Category: Culture

Issues that address the core elements of American Culture in history and in the present

The Casualty List: The Myth of the “Just Transition” for Healthcare Workers

~ Dr. K ~ Leave a comment

Part 3 in the Medicare for All House of Cards Series

Medicare for All sounds like a great solution to the problems in the US healthcare system, but when people talk about it they often do so without any recognition of the human cost of making this kind of structural change.  Implementing this plan would completely eliminate the health insurance industry and severely decrease opportunities for hundreds of thousands of Americans in businesses tied to that industry.  This cost must be added to the assessment of the overall plan.

The policy makers putting forth the Medicare for All plan are fully aware of the potential impact on the workforce.  When policymakers discuss these types of massive structural shifts, they frequently lean on a comforting euphemism: the “just transition.” In the Medicare for All Act of 2025 (S.1506/H.R.3069)¹, this concept takes the form of a federally funded worker transition program. Recognizing that a single-payer system would eliminate the private commercial health insurance market, the bill’s supporters promise to protect the livelihood of every displaced worker.

It is a noble promise, but it runs up against a significant logistical reality. A 2018 economic analysis by researchers at the Political Economy Research Institute (PERI) at UMass Amherst, a study conducted in support of Medicare for All, not against it, estimated that eliminating the private insurance and medical billing bureaucracy would displace approximately 1.8 million workers, including nearly 300,000 aged 60 or older.² A critical look at the funding mechanism and America’s historical record with federal job-retraining reveals real reasons for caution.

The Legislative Blueprint

The bill text provides for wage replacement, continued retirement and pension benefits, job training and placement, preferential hiring for displaced workers into new government roles, and education benefits.¹ Beyond that general framework, the precise formulas, how long wage support lasts, how it’s calculated for workers with variable income, and how tightly the transition period is bounded, are not fully specified in the bill text as introduced, leaving important implementation details to be worked out administratively.

This creates real ambiguity for certain groups. Independent insurance agents and brokers whose income relies on fluctuating commissions and policy renewals present a genuine complication: calculating a fair wage-replacement baseline for a self-employed contractor is more complex than for a salaried employee, and the bill does not appear to address the loss of a broker’s “book of business,” an active client portfolio that functions as a sellable asset, as a compensable loss.

The Structural Vulnerability of the Funding Model

Rep. Jayapal has publicly confirmed the funding mechanism: 1% of the total cost of the bill, set aside annually for five years, to support displaced workers.³ If, as estimates suggest, the single-payer budget runs $3–3.4 trillion annually, that translates to roughly $30–34 billion a year for worker transition.  This money comes out of the same overall health care budget, rather than from a separate, dedicated fund. That creates a structural tension: every dollar spent on severance, retraining, and placement services for displaced workers is a dollar not spent on direct patient care. And because the fund is bounded at five years, the program faces a hard cutoff if structural unemployment in this sector proves more persistent than anticipated.

The Historical Record: Why Federal Retraining Often Falls Short

Proponents argue that unprecedented funding levels will succeed where past programs failed. But America’s track record with federal job retraining gives real reason for skepticism. The clearest example is Trade Adjustment Assistance (TAA), the flagship federal program for retraining manufacturing workers displaced by trade. A rigorous 2012 evaluation conducted by Mathematica Policy Research for the U.S. Department of Labor, using a matched comparison group of similar displaced workers who did not participate in TAA, found that TAA participants earned about $3,300 less annually than their non-participating counterparts in the final year of the multi-year follow-up period, and calculated the program’s overall net benefit to society as negative.⁴ The researchers noted this may partly reflect the time it takes older, long-tenured workers to successfully retrain, a dynamic that could plausibly recur among displaced insurance-industry workers, many of whom are older, specialized administrative staff. Coal-to-clean-energy retraining programs offer a second cautionary parallel: these initiatives have consistently struggled with geographic and skill mismatches between displaced workers and available new jobs.

The Bottom Line

The Worker Transition program relies on succeeding where comparable federal efforts have historically struggled. Generous funding can pay for training and temporary income support, but it cannot guarantee that hundreds of thousands of specialized insurance and billing workers will find comparable new roles on the timeline the bill anticipates. The gap between the money committed and the outcomes historically achieved by similar programs is worth taking seriously before assuming this transition will go smoothly.

Let’s be clear, the problem with the Sanders plan isn’t a lack of funding for workers; it is a fundamental misunderstanding of labor logistics. Throwing $150 billion at a problem can buy tuition and extend unemployment checks, but it cannot instantly manufacture hundreds of thousands of vacant, high-paying, white-collar jobs that perfectly match the skills of displaced corporate insurance workers. Shifting an entire workforce by government decree is an incredibly slow, friction-heavy process. By limiting the trust fund to a strict five-year window, the plan assumes an economic agility that the federal government has never historically been able to deliver.

Sources

  1. Medicare for All Act, H.R. 3069, 119th Cong. (2025); S. 1506, 119th Cong. (2025). Full text: congress.gov/bill/119th-congress/house-bill/3069/text
  2. Pollin, R., Heintz, J., Arno, P., Wicks-Lim, J., & Ash, M. (2018). Economic Analysis of Medicare for All. Political Economy Research Institute, University of Massachusetts Amherst, Appendix 6: “Estimating Displaced Workers.” peri.umass.edu/publication/economic-analysis-of-medicare-for-all
  3. Jayapal, P., quoted in “‘Medicare-for-all’ sponsor says plan would gut 1 million private insurance jobs,” Fox News (2019). foxnews.com/politics/medicare-for-all-would-gut-a-million-private-insurance-jobs
  4. Schochet, P.Z., D’Amico, R., Berk, J., Dolfin, S., & Wozny, N. (2012). Estimated Impacts for Participants in the Trade Adjustment Assistance (TAA) Program Under the 2002 Amendments. Mathematica Policy Research, prepared for the U.S. Department of Labor. dol.gov/sites/dolgov/files/ETA/publications/ETAOP_2013_08.pdf

For Further Reading: Sources for the “House of Cards” Medicare for All Series

This document consolidates every source used to verify claims across all three essays in the Medicare for All series, plus additional context readers may find useful. Organized by topic.

The Bill Itself

Federal Cost Estimates

  • Blahous, C. (2018). The Costs of a National Single-Payer Healthcare System. Mercatus Center at George Mason University. Estimated ~$32.6 trillion in added federal costs over 10 years (2022–31), using assumptions favorable to the plan’s proponents as a lower-bound estimate. mercatus.org — “How the Urban Institute’s Estimates of Medicare for All Costs Stack Up”
  • Urban Institute & Commonwealth Fund (2019). From Incremental to Comprehensive Health Insurance Reform. Estimated ~$32–34 trillion in added federal costs over 10 years (2020–29). urban.org/research/publication/estimating-cost-single-payer-plan
  • Congressional Budget Office (December 2020). How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems. Modeled four illustrative single-payer designs; savings ranged from $42 billion to $743 billion in 2030 depending on assumptions, with the closest match to current bills (“Option 3”) yielding roughly $650 billion in savings — the source of the frequently cited “$650 billion” figure. Note: this is an analysis of illustrative design options, not a formal score of H.R. 3069/S. 1506. cbo.gov/publication/56898
  • Pollin, R., Heintz, J., Arno, P., Wicks-Lim, J., & Ash, M. (2018). Economic Analysis of Medicare for All. Political Economy Research Institute (PERI), UMass Amherst. A study conducted in support of the 2017 Sanders bill; estimated net national health spending would fall by about 9.6% under the plan. peri.umass.edu/publication/economic-analysis-of-medicare-for-all
  • Yale School of Public Health study (Galvani et al., 2020), published in The Lancet — estimated Medicare for All could save approximately 68,000 lives and reduce health spending by roughly 13% (~$450 billion) annually. Referenced in: Public Citizen, “Fact Check: Medicare for All Would Save the U.S. Trillions”

Worker Displacement and Transition

  • PERI (2018), Appendix 6: “Estimating Displaced Workers” — estimated approximately 1.8 million workers displaced from private health insurance and related administrative roles, including nearly 300,000 aged 60 or older. Same source as above.
  • Jayapal, P. — public statement confirming the “1% of total bill cost, set aside annually for five years” worker transition funding mechanism, and a separate public estimate of “about a million” displaced workers. Reported in: Fox News, “‘Medicare-for-all’ sponsor says plan would gut 1 million private insurance jobs” (2019)
  • Schochet, P.Z., D’Amico, R., Berk, J., Dolfin, S., & Wozny, N. (2012). Estimated Impacts for Participants in the Trade Adjustment Assistance (TAA) Program Under the 2002 Amendments. Mathematica Policy Research, prepared for the U.S. Department of Labor. Found TAA participants earned about $3,300 less annually than a matched comparison group in the final follow-up year; overall net benefit to society calculated as negative. dol.gov/sites/dolgov/files/ETA/publications/ETAOP_2013_08.pdf
  • U.S. Department of Labor, “National Evaluation of the Trade Adjustment Assistance Program” — background on TAA program design and participation rates. dol.gov/agencies/eta/research/publications/national-evaluation-trade-adjustment-assistance-program

International Comparisons

Independent Fact-Checking and Context

The Scale Illusion: “Medicare for All” Is a Global Outlier

~ Dr. K ~ Leave a comment

Part 2 in the Medicare for All House of Cards Series

“Every other developed country has universal healthcare.”  It’s been said so many times that it’s almost cliché.  Here’s the problem, universal healthcare doesn’t mean the same thing to everyone who says it and it comes in many forms even for the nations that have it.  For our purposes, let’s call it “single-payer healthcare systems” so that we can build a clear picture of what we are trying to build.  And let’s also make sure when we compare what happens in the US to what happens in other places, we make sure our comparisons take into account the scope and scale of what we are proposing.

Whenever single-payer healthcare is defended in American political discourse, proponents invariably point outside our borders, to Canada, the United Kingdom, or Western Europe, as proof that universal, government-run systems are efficient, affordable, and popular. This comparison is incomplete and perhaps even inappropriate.

The single-payer system envisioned in the Medicare for All Act of 2025¹ is not a standard adoption of European-style socialized medicine. Despite arguments to the contrary, the US is not the same as those other nations often used for comparison. Examining the sheer scale and the specific design choices embedded in the American plan shows it departs from every existing universal system in the developed world in several important respects.

First: The US Context Demands an Unprecedented Leap in Scale

The most immediate difference between the proposed system and existing international models is scale. The United Kingdom’s National Health Service covers a population of roughly 67–68 million.² Canada’s Medicare system covers about 41 million people, and unlike the centralized U.S. proposal it is not run as a single national program; each of Canada’s provinces and territories administers its own plan under the framework of the federal Canada Health Act.³

The Medicare for All Act would consolidate a population of roughly 340 million people under a single federal program managed out of Washington.¹ A federal agency processing claims and setting national payment rates for over $3 trillion in annual spending across a population eight times the size of any comparable existing system represents a genuinely novel scale of administrative centralization.  This is not necessarily unworkable, but it is untested at this scale.

Second: The Abolition of Cost-Sharing and Expanded Areas of Coverage Call for an Unprecedented Expansion of Scope

The current Medicare for All proposal calls for an elimination of nearly all point-of-service costs including copays, deductibles, and coinsurance, with only a $200 annual cap for prescription drugs.¹  This is unusual by international standards. According to the Commonwealth Fund’s International Health Care System Profiles, most peer nations retain some form of cost-sharing:

  • Canada provides first-dollar coverage for physician and hospital services with no cost-sharing, but this doesn’t extend to dental care, vision care, or outpatient prescription drugs, which are excluded from the core public system in most provinces. About two-thirds of Canadians carry supplementary private insurance, commonly through employer plans, to cover these gaps. These supplemental plans would be outlawed under the Sanders plan in the US.  Canada has historically been the only developed country with universal health coverage that doesn’t include a national pharmacare program, though the government introduced initial pharmacare legislation in 2024.³ ⁴
  • France’s system reimburses a substantial share of routine outpatient costs through the public insurer, with patients typically responsible for the remainder, which most French residents cover through supplemental “Mutuelle” insurance, similar in spirit to Canada’s supplemental market.⁵

By eliminating essentially all of these gaps and cost-sharing mechanisms at once, the Sanders bill removes a tool that most peer systems still use, in some form, to manage utilization and cost.

Universal systems outside the US typically draw firmer lines around what the public system covers. As noted above, Canada’s core public program has historically excluded dental, vision, and outpatient drug coverage, pushing citizens toward private supplemental insurance or provincial safety-net programs for those services.³ ⁴ The Medicare for All Act, by contrast, folds comprehensive adult dental, vision, hearing, and long-term care directly into the core federal program at no cost to the patient¹  This is a substantially broader guaranteed benefit package than what any of these peer nations currently provides through their public system alone.

Perhaps the most restrictive element of the bill is its prohibition on private insurers selling coverage that duplicates the federal program’s benefits.¹ This is a genuine outlier internationally:

  • Germany, France, and the Netherlands achieve universal coverage not through a single government payer but through tightly regulated markets of competing nonprofit or private “sickness funds” and insurers.⁵
  • The UK’s NHS, despite being a pure single-payer system, does not prohibit private insurance. UK residents can purchase private medical insurance that runs in parallel to the NHS, allowing them to bypass NHS waiting lists for eligible treatment at private facilities,  providing a safety valve the Sanders bill’s duplicate-coverage ban would eliminate.⁶

The Bottom Line

The Medicare for All Act is not a straightforward import of an existing European or Canadian model. It combines an unprecedented population scale, the near-total elimination of cost-sharing mechanisms that most peer systems still rely on, a broader core benefit package than any comparable country currently guarantees, and a ban on private competition stricter than what even single-payer Britain imposes. Whether that combination is a strength (a more genuinely universal system) or a liability (an untested set of simultaneous departures from every working model) is the crux of the policy debate — but it should be argued on those terms, rather than on the premise that the bill simply replicates what other countries already do successfully.

Sources

  1. Medicare for All Act, H.R. 3069, 119th Cong. (2025); S. 1506, 119th Cong. (2025). Full text: congress.gov/bill/119th-congress/house-bill/3069/text
  2. Office for National Statistics, UK population estimates; NHS England, “Overview of the NHS.” Commonwealth Fund International Health Care System Profiles — United Kingdom: commonwealthfund.org/international-health-policy-center/countries/united-kingdom
  3. Commonwealth Fund International Health Care System Profiles — Canada (2026 update): commonwealthfund.org/international-health-policy-center/countries/canada; PDF: commonwealthfund.org/sites/default/files/2026-04/2026_Country-Profiles_Canada.pdf
  4. Canadian Medical Association, “Who pays for Canadian health care?” cma.ca/healthcare-for-real/who-pays-canadian-health-care
  5. Commonwealth Fund International Health Care System Profiles — France, Germany, Netherlands: commonwealthfund.org/international-health-policy-center/system-profiles
  6. Commonwealth Fund International Health Care System Profiles — United Kingdom; general description of parallel NHS/private insurance structure consistent with the National Health Service Act 2006 framework.

Medicare for All: A Bold Promise or a House of Cards?

~ Dr. K ~ Leave a comment

The American healthcare system is broken!  That’s something a majority of Americans can agree on.  How to fix it does not have such strong consensus.  When it comes to fixing American healthcare, few proposals have generated as much passion, or as much fierce debate, as Senator Bernie Sanders’ Medicare for All. 

On the surface, the promise is incredibly appealing: you walk into any hospital or doctor’s office, receive whatever care you need, and walk out without ever seeing a bill, a copay, or a deductible. No more fighting with insurance companies over claims. No more medical debt. Who wouldn’t want that? 

But you can’t just legislate this into existence without considering the costs and the consequences.  This is the first in a series of essays exploring those parts of the story. To understand if Medicare for All makes “good sense,” it is vital to look past the rhetoric and closely examine the math, the mechanics, and the monumental disruptions it would introduce to the American economy.

The first thing to understand is how Medicare for All is designed

The Sanders plan is a “single-payer” national health insurance program. This means the federal government completely replaces private commercial insurance and becomes the sole entity paying for medical care in the United States.  Often called a “single payer” system, it is designed to consolidate the entire healthcare delivery system into a single administrative structure.

The structure relies on four core pillars:

  • Universal Coverage: Every U.S. resident is automatically enrolled, with coverage beginning at birth or on establishing residency.
  • Zero Out-of-Pocket Costs: All premiums, deductibles, and copays are eliminated for covered services, with prescription drugs the sole exception. (prescription drugs would have a small annual out of pocket max satisfied through co-pays)
  • Comprehensive Benefits: The plan covers hospital care, mental health and substance abuse treatment, dental, vision, hearing, long-term care, and reproductive and gender-affirming care.
  • A Ban on Duplicate Private Insurance: Private insurers and employers may only sell coverage that supplements the government program, not coverage that duplicates it.  Note this one.  It means the health insurance companies are out of business.

The current version of Medicare for All legislation suggests this system could be fully introduced over two years. ¹ Starting one year after enactment, children 18 and under, adults 55 and older, and those already on Medicare become eligible; by year two, coverage extends to everyone else.  This sounds great, and many believe it is a substantial improvement over earlier versions that suggested it would take 4 years to implement.  However, this faster on-ramp makes the cost analyses even more problematic.

Does this plan make Good Sense?  Initial analysis reveals at least three critical concerns that could each be the “fatal flaw.”

1. The Trillion-Dollar Revenue Disparity

The most immediately glaring issue with Medicare for All is the math on the federal balance sheet. A 2019–2020 Urban Institute and Commonwealth Fund analysis put the federal cost of a comparable single-payer system at roughly $32 trillion over ten years; a separate 2018 study by Charles Blahous of the Mercatus Center put the figure at $32.6 trillion over the same period, using assumptions favorable to the plan’s proponents.² ³ Both studies modeled the bill’s earlier four-year phase-in.  No independent group has re-run these models against the 2025 bill’s compressed two-year timeline.  When those models are run it is likely that the overall costs will increase as larger numbers of American come on board earlier increasing utilization costs.

To pay for this, proponents, led by Senator Bernie Sanders, proposed a menu of progressive taxes, including a 4% individual income surcharge, a 7.5% employer payroll tax, and various wealth and corporate taxes. Independent analysts estimate that these combined taxes would likely fall well short of the $3.2–3.4 trillion in new annual spending, leaving a structural funding gap which could easily be in the hundreds of billions to over a trillion dollars per year, depending on which revenue and cost assumptions are used. Closing that gap would require either significantly higher taxes on all Americans, especially middle-class families, or a broad-based consumption tax.  The argument that the increased costs are offset by savings across the healthcare system are considered in point number 3 below. Note, however, that the projected savings across the system do not equal the estimate 1 plus trillion-dollar annual budget deficits.

2. The Patient Influx vs. Shrinking Provider Pool

If you make a vital service completely free at the point of delivery, demand for that service will inevitably rise. Under the compressed two-year design, most of that demand surge, everyone not already covered in year one, arrives in a single additional year rather than spread across three.  There are clear reasons to doubt that the system will have the capacity to meet that surge.

The supply of doctors, nurses, and hospital beds cannot scale overnight under any timeline. Because the plan aims to control costs by capping reimbursement rates near traditional Medicare levels, rates the Medicare Payment Advisory Commission (MedPAC) and multiple hospital associations have long noted run below private insurance rates, many hospitals could face revenue shortfalls that prompt closures or early physician retirements, shrinking the provider pool just as the compressed timeline asks it to absorb more patients, faster.

When a faster patient influx meets a static or shrinking pool of providers, the result is unavoidable: care rationing shifts from financial to temporal. Patients won’t be priced out of care, they’ll be timed out of it, facing longer waits for elective surgeries, specialist visits, and diagnostic imaging.  The outcry today is that people are not getting necessary care because they can’t afford it.  The likely outcome of the Medicare for All plan is that people will not get necessary care because they can’t get an appointment with a doctor, or they can’t get the test they need, or they can’t get a surgery scheduled.

The plan’s financial viability makes a huge and unsubstantiated assumption.  It assumes up front that administrative costs will fall from the 12–15% typical of private insurers to the roughly 2% reported for traditional Medicare.  The argument offers up substantial savings numbers for the system as a whole. For example, a December 2020 Congressional Budget Office working paper modeled several illustrative single-payer designs and found administrative savings ranging from $42 billion to $743 billion annually depending on assumptions.  The most often cited savings number is $650 billion, but this comes from CBO’s most favorable “low payment rate, low cost-sharing” scenario, not a formal score of this bill.⁴ That analysis, like the Urban and Mercatus estimates, predates the 2025 bill’s faster rollout.  In other words, these are highly optimistic numbers that are not supported by solid financial models.  More detail on this problem will come in a later essay.

3. The Myth of Effortless Administrative Gains

Sources

Not only is the administrative gain open to dispute, dismantling the private insurance sector would displace a substantial share of the health insurance workforce. A 2018 economic analysis by researchers at the University of Massachusetts Amherst’s Political Economy Research Institute (PERI), a study broadly sympathetic to Medicare for All, estimated the number of displaced workers in insurance and related administrative roles at approximately 1.8 million, including nearly 300,000 workers aged 60 or older.⁵ What happens to those workers and those jobs?

While the plan proposes a federally funded Worker Transition Trust Fund to provide retraining and temporary wage replacement, history shows that government-run retraining programs struggle to efficiently transition displaced workers into comparable, high-paying careers.  This is such an important part of this analysis it will get major focus in one of the later essays in this series.

The Bottom Line

Medicare for All sounds good.  It plan attempts to pull off an unprecedented economic feat: covering 340 million people with the most generous benefits package in the developed world, outlawing market competition, and eliminating out-of-pocket costs — all while assuming administrative costs fall dramatically. The 2025 version raises the stakes further by compressing the rollout from four years to two, asking the tax base, the provider system, and the administrative machinery to adjust faster than any existing cost model has actually tested.

Good sense dictates that before we tear down the foundation of American healthcare on a tighter schedule than originally proposed, we should make sure the replacement blueprint isn’t a house of cards.

  1. Reintroduced in April 2025 alongside Reps. Pramila Jayapal and Debbie Dingell as S.1506 in the Senate and H.R.3069 in the House.  Medicare for All Act, H.R. 3069, 119th Cong. (2025); S. 1506, 119th Cong. (2025). Full text: congress.gov/bill/119th-congress/house-bill/3069/text
  1. Urban Institute & Commonwealth Fund (2019). From Incremental to Comprehensive Health Insurance Reform. urban.org/research/publication/estimating-cost-single-payer-plan
  2. Blahous, C. (2018). The Costs of a National Single-Payer Healthcare System. Mercatus Center at George Mason University. mercatus.org — “How the Urban Institute’s Estimates of Medicare for All Costs Stack Up”
  3. Congressional Budget Office (December 2020). How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems. cbo.gov/publication/56898
  4. Pollin, R., Heintz, J., Arno, P., Wicks-Lim, J., & Ash, M. (2018). Economic Analysis of Medicare for All. Political Economy Research Institute, University of Massachusetts Amherst, Appendix 6. peri.umass.edu/publication/economic-analysis-of-medicare-for-all
  5. Jayapal, P., quoted in “‘Medicare-for-all’ sponsor says plan would gut 1 million private insurance jobs,” Fox News (2019). foxnews.com/politics/medicare-for-all-would-gut-a-million-private-insurance-jobs

Navigating the Post-Truth Era: Balancing Facts and Feelings

~ Dr. K ~ Leave a comment

Over the past century, Western societies have increasingly expanded the authority granted to subjective experience in defining personal identity and public life. This development has brought new insights into human experience while also creating difficult questions about how subjective experience should relate to empirical evidence, shared institutions, and democratic decision-making.

This may describe one of the most significant cultural changes of the modern era. For most of Western history, truth was understood to exist outside ourselves. Whether grounded in God, nature, science, law, or long-established institutions, truth was assumed to be something that individuals discovered rather than created. Personal experience certainly mattered, but it was generally viewed as one source of knowledge among many. Experience could illuminate reality, but it did not define reality.

Over the last century, that balance has gradually shifted. Our culture has increasingly elevated subjective experience from being evidence about the world to becoming an authority over the world. The question has subtly changed from “What is true?” to “What is true for me?” This shift has produced genuine benefits. It has encouraged greater attention to mental health, increased awareness of trauma, and given voice to people whose experiences were too often dismissed or ignored. It has reminded us that statistics do not tell every human story and that empathy requires listening before judging. But every cultural gain comes with its own set of challenges.

When personal experience becomes the highest authority, disagreement becomes increasingly difficult. If my deepest feelings define reality, then questioning my conclusions can feel like questioning my identity. Debate no longer concerns competing interpretations of evidence; it becomes a conflict between competing personal realities. This helps explain why contemporary public discourse often feels so different from previous generations.

Political debates rarely stay focused on evidence for long. Scientific findings are frequently filtered through ideological commitments before they are evaluated. Social media algorithms reward emotional certainty over careful reasoning. Public conversations increasingly ask us not merely to disagree with one another but to choose which competing narratives we will inhabit. In this environment, facts often become secondary to identity. Psychologist Jonathan Haidt argues that “Intuitions come first, strategic reasoning second.” We often believe we are reasoning our way to conclusions when we are actually defending conclusions our emotions have already reached.

The modern phrase “my truth” captures this transformation perfectly. It usually does not mean “my perspective” or “my experience.” It often suggests that personal experience possesses its own independent authority regardless of whether it corresponds with external reality.

This is one reason the phrase “post-truth” has become so common. A post-truth society is not necessarily one in which facts disappear. Rather, it is one in which facts lose their ability to settle disagreements because different groups no longer recognize the same standards of authority. Hannah Arendt warned more than fifty years ago that “Freedom of opinion is a farce unless factual information is guaranteed.” Democracy depends on vigorous debate, but debate becomes impossible if citizens no longer share a common understanding of basic facts.

“Freedom of opinion is a farce unless factual information is guaranteed.”
— Hannah Arendt, Truth and Politics (1967)

History offers an interesting parallel. During the Modernist-Fundamentalist conflict of the early twentieth century, Christians fiercely debated the authority of Scripture, science, historical criticism, and religious experience. Both sides appealed to sources outside themselves—even when they disagreed profoundly about which sources deserved the greatest authority. The central question was, “What should count as authoritative?”

Today’s cultural conflicts often ask a different question altogether. Increasingly, authority itself is being relocated into the individual. Personal authenticity has become the highest moral value. To deny someone’s internal understanding of themselves is frequently seen not merely as disagreement but as harm. This development can be seen in debates over gender identity, politics, race, religion, and countless other issues. These debates are not simply disagreements about policy. They reflect competing understandings of where truth ultimately resides. Competing world views that are increasingly incompatible.

One worldview continues to believe that reality exists independently of us and that our responsibility is to discover and understand it as honestly as possible. The other increasingly argues that our internal experience plays a central role in defining who we are and how society should recognize us. Neither position is entirely wrong, but the conflict between them makes it ever more difficult to reconcile the two.

Objective facts without compassion can become cold and dehumanizing. Human beings are more than data points, and every statistic represents real lives with real experiences. Yet subjective experience without objective reference points creates its own dangers. If every deeply held conviction becomes equally authoritative, society loses the shared standards necessary for resolving disagreements peacefully. Democracy depends upon citizens who can disagree while still appealing to common evidence, common language, and common institutions. That may be the greatest challenge facing contemporary culture. 

The real danger of the post-truth age is not that people tell more lies than previous generations. Human beings have always distorted the truth when it served their interests. The deeper danger is that we increasingly lack agreement about what counts as truth in the first place. Once that happens, every disagreement becomes a struggle for power rather than a search for understanding.

“Everyone is entitled to his own opinion, but not to his own facts.“

Daniel Patrick Moynihan

Perhaps recovering healthy public discourse does not require choosing between objective facts and subjective experience. We need both. Human experience often raises important questions that demand our attention. Empirical evidence helps us test our conclusions. Compassion reminds us why the discussion matters. Humility reminds us that none of us sees the whole picture.

Truth has always required both careful observation and honest self-examination. The challenge before our generation is not deciding whether feelings matter. They do. The challenge is remembering that feelings, however deeply felt, are not the same thing as facts. A healthy society requires both empathy for individual experience and a shared commitment to realities that exist beyond ourselves. Only then can disagreement become what it ought to be—not a battle between competing identities, but a common search for what is true.

Selected References for Further Reading

Foundational Works on Truth, Identity, and Modern Culture

Arendt, Hannah. Between Past and Future: Eight Exercises in Political Thought. New York: Viking Press, 1961. (See especially the essay “Truth and Politics,” added in the 1968 edition.)

Bellah, Robert N., Richard Madsen, William M. Sullivan, Ann Swidler, and Steven M. Tipton. Habits of the Heart: Individualism and Commitment in American Life. Berkeley: University of California Press, 1985.

Berger, Peter L., Brigitte Berger, and Hansfried Kellner. The Homeless Mind: Modernization and Consciousness. New York: Random House, 1973.

Cassam, Quassim. Vices of the Mind: From the Intellectual to the Political. Oxford: Oxford University Press, 2019.

Haidt, Jonathan. The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure. New York: Penguin Press, 2018.

Haidt, Jonathan. The Righteous Mind: Why Good People Are Divided by Politics and Religion. New York: Pantheon Books, 2012.

Higgins, Kathleen. “Post-Truth: A Guide for the Perplexed.” Nature, Vol. 540 (2016): 9.

Keyes, Ralph. The Post-Truth Era: Dishonesty and Deception in Contemporary Life. New York: St. Martin’s Press, 2004.

Lasch, Christopher. The Culture of Narcissism: American Life in an Age of Diminishing Expectations. New York: W. W. Norton & Company, 1979.

Levin, Yuval. A Time to Build: From Family and Community to Congress and the Campus, How Recommitting to Our Institutions Can Revive the American Dream. New York: Basic Books, 2020.

MacIntyre, Alasdair. After Virtue: A Study in Moral Theory. 3rd ed. Notre Dame, IN: University of Notre Dame Press, 2007.

McIntyre, Lee. Post-Truth. Cambridge, MA: MIT Press, 2018.

Moynihan, Daniel Patrick. Daniel Patrick Moynihan: A Portrait in Letters of an American Visionary. Edited by Steven R. Weisman. New York: PublicAffairs, 2010. (Contains the frequently quoted statement, “Everyone is entitled to his own opinion, but not to his own facts.”)

Postman, Neil. Amusing Ourselves to Death: Public Discourse in the Age of Show Business. New York: Penguin Books, 1985.

Rieff, Philip. The Triumph of the Therapeutic: Uses of Faith after Freud. Chicago: University of Chicago Press, 1966.

Taylor, Charles. A Secular Age. Cambridge, MA: Harvard University Press, 2007.

Taylor, Charles. Sources of the Self: The Making of the Modern Identity. Cambridge, MA: Harvard University Press, 1989.

Trueman, Carl R. The Rise and Triumph of the Modern Self: Cultural Amnesia, Expressive Individualism, and the Road to Sexual Revolution. Wheaton, IL: Crossway, 2020.

Weaver, Richard M. Ideas Have Consequences. Chicago: University of Chicago Press, 1948.

Historical Background on American Religion and Culture

Marsden, George M. Fundamentalism and American Culture. 2nd ed. New York: Oxford University Press, 2006.

Noll, Mark A. The Scandal of the Evangelical Mind. Grand Rapids, MI: Eerdmans, 1994.

Smith, Christian. What Is a Person? Rethinking Humanity, Social Life, and the Moral Good from the Person Up. Chicago: University of Chicago Press, 2010.

My Pet Peeve: When Words Become Weapons

~ Dr. K ~ Leave a comment

Some things just set me off

Everyone has a pet peeve. Some people are irritated by slow drivers in the passing lane. Others can’t stand people who leave shopping carts in the middle of a parking lot. Mine is a little different. What bothers me is watching words lose their meaning because people find them useful for advancing a narrative.

Words are among the most important tools we possess. They allow us to describe reality, exchange ideas, challenge assumptions, persuade others, and understand people whose experiences differ from our own. The value of language rests on a simple premise: words should mean what they mean. The moment we begin choosing words primarily for their emotional impact rather than their accuracy, language stops serving truth and starts serving power. That shift is becoming increasingly visible in our politics, our media, and especially our social media conversations.

The problem is not that people disagree. Disagreement is both inevitable and healthy in a free society. The problem is that we increasingly choose language designed to discredit opponents rather than understand them. Instead of describing what someone believes, we assign them a label. Instead of evaluating arguments, we question motives. Instead of persuading, we condemn. The result is a public conversation that generates enormous amounts of outrage while producing very little understanding.

One of the clearest examples can be found in the way political labels are used today. Words such as fascist, extremist, radical, threat to democracy, and even Nazi once described specific political movements or identifiable behaviors. These terms still have legitimate uses. History contains genuine fascists, genuine extremists, and genuine threats to democratic institutions. The problem arises when these words become catch-all descriptions for anyone whose views we strongly oppose.

In contemporary political discourse, the same individual may be described as a fascist by one side and a defender of democracy by the other. The labels often reveal more about the speaker than the person being described. Rather than helping us understand political movements, these terms frequently function as shortcuts that allow us to dismiss entire groups of people without engaging their arguments. Once someone has been labeled a fascist, there is little incentive to ask whether their ideas have merit. The label itself performs the work that evidence and argument once did.

The same pattern appears in our moral vocabulary. Consider how frequently the word hate appears in modern discourse. Hatred is a real and destructive force, and history provides countless examples of the damage it can cause. Yet disagreement is not the same thing as hatred. A person may oppose a policy without hating the people affected by it. Someone may disagree with a social movement without harboring hostility toward those who support it. Citizens in a pluralistic society will inevitably disagree about questions of religion, morality, education, economics, and public policy. If every disagreement is interpreted as evidence of hatred, then meaningful debate becomes impossible because disagreement itself becomes a moral offense.

Related terms such as bigot, racist, sexist, and phobic often suffer from the same inflation. These words describe serious forms of prejudice and should not be treated lightly. Yet they are increasingly deployed as rhetorical weapons against anyone who questions a prevailing view. The accusation itself becomes the argument. Rather than demonstrating prejudice, people simply assume it. Rather than persuading opponents, they seek to shame them into silence. In the process, words that once identified genuine injustice become less effective at identifying it because they are applied so broadly.

A similar trend has emerged through the popularization of psychological terminology. Social media has introduced millions of people to concepts that were once largely confined to clinical settings. Terms such as gaslighting, narcissist, trauma, triggered, and toxic now appear in everyday conversation. There is nothing wrong with broader public awareness of mental health issues. In fact, much of that awareness has been beneficial. The difficulty arises when clinical language is expanded to describe virtually every unpleasant human interaction.

A disagreement becomes gaslighting. A selfish person becomes a narcissist. An uncomfortable experience becomes trauma. A difficult relationship becomes toxic. Being upset becomes being triggered. The original concepts become stretched far beyond their intended meanings. As a result, the language loses its precision and our ability to distinguish between genuinely serious conditions and ordinary human struggles begins to erode.

The common thread running through all of these examples is not political ideology, social philosophy, or even partisanship. The common thread is the gradual erosion of distinctions. Language functions best when it helps us recognize differences between related ideas. A lie is not the same thing as a mistake. A failed prediction is not the same thing as a lie. Disagreement is not the same thing as hatred. Fear is not necessarily prejudice. Selfishness is not narcissism. Being offended is not trauma. These distinctions may seem small, but they are essential to clear thinking. When we stop making them, we stop evaluating ideas carefully and begin reacting emotionally to labels.

This is why the issue is larger than politics. At its heart, it is a question of literacy. Literacy is often defined as the ability to read and write, but in a broader sense it involves the ability to understand ideas, recognize nuance, evaluate evidence, and distinguish between concepts that are similar but not identical. A literate society understands that precision matters. It understands that words are tools for describing reality, not merely instruments for winning arguments.

Unfortunately, many of the incentives that shape modern communication push us in the opposite direction. Social media platforms reward engagement, and engagement is often driven by outrage. Nuance rarely goes viral. Precision is seldom shared thousands of times. The careful explanation that acknowledges complexity is routinely outperformed by the simple accusation that divides the world into heroes and villains.

Consider the difference between saying, “I believe that policy will have harmful consequences,” and saying, “That policy is hateful.” The first statement invites discussion. It leaves room for evidence, debate, and persuasion. The second statement transforms a disagreement about policy into a judgment about character. Once that happens, the focus shifts away from whether the policy is good or bad and toward whether the people who support it are good or bad.

The same dynamic appears throughout our public conversations. “I think you’re mistaken” becomes “You’re lying.” “I disagree with your position” becomes “You’re a bigot.” “Your argument has authoritarian tendencies” becomes “You’re a fascist.” In each case, the language moves away from describing ideas and toward condemning people. The stronger accusation generates a stronger emotional response, which is precisely why it is so attractive in a media environment that rewards attention above all else.

What makes this trend particularly troubling is that it undermines one of the most important habits of democratic life: the ability to disagree with someone without questioning their humanity. Democracies are built on the assumption that reasonable people can hold different views about complicated issues. They require citizens who can engage opponents, challenge assumptions, defend their positions, and occasionally admit they were wrong. None of those things are possible when every disagreement is interpreted as evidence of malice, ignorance, hatred, or moral deficiency.

Perhaps that is the most significant cultural shift of our time. Previous generations often viewed disagreement as a problem to be debated. Increasingly, we view disagreement as proof that the other person is morally defective. We no longer ask, “Why does this person think differently than I do?” Instead, we ask, “What kind of person would think differently than I do?” The first question invites understanding. The second invites condemnation.

This shift helps explain why so many conversations seem incapable of producing resolution. If I believe my opponent is simply mistaken, there is a possibility that evidence, experience, or reasoned discussion might change one of our minds. If I believe my opponent is hateful, fascist, phobic, toxic, or dishonest by nature, there is little reason to engage them at all. The conversation is effectively over before it begins. Labels replace arguments. Motives replace evidence. Outrage replaces understanding.

None of this means we should abandon strong language when it is warranted. There are lies. There is hatred. There are genuine extremists. There are people who manipulate others psychologically. There are prejudices that deserve to be confronted directly and honestly. The answer is not to stop using these words. The answer is to use them carefully and accurately.

Strong words carry moral weight because they describe serious realities. When we apply them indiscriminately, we diminish their value. A society that calls every political opponent a fascist may eventually struggle to recognize actual authoritarianism. A culture that labels every disagreement as hate may find it difficult to identify genuine hatred when it appears. A public conversation that treats every uncomfortable experience as trauma risks trivializing the suffering of those who have endured truly traumatic events.

The irony is that many people use exaggerated language because they believe the issues they care about are important. Yet exaggeration often weakens the very arguments it is intended to strengthen. Credibility depends upon precision. People are more likely to trust those who describe reality carefully than those who reach immediately for the most inflammatory label available.

My pet peeve may sound trivial at first. It is, after all, a complaint about words. But words shape thoughts, and thoughts shape actions. The way we speak influences the way we understand one another and the way we understand the world around us. When language becomes detached from meaning, our ability to reason together begins to deteriorate.

Perhaps the solution begins with a simple commitment to intellectual honesty. Call a lie a lie, but only when someone intends to deceive. Call hate hate, but only when genuine hostility exists. Call fascism fascism, but only when the label accurately describes reality. Use strong words when strong words are deserved, but resist the temptation to use them merely because they advance a narrative or damage an opponent.

In the end, a healthy society requires more than freedom of speech. It requires discipline in speech. The more carefully we use our words, the more clearly we can think. And in an age increasingly defined by outrage, tribalism, and ideological division, clear thinking may be one of the most important civic virtues we have left.

The Death of the Middle Ground

~ Dr. K ~ Leave a comment

Spend ten minutes on social media and you’ll quickly discover that America is angry.

Conservatives are convinced progressives are destroying the country and that socialism is just around the corner. Progressives are convinced conservatives are destroying democracy and introducing Fascism to destroy our liberties. Every election is described as the most important in history. Every controversy becomes a moral emergency. Every disagreement is framed as a battle between good and evil.

If you spend enough time online, you might conclude that Americans have never been more divided. But I wonder if that’s really true.

America has always been a nation of disagreement. It only takes a brief look at our history to see that this is true. We have argued about religion, politics, economics, education, immigration, war, race, and countless other issues. Some of those disagreements have been intense enough to divide families, split churches, reshape political parties, and alter the course of the nation itself. Disagreement is not new in America.

In fact, disagreement has often been one of America’s greatest strengths. The founders disagreed. Religious leaders disagreed. Political parties disagreed. Citizens disagreed. The expectation was never that everyone would think alike. The expectation was that ideas would be tested through debate, persuasion, and experience and in the end, peace and tranquility would be maintained through compromise.

What is perhaps most troubling today is not that we disagree, but that we seem to be changing how we think about disagreement itself. Previous generations often viewed disagreement as a problem to be debated. Increasingly, we view disagreement as proof that the other person is morally defective. You’re not just wrong, you are evil.

For much of our history, Americans encountered disagreement within institutions that required ongoing relationships. We worshiped together. We served on civic committees together. We attended community meetings together. We worked together. We coached our children’s baseball teams together. The person whose politics irritated you was still your neighbor. The church member whose views frustrated you still sat beside you on Sunday morning. The coworker who saw the world differently was still someone you shared lunch with on Monday.

Those relationships mattered. They reminded us that human beings are more complicated than their opinions. They taught us that disagreement and respect could coexist. They forced us to recognize that intelligent, decent people sometimes arrive at very different conclusions. 

Today many of those institutions have weakened, and social media has increasingly become our public square. Unfortunately, social media was never designed to help us understand one another. It was designed to capture our attention. The more time we spend scrolling, commenting, sharing, and reacting, the more valuable we become to advertisers. And few things capture attention more effectively than outrage. We have outrage to spare in today’s social media environment. Influencers, activists, and organizers frequently wield righteous anger, fear, and indignation as powerful tools of persuasion.

Anger keeps us engaged. It makes us want to fight back. Fear keeps us watching, waiting for the next attack.  Indignation keeps us clicking, looking for the next sign of injustice. The algorithms have learned what sensationalist publishers have known for generations: calm and thoughtful discussion rarely goes viral. Conflict almost always does. 

As a result, the loudest voices become the most visible voices. The most extreme activist on the left begins to represent “the left.” The most extreme activist on the right begins to represent “the right.” Before long, millions of Americans find themselves reacting not to their actual neighbors but to carefully selected examples of the most provocative people on the other side.

Add to this the moral certitude of those who know they will never have to face the target of their criticism and you create an environment where disagreement quickly turns into contempt. It becomes easier to question motives than arguments, easier to attack character than ideas, and easier to assume the worst than seek understanding. 

The result is a growing belief that everyone is becoming more extreme. Yet most Americans don’t actually live at the ideological edges. Most people hold a mixture of views. They support some policies and oppose others. They hold convictions that don’t fit neatly into partisan categories. Like most human beings, they wrestle with competing values and imperfect choices. Real life is complicated.

But let’s face it, complexity doesn’t perform well online. Nuance doesn’t fit into a meme and humility rarely generates clicks. Certainty does, especially when it is delivered in all caps with a link to someone who already agrees with you.

History offers an important lesson here. A century ago, American Protestants engaged in one of the most significant religious conflicts in our nation’s history. The Modernist-Fundamentalist controversy divided denominations, seminaries, churches, and religious leaders. The dispute touched questions of science, biblical interpretation, theology, and the relationship between faith and modern culture. It was passionate, deeply consequential, and often painful.

Yet for all its intensity, the conflict generally unfolded through institutions that demanded serious engagement. Participants wrote books. They delivered lectures. They debated in denominational assemblies. They published articles and responded to criticism. The arguments lasted for decades because people were expected to explain their reasoning and defend their ideas.

More recently, the United Methodist Church experienced its own painful division over questions of sexuality, gender, and inclusion. In some ways, the two conflicts were remarkably similar. Both wrestled with a fundamental question: How should a religious community respond when long-held traditions encounter changing cultural understandings? In both cases, one side emphasized adaptation while the other emphasized continuity. In both cases, sincere people reached very different conclusions about faithfulness, authority, and the future of the church. But there was also an important difference.

The earlier conflict occurred in a culture that still expected extended argument and patient deliberation. The Methodist conflict unfolded in a world shaped by social media, instant communication, online activism, and twenty-four-hour commentary. The underlying issues were no less serious and the participants were no less sincere, but the environment had changed.

Complex arguments were reduced to slogans. Questions became tied to identities. Theological disagreements became intertwined with questions of personal morality and legitimacy. Participants increasingly encountered caricatures of their opponents rather than the strongest versions of opposing arguments.

That shift reflects something larger than any single church controversy. Previous generations generally treated disagreement as something to be examined, challenged, debated, and tested. Increasingly, we treat disagreement as evidence that the other person is ignorant, hateful, selfish, or morally compromised. Once disagreement becomes a judgment of character rather than a discussion of ideas, meaningful conversation becomes almost impossible.

In the era of instant and constant communication created by social media, conflict becomes something different. To be sure, conflict was not caused by social media. The issues are real and would have existed regardless. What social media changed is how the conflict is experienced.

That distinction matters. When we constantly encounter opposing viewpoints through outrage-driven platforms, we begin to assume the worst about people who disagree with us. We stop asking whether they might have reasons for their beliefs. We stop listening long enough to understand those reasons. Eventually we stop seeing fellow citizens altogether. All we see are enemies who need to be defeated, and our words are bent to that task.

At least in the minds of some observers, this may be the greatest danger facing our culture today. A healthy society does not require unanimous agreement. It never has. The goal of a free people is not to eliminate disagreement but to create conditions where disagreement can coexist with mutual respect. Democracy, community, friendship, and even family depend upon that principle.

The future of our nation will not be determined by whether conservatives defeat progressives or progressives defeat conservatives. It will not be determined by whether one ideology finally triumphs over another. It will more likely be determined by whether ordinary Americans can recover the ability to argue passionately without hating one another, to defend convictions without questioning the humanity of those who disagree, and to recognize that no political movement, religious tradition, or ideological tribe possesses a monopoly on wisdom.

It is encouraging to believe we have not lost the ability to think. Neither have we lost the ability to speak. Sadly, what may be slipping away is our willingness to listen to those with whom we disagree. A society can survive disagreement. In fact, disagreement is often the source of its strength. New ideas emerge through disagreement. Bad ideas are exposed through disagreement. Democracies depend upon disagreement. What a society cannot survive indefinitely is the belief that disagreement itself is evidence of evil—that anyone who reaches a different conclusion must therefore be ignorant, malicious, or beyond redemption.

The challenge before us is not to eliminate disagreement.

The challenge is to learn how to disagree well again.

Are We Becoming Easier to Manipulate?

~ Dr. K ~ Leave a comment

I recently read a study examining the relationship between literacy and voting. What caught my attention wasn’t the politics. It was the literacy.  As I ready through the article I was reminded of several recent interactions on Facebook posts with people who seemed to understand the words they were reading but lacked the ability to think critically through the arguments and make informed decisions.  I think we need to take a closer look at this issue.

For years we’ve been told that Americans are becoming more educated. In one sense, that’s true. High school graduation rates are higher than ever, and a larger percentage of Americans hold college degrees than any previous generation. But researchers are increasingly pointing out that educational attainment and literacy are not the same thing.

Educational attainment measures how many years of school we completed or what degrees we earned. Literacy measures something different: our ability to understand information, evaluate arguments, recognize contradictions, weigh evidence, and apply what we learn to real-world decisions.

Recent national and international assessments found that nearly three in ten American adults now score at the lowest levels of literacy proficiency, a significant increase from just a few years ago. Even more concerning, literacy scores declined across every educational attainment level, including among college-educated adults. (Institute of Education Sciences)

Take a look at that again.  Literacy scores are declining across every educational attainment level.  That’s a cause for concern, because literacy matters for far more than reading books. It affects our ability to understand economic policy, healthcare proposals, foreign affairs, legal questions, scientific claims, and the endless stream of statistics and competing narratives that flood our news feeds every day.

Researchers define literacy not simply as reading words but as the ability to comprehend, evaluate, and use information. (APM Research Lab) This is where elections come in.  One recent study found that many ballot propositions are written at reading levels well above the abilities of large portions of the voting population. In fact, while 39% of adults have a high school education or less, nearly three-quarters of ballot measures were written above that reading level. (Sage Journals)

But the issue goes beyond ballot initiatives. Every election cycle we are asked to evaluate candidates making claims about taxes, healthcare, immigration, crime, education, government spending, foreign policy, and dozens of other complex issues. A healthy democracy does not require every citizen to be an expert. But it does require citizens who can ask questions, examine evidence, challenge their own assumptions, and look beyond slogans and talking points.

When literacy declines, public debate can become more emotional, more tribal, and more dependent on simple narratives that confirm what we already believe. The question is not whether people have the right to vote. They absolutely do. The question is whether we are doing the work required to be informed voters.

As we approach another election season, perhaps the most important civic question is not “Who are you voting for?” Perhaps it is: “How do you know what you know?”

I’d be interested in hearing what others think. Is America becoming better informed, less informed, or simply overwhelmed by the amount of information competing for our attention?

#GoodSense

Medicare for All: The Hidden Truths Uncovered

~ Dr. K ~ Leave a comment

I see more and more posts with people advocating Medicare for All or some other form of single payer healthcare system in the United States. It’s a grand idea, but it just won’t work. Let me explain why.
Let’s start with some core assumptions behind this debate.

  1. A single-payer system would make healthcare services available to all Americans on an equal basis with no “out of pocket” cost for services provided.
  2. A single-payer system would remove the need for private/commercial insurance coverage and the associated premiums and out of pocket costs.
  3. All medical services can and would be available through the single-payer system.
  4. Costs for a single-payer system could be covered by reducing current spending on other programs (i.e. defense) and/or by increasing taxes paid by high income/high net worth individuals.
  5. Systems similar to those in other developed countries could be used as a model for an effective system in the United States.
    Let’s consider the idea of Medicare for all. In this model, Medicare would be expanded to include every American. When people suggest this, I think most don’t understand how Medicare actually works.
    What is Medicare?: Medicare is the federal health insurance program primarily for people aged 65 and older, though it also covers younger individuals with certain disabilities or conditions like End-Stage Renal Disease. Medicare is divided into four parts:
    • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.
    • Part B (Medical Insurance): Covers outpatient care, doctors’ services, preventive services, and medical supplies.
    • Part C (Medicare Advantage): Private plans approved by Medicare that bundle Parts A and B, often with additional benefits (i.e. Dental, Vision, Fitness).
    • Part D (Prescription Drug Coverage): Helps cover the cost of medications.
    Because original medicare does not cover all costs and does not include prescription drug coverage, the system has approved additional coverage options to help.
    • Medicare Supplements (sometimes called Medigap) offer supplemental coverage that helps cover the cost of out of pocket expenses not covered my Part A and Part B.
    So, Medicare operates as a partnership between the government and private insurance companies. But let’s keep looking to see what else we need to know.

Medicare is not free; Medicare is often misunderstood as “free healthcare,” but in reality, it is a cost-sharing system between the government and beneficiaries. enrollees pay premiums, deductibles, and coinsurance, and the program itself is funded by payroll taxes, premiums, and general federal revenue. To understand why expanding it to all Americans would be so expensive, it’s important to look at how much Medicare actually pays versus what patients still owe.
The Cost of Medicare for Current Seniors
Medicare already represents a significant financial burden:
Medicare Part A (Hospital Insurance)
• Coverage: Inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.
• Costs Covered:
o After you pay the deductible ($1,676 in 2025), Medicare Part A covers 100% of hospital costs for days 1–60 of a benefit period.
o For days 61–90, patients pay a daily coinsurance ($419 in 2025).
o Beyond 90 days, patients can use lifetime reserve days (up to 60 total), but coinsurance rises to $838 per day.
• Bottom Line: Medicare Part A covers the bulk of short-term hospital stays, but extended stays quickly shift costs back to patients.
Medicare Part B (Medical Insurance)
• Part B: The standard monthly premium in 2025 is $185 (going up to $205 in 2026), with a deductible of $257 ($283 for 2026). Higher-income seniors pay more (sometimes a lot more. Do a quick Google search for IIRMA and check it out).
• Coverage: Outpatient care, doctor visits, preventive services, lab tests, imaging, durable medical equipment, and mental health services.
• Costs Covered:
o After the annual deductible, Medicare Part B pays 80% of approved medical costs.
o Patients are responsible for the remaining 20% coinsurance, and some providers may charge up to 15% more (known as “excess charges”) if they accept Medicare but not full assignment.
• Bottom Line: Medicare Part B is a cost-sharing plan, not full coverage. Patients must budget for 20% of nearly all outpatient services.
• Oh, and Medicare Part B does not cover an annual physical with no cost sharing like ACA or employer sponsored plans do.
Medicare Part D
• Part D: Prescription drug coverage also comes with premiums and income-related surcharges. Deductibles can vary by plan but could be as high as $615.00 in 2026 while premiums are projected to average $35.00 with some people paying significantly more. And then, members must still pay the co-pays for their specific medications up to the annual out of pocket limit of $2,100.
These costs are substantial even for the current senior population. Expanding Medicare to cover all Americans would multiply these expenses dramatically, requiring either massive tax increases or unsustainable federal borrowing. In fact, it is quite possible that implanting this system would actually force most American households to pay more out of pocket (in the form of taxes) than they currently pay through premiums and out-of-pocket costs under their private insurance plans.
So, ok it would be expensive. And maybe we could find away to reduce costs or increase taxes enough to pay for it, but what happens when we add everyone in the country to this single system? How does the system absorb all of those new members?

The Strain on Provider Networks
Medicare’s provider networks are already limited compared to private insurance. Studies show that Medicare Advantage enrollees often have access to only about half of the physicians in their area compared to traditional Medicare. Narrow networks and reimbursement challenges mean that many providers are reluctant to accept Medicare patients.
If Medicare for All were implemented many researchers predict:
• Provider shortages would worsen. Doctors and hospitals already face reimbursement rates lower than private insurance, which could discourage participation.
• Rural hospitals in the US are already under financial strain. Forcing them to accept all patients with current Medicare reimbursement rates could force many of them into bankruptcy. At the very least it would force providers to ration their time and create long waiting lists for non-urgent services.
• Wait times would increase. With tens of millions of new patients entering the system, the demand for services would far outpace supply.
• Quality of care could decline. Overburdened networks would struggle to maintain standards, especially for complex or specialized care.

Conclusion
Medicare for All may sound appealing as a universal solution, but the reality is stark:
• Medicare is already expensive for seniors and taxpayers.
• Expanding it nationwide would require enormous new funding.
• Provider networks would be overwhelmed, leading to longer waits and reduced access.
• We haven’t even considered the disruption that would be caused by the loss of 600,000 to 900,000 jobs in the private health insurance industry. None of the models account for that disruption.
For these reasons and more, I believe Medicare for All is not a practical or sustainable path for the U.S. healthcare system. Instead, reforms should focus on improving affordability and access without dismantling the balance between public and private coverage.

The Limits of Diversity and Tolerance

~ Dr. K ~ Leave a comment

I have always thought of myself as a tolerant person and someone who values diversity. I still think of myself that way, but more and more I am seeing the limits of those concepts in our culture. Maybe you have seen it too. It leads me to ask a question: What are the limits of diversity and tolerance?

There is incredible pressure in American culture today to be “inclusive” and tolerant. I don’t think anyone would disagree with that. And, I think there is much good in the diversity we are working to embrace. At the same time, there is a growing sense of discomfort among many in the culture who do not feel “accepted.” What is interesting to me today is how many of those people come from majority population segments. Here’s the crux of the matter. Diversity and tolerance today press upon us the need to recognize, understand, support, accept and embrace minority cultures. It emphasizes the importance of “seeing” and “embracing” the cultures of people of color, LGBTQ+ cultures, minority religious cultures and other minority identities. In so far as we can embrace that kind of diversity and demonstrate acceptance of those peoples and those cultures, we are ourselves accepted. But what happens if someone or some group of people find those cultural expressions unacceptable?

If I wrote today that I cannot “accept” the efforts of the transgender community to promote and extend the “rights” of biological males to participate in sporting activities with biological females and that I would vote against the extension of such “rights,” would that make me intolerant? I suppose it would, but what if I wrote that I believe on the premise of “critical race theory” that white Americans are infected by systemic racism and their access to power and influence should be specifically limited. Am I not also now intolerant?

These are just some things I have been thinking about that I want to explore further. Here is the central idea, and I would like to have some discussion around it. I believe that the very heart of culture, all culture, is the values you hold so dear that you are unwilling to yield those values. In other words, culture is completely centered in the non-negotiable values you hold as your own. I believe that everyone one of us has those values and that when we encounter threats to those values we express our “intolerance” in whatever ways we believe are necessary to protect and defend our culture. I also believe that the modern appeals to tolerance and diversity neglect or even perhaps ignore the values of other cultures and are attempting an overthrow of culture that is neither diverse nor tolerant. On the contrary, modern movements for tolerance and diversity seem to be intentionally intolerant of any culture or group that does not specifically adopt, promote and accept their views of culture.

I have no doubt there are many people who will disagree with this, but I’m curious so see what you think. Let’s talk

Shalom,

Kevin

Tired of Being Misled!

~ Dr. K ~ Leave a comment

“False testimony my be refuted, but once it is voiced, everyone repeats it” Proverbs 21:28 as translated by Rabbi Rami M. Shappiro

Ok, so have you visited social media any time recently? Or how about have you watch the news on TV or cable? Have you read the newspaper? If the answer is yes, then you may agree with me that it seems like there is no way to know what is true any more. Raise your hand if you agree.

I may just be speaking for myself, here, but I am really tired of reading posts or watching stories that are filled with “spin.” It seems like every person’s goal is simply to prove their own point of view without consideration for what is actually true or right or good or valuable. There are so many examples of this that it is hard to decide which ones to use. Here is one.

On a recent newscast a reporter declared that President Trump had contradicted his own leading scientists regarding the expected availability of a vaccine for the corona virus. They went on to play a recorded clip from the President followed by one from the head of the CDC as proof of the contradiction. They also threw in a clip from Dr. Fauchi to further support their contention. On the surface, it appeared their complaint was valid. But wait a minute…

A simple review of the larger context of the statements by all three people reveals that maybe the story is not quite so simple. It turns out that the President was talking about how quickly a vaccine might be available to distribute to a broad segment of the population that are most at risk from the virus while the CDC Director was talking about how quickly the vaccine would be available for the “majority” of Americans. Those are actually two very different things. And, to top it all off, it turns out Dr. Fauchi agreed with both the President and the CDC Director.

What bothers me the most here is not whether or when a vaccine will be available. What bothers me is the apparent effort by the media to twist the facts of the story (because after all, these are all facts) in order to promote a narrative that attempts to discredit the President. I know they don’t like him. I know they don’t agree with him. I know they would like to see him voted out of office. But this is a form of deception that is insidious and dangerous. It threatens our culture because it diminishes the trustworthiness of the free press.

What makes it worse, in my view, is the way so many Americans are quick to pick up on such a story and spread it immediately and without criticism across social media. In a world where fewer and fewer people actually watch the news or read the papers, social media has become the source of much of what we know about our world. It is a powerful tool for both good and evil and it is being used for both purposes. When people uncritically repeat so called “facts” in social media they often unwittingly spread falsehoods. And the industry “fact checkers” are no help at all. Their purported objectivity is so obviously biased that it is laughable to call it anything but censorship and propaganda.

Once a story like this hits the media, whether broadcast or social, it seems unstoppable. Solomon saw the problem thousands of years ago. A false story, once started, even if it is proved false, will continue to spread. And why is that? It is because people continue to repeat it without discrimination. If it fits their preconceived ideas then it is repeated and promoted without hesitation. And of course, if you challenge someone who posts this information, you are likely to be attacked, called a fool, ridiculed, and/or dismissed.

Don’t be fooled. As we move quickly toward what could be the most important national election in a century or more, I want to urge people to be discerning. Ask more questions. Be slow to accept and even slower to respond. Look past the spin no matter where it comes from and treat every story with a healthy dose of skepticism. Don’t think that you already know – remember what Solomon wrote, “Know-It-Alls display their ignorance.” Don’t be an know-it-all and don’t spread false reports.

Shalom,

Kevin