RFK Jr. and the Elites’ Big Lie

Robert F. Kennedy Jr. is known first and foremost for his anti-vaccine crusades. However, he has also been saying some things that make sense. When Donald Trump first announced him as his pick for Secretary of Health and Human Services, he announced his plans to go after the corruption in the pharmaceutical industry. That has the potential to shake up an industry that costs the country more than $650 billion a year, or $5,000 per family. 

More recently, he indicated his intention to go after the pay schedules for physicians in Medicare. That is also a really big deal. The Medicare pay schedules for physicians are largely designed by the physicians themselves, with the specialists deciding how much Medicare should pay them. 

The result is a system that tends to hugely overpay specialists, partly at the expense of primary care physicians and partly at the expense of the rest of us who must foot Medicare’s bill. The impact of Medicare’s physician payment structure is amplified by the fact that many private insurers follow Medicare in setting their own compensation levels for physicians’ services.

That’s a big part of the story of why we pay our doctors so much more than doctors in other wealthy countries. The average doctor in the United States makes more than $365,000 a year. That’s more than twice as much as their counterparts in other wealthy countries. If we paid our physicians as much as doctors in Germany or Canada, it would save us close to $200 billion a year.

The high pay for our specialists is a big part of this story. While our primary care physicians also get paid more than their counterparts in other wealthy countries, the gap is much larger for specialists. Also, a much larger share of our physicians are specialists than in other countries. In most countries, primary care physicians do many of the tasks for which we rely on highly paid specialists.

The story of doctors’ pay is big money, more than is at stake in things like the expanded child tax credit or other issues that we often have major political battles over. However, it is almost never raised as a topic for political debate. Or at least had not been before RFK Jr. brought it up. 

A major part of the story is that it runs at odds with the Big Lie, which has dominated the debate over economic policy for the past half-century. The Big Lie is the debate has been over whether we should have “neoliberal” free market policies or social welfare policies that protect ordinary people from the market. 

The physician pay schedule story undermines the Big Lie because it is a way in which the government is very directly intervening in the market to shift income upward, giving money to roughly 1 million physicians at the expense of everyone else. It is not the whole story of government intervention boosting doctors’ pay. 

The government also severely restricts the ability of foreign-trained physicians to practice in the United States, even as our “free trade” policies have sought to put manufacturing workers in direct competition with low-paid workers in the developing world. And we have all sorts of restrictions on the activities of physicians’ assistants and nurse practitioners that require doctors to do many tasks for which lower-paid health care professionals are fully qualified.

These rules are great examples of how the government has structured the market to benefit a narrow groups of very highly paid workers while imposing higher health care costs on everyone else. The government-granted patent monopolies, which make drugs expensive, is another very important example. Those shift close to $500 billion a year in income to the drug companies. 

This is the story I tell in “Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer” (it’s free). The basic point is that there is no “neoliberal” free-market. The market is infinitely malleable and can be structured in ways that produce hugely different outcomes. Those with political power have used it to structure the market in ways that give themselves more money.

It is understandable that those who like the resulting distribution of income would be anxious about blaming it on the workings of a free market, but for some reason those who claim to want more equality also accept this Big Lie. RFK Jr.’s plans to overhaul the Medicare physicians’ payment system, as well as efforts to end corruption in the pharmaceutical industry, both could lead to less inequality and undermine the Big Lie theory of inequality.

As much as I would like to see progress in both areas, I still can’t stomach RFK Jr. His anti-vaccine rants threaten the enormous progress we have made in improving public health with vaccines over the centuries. His fantasies and lies also threaten the lives of people who have spent their careers trying to develop and promote vaccines in the interest of saving lives. They also have been blatantly racist and antisemitic.

I’m afraid that I can’t see a scenario where I want to see someone like RFK Jr. hold a position of major responsibility in the government. However, I would like people to take at least some of the things he says seriously.