Roemer's law states that "a hospital bed built is a bed filled." In essence, Roemer's Law argues that hospitals and physicians do what they can to take advantage of their available resources and if demand for services are less than capacity, hospitals and physicians will figure ways to induce more demand. The motivation here is to make as much money as capacity allows.
For the purposes of this post, I’m defining mandatory insurance coverage as 99% of the U.S.population with some form of public or private health insurance. As for the remaining 1%, there will always be a few conscientious objectors, especially in America.
So how do we do it? Mostly by following the example of Massachusetts, which has already achieved 98% coverage. So how does Massachusetts do it?
Note: This is an AI-assisted exploration. I am not assuming that AI summaries tell the whole truth and nothing but the truth, nor am I assuming the whole truth and nothing but the truth is knowable or unknowable. Not to imply that the search for truth is a lost cause!
A universal healthcare system could be established in the U.S. by leveraging existing structures like Medicare, Medicaid, and the insurance industry, using a range of provider and consumer incentives to control costs. Our current system already covers around 92% of the U.S. population under age 65 - only 8% to go!. That seems eminently doable, especially considering that over half the currently uninsured are actually eligible for healthcare coverage but simply have not enrolled in a government program. The rest are ineligible for government assistance, mostly due to immigration status or affordable alternatives given their income. Here’s the breakdown…
California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C., already have insurance mandates. Residents in these areas must have qualifying health coverage or face tax penalties. Except for New Jersey, their uninsured populations are lower than the U.S. rate of 7.9%. For instance, the uninsured rate is just 2.8% in Massachusetts and 3% in Washington D.C. That’s not too far from universal coverage.
While I’m against medicalizing unpleasant personalities as “disorders”, this description does appear to fit Trump to a T - as far as it goes. But it doesn’t go far enough these days. He’s more grandiose than ever and less connected to the real world. Which has got me to wondering if there’s something neurological going on.
But there’s a lot more to political differences than values or moral intuitions. For one thing, people have different understandings of how the world works: what is and what leads to what. And our intuitions are not independent of how we interpret situations. That is, how we feel about things requires some understanding of “what the hell is going on here”. In other words, emotion requires appraisal and appraisal includes a take on the causal dynamics of whatever we’re reacting to.
A universal healthcare system can be established in the U.S. by leveraging existing structures like Medicare, Medicaid, and the insurance industry, using a range of provider and consumer incentives to control costs. The old and disabled would continue to receive Medicare and government support would be available for low-income households.
Here are components of the existing system that would be retained, expanded or tweaked in my proposed universal healthcare system…
Should the U.S. have a universal healthcare system? By all means! No American should be denied necessary care. Besides, according to the latest Pew survey, 66% of Americans want a universal system, the younger the stronger the support. Even Republicans are getting on the universal healthcare bandwagon - 41% in the latest poll, up from 32% in 2021 (Pew Research, 2025). The time has come to get serious about what such a system should look like in the U.S.
Per capita healthcare spending in the U.S. was over $15,000 in 2024. That’s around 2,5 times the OECD average for member countries and most of those countries provide universal care. U.S. healthcare spending is projected to grow faster than inflation over the next several years, reaching over $24,00 per capita by 2033, or roughly 20% of GDP. This is an untenable situation, especially if we want universal healthcare, which would require coverage for another 25 million Americans. We obviously need to come up with a less costly healthcare system that performs well and serves all Americans. Here are some ideas on what that system would look like, bare bones version…
My debate club will be hosting a debate next week on the Trump administration’s recent actions in Venezuela. Speakers will argue for and against the capture of President Maduro as well as U.S. plans to “overhaul” the country post-Maduro. Here are some of the arguments for and against the administration’s actions and plans for Venezuela.
Over the multi-month exchange, this individual mocked and misrepresented counter-arguments and never budged from her original position. Nothing could penetrate her fortress of moral certainty or widen her perspective beyond a narrow moral reasoning. She repeatedly brushed off considerations such as evidence of culpability and constitutional protections as nothing but a smokescreen used by bad people to hide their bad values.
“We cannot ask authors to embrace intellectual humility and calibration unless the editors are prepared to follow through—to prefer manuscripts with well-calibrated claims to those that overclaim.…unwarranted bold claims will harm chances of acceptance, and exaggeration will be considered a potential basis for desk rejection. We are looking for excellent research, but we expect even the best research to have flaws, and we want those flaws to be factored into the whole manuscript, including the conclusions drawn.” - Simine Vazire, Editor-in-Chief, Psychological Science
Retrieval practice forces ours brains to actively reconstruct knowledge, which boosts understanding and higher-order thinking like problem-solving and metacognitive awareness.
A final question: assuming the not-so-grim future is plausible, what needs to happen between now and then to make it a reality?
Between October 15 and 26, 2025, the Manhattan Institute surveyed 2295 Republicans and/or 2024 Trump voters (aka the “GOP coalition”), plus an additional 500 registered voters. The sample was reached primarily via online panel interviews.
Gallup and Pew Research also conducted 2025 surveys that included questions on immigrants and immigration. This post will compare Republican responses in those surveys with what the Manhattan Institute found for the GOP coalition.
Now, why would people be afraid of being thought a Republican? Because an awful lot of Democrats and others on the left see Republicans as morons, hysterics, racists, benighted fools, ignorant jerks, self-justifying assholes, callous, immigrant-hating, morally bankrupt, thick…
One would think if people truly cared about achieving a valued social good - say, the elimination of poverty - they would also sweat over the details as to how to achieve this social good without jeopardizing other social goods. Which means they and their shared-values fellows would be having robust and thoughtful arguments on policy, no consensus expected.
I am not quoting Paxton as the ultimate authority on fascism. No scholar is. Historians and political scientists (aka “experts”) differ in their definitions of fascism and opinions of Trump. However, I have noticed that definitions of fascism have morphed over time, perhaps repurposed to boost present-day relevance and create a tighter fit with current figures or political movements.
According the the College Board, first-time full-time students at public two-year colleges have been receiving enough grant aid to cover their tuition and fees since 2010, on average.