weekend - like Lucy will.

About Dean Clough

Plans To Enjoy Life.