The US looks more and more like a third world country

Fraying institutions

People get sorted not so much into red and blue worlds but into different financial systems, living conditions, and educational opportunities. When they get sick, deal with the law, travel—you name it—their experiences are like night and day. They exist in separate spheres. Pretty much the only way for someone in the low-wage sector to break into the affluent one is through a top-notch education—but that path is riddled with obstacles, even if you can find the money.

For most, escape is a distant dream.

The well-educated affluent sector makes decisions, sets the agenda, while the rest are just trying to survive – and getting sicker and dying younger. One cohort makes moves, while the other is caught in the aftermath.

As a rule, here’s what usually happens when a country splits into a dual economy:

• The low-wage sector has hardly any say in public policy.
• The high-income sector keeps wages down in the low-wage area to secure cheap labor for their businesses.
• Social control is used to keep low-wage workers from pushing back against policies that favor the wealthy.
• The main goal for the richest in the high-income sector is to cut taxes.
• Social and economic mobility become rarer.

We see

• Across party lines, the majority of Americans support raising taxes on the wealthy and big corporations.
• Most Americans want to increase Social Security benefits and oppose cuts.
• The majority favor higher taxes on the wealthy to keep Social Security robust.
• Most U.S. adults think the federal government should guarantee healthcare coverage for everyone. The majority favor single-payer – a single government program for healthcare.
• A bipartisan majority of voters want to expand Medicare to cover long-term, in-home care services.

And on it goes. Americans see very little real action from politicians in either party on these issues. In fact, they often see the opposite. Misleading rhetoric won’t make their concerns vanish.

The electorate is not stupid. Most Americans know perfectly well that their wages have not kept up with inflation, no matter how politicians try to spin it. They see the ever-rising costs of essential goods — keeping a roof over their heads, seeing a doctor, and going to college. They realize that the rich are profiting off their hard work and refusing to contribute their fair share in taxes. Black men, in particular, are worse off than they were before the pandemic – and people wonder why they aren’t supporting the status quo as they once did.

Medicine

Makary

Explains a lot about how the practice of medicine can be improved.

He does not call the medical establishment nefarious; rather, he accuses it of frequently embracing a narrative — that stress causes ulcers, for instance — without evidence, ignoring scientific findings that do not support the idea, and blackballing those who question their position.

Medical journals, for example, are a primary way in which doctors learn about new scientific knowledge that informs the medical care they provide. Most journals use a peer-review process, meaning that an article is only accepted for publication if a panel of experts deems it to be accurate and of high quality.

Makary has written more than 250 peer-reviewed articles in medical journals, but he is no fan of the genre. In his view, editorial boards, the gatekeepers of peer-reviewed publishing “tend to be composed of like-minded friends.”

“I have been shocked to see studies so flawed that the results are rendered invalid, yet they were published in prestigious medical journals and upheld as scientific proof when instead they just support a groupthink narrative,” 

Some issues with Medicare Advantage

Problematic

this year 54 percent of all beneficiaries are enrolled in private Medicare plans. 

To those in favor of market-oriented solutions, this would seem like a success story. It would be, except one crucial piece of context: It is costing taxpayers a lot of money. The Medicare Advisory Payment Commission (MedPac), a nonpartisan congressional agency, estimates that the CMS has spent 23 percent more on Medicare Advantage patients than it would have if those patients were in traditional Medicare.

Free market abuses rather than automatic “efficiency “

Monopoly power

Incentives to cheat.