I'm busy writing stuff, so let's see if I can't get you all to generate a bunch of content for me in the comments.
So I'm spinning the Wheel of Contentious Topics, buzz buzz buzz, around and around it goes, it's slowing down now... "gun control", "abortion", "religion", "Kirk or Picard"... and it's stopped on "health care in the USA"!
The previously-mentioned TechSkeptic just wrote an excellent post about the bizarre US health-care-reform situation. In brief, opponents of real reform are standing next to their rusted-out AMC Gremlin and insisting that all it needs is a lick of paint and some new seat-covers to be as good as any other car in the world today. And you shouldn't believe what people from other countries tell you about the cars over there, because that's all Communist propaganda.
I'm on the other side of the planet, and so don't actually spend a lot of time thinking about the plight of sick Americans. But I do watch The Daily Show, and the US health-care situation is an interesting example of a common problem.
I wonder if the USA will ever find its way out of this mess, where elected representatives choose talking points that are blatantly counterfactual, safe in the knowledge that a bunch of right-wing authoritarian voters (I strongly recommend Bob Altemeyer's book The Authoritarians, which is a free download) will believe them. This "authoritarian follower" population gives the cheerful promulgators of all sorts of lies guaranteed support from that ironclad 30% of the US public that never gave up on Dubya. And, often, a lot more than 30% of the US voting population fall into line.
(The 2008 presidential election had a very large voter turnout, by US standards, but almost four out of every ten eligible voters still didn't care enough to turn up. Here in Australia we probably have just as many people who don't care who gets elected, but we make them vote at least pretend to vote anyway, if they want to avoid a small fine.)
I don't mean to suggest that purest BS raining from on high upon a grateful populace is a phenomenon limited to the USA. The whole world has always had this same problem. But mass acceptance of definite and objective governmental lies seems to me to have reached its fullest flower during the Dubya administration, and it hasn't died back much now that he's finally gone.
(While I'm recommending books you can read for free, allow me to point you to Harry Frankfurt's much-less-frivolous-than-it-sounds On Bullshit. Every modern human should also own a copy of How to Lie with Statistics, but I'm afraid you'll probably have to pay for that.)
Right-wing authoritarians, as described by Bob Altemeyer, do actually understand the concept of being lied to, and also understand that their chosen authorities are often motivated to lie to them. But, often, authoritarian followers simply ignore this knowledge when they're listening to their chosen authorities.
This is the same sort of compartmentalisation that allows so many Americans to be perfectly fine with food stamps, bank-deposit insurance, unemployment benefits, Social Security and the threadbare safety net of Medicaid - especially if they're the beneficiary - but vehemently opposed to "socialism". The broadness of the definition of socialism that people use in these arguments makes pretty much every taxpayer-funded, universally-available government service technically "socialist", and therefore presumably abhorrent. Nobody seems to have a big problem with fire brigades, garbage collection, highways, bridges or public libraries, though. But, just as a segment of the US population would be perfectly happy to be ruled by a king (or a Bond villain, for that matter) as long as he wasn't called a king, many Americans are perfectly happy with "socialist" policies as long as nobody calls them socialist.
Apply no "socialist" government controls to any market you like and the result will invariably be corruption, cartels and frank fraud, giving rise to endlessly repeated boom-and-bust cycles, a minor example of which you might just possibly have noticed recently.
(On this subject, Upton Sinclair's classic The Jungle is another free book you might like to read. See also Charles Mackay's even older Extraordinary Popular Delusions and the Madness of Crowds.)
There's a lot more behind the weird American authoritarian hatred for anything-called-socialism than mere common-or-garden cognitive dissonance, though. Bob Altemeyer has, for more than 40 years now, been doing psychological research on why authoritarian followers and their usual leaders, "social dominators", behave in the way that they do. He's ended up with a very large stack of evidence of far higher quality than is usual in the social sciences, and discovered some very surprising things. Once again - read the book. I found it entirely fascinating, and often blackly hilarious.
Aaaaanyway, getting back to the subject of the USA's adoration of dreadful health care, it is obvious that the USA could randomly throw a dart at a list of other countries in the developed world (and a few less-developed countries...), adopt the health-care system of whatever country they hit, and have a guarantee that it'd work better than what they've got. Provided, that is, that the USA actually managed to implement the new system properly. All bets are off if the new system turns into one of those military-industrial-political boondoggles the USA is so good at, where Congressmen and Senators secure re-election by making sure that every state gets a finger in every pie. The EU bows in awe at America's ability to add such amazing amounts of open avarice to every kind of normal bureaucratic friction.
To people in other countries, like for instance Australia where I live, it's difficult to even believe that for a significant fraction of the US population, the best health-care option available is to join the crowd in the hospital emergency room - whether or not your condition actually constitutes an emergency, of course - and hope for the best. We foreigners are similarly staggered by the fact that for an even larger segment of the US population, contracting a serious illness makes it probable that you will end up bankrupt.
We Aussies have a pretty standard underfunded-but-more-or-less-functional public-health safety-net. We pay half as much per capita for health care as the USA, and outlive you by around 2.8 years. I don't think it's just the Vegemite that's responsible for this.
The UK's population only outlives the USA's by a bit less than a year, but despite that segment of the UK's population who use the free ambulances as taxis, their National Health Service only costs them about 41% as much per capita as Americans pay.
And the list, of course, goes on. And on. And on.
So, despite what I now know about authoritarian believers, I'm still staggered by the sheer balls of the legislators and other talking heads who claim that the US health-care system is actually a good one.
It's as if they're standing up and baldly declaring the USA to be a Buddhist nation, and all of their buddies are going along with it.
Hmm. It's possible that my "get readers to write stuff so I don't have to" strategy has gone slightly awry. Commenters may have some difficulty in out-rambling the above.
Do, nonetheless, feel free to try.
31 July 2009 at 5:21 pm
You forgot to talk about our PBS and why it is hated and feared by drug companies the world over. Back to the Google with ye!
[For the benefit of foreign readers, hubris is referring to the Pharmaceutical Benefits Scheme, not the US Public Broadcasting Service. -Dan]
31 July 2009 at 6:12 pm
Was anyone else hoping he'd land on Kirk vs. Picard?
31 July 2009 at 6:19 pm
If you're into the whole "WTF do US voters believe their candidates?" thing, and want an entertaining/depressing insight into a large section of the US, check out "Deer Hunting with Jesus", by Joe Bageant. (Your local library's copy is due back on the 17th, speaking of socialist institutions)
Otherwise, it's kind of weird knowing that even our mess of a health system is comparatively sane and workable compared to the US.
31 July 2009 at 7:40 pm
I have to laugh at many american's argument against national healthcare, "I don't like national healthcare because nothing is more important than my health." Lahjick+1
31 July 2009 at 9:32 pm
"Lahjick"???
Logic's got nothing to do with it... although it was kinda funny hearing lots of vox populi on the news earlier today saying how organic foods must be better for you & the environment, it's logical!
Speaking of crazy Americans and the socialist bogeyman... I've got a friend who's an otherwise nice guy. Fairly high-level scientific, very smart. But Global Climate Change is all a Big Socialist Conspiracy - it must be, because Al Gore supports it!
Yes, my friend votes Republican, how did you guess?
And, yes, he also thinks the US has a better health care system than we do here in Oz. Rush Limbaugh & co told him so!
31 July 2009 at 9:38 pm
Well, at the moment, the big obstacle blocking healthcare reform in Congress isn't the right-wing lunatic fringe, since the Republicans don't have a leg to stand on in Congress at the moment (which is pretty obvious if you take a look at their plan: CBS News link). What's really holding up the works are the so-called Blue Dog Democrats, fiscally conservative Dems, mostly from more solidly Republican parts of the nation. They're beholden to their constituents, who by and large believe all of the FUD that's circulating about healthcare reform, so they have to stand opposed to it if they'd like to get re-elected. And, of course, with that much money up for grabs, I wouldn't be surprised if more than a few of them are trying to get some of it for themselves.
31 July 2009 at 9:47 pm
It is a persistent urban legend that healthcare is strongly correlated with health. See, for example, this RAND health insurance experiment. Or this analysis of same experiment. If increased healthcare is not correlated with increased health then much of this debate becomes silly, to say the least.
Disclaimer: I am not defending the current state of the US healthcare system, just trying to inject some perspective into an irrationally polarizing dialog.
31 July 2009 at 9:54 pm
@phrantic: at least that argument has some *slim* chance of an amicable resolution.
31 July 2009 at 10:29 pm
The "Blue Dogs" are beholden not to their constituents but to the insurance industry. Bastards. I hate my government so much right now...
31 July 2009 at 11:03 pm
You have made me sad in the morning. I'll have to spike my coffee to get through the day.
Probably with dilaudid.
1 August 2009 at 2:06 am
Yeah, I hate authoritarians. Why won't let let me spend other people's money?
1 August 2009 at 2:21 am
I'm a big fan of your site Dan, but I don't think you quite have a grasp of American political philosophy. Some people may very well be rabid opponents of "socialism" just as you describe (I've never actually met any, and I've met more than a few crack pot right wingers), but the real argument, often misunderstood, isn't whether or not health care should be reformed, but whether the Federal government has the power and mandate to do so. It's not a power enumerated to the Federal government by the Constitution, the Constitution being a document limiting powers, not granting powers.
I'm a proponent of limited government, but I'd be thrilled to see American health care reformed. However, I'd like to see it done properly, either through a state government coalition (each of our states has its own consitution, many of which are quite different from The Constitution) or with a Constitutional amendment, not through some quickly pushed through, ill-thought out, pork filled boondoggle of a law. It's a lot harder to push crap through with a Constitutional amendment. That was the point. Sadly, that point is widely ignored.
1 August 2009 at 2:50 am
"Commenters may have some difficulty in out-rambling the above."
Challenge accepted, sir!
While I don't have anything nearly as insightful to say about authority and the 30% that will seig heil while goosestepping off a cliff behind King George II, I can demonstrate why logic and reason will utterly fail here, with a brilliantly appropriate "How to Spot a Psychopath" e-mail that is making the rounds in conservative circles (I had a sincere friend forward this to me as a real overview of the House bill (which he labeled "Obamacare", even though it's from the House... whatev)):
http://www.liberty.edu/media/9980/attachments/healthcare_overview_obama_072909.pdf
I tracked down the original, which is a bit wackier, but also looks less Official because it's a bunch of tweets strung together and lacks a letterhead. Here is the briefest summary I could compile with quotes:
The government gets "real-time access" and "direct access to your bank accounts" and "control of your marriage." The government will come "into your house and teaching/telling you how to parent" then "tell us what to eat" then "Your children will be indoctrinated and your grandchildren may be aborted!" through "...more government brainwashing in school" and "compulsory ABORTIONS," because "Abortion and government control intertwined" and (through the National Medical Device Registry) "U WILL b tracked." Oh, and it mentions ACORN four times and illegal aliens a bunch of times as well. The screed inexplicably opposes research, modern databases and fraud-reduction programs and hints at euthanasia. Doctors will be told where to live, how much they make and what they can buy. And "health care for animals".
If 30% of the country is sympathetic to this "overview," then that might explain the growing opposition. Heck, I'm against compulsory abortions, brainwashing and tracking chips implanted in my ass, so I must be against healthcare reform too!
1 August 2009 at 3:05 am
Well, you are both right an wrong about the US health care system. Parts of it work beautifully. Parts of it are horrifying.
Unfortunatley for us 'Murricans the parts that work great - namely medical research (the US produces more new medical procedures and advances than the next 3 first world nations combined) gets subsidized by the parts that really suck - namely cost to patients for care and access for the non-insured. (Hell, the idea that there ARE non-insured is freaking mind-boggling)
As for the socialism issue... I've found that every single person I've heard complain about socialism in this country, without exception, when asked to define it cannot do so correctly. The most common definitions I get are more closely related to communism than anything else - and they don't even get that right most of the time. It's depressing. Very Very depressing.
I blame Joseph McCarthy, Ronald Reagan, and our dismal school systems.
All that being said though... it's much tougher to implement a national healthcare system here than most anywhere else in the world. Our federal government just doesn't have the end-all-be-all kind of power that exists in other nations. We still invest most of our internal political power with the states. I know it doesn't look like that from the outside, since all you really hear about is the President and the Congress but the states actually have far more power in day to day affairs (like healthcare administration) than the feds do. The EU is a bad comparison for the US - it's member nations typically already had universal healthcare long before the EU was constituted. The EU, as a governing body, did not have to create any health systems it mostly just had to standardize existing ones. In reality it will take a concerted effort by the larger states to create a viable national heath system... and that doesn't seem likely to happen anytime soon with our current financial woes. It's criminal really.
Also, if you have the money, US healthcare is second to none... it's just that 95% of us don't have the money. Of course, everybody in Congress *does* have the money... so they fail to see the problem in any real and visceral way. What the US needs is a national level initiative process whereby voters can directly craft and pass legislation regarding the Congress which is binding and unalterable by the Congress. Then we could strip them of their retirement system (full pay plus cost of living increases for the rest of your life if you serve even one day in Congress) and their health care system (full care for the rest of their life) and force them to use Social Security as their ONLY retirement and MediCare as their ONLY insurance. I guarantee you we'd see real healthcare reform and fixes to the Social Security system in about 15 minutes. Too bad it can't happen.
1 August 2009 at 3:11 am
Blargh, don't get me started on the way our pols get bought and sold. I'm not in love with the current system, but I'm *sure* anything they do to "fix" things will only make it worse (see above).
The main problem as I see it is the "long tail" of costs. If you simply took all medical care provided in a given country, sorted by cost of care per individual, and denied the top 1% of entries, you'd probably go from a cost-per-capita like the US has to a cost-per-capita like you Aussies or the Brits have -- that is, a grossly disproportionate percentage of expenditures are on a small number of very expensive cases. And frankly that's more or less how the socialized systems work -- put the decisions in the hands of the gov't, they stand up an office to decide how much a life is worth, and if your treatment is too pricey, they try to "make you comfortable" on the way out, and that's it. Result: much lower average cost.
The options as I see them are a) let people with money pay to extend their lives (the poor can go into debt, find a charity, or just die); b) extend everybody's life (at everybody's expense, via heavy taxation or irresponsible borrowing); c) provide a lottery system or create long queues to use constrained resources (capacity for 1000 operations / week; 2000 people / week need them); or d) let a disinterested 3rd party determine who gets care and who doesn't, hopefully by some "objective" standards. As I understand it, most socialized health care systems work on a mixture of C and D. I'm not saying the current system in the US (pretty much A, with a little of B) is *better*, but I'm not strongly inclined to switch. One of the main reasons? I had cancer. I should be basically fine (touch wood) because I was able to get a MRI within a few days of my initial diagnosis, which confirmed it. I was then able to go under the knife a few days after that. Had I been in, say, Canada, (due to C above) the process might have taken 2-10 times as long, and in that case, who knows what might have happened?
My main concern is that right now, I can get as much or as little health care as *I* want -- I can decide what has value for me. If the gov't takes over, it doesn't matter how much I want that second opinion, I simply don't have the option of getting it. And that's not all -- as I said (and as Dan pointed out), I don't trust politicians to make the switch without throwing in enough pork, favors, and general selling-out to bog the whole system down to the point of collapse.
P.S.: let's not forget the substantial chunk of America's health-care spending that goes to research, which benefits the whole world. If my operation hadn't been totally successful, I still had a good shot at recovery because of anti-cancer drugs discovered and manufactured in the US. If we cut health-care spending, how do you think those researchers will fare?
1 August 2009 at 3:12 am
@ videopia - Well, there's your problem... it's produced by Liberty "University" - a well known bastion for hyper conservative evangelical christian non-thought! If these guys qualify as a university then you can just call me the pope.
1 August 2009 at 3:18 am
I'm getting sick of how Internet debate invariably picks strawmen for opponents -- the Two-Toothed Abortion Clinic Bomber (if your view leans left) or the Gay-Married Communist Party Chairman (if your view leans right). I mean I guess there probably are a scary percentage of Americans who honestly believe those snippets from videopia's post, but I like to tell myself that most people are, on average, not totally crazy and more or less centrist (for my personal definition of "center", I'm sure). I try not to base my discussion on what "the other side" thinks, so I can avoid (even accidentally) caricaturing the other side.
1 August 2009 at 4:01 am
One of the interesting aspects of this is that the reason all those other countries can have cheaper health care is that they are free-riding on the American expensive system.
Many, even most, new treatments are developed here and it is the payback from sales in North America that pays for that development. Everyone else then buys those treatments at a reduced rate, because they're subsidized by us.
That's particularly true for new prescription drugs, for example. Mostly they cost a lot more here than in Canada, for example. A lot of people wonder why we can't pay the same kinds of rates as the Canadians. But if we did, the rate of development of new drugs would drop way off. We could buy the existing drugs cheaply, but there wouldn't be many new ones.
The Europeans have spent decades perfecting the process of free-riding on American expenditures (see e.g. NATO). But in the long run it isn't possible for everyone to free-ride. SOMEONE has to pay full fare.
1 August 2009 at 4:41 am
My main concern is that right now, I can get as much or as little health care as *I* want -- I can decide what has value for me. If the gov't takes over, it doesn't matter how much I want that second opinion, I simply don't have the option of getting it.
What gives you that odd impression? Under almost every universal plan I know of, if you want to pay for a second opinion out of pocket (or under a supplementary coverage plan), you're more than welcome to. There are nationalized plans that are more draconian all-or-nothing for the physician, but in general all they do is provide for the user is a floor of service, you're more than welcome to use the free market to access higher classes of service or get elective procedures done faster than the national plan will get around to it.
We already have long queues for basic functions - my primary care physician had an 18 month queue for annual physicals, and you can't say that the insurance industry is any better for being an _interested_ third party determining who does and doesn't get care, it's just that their interests are entirely unaccountable to the average user.
Now I think there's a fair argument to be made about whether nationalizing will throw the x% of the US population that is employed by the insurance industry out of work, but I don't think I've ever really seen that argument made, it's always weird personal anecdotes about how the status quo is _just fine_.
1 August 2009 at 4:53 am
Mr. Dan,
I would suggest that you look at the demographics of the 45 million or so uninsured in the US.
Millions of illegal immigrants.
Millions who can afford but choose not to buy insurance.
Millions who are eligible but who choose not to enroll in government programs.
The problem is a bit more complex than you let on.
1 August 2009 at 5:00 am
And I think at least part of the reason for the currently long queues is that due to how our current insurance industry has divided coverage between in-network and out-of-network providers, people are incapable of going to a different provider who has a shorter lead time without risking going out of their insurance provider's network. Frankly I think there's a ton of improvement that could have been voluntarily done by the industry that would have staved off nationalization demands, but they took the more profitable option instead. Things like:
. Recission,
. Pre-existing conditions,
. Weaseling out of every conceivable loophole,
. Lifetime caps that are ridiculously low,
. Patient uncertainty going in whether a procedure will be covered or not (the anesthesiologist that you didn't have any say in? Yeah, they're not part of our network, so we will be covering little to nothing of their bill),
. Group coverage rates that make it much more effective to provide insurance coverage as a megacorp and almost impossible to cover as a small business (and even then, megacorps are migrating to countries that provide universal coverage because it's still even cheaper since there's no local administration)
. Clinging to the free market while not actually allowing for much free market movement (i.e. the only choice I have for a different insurer is either to change jobs or to pay entirely out of pocket for non-group private coverage at exorbitant rates)
. The whole network thing
All of these have created this gigantic mess that only seems to have one solution: throw it all away and start over. I'd cry for them if they hadn't brought it on themselves.
1 August 2009 at 5:11 am
And somehow, the great and mighty United States, whose unofficial motto was always "we can do anything we damn well please if we set our minds to it" is suddenly stymied by something that virtually every other industrialized nation has found relatively simple to implement. Instead we listen to (well financed) insurance industry shills claim that it's utterly impossible and we shouldn't even consider it.
1 August 2009 at 7:53 am
Frankly, you're full of shit. You forgot about option e), the cost of everything health-related here is so much cheaper because we don't have a ridiculous playoff between an insurance agency and healthcare providers both jacking prices up. Those prices are in no way indicative of actual costs to provide healthcare (which is presumably why Cuba can still outperform you despite being impoverished and subject to a trade embargo by you), so that's the option that we (Aussies) take. Medicare is essentially run as a not-for-profit, which is how we're able to provide all those expensive procedures for everybody who needs them and still run at less than what it costs in America per capita. Healthcare is even cheap enough that you can go to the doctor even if you think that there might be something wrong, or just for regular checkups. We call that preventative medicine, and it's a big part of why we're healthier.
Is that supposed to be impressive? I was very ill and they thought I might have had cancer, so I needed an MRI and a CT to confirm, which took place a couple of hours later (and a lot of that time was preparatory, drinking the radioactive dye stuff etc.). It wasn't cancer, but the chemo was ready to go immediately pending the radiologist's report regardless. That's because access to any limited facilities are triaged according to need rather than ability to pay, and life-threatening conditions get to push in ahead of someone checking how their breast implants are settling in. And yes, even say, Canada triages patients.
P.S.: that's completely irrelevant, because you've conflated the healthcare and pharmaceutical/medical device industries. We're talking about healthcare and healthcare insurance, which is the dispensation of funds for the treatment of health problems. The investment of money in developing novel compounds/techniques/devices is perfectly able to operate in the non-USA developed world, because we still have a free market. We're a very small country, but we still have made a few contributions to medicine (Cochlear makes the cochlear implants that allow deaf people to hear, CSL and Resmed are other big ones. Oh yeah, and we made that cervical cancer vaccine). Europe has some truly enormous pharmaceutical firms. Honestly, you've never hear of GSK? Sanofi-Aventis? Hoffman La-Roche? Bayer? Those Europeans with their socialist healthcare make a lot of the drugs that you are able to buy. Of the ten largest pharmaceutical firms by sales, only four of them are American, and not the top four.
And there's the rub, isn't it. If you can't institute it without beholden interests sabotaging it, then all the experience from the rest of the wealthy world won't help. Who knows, perhaps Americans are just culturally incapable of creating something that benefits everybody. How did the whole emergency fire services thing go? I'm not really affected either way, but I hope it works out for you guys.
Honestly, I usually don't write in for these things, but wilfully ignorant non-reality-based points like these just make me so upset.
1 August 2009 at 8:31 am
@pfriedel: AFAIK there are several major nationalized-care countries that prohibit private practice. I do not have a name in front of me, but I'm pretty sure I'm not making it up. In some cases, private practice is outlawed wholesale, but more common is a de-facto ban by forcing providers to choose between the small-but-steady gov't check (accepting the national plan) or the bigger-but-less-frequent private pay -- it's just not practical to ignore all the people that jump on the "free" plan.
One thing that always nags at me when we say we want to emulate "the rest of the world" -- when somebody really can't get the care they need in their own country, where do they go? Well, OK, sometimes India (lots of cheap flights and a Euro goes a long way), but otherwise to the USA, because we have the best that money can buy (I mean, we spend so much of it...)
1 August 2009 at 8:33 am
Also: forgot to address something Dan said above -- I'd bet you a dollar that if you adjusted for per-capita income the life expectancy difference you cite would disappear. What do I mean? Rich countries (like ours) develop poor health habits, and it's a cultural problem. I bet the average amount of exercise an Aussie gets is way above the American average, and I'd wager your diet is (again on average) not nearly as bad. Neither of those things are going to be changed by our health-care scheme (I hope).
1 August 2009 at 9:25 am
List of countries by GDP per capita: the numbers vary depending on who is doing the calculation, but we're usually 13th and you're 15th. Not much of a difference.
Unfortunately, we're now the nation with the greatest proportion of overweight citizens on earth. The national icon of the sports-loving bronzed nation is unfortunately not all it's cracked up to be - as you said, rich nations have lots of fatties and we have an even bigger problem than most. It's not just us either, you're getting a lot of competition from some European states for the fatty prize.
Just for completeness, list of countries by life expectancy. No news here, but despite both of these factors (we're wealthier in absolute per capita terms and fatter), we live longer. Sorry, but these things have nothing to do with it.
I know that this might come off as a 'we're so great' thing, but it's really not. As Dan has said, our public health system is, putting it kindly, a mess. There is always unrest in the news from nurses not getting paid enough or budgets being too tight, and given how it's neglected it's amazing that we even get what we do. However, that just goes to show that even what we have is better than yours, and yours is much, much more expensive too.
1 August 2009 at 10:30 am
I don't know that much about the way things work outside of the good old US of A, but I can tell you they don't work well here.
Between myself and my employer, the health insurance rate for my family (of two, very soon to be 3) comes to $1447 PER MONTH. for this, I get to go to my primary care physician, on the odd chance I can get an appointment with him, and only have to pay $10 out of pocket. If I want to see any kind of a specialist, I have to see my primary first, and get a referral to the specialist. (two co-pays of $10, just to get in the door). for emergency care, I can expect to be billed (or have to pay) $50 out of pocket. If I have a drug prescribed, I pay $10, $20, or $35 (usually per month, unless it's a short round of antibiotics or something), unless of course the HMO decides the drug is too expensive or not medically necessary, in which case I have to pay full retail if I still want it.
And I have it good! that's actually not terrible coverage! (it helps that my company picks up the better part of the tab)
There are minor difficulties with the system. for example, for whatever reason, the insurance company can't manage to pay ANY of the emergency departments around here directly - the hospital submits a claim, the insurance company (assuming the approve it), mails me a check, and I have to sign the check over to the hospital and mail it to them. how is that the best way?
And then, there's the billing process. I'm on a CPAP machine for OSA (holy crap, I feel old complaining about all this!), and for the first 6 months of the rental, the providing company was screwing something up. so, the provider was billing the insurance company using the wrong provider ID, the claim would be refused, I'd be sent a claim summary saying it was refused. for 6 months, until I called both sides, this happened. I never got a bill, and the provider was still eventually getting paid, but what a waste of resources!
And, then, there's the crap they won't cover. Say what you might about chiropractic care (I don't believe well over half the shit they claim it does for you myself), but I haven't had any back problems since I've been seeing a chiropractor; which I have to pay for out of pocket, because none of the insurance plans available to me cover it. I can't help but think that the amount of money the insurance company has spent on me when I throw out my back would more than cover the cost of preventing it from happening in the first place. Oh, and the time that they refused to fill an emergency department prescription for my wife because they didn't like that particular drug, and suggested that the solution would be to see her primary care physician 3 days later (next business day) for an alternative. That was fun.
Yup. our system sucks. Unless, of course, you're on the Senate health care plan, or, you know, rich. In that case, you're just fine. but for those of us with more limited means, it sucks.
1 August 2009 at 12:04 pm
As long as we're throwing around life expectancy and infant mortality numbers, we should note how they are reported around the world. The U.S. reports just about anything resembling a live birth as a living person, however briefly, while other nations have different standards for what qualifies as "infant mortality" versus "stillborn" (i.e. does not count toward mortality rates).
I note that the Wikipedia article cited does not mention reporting methodology, which means that some of the difference in life expectancy may be accounted for right there. A less homogeneous population over a large area might have something to do with it as well.
I do find it odd that people who do not want their federal government to have more influence in their lives are characterized as "authoritarians".
[A right-wing-authoritarian-follower, by Altemeyer's definition, has a high degree of submissiveness to their chosen authorities (which aren't necessarily governmental), expresses aggression towards people who don't belong to the same "ingroup" as the authoritarian-follower, and not only follows their ingroup's social conventions, but believes that everybody else should follow them too.
There's no actual political alignment indicated by the "right wing" in the name; right-wing-authoritarians are just people who follow the current controllers of their society, while left-wing-authoritarians want some other group to be put in charge. If this happens, followers of the new authorities now qualify as right-wing-authoritarians again. So, by Altemeyer's definition, supporters of the government of the USSR were right-wing authoritarians, and anybody who actually greeted the 2003 American invasion of Iraq with hugs and flowers would have been a left-wing authoritarian.
Libertarians who oppose health-care reform for the reason you mention, just because they don't want any government telling them what to do, will still qualify as authoritarians if they fulfil the abovementioned right-wing-authoritarian criteria about some other authority. If they don't, they won't. -Dan]
1 August 2009 at 12:23 pm
I feel the need to correct you on the statement that here in Australia we make people vote to avoid a small fine. The situation is actually just compulsory attendance. All you are actually obliged to do is rock up to a polling place and have your name ticked off. Whatever you do with the piece of paper they hand you is really of no concern. Unless, of course, you take it home, photocopy it, fill them all in then rush back and try to stuff them all in the box.
1 August 2009 at 1:04 pm
You're of course quite right, taiti; I've amended the post accordingly.
I wonder if there are statistics on how many people "vote informally" in really obnoxious ways? Like, wrapping their ballot around a well-aged sardine, or something. Given how easy it is to make a small delayed-action fire-bomb, I think it's further evidence of the basically civilised nature of human beings that I don't remember ever hearing about a ballot-box going up in flames.
(Standard Australian ballot boxes, by the way, are made of cardboard. This tells you that for all its flaws*, the mechanics of our electoral system have been constructed by people who think seriously about security, not just the modern "security theatre". The security of an electoral system comes from people, not from impregnable lockboxes and opaque but very high-tech-looking voting machines.)
* Example: The New South Wales Upper House election ballot paper has for some time now been hilariously gigantic. I have actually numbered all of the boxes on one of those, more than once. The mind boggles at what it'd turn into if Australia had a US-style enthusiasm for voting machines, instead of simple paper.
2 August 2009 at 12:37 am
I used to live in the UK. Once I had a suspected lump in my chest. I was in to the GP that morning (no appointment necessary, just get there early and queue for an hour or so).
3 days later I was recovering from the operation to remove it.
Everything was of course free.
I've had a couple of friends phone NHS direct (our non-emergency medical helpline) with chest pains, and had an ambulance picking them up within 15 minutes. That's in London which probably has the busiest medical system in the country.
I also have friends who have good private health care through work, they've used it before but have recently had heart surgery on the NHS because the wait times were comparable and the private cover not much better "I had my own room which was pretty cool, but lonely"
I moved to New York in February. I now have insurance provided through work, which I'm told by other employees it a pretty good policy.
There are small co-pays for visits to the doctor which I can afford to pay. But if I have to stay in hospital it costs my $250 per day for the first 5 days, and of course I have to pay a portion of the cost of treatment, depending on what the treatment is.
The last thing I want to worry about when I'm ill is how I'll pay.
I'm one of the lucky ones with a reasonable income and "good" insurance.
People moan about the NHS but you don't know what you've lost 'till it's gone.
2 August 2009 at 1:51 am
That's right, royal. If they disagree with you, have a way to back up their assertions, and are excited, then they're authoritarian. What, you thought it meant the desire to subject you under their control? Don't make me laugh; where'd you get that, the OED?
The only assertions that are righteous are unsupported ones, and ones that force people to pay for other people's mistakes. That is progressive toward our bright future. How else are we to redeem the individual? God doesn't exist. The collective does, hail the collective.
2 August 2009 at 7:49 am
[A right-wing-authoritarian-follower, by Altemeyer's definition, has a high degree of submissiveness to their chosen authorities (which aren't necessarily governmental), expresses aggression towards people who don't belong to the same "ingroup" as the authoritarian-follower, and not only follows their ingroup's social conventions, but believes that everybody else should follow them too.
There's no actual political alignment indicated by the "right wing" in the name; right-wing-authoritarians are just people who follow the current controllers of their society, while left-wing-authoritarians want some other group to be put in charge. If this happens, followers of the new authorities now qualify as right-wing-authoritarians again. So, by Altemeyer's definition, supporters of the government of the USSR were right-wing authoritarians, and anybody who actually greeted the 2003 American invasion of Iraq with hugs and flowers would have been a left-wing authoritarian.
Libertarians who oppose health-care reform for the reason you mention, just because they don't want any government telling them what to do, will still qualify as authoritarians if they fulfil the abovementioned right-wing-authoritarian criteria about some other authority. If they don't, they won't. -Dan]
Also: black is white, war is peace, and freedom is slavery.
2 August 2009 at 4:02 pm
Much of the above is why I refuse to accept a label of any kind. Put a specimen in a jar and cover the entire jar with a label describing the specimen. You can't see what's in the jar, only the label.
Now tell me what's in the jar?
2 August 2009 at 5:26 pm
I think in that case the question isn't what is in the jar, it's whether or not it's alive. Schroedinger's activist...:P
3 August 2009 at 10:17 am
One of Altemeyer's surprising discoveries is that people with quite different political alignments - like, for instance, supporters of capitalist and of communist regimes - give the same answers on authoritarianism questionnaires. They use the same reasoning, such as it is, but can arrive at conclusions all over the left/right axis of the political orientation chart.
So, in this respect, they are indeed the same sort of authoritarian. Their beliefs are determined by where they live and/or who's in charge, not by any actual logical process. And, very notably indeed, they cannot "back up their assertions" with logic; the same illogical arguments are good enough for them, wherever they are and whichever authoritarian leaders they follow. A person who can logically explain what they believe, and can alter their beliefs based on evidence, is unlikely to score highly on the RWA tests. Very unlikely, actually - there are a lot of correlations here that're far, far stronger than those usually achieved by sociological resarch.
The book really is free, you know.
Altemeyer's been working on this stuff for forty years.
Could you at least have a go at chapter one?
3 August 2009 at 12:44 pm
Working my way through the book now - it's amazing how entertaining an academic work can be when it's written from a "retirement" perspective.
Also:
I heartily laughed when presented with the "global simulation" results - total annihilation within a few years at the hands of high RWAs, or, at best, a billion people dead from lack of essentials.
Then it suddenly wasn't so funny.
Cheers for the links, Dan - best non-fiction I've had since On Killing and The Mind of God.
3 August 2009 at 9:58 pm
American health system? Not my problem, I always got very good travel insurance the 1.5 times I went there.
Our system? Er, it works, I guess, if you have private health cover, which I do, and is reasonably affordable. If you don't... good luck.
My father-in-law is not covered by private health cover, and it his age it is hideously expensive. So he relies on the amusingly-named "Medicare". He has carpal tunnel symdrome in both wrists; a legacy of working most of his life on diesel engines in the years before decent workplace cover. Having paid tax all his life, he must now sit on 12-month waiting lists for the simple 1/2 hour day surgery needed to fix it. He had hid first op about a month ago, it went well, luckily, and his left hand is healing well.
They don't do both hands at once, so you aren't totally incapacitated. His docor recommended doing his right (writing, mousing, helping to hold steering wheel) hand in six weeks. Our
bunch of ucking farsholes clowns moronsglorious NSW State government says 'no, that's a seperate operation, so back onto the 12-month waiting list you go'.It was terrbile to see his birthday card to my wife - he can barely write. His doctor is in despair - he will likely loose the use of his hand after another 12-month wait. I'm thinking of actually paying for the op outright, though it will chew up my careful savings-for-hilariously-priced-house.
It looks to me like health in Australia is heading in the direction of the US - user pays for everything. I know our Federal government is claiming some grandiose scheme to right all wrongs; but I listen to the other side. My brother works in insurance, and the actuaries are getting quite scared of the baby-boomer spike. In 2011, the largest population spike Australia has ever seen will start to hit their first big health problems. Actuaries are shitting bricks (quaint Australian technical term, there) about the massive spike in costs, as currently there isn't any money to cover it. Neither do we have the infrastructure, staff or resources to cope. We've just seen the state hospital system in near-collapse due to a bad flu season (bugger the Swine flu, your common-or-garden flu kills about 3,000 people here each year, yet doesn't rate a headline) so how they are going to cope with a possibly 5-fold increase in cancer beds will be amusing to say the least.
We're heading for a health car-crash of biblical proportions.
Keep your private insurance topped up, and don't get ill.
4 August 2009 at 12:05 am
I'm an American with health insurance. it's not great insurance but it is coverage. i think we should have national coverage, but i don't think my government can provide me with the coverage i have let alone something better. one of their "great" ideas on how to pay for coverage for those who lack any coverage is to make my current benefits taxable. currently all i pay and all that my employer pays for my coverage is not taxed. so in order to cover those without, my benefits go in the toilet(loo/dunny whatever the hell you want to call it). I'm not rich. i'm not poor, but i have ok health care at best that is likly to get worse not better with my governments current proposals. the real issue here in the states is that our government is run by a bunch of piles of shit in suits that are as corrupt as is humanly possible while trying to avoid prosecution (some don't but most do).
I want them all (dems-reps) involved in my life as little as possible just as i wish to keep all pickpockets at arm’s length. Socialism has nothing to do with it. their ability to squander and piss away all that is good and just is the underlying issue.
4 August 2009 at 1:40 am
I grew up under the NZ system where we have universal coverage for healthcare. It is generally separated out between accident care, aging & disability and non-accident related care.
Accidents are usually fully covered by ACC in exchange for giving up the right to sue people for ridiculous sums for potentially causing said accidents.
Aged & disability care is usually subsidised to a varying amount according to what it is.
The rest varies a lot, from fully funded & a long waiting list to pay your own way and a short waiting list. Medications are readily subsidised, especially for low income earners, with a set nominal fee per prescription.
We have a government department that does a damn good job at keeping the cost of medicines down for the most part.
You can get faster care in private practice, but the public sector usually does a good enough job, and everyone public or private does emergency care because of the ACC cover.
It is a good system with generally good results, although there are lengthy delays for aging related issues due to the baby boom, same as everywhere else. Unlike the US & European systems, if you injure yourself you are assured of good emergency treatment, the variation comes in rehabilitation where you get what you pay for. I've had everything from vaccinations to surgery covered by the government and all I had to pay was a nominal fee for the visit to the GP.
As an aside to Corinoco, I believe if you have elective surgery such as that hand operation, the doctors can arrange for you to have the follow up when *they* say it should be, the waiting lists are somewhat flexible to allow for that sort of thing.
4 August 2009 at 5:28 am
Coderer: "And frankly that's more or less how the socialized systems work -- put the decisions in the hands of the gov't, they stand up an office to decide how much a life is worth, and if your treatment is too pricey, they try to "make you comfortable" on the way out, and that's it. Result: much lower average cost."
This isn't actually true, of the systems I know anyway. Both the U.K. and Canada evaluate treatments on effectiveness, not cost, where life-threatening diseases are concerned. Even extremely expensive life-preserving treatments are provided.
As others have said, the major flaw in your argument is that there's no reason a nationalized health care system has to be in opposition to private care. It's perfectly fine to have a system where everyone pays the premiums for the national care system, and private practice is allowed alongside that; this is how things work in the UK. You can live in the UK and never visit a government-provided health service, if you like - you can have a private doctor, go to a private hospital, private dentist, private clinics for everything else. You just have to pay your taxes to support the nationalized service as well.
There are places where private practice competing with the government-provided service is outlawed - it is here where I live, in British Columbia, for instance - but there's no reason the U.S. would have to adopt that system, and I think it's highly unlikely that it ever would.
Your suggestion that treatment of cancer would take twice to ten times as long in Canada as in the States does not appear to be backed up by any actual evidence, which would be a good thing to provide when making such a contentious statement.
4 August 2009 at 11:45 am
On Friday I wrote a big post that got eaten by the horrible wireless network at the hotel I was staying at. At any rate, I'll try to sum up.
I'm an American.
I have health insurance from my employer and pay for it. I am not taxed on my pay that pays for this insurance -essentially a reward for being a responsible citizen. Taxing this would punish my responsibility rather than reward it.
I am damn-near an Ayn Rand Objectivist, but not quite. I do not think there should be universal healthcare. It is too expensive, inefective, and I simply do not care to support people who have elected to make a poor personal choice. Furthermore, I do not want the government to have its finger that far up my ass, so to speak.
On the other hand I do believe that there should be some sort of "safety net" for those who truly are unable to care for themselves (this is where I part ways with strict objectivists); but it should have a definite goal of setting the citizen on his feet again; most of our social welfare programs in this country are like spider's webs; they might break your fall but it's nearly impossible to get out of them. On top of that they encourage abuse and shortchange those who truly need them.
4 August 2009 at 2:57 pm
Does this phrase always mean "What follows is unhinged rambling", or is it just a coincidence?
Hating people for being poor is one thing, but hating yourself? Did you not notice that everyone else in the Western world pays less for better healthcare outcomes than the US? I believe it was mentioned above. If you find your particular untested fringe ideology more convincing than actual real-world results, that's cool, but it's a bit harsh to inflict the resultant extra death, sickness, injury and *GASP* fiscal strain that on all of your compatriots.
Would you be happy if, say, everyone else in the US could have a more efficient healthcare system, and you could pay, say, 50% extra and still call yourself an Objectivist?
5 August 2009 at 12:18 am
It frustrates me that in the US, the amount of money that we don't pay to the government in taxes because medical care / health insurance is tax exempt (per capita) is more than most first world governments spend on universal health care. It further frustrates me that I can't distill this concept into a sound bite to respond to all the
idiotspeople calling universal health care "socialism" and who don't understand just how broken our system really is because the cost that we pay for health care is largely hidden from us.I think it should also be noted that the country can administer a large health care plan and do it for a reasonable price. For a good example, look at the military health care plan.
5 August 2009 at 4:52 am
Pssh. The military plan? We should look at what the army does? Bunch of fucking commie pinko socialists, if you ask me.
5 August 2009 at 6:54 am
I’m Brazilian, and we like almost all the sane world have a public health system. And a ecosystem of private insurance companies.
What differentiates the public from the private systems is mostly comfort. If you had an emergency you will be treated almost equally using public or private insurance. Some hospitals don’t admit public insurance patients, but rescue/emergency will never send you to one of those.
But if you need a check-up, and wish to use the public system, you will have to book the consult with some antecedence and are restricted to some doctors. If you use a private insurance you just call (almost) any doctor and go on the same or next day.
And with public insurance, if you need to be interned, it WILL the on the cheaper accommodations. A infirmary with many people in the same room. Private it’s based on your coverage (and how much you pay), it can range from the same accommodations as the public system to individual rooms with TV and other amenities.
There are lots of critics of the public system, it sure is not perfect. But no matter who you are or how much you gain. You are covered. You can go to a hospital and se a doctor without fear of bankruptcy.
Other thing that the public system manages is to keep the prices down. I pay BRL 165.00 month (roughly US $ 90.00) and have one of, if not, the best private coverage in the country. I can consult with the best doctors here with no problems and without paying any extras.
I simply cannot comprehend how Americans pay so much for theirs insurance and find it normal. Like abfarrer say $1447 to two people. And he has to pay 10 bucks extra for an appointment! It’s an absurd!
5 August 2009 at 7:55 am
Of course, even though I am strongly in favor of a nationalized public healthcare system for the US, I can still why it may pose some huge problems here. Not because the cost of care would be too high and the service too low (it wouldn't be) or because the government couldn't possibly run it well (it most certainly could) but simply due to the nature of liability in the US legal system.
Currently, a large source of our exorbitant healthcare costs can be laid squarely at the feet of our societies highly litigious nature. The costs of malpractice insurance to physicians is unbelieveable - it's often more than median income of an average American just for their personal insurance. When you throw in the fact that any hospital they may practice in must then have a policy for each physician (on top of the physicians personal policy) as well as an umbrella policy for the hospital as a whole... well, it gets insane rather quickly.
Of course, this brings us back to insurance companies... who, oddly enough, are actually fairly innocent (as these things go) in this case. The real culprits are the lawyers and the far too common multi-million dollar awards for procedures gone bad in which the patient was warned, up front, that the procedure had a high probability of failure and chose to go ahead anyways. The patient signed many pages of waivers and informed consent documents and indicated that they knew the odds... and then proceeded to sue when things went as they were likely to go. Or worse yet, the family sues when doctors fail to save the life of a patient... whom would have already been dead quite a bit sooner had it not been for the physicians efforts.
So, I guess we need to start with reform to the legal system to deal with these issues. I suggest we start by making waivers and consent forms worth more in court than used toilet tissue so that malpractice is limited to actual cases of malpractice - things like amputating the wrong limb and not things like failing to save the 400lb guy with high blood pressure and cirrhosis when his heart finally gives out (true story unfortunately, they walked with a little over 2 million). Good luck to whomever tries to do it - I've not got that kind of energy left in me.
5 August 2009 at 9:31 am
OK, jumping back in briefly to answer some points I saw above:
* I swear that somewhere in my memory are stats show that (at least for certain kinds of cancer) you are more-than-twice as likely to die waiting in Canada and/or the UK, but a) I'm sure they were worst-case, selected by someone trying to make a point and b) I can't find the references anyway. So consider that notion retracted -- sorry.
* Corinoco brings up a good point -- like all state-funded programs, universal health care in the Western world is in for a nasty shock when it notices the inverted-family-tree birth rates it's experiencing are going to put the burden of (expensive!) elder-care on a dwindling number of wage-earning workers. I'm not saying that the US's current private system handles that problem any better, but gov't seems to have an easier time borrowing from future generations than we can do on our own.
* I don't want to spend a lot of time on it, but I've heard some horror stories about military health care, and it's often cited as a reason *not* to move toward universal coverage. Read into that whatever you like, I guess?
* Opponents of universal health care suggest that it's hard for the private insurance industry to keep going when everybody is paying for the universal system as well -- the attitude tends to be "I'm already paying for it, might as well use it". The quotes from congress-critters about "killing private insurance" that are floating around don't help matters.
* @Dan: since the "progressive" / "liberal" / "anti-conservative" Democrat party now controls two (soon three?) branches of our government, do they still meet the definition of "left-wing", if "right-wing" is "the current controllers of [...] society"? Or would that mean those that parrot arguments of the Democrat party, instead of using a reasoned argument, are "right-wing authoritarians" now? If so, I think the term has been overloaded out of all usefulness.
5 August 2009 at 3:17 pm
@Coderer
Right-wing/left-wing may well be overloaded terms... but in the essay Dan linked, we're talking specifically about authoritarians, regardless of political inclination.
If one were an authoritarian follower and they hailed the Democrat government and president as being above the law and all reproach even if, for example, said govt/president began illegally detaining, spying on and torturing people, then sure - they'd be a "right-wing authoritarian" (RWA), despite them potentially having (or supporting) left-wing economic views.
Could Altemeyer have used a different term to differentiate between authoritarian supportors of current or alternative governments? Possibly, but I don't see why there should be any trouble following the distinction - but then, given I've actually bothered to read the book, maybe it's easier for me.
5 August 2009 at 4:44 pm
@ pompomtom:
I don't see how you come to the conclusion that I hate myself or poor people. "Poor" is something like "Black" or "White"; it has no bearing on your character. I've known miserable, surly poor people who are poor because of their own stupidity and laziness; true parasite who are happy to suck up government benefits and forever ride the coattails of their fellow citizens, and I have known bright, intelligent and hard-working poor people who are poor through no fault of their own (or a single decision that only proved indavisable in retrospect) and have tried as hard as possible to better their station, often without success and far more often without any effective aid from the state. It is true that being poor can make you into an asshole, but it doesn't have to, any more than being disabled, or being made fun of in school, etc.
Government-run universal healthcare is simply a terrible idea, and I don't know why people can't see that it is. The quality of healthcare in countries with nationalized healthcare is poor, and I don't think that it's the government's place to control people on that level, because it leads to the sort of lunacy that is happening in England (& other places; New York City with its "trans-fat" ban, etc); Health & Safety run amuk to try to prevent every conceivable accident or injury or disease because it drains the governments coffers, so people are told what to eat, what to drink, what not to smoke, etc. This is only rational from the government's point of view -if you were in charge of people and at the same time had to pay their healthcare, you'd tell them to avoid all unhealthful things. Perfectly rational line of thinking, but unfortunately it completely tramples the rights of the individual. I'm sure some of you will think that certain rights are more important, but that's only to you. Sure, the non-smokers don't care about the smokers, the vegetarians don't care about us who eat meat, just as most men don't care about a woman's right to have an abortion. I am the man who does care, and I think that all rights and freedoms are equally important, and that thinking otherwise leads only to totalitarianism. Some Freedoms are not More Equal than Others.
5 August 2009 at 9:00 pm
@Red October:
The only problem with your "Some Freedoms are not More Equal than Others" statement is that some individual rights must be limited in order to maintain the rights of others. Or in other words believing that people have the right to do whatever they like to themselves but do not have the right to impose their actions on others without consent.
A simplistic example is with smoking. Say person A smokes. Person B doesn't. A has the right to smoke, but not to impose the smoke on B via secondary effects. This is why smoking has been banned indoors from most public facilities. What about the children of A. Do you think A has the right to expose them to the risk of lung cancer et al before they are old enough to decide for themselves?
Another straw man, A has a gun, and has the right to fire it at will. B has the right to not be in the line of fire when this happens. Society restricts the right of A to only being able to use the gun on firing ranges so that B can only get shot at when they specifically exercise their right to walk down the range in full knowledge of what will happen.
Objectivism is an interesting philosophy, and has some good points, but where it falls down is the underlying hypocrisy where all rights are equal but the rights of the believing individual to do what they like are considered greater than the rights of society to limit the damage that that individual can do.
6 August 2009 at 2:40 am
Red October - You keep saying that the quality of healthcare in nationalized systems is poor... but the actual data doesn't back you up. Especially when you look at the health of the lowest echelon of society - ie. the poor. In the US there are people everyday who die form wholly preventable and curable illnesses due to the fact that are poor and do not seek health care for fear of having to pay for it. Or worse yet, they only seek healthcare via the emergency room - which is both very expensive to the rest of us and wholly unsuited to dealing with the typical chronic healthcare issues the poor face. In other words, the ER is great if you've got a trauma wound and nearly useless for that persistent cough which may or may not be TB.
I will agree that if you have the money for it (either through good insurance or just being wealthy) care in the US is the best you can get. If you do not have the money than every other first world nation and most 2nd world nations are a better place to be if you get sick in any significant way. Does that seem right to you? The US, home of the idea of equality for all and that a person can raise their lot in life from beggar to tycoon if they are willing to work hard enough, is also a place where if you are poor you get to have a much greater chance of death from easily preventable illnesses? That contrast of ideas causes a very unconformtable dissonance in my mind.
And as for the whole nanny state argument - it's a straw man. Last I checked smoking was not illegal in the UK or Canada or any nationalized healthcare nation. Neither is drinking, McDonalds, fish and chips, trans-fats, sitting on your butt watching TV all day or driving the 200 yards down the the block to the store. The whole idea that the government will tell you what you can and can't do more because of nationalized healthcare is just a bit of FUD not supported by the reality of nations with national healthcare.
In the interest of openness I will admit that I am not an impartial observer in these debates. I currently work for a Public Health department in California. I see the results of no insurance and the costs to taxpayers every day. I can also tell you, without any doubt, that it costs several orders of magnitude less to prevent illness or treat it early than it does to treat late progression cases. TB is a prime example as it is a resurgent and serious health issue in the US. Uninsured folks are several times more likely to have full blown cases of TB (which are VERY expensive to treat) than the insured. This is because TB is typically caught early in the insured and then is relatively easily and cheaply dealt with. Guess who pays for the uninsured who come down with TB? That's right, the taxpayers - you and me. You can treat 10-12 early detected cases of TB for the cost of one full blown case... and in doing so you also decrease the prevalence of the disease which saves even more money.
The fact is that right now we already have government paying for healthcare but we are only doing so when the illness has progressed so far as to be a public health threat or an imminent threat to the life of the patient. This is an insanely expensive way to do things. I work for a county with ~250,000 residents and we spend upwards of 8 million dollars a year on indigent healthcare. We spend another 24 million on other healthcare programs (prescription assistance, children's medical services, etc.) for the under insured but non-indigent population. This equates to 11% of the entire county budget. In actuality we spend about 2 times the amount I've listed in Health Services - the rest of the money comes from Federal and State grants and matching programs (all of which, I might add, are paid for by you and me). It's a huge amount of money spent in a bad way for good things. It could be done much more effectively by simply insuring the folks so they get the much less expensive preventive care they so desperately need. It should also be noted that my county's per capita expenditure is one of the lowest for similar sized counties! Other counties are paying even more for these programs! It's insanity. Expensive insanity.
OK, rant done. Have a nice day! ;)
6 August 2009 at 3:02 am
The US health care system is screwed up, largely because of all the government meddling. Employer-provided health insurance was a dodge to get around wage controls.
Whatever the government comes up with may be slightly better or slightly worse, but it won't fix the primary problem, which is too many chefs in this kitchen. Just like the 3-body gravity problem, the more you cram in between the patient and the health provider the more opportunities arrive for everything to go pear-shaped.
I'm self-employed, and I have a Health Savings Account. For catastrophic coverage--basically anything more than $5,000 per year--I have an inexpensive insurance policy. For ordinary expenses--doctor visits, prescription drugs, etc.--I pay out of pre-tax dollars. As it turns out, when you tell health providers that you're not using insurance, they charge you something closer to, you know, what it actually costs. The provider has neither the overhead of dealing with an insurance company, nor the opportunity to go gold-mining with superfluous procedures.
Now, this works for me because I'm a healthy guy. People who have it worse off than I couldn't get coverage. And that's a problem. But the fear for me is not rampant socialism, but that public plans will tend to shove out private plans. Which would be fine if the public plan were better and cheaper, but I have no confidence that it will be.
6 August 2009 at 9:01 am
The fact that private insurance seems to survive quite happily in countries with public healthcare seems to invalidate the worry that it will eliminate private insurance. It just becomes a hell of a lot cheaper.
6 August 2009 at 1:13 pm
To live in a society, any society, you have to accept that, sooner or later, you're going to give up a freedom for a sound reason -For example while it's perfectly reasonable to have a pistol, it's not reasonable to fire it into the air in the city, because you don't know where your shell will land and there are very good odds it will injure someone or damage something. It comes down to my right to swing my fist ending at your nose. If you attempt to do anything else than create laws that amount to that, you end up with people making values judgements about other poeple's conduct and you end up with things like bans on Trans fat, laser pointers & pornography; insane taxes on cigarettes, liqour & automobiles, etc., mandatory safety belt & helmet laws, the "War on Drugs", gun laws that ensure only those willing to flout them are armed, and a whole host of other problems that come from what amounts to letting paranoid helicopter moms from the bible belt write your legislation.
My smoking, drinking, driving of a fast car (Irresponsible!), or a big car (might hit someone else!), or a small car (what happens if *I* get hit?), or eating unhealthy food, etc., are all personal choices for which I take responsibility. I have health insurance through my employer, and for whatever boneheaded reason, my state makes me have it. If I didn't, I'd have to pay a fine (Whoops! Guess I know what the reason is now!). Except if I were too poor to afford health insurance, in which case I'd be exempt from the fine... how does this make sense again? I've never said anything that amounts to "screw the poor"; if anything I've said that the current way things work screws them pretty hard. But effective social programs, including healthcare, for the truly needy (which I am in favor of), are quite a different thing from nationalizing healthcare for everyone, which, while it may bring up the standard of care for the poorest, will do so at the expense of everyone else -as was said before, if you can pay for it (or your insurance firm), healthcare in the US is top-shelf. I see no reason to compromise that because Johnny Socialism wants nationalized health care because he think's it's a good idea. I simply can't understand why effective public options reserved for the poor can't go hand-in-hand with private insurance for everyone who chooses to have it.
6 August 2009 at 8:18 pm
So what it boils down to is that you think good quality healthcare is a privilege for those that can pay for it? But you don't mind salving your conscience by allowing the poor a chance through 'social programs'.
The point the rest of us are trying to make is that in the rest of the world, good quality treatment is universal. The benefits you get by paying more are less tangible - privacy, more provision of facilities, shorter access time and so forth. The actual remedial work is identical.
Prophylactic treatment is universal, for example rich and poor are equally likely to get breast cancer, so in NZ there is free screening available nationwide. Immunisation programs are mandatory and implemented for all children up to a certain age, so many diseases simply don't occur as children aren't restricted from access to the program due to beliefs or cost.
The main benefit to universal healthcare is that basic health rises for everyone, regardless of status or financial position. You can then get *more* with private policies if you feel it is necesssary, but you know that you have a base level of quality care available for minimal cost which can be of great financial benefit if you are a relatively healthy person who doesn't actually need regular medical attention.
6 August 2009 at 8:39 pm
@Red October: you say this:
Which I agree with absolutely. But you follow it up with this:
Well, I say that this is the reason you can't drive a big, fast car, without obeying exactly the same road rules & speeds as that guy in the Smart ForTwo (that accident happened just a few blocks from my house).
My point is that you have the right to smoke, drink, drive fast/big cars. But can you say, with any degree of certainty, that you can control your second hand smoke so that it doesn't pollute my breathing air? Can you say, in all honesty, that if you lose control of your big fast car, that you can be absolutely sure it wont run into the family crossing the road?
That's why such rights are restricted. To protect innocent third parties.
Now, I would argue that there should be places where such rights can be exercised. And, by and large, there are. You can go out to racetracks for racedays that are open to the public. You can easily find places to smoke that don't involve breathing a plume of foul-smelling toxins in the face of people who choose not to. Hell, here in Oz, where the government "took all the guns away", you can go to a firing range and shoot pistols & rifles to your heart's content. One guy even built a pistol range in his backyard, and the government was fine with that, because he did it in a way that was safe for others (he put the damn thing underground!).
Back on-topic - yes, we have nationalised public health care. We also have private health cover, if you want to get a higher level of service, or cover those things the public system currently doesn't (like dental work). Those who tell you private and public health cover can't work together are lying.
Think about it - would US politicians really subject themselves to the same level of health care as everyone else?
Not a chance... your private cover is perfectly safe! :-D
7 August 2009 at 12:12 am
Sometimes I wonder if citizens of the USA know what universal heath-care delivers?
To me in Australia it means there's a medical safety net for everybody, even an out of work, homeless, penny-less person will get emergency surgery if it's needed. The queues for non-emergency (still free) surgery are long though.
Your average working (or retired) Joe can get heart surgery, or cancer treatment or whatever and not go broke, or even have to pay.
If someone wants a private hospital room, or no queuing for non-emergency surgery, or their choice of pediatrician, etc they can opt for private health insurance, and still got to a public hospital for no charge if they want. The private health insurance provides the extras over public.
I'm a regular suburbanite with a family. The kids were all born at public hospitals with no charge. We've been to public hospital for various things such as stitches, asthma attacks, croup and like everybody else in the country, we can do this without paying a cent.
I still opt for private health insurance, it costs me AU$4,000 (~US$3,000) per year for a family of five for "blue-ribbon" cover. The only time it's been used is for reading glasses and the kids teeth. Here in Australia dental isn't part of the public health system, although it should be IMHO.
It's not a perfect system and people without private health insurance do have to wait for less urgent treatment (still free), but my gosh, I don't understand how people in the USA argue against a health safety net for every citizen, especially if they are already paying 2x as much without one.
7 August 2009 at 12:51 am
I thought private insurance was not available in Canada. I could be misremembering, or misunderstanding the situation.
But in the US, right now, when you reach 65, you cannot NOT take Medicare. That's what you get. You can get supplemental insurance, but otherwise, you get Medicare. Period.
The way the current debate for reform in the US is going, the public option will be in competition with private plans. This is different from other countries' schemes as I understand them.
7 August 2009 at 1:04 am
BTW, Dan, thanks for the recommendation for Altemeyer's book. It's excellent reading.
7 August 2009 at 1:24 am
rho - Are you trying to say that you cannot also have a private insurance plan at the age of 65? Because if you are, then you are mistaken. There is absolutely nothing preventing you from taking out or already having a separate insurance plan at or after the age of 65. If you've got, for example, a Blue Shield policy it does not cancel when you turn 65 unless you happen to cancel it or not pay the premium.
As for having to take Medicare... what? No, you don't. You have to actively sign up for Medicare and are advised to do so, if you want Medicare, 3 months prior to your 65th birthday so that everything can be in place and ready to go on your first day of eligibility (your 65th birthday). There is no requirement to take it though you'd be a fool not to - even if you have great private coverage. Your taxes for your entire working life have paid for it and you are entitled to it. It will usually pick up the tab for whatever your private insurance won't (co-pays and such). If you do not have any insurance at 65 then it can literally be a lifesaver.
While Medicare has its problems (I could post pages of them) it is a hell of a lot better than nothing for retired folks who don't have medical care as part of a retirement package and cannot afford private insurance. It needs to be revamped for many of the same reasons as I outlined in a previous post - it puts to little emphasis on preventative care to be truly cost effective. That is fixable though.
7 August 2009 at 1:33 am
I need to clarify a bit, you are atuomatically enrolled in Medicare parts A and C IF you are receiving Social Security payments. Many 65 year olds are not receiving Social Security since they can work another couple of years and get a noticeably larger SocSec payment for the effort. Part B of Medicare, since it requires a copay, can be flat out refused. However, even though you are enrolled in parts A and C you are not, in any way, forced to use them. Just like Social Security actually - you are automatically a part of the Social Security system but you do not have to draw funds from it if you don't want to.
For any one who is sufficiently bored or interested in Medicare you can learn a lot more here http://www.ssa.gov/pubs/10043.html You'd have to be very bored though. ;)
7 August 2009 at 5:45 am
rho: you are misunderstanding, to some degree. For a start, Canada's just one system (or rather, set of systems; I pay my premiums to my province, not to the federal government). Australia and the U.K. run systems where you can have full private healthcare if you choose (there are parallel private healthcare systems running alongside the national one). This isn't just a theory, either - there are significant private hospitals, insurance companies and full-service healthcare providers in the U.K. (the most well-known is BUPA, but there are others) which have been running successfully for many years. I don't know as much about Australia, but I believe it's the same there.
In Canada, the situation varies by province. In some provinces, private healthcare that covers the same areas as the public system is illegal, so parallel private systems don't exist not because it would be economically impossible for them to, but because the law doesn't allow it. Even in these provinces there is some private practice, because the public system doesn't cover everything. For instance, here in B.C., parallel private systems are not permitted (I couldn't choose to have heart surgery at a private hospital, for instance), but I have private insurance to cover dentistry, optical stuff, some physiotherapy and other things the public system doesn't cover. Some private policies can also provide purely incidental perks like a private room or a TV or something, if you're hospitalized under the public system; in this case, your provincial insurance pays for your actual care, your private insurance pays whatever costs are associated with the extra 'service'.
There's two thoughts behind this policy, where it exists: the practical, that a private system would inevitably attract talented staff away from the public system leaving it under-resourced, and the ideological, that it's simply unethical for the rich to get a higher standard of healthcare than the poor purely because they have money. Those arguments carry weight in the Canadian public discourse. Obviously, America's public discourse is a lot different, and anyone trying such arguments in America would likely be on a dead loser. So you can't just imagine that Canada's various provincial systems are the _only_ possible model for providing nationalized healthcare. They're not, and any American nationalized healthcare system will inevitably look very different from those in Canada.
7 August 2009 at 10:55 am
@AdamW:
Yes, there are stacks of private hospitals and insurance companies that have been running successfully side by side with the public system for years. Anyone who argues to the contrary clearly has ulterior motives.
@Americans:
My personal experience indicates that the primary difference between the public and private systems is that the private system has an emphasis on quality and customer satisfaction/service (as most private enterprise must to survive). That's not to say the public system does not provide quality healthcare - I can't find much evidence of more incompetence in the public system than the private - but I'd rather go through the private system for anything important or lengthy. Public hospitals (here in Brisbane and other parts of Australia) are somewhat understaffed and so the staff are often surly and you can face long delays in the emergency room if your condition is not life threatening. But you will be looked after, and for free. If you can afford private cover (not very expensive at all) then you will face much shorter waits and much nicer staff one of the many private hospitals. One might argue there are also other reasons to go to a private hospital.
Basic private cover is available at around 50 bucks per month which (subject to certain conditions) will cover you for 100% of emergency costs at a private hospital, e.g. Ambulance, theatre fees, doctors charges, pharmacueticals, etc. And you can add on extras like dental, physio (including massage!), etc from there. There is also a government rebate on private health cover to encourage people to use it. I have private health insurance for my fiance, I use the public system.
I agree that healthcare would probably be more expensive due to practitioner/institution insurance if Australia were as litigous as the US.
I guess to sumarise, we have a quality (if understaffed in most states) public system that is free to all Australians regardless of how wealthy they are, and a private system that lets people choose their level of extra cover and comfort. It beats the fiasco you guys have and is apparently much cheaper so why not try it?
7 August 2009 at 11:31 am
*sigh* ^other link was busted above. [Fixed now! -Dan] Note that even the public figure is well ahead of the US figure.
7 August 2009 at 11:47 am
The problem seems to be that these 'people' are looking at the costs and benefits of the actual real-world implementations of the systems in question. You, OTOH, are trying to fit the world to your ideology.
Libertarianism: All the compassion of Fascism, but with the real-world economic applicability of Communism.
7 August 2009 at 3:06 pm
@ Mayhem:
So when public healthcare is for the poor, it's shite and merely "assuages the conscience" of the "rich" who have private care, but when it's for everyone it's quality. I fail to see the logic in this.
If the public option is reserved only for those who need it, then logically there will be more to go round amongst the needy and the quality of care will go up, without driving down the standard for everyone else. This doesn't happen now because I will tell you, as will any American who has managed to pull his head out of his ass (there are more of us than you would think) our government is doing a piss-poor job of things at the moment. But in an ideal world, that'd how it'd play out.
@ Bern:
I'm begining to think you'd very much like to write legislation of the sort I think is harmful to freedoms. We're all "innocent third parties" to one-another's freedoms -when I'm driving my Suburban I'm a threat to the guy in the Smart; but when I'm in my MR2 I may just run afoul of someone else in their Suburban. Neither one of us would fair very well if we met a Cement Truck or a bridge abutment. A seemingly sensible argument could be made to ban both unusually large and unusually small cars since they are a "threat" to either their operators or others, but I don't think that would be a good idea because I respect the right of my fellow citizen to choose his vehicle based on his own wants, needs, and desires of comfort, capacity for goods and people, fuel economy, fun factor, and everything else that makes every vehicle from the Smart ForTwo to the Chevy Kodiak pickup (in Australian: A Ute based on an HGV; infinitely useful to people with a large boat or a small penis) a sensible choice for *someone*. I also respect their right to eat, drink, and smoke what they please, sleep with and marry whosoever they want, and to own such dangerous things as laser pointers and Mercurochrome. (Note to non-Americans: because the FDA believed an URBAN LEGEND about burn victims being slathered with the stuff and thereby contracting mercury poisoning, they banned it. No wonder our healthcare is poor; we can't even buy a decent antiseptic solution!)
When you get right down to it, the government's job is not to distribute equally, but only to make sure everyone survives. There is no more need for someone who can afford to look after himself to have public healthcare than there is for him to go raiding food pantries or checking into homeless shelters, and, frankly, anyone who had the gall to do so is a scoundrel.
7 August 2009 at 4:39 pm
@Red October
Nobody is banning cars ffs. But no matter what car/truck/EV you buy, you have to drive it within the same constraints as everyone else - just because your Ferrari can hit 240Km/h doesn't give you the "right" to drive at that speed down my (or indeed, your) street.
The issue here isn't handouts for the poor - it's granting certain basic rights to everyone - access to a certain standard of healthcare is one of those rights.
Let's not get confused into thinking that just because the US has failed to do so means they can't ever do it - other countries can and have done it successfully. Western countries, eastern countries, countries who speak English, countries who speak French, hell even frickin' countries with bad human rights records have done it better than you guys.
Just because a nation provides a baseline level of care to everyone, regardless of their capacity to afford it, doesn't mean it'll automatically be crap - it's done elsewhere, and it's done well.
Why should everyone pay for healthcare when some people might want to "choose" not to spend their money on it?
Because it benefits the whole of society to have a baseline standard of health.
I mean, seriously... why should we have a fire department when some people who could afford it might choose not to pay for insurance from a private fire fighting firm?
Because otherwise everyone's house will burn down.
7 August 2009 at 4:59 pm
The problem with this idea for the USA is that almost nobody can "afford to look after himself", largely because your health-care system vastly increases the price of everything, thanks to cartelism and buddy-buddy deals between legislators, insurance companies and other for-profit bodies in the health-care industry. In a real free health-care market it would at least be possible to buy reasonably-priced private health insurance that'd actually pay out enough to cover your treatment should you get sick. In the USA this is occasionally possible, but usually not.
I realise you're not arguing that the current US system is awesome. You are, however, arguing that government-run health-care is "a terrible idea", despite the very numerous examples of countries in which it works very well, or at least a heck of a lot better than nothing, at a substantially lower cost to the taxpayer than the dreadful US system.
I hold pretty much the precise opposite of this libertarian view about health care: I think it's actively dangerous to have a health-care industry that's driven by the profit motive.
You can make a decent argument that profit should be a partial motive in health research - though, at the moment, there's a very long list of bad things that pharmaceutical megacorps have done to maximise profit, rather than maximise the effectiveness and affordability of their products. But for-profit hospitals are a horrible, horrible idea if there isn't a parallel free system for the poor. Well, unless the country has no poor people, anyway. (I don't think any country actually qualifies, here, except for cases like Kuwait where there are plenty of poor people but they're mostly non-citizens that the official stats ignore.)
As a parallel example, consider fire brigades.
The first "modern" fire brigades - organised teams with horse-drawn fire engines - were private, for-profit bodies, often employed by insurance companies. I presume some of them were conscientious and honest, especially the ones affiliated with the better insurance companies, but even those guys would only put out a fire if the owners of the burning thing had already bought insurance from their company. And however many honourable brigades there were, they faced serious competition from operators who ran a "fire protection racket". It cost money to sign up for protection from these dodgy guys; it cost a lot of money to sign up if your building was already on fire. And if you didn't sign up with every brigade that served your location... well, guv'nor, it's a luvverly building you've got here, sturdy wooden construction, a real beaut... but wouldn't it be awful if by some strange coincidence it should be set, I mean catch, on fire at exactly half past nine tomorrow evening?
See also defense, prisons, public transport and news media, all of which the USA has boldly explored making as profit-driven as possible, with uniformly disastrous results. As Bill Maher says, Not Everything in America Has to Make a Profit.
Remember that in a pure laissez-faire capitalist system, there are no human rights. If you piss off someone powerful, he can just send the boys round and have you killed. He won't go to jail unless there's a profit motive for making a justice system that'd try and convict him - and there's no way the people with the money to set up private police forces and prisons will make it possible that they'll ever end up on the wrong end of the nightsticks. Everybody has to pitch in together to create a proper justice system; the Tragedy of the Commons ensures that rational actors in a pure capitalist-libertarian society will never do so. Anybody who decides to be selfless will be outcompeted - to put it politely - by the selfish.
The opposite of pure profit-driven tooth-and-claw capitalism is a 100%-government-administered system in which - in many real-world examples - nobody gets paid any extra for doing a good job, or indeed for doing anything at all but making sure they can't be fired. This, also, is a recipe for disaster, unless the system is well-enough funded that even minimal effort on the part of the workers will get an acceptable amount of the job done, and/or the personal and professional ethics of the people involved prevent the system from slumping into uselessness.
Capitalism-tempered-by-appropriate-government-regulation, on the other hand, actually seems to work pretty well. It really is actually possible for government-administered systems with very little profit motive at all to work very well, and it's even possible for well-run government-administered systems to become well-run private corporations, or vice versa, and continue to function. People in English-speaking countries have just been so poorly served by our spineless and corrupt governments for so many years now that we've come to believe that such events must be myths.
If our governments continue to be so perniciously infected with bad-faith operators, nothing will change.
7 August 2009 at 5:01 pm
"why should we have a fire department when some people who could afford it might choose not to pay for insurance from a private fire fighting firm?"
Volunteer fire departments died out hundreds of years ago because municipal services provide a higher quality product at a better price.
"Because it benefits the whole of society to have a baseline standard of health."
Equality is preferable to prosperity, because it eliminates envy, and envy is caused by the oppression of fat cats through the use of capital to coerce people into doing things they don't want to do, like work and carry out voluntary market transactions.
"it's granting certain basic rights to everyone - access to a certain standard of healthcare is one of those rights."
I would kill and die to keep medicine in the hands of policitians. Coercion of professionals is a fundamental right. Rights are provided by government by consent and demand of the demos. As the tool of the collective, only government has the right to public works -- private firms don't have the right incentives to succeed, and represent the fundamental failure in the market to supply services like fire fighting, security, medicine, and housing. The US system is just the latest example of a free market collapsing in on itself; if there had been some regulation, maybe it would have lasted longer.
7 August 2009 at 5:03 pm
"Remember that in a pure laissez-faire capitalist system, there are no human rights."
That's correct. Rights are defined as privileges granted by laws. How can you ensure security in and lack of offense of your person if there exists no state to protect you, but only immortal corporations designed to rape you for profit and move on while everyone waits for their own turn as you sob into your cardboard box?
7 August 2009 at 5:04 pm
Red: your last paragraph is just odd. It seems based on the strange idea that no-one pays for public healthcare. Of course we do, it doesn't fall like mana from heaven. I pay for it the same way you do: I pay a monthly medical insurance fee into a fund which covers the cost of treatment if I fall ill. It just happens that my insurer is the provincial government, and I'm legally obliged to pay the fees.
Those on low incomes pay reduced fees or no fees at all, but those of us who can 'afford to look after' ourselves pay the full rate. This system appears to work quite well, because my full rate is $54 a month, which I think is really rather a bargain. (And hey, my full rate funds the treatment for those who _can't_ afford to pay, which I'm happy to do as well.)
"When you get right down to it, the government's job is not to distribute equally, but only to make sure everyone survives."
That's a rather contentious statement. You probably wouldn't find a majority claim to agree with it in most countries outside the U.S., and if you asked a few pointed questions, probably a majority don't agree with it in practice in the U.S. either...you posit a pair of opposites, but there's actually a rather messy and very large continuum in the middle there, where most people's views fall.
7 August 2009 at 5:06 pm
"Well, unless the country has no poor people, anyway. (I don't think any country actually qualifies, here..."
Possibly Monaco. I believe most of the people in service industries and so on there don't reside in Monaco, but live outside it. (I've no idea what the healthcare system in Monaco is, though. Probably 'go to a hospital in France'. :>)
7 August 2009 at 11:22 pm
I actually thought of Monaco as I wrote that, but couldn't scare up any stats in 30 seconds and so didn't bother :-).
I suspect Liechtenstein and Vatican City may provide similarly misleading outliers to be stealthily given great importance in a How To Lie With Statistics graph on this subject.
8 August 2009 at 12:27 am
Here's a mean-spirited, poorly-framed deleted MetaFilter thread which has taught me a number of things I did not previously know about the US health-care situation.
My current state of mind, based on this new information, is that the USA is obviously going to be lost to the zombie apocalypse, and the rest of the world needs to start putting up 50-foot iron walls studded with artillery pillboxes to keep your infection away from our shores.
[EDIT: And here's ANOTHER deleted thread!]
8 August 2009 at 1:59 am
.......bbbbrrrraaaaaiiiinnnnnsssssssss.........
8 August 2009 at 2:20 am
@j: The cars are just an example; banning "dangerous" things is what governments are wont to do when they have to pay for everyone's healthcare; it makes sense to the person who holds the purse-strings because odds are he could give a flying fuck for the rights of you and me.
Anyway, I agree that we all have certain basic human rights, and health is one of them. However I don't expect the government to be constantly concerned with my health unless it has reason to, any more than I expect troopers to follow me around lest I get mugged. That's why I think there should be public healthcare available for the legitimately needy, and everyone else can see to themselves, just as there are shelters and food banks already for the poor, but I'd be a cad if I tried to use them when I've got a bed to sleep in and food in the 'fridge.
@Dan: Actually, the first fire brigades were Roman, and as far as I know they were actually a public service. Leave it to Rome :) Anyways, I by and large see your point, and while it may not be clear, I don't believe in pure Capitalism, because, like any "Pure" system, it will fall flat on its face when it encounters an edge case -in the case of capitalism, it's the guy who isn't satisfied making all the honest units of currency he can stuff in his pockets, and wants to make some dishonest ones too. Without laws that define that as infinging on the rights of others, you get chaos. The same is true of pure communism, pure anarchy, and any other type of government touted by high-minded idealists who have no experience in the real world.
Government-run healthcare isn't a terrible idea becaues it provides poor treatment (admittedly it can provide good treatment, but I have absolute zero faith in my government, already rife with lobbyists, career politicians, lawyers, and other dishonest types, to make anything like a good show of it), it's a terrible idea because it holds great potential to infringe on the rights of the citizen, and isn't strictly necessary.
Regarding the goverment distributing equally, when this happens, you start towards socialism and the loss of human rights that comes with it. It's not the government's place to decide what's OK, only what's not. It's not OK for someone to starve or die of preventable illness (like it's not OK for him to be murdered or mugged)-so there should be protections from this. I have a problem when the government tells someone it's NOT OK for him to smoke, to eat certain foods, to drive a certain car, to own a certain object because it *might* prove dangerous, to make a certain amount of money or invest it in a certain way, and decides to penalize him for doing so or outright ban him from doing it. I understand that someone must pay for public services of all stripes, which leads me to another problem in the US, something around half of us don't pay taxes, yet we can all vote. I'd make tax-payment the requirement for voting (or at least voting about taxes), and set a low flat tax on everyone. If we had a sensible government, I strongly think this would work pretty well. As it stands our government is some kind of Roach Motel for money, it goes in, but it hardly ever comes back out.
8 August 2009 at 3:13 am
Red October - "I agree that we all have certain basic human rights, and health is one of them. However I don't expect the government to be constantly concerned with my health unless it has reason to"
That's just it - it does have reason to! It's called public health. If you, the well enough off individual to pay for your own healthcare, become sick with a serious transmissible disease then you are putting the poor you come into contact with (not even direct contact - 3rd and 4th party will do nicely) at great risk. This has a very direct effect on the coffers of state and the wallets of the taxpayer. But really, the public health argument is neither here nor there.
You say health is a basic human right an yet are against a nationalized healthcare system... this makes absolutely no sense! Either it's a right, which the government should see to making sure is protected, or it's a privilege of wealth in which case the government would probably just tax the hell out of it. National healthcare, if health is a right, would simply be that particular right's version of freedom of speech. A tangible first amendment if you will.
Hypothetically, would you be for a national system that has income limits associated with it? Say, if you make in excess of $60,000 as an individual (and bumping that amount up for each dependent) you don't get the nationalized plan but instead have to pay for your own insurance or a more expensive version of the nationalized version? As a reciprocal, if you are making less than the federal poverty limit you pay nothing at all in this system. Would you go for a system like this?
8 August 2009 at 6:56 am
"which leads me to another problem in the US, something around half of us don't pay taxes"
This is not remotely true. You probably mean _income_ tax. Unless you buy nothing at all (except the very tightly-defined 'essentials'), you're paying at least sales taxes. I doubt that more than a tiny minority of non-dependents in the U.S. really pay _no_ tax at all. To that, I'd only say the income tax has never historically been linked to the right of suffrage in any system I can think of. Income taxes were originally introduced temporarily, at very low levels, on quite high levels of income (which is of course the reason why quite a lot of people profess to be fundamentally opposed to them.)
8 August 2009 at 7:02 am
@Stark: Government can be defined as the entity that holds a monopoly on the use of force. Government can *force* you to pay your taxes -- keep asking yourself "what happens if I don't", and follow that to its conclusion. Thus, any action coerced by government is in effect done at gunpoint. So if my taxes are used to pay for a service that only benefits a group I'm not a member of, they are taking the fruits of my labors at gunpoint and giving it to someone else. When Robin Hood does that, we cheer. When a mugger does that, it's called theft. When you institutionally force someone to give the fruits of their labors to a third party, that's called slavery. So the short answer to your hypothetical is, "I would be against such a system, because I oppose slavery".
Here's my more general question: the US already has a system whereby people who cannot afford care (as the government determines it) are covered -- medicare / medicaid. How can the argument in favor of nationalized care be "we need to cover those that cannot afford it", when by definition those that cannot afford it are already covered?
8 August 2009 at 7:08 am
@Adam: I don't know what country you hail from, but the US does not have a federal sales tax. Just a few google hits:
http://www.taxfoundation.org/news/show/1410.html
http://www.factcheck.org/askfactcheck/do_40_percent_of_americans_pay_no.html
I don't know the first group; I'm vaguely aware that the second were involved in the last US presidential election. Point is, yes, quite a large number (more than a third, less than half) of Americans pay almost nothing to the Federal government, and thus if they can "write themselves a check" from the Federal coffers, they have little motivation to vote against it.
8 August 2009 at 7:22 am
"Regarding the goverment distributing equally, when this happens, you start towards socialism and the loss of human rights that comes with it."
Again, you're positing extremes when the reality is far more mundane and complex. If you really want to look at things this way, most countries have 'started towards socialism'. America has lots of government programs which go far beyond just making sure everyone survives but stop far short of distributing everything equally. I can't, offhand, think of a jurisdiction in the world where this doesn't apply. The screaming arguments about the evils of pure capitalism or pure communism don't really make any sense, because everyone's stuck somewhere in the middle (even professedly 'capitalist' and professedly 'communist' countries).
Here's another way to look at it: take the U.S. Constitution's concept of balancing power between the branches of government. Now extend it and bring other groups which can wield significant power - in this case, call it 'commerce' or 'enterprise' - into the equation. Just as with the three branches of government, you want a balance of power between government and commerce. Giving all the power to _either_ side is equally disastrous. As Dan's pointed out before, when everyone's sitting somewhere in the middle and any particular change is really more of a tweak than a fundamental philosophical shift, the screaming arguments about the perils of each ideological extreme are just a pointless waste of time. Introducing public medical insurance in the U.S. is _not_ going to result in it becoming North Korea.
[See also The Daily Show's "Shit That's Never Gonna Happen". -Dan]
8 August 2009 at 7:36 am
coderer: in response to your response to stark, your logic fails. That chain only works if the government which lords its power over you is not _answerable_ to you. In a reasonable democracy, this is not the case. The government is answerable to - and is representing the will of - the populace. So your argument is effectively that you're enslaving yourself.
Your argument (which is derived from Hobbes, BTW, who I have a lot of time for in his historical context, but who doesn't apply un-problematically to the modern world) works only if the government is some sort of absolutist one. Otherwise its abusrd; by that logic, any kind of taxation levelled by a democratic government is 'slavery', which is just silly.
I'm not an expert on the U.S. system, but I believe that in practice Medicare and Medicaid go nowhere close to covering all basic health needs for those who cannot afford good private insurance. If they did, there wouldn't be a problem. Hillary Clinton's abortive attempt to reform healthcare under Bill's government was based on expanding these programs, IIRC, and its failure is probably why they're trying to do it a bit differently this time.
In response to your response to me: sure, if we're talking an exclusively federal level, it's a more complex picture, I was just considering government taxation in general.
Still, tying the right to vote to the obligation to pay taxes is...perilous, to say the least. That stops being a democracy and becomes something like a very broad-based aristocracy. The implications are rather ugly, too. Do the people who pay more taxes get more votes? That would seem to be only fair, after all. Does it matter that the government is perfectly entitled to screw with the lives of the non-taxpayers who can't vote it in or out?
A system where only the rich (or some other, privileged group - whites, males...) voted was what most countries had before they had a close-to-fully-representative democracy. It didn't tend to work out that well. Your argument can easily be reversed: the rich have no incentive to vote for the amelioration of the condition of the poor, and they generally didn't. There was a huge wave of reforms in the U.K. in the late nineteenth century as a direct result of the broadening of the electorate. Some of those a really doctrinaire 'small government' supporter could object to - the first old age pensions, for instance - but some are rather hard to argue with, like laws against the adulteration of food and drink. Previously no-one had bothered to enact that kind of legislation because the rich didn't have those problems, it was the poor who got killed by adulterated flour.
The alternative Red October proposes - where everyone pays a federal tax and so the broad electorate is preserved - seems to address the ideological objections, but I'm not sure it's workable. What about someone with no income at all (say someone who recently lost their job)? How are they going to pay tax? Say they're on social security and they pay tax out of that - they still have no incentive to vote for a reduction in social security on the basis that it would save them tax, do they?
8 August 2009 at 8:59 am
Coderer - I agree with you about the plan I proposed - I myself would not be for such a plan for exactly the reasons you mention and a quite a few more. I was simply curious as to whether Red October would see such a plan as an equitable solution.
As for Medicare/Medicaid - they are, in their current form, woefully inadequate to meet the needs of the low income populace of the US. I have a large amount of direct experience here working in the public health sphere as I do. Their income requirements for under age 65 usage of the system are laughable at best and criminal at worst. They leave a huge section of the working poor completely out in the cold. Also, they way they are setup now, they provide virtually no preventative care which means small illnesses, easily and cheaply treated if caught early, become big illnesses with large price tags to go along with them. Not exactly an ideal way to spend our taxes on healthcare if you ask me.
I guess my main point in all of this is that we, the American taxpayers, are going to pay for healthcare from the government in some way. Whether it be a new national health plan or the existing Medicare/Medicaid system. Right now our system is hemorrhaging money and is hugely inefficient - for reasons which have been outlined in the preceding 80+ posts. Do we continue to do things as we have been, which leaves lots of people completely uncovered and many more people covered but likely to end up bankrupt if any major illness hits and also happens to cost, per capita, 3 times what our fellow first world neighbors pay? Or maybe, do we try to change the system to something more in line with what has been proven to work in many, many other countries and cost, per capita, far less than we currently spend?
I know the second option sounds better to me... and I'm one of the lucky ones whose coverage is sufficient that I won't likely end up bankrupt due to major illness. Hell, I even got to test that recently (April) when my wife's heart stopped for half a minute and we ended up in ICU for 3 weeks and getting a pacemaker put in. She's OK now, thanks to being young (35) and strong and excellent doctors... but the bill, without insurance came to just over $690,000. With insurance we paid about $350 all said and done... but I can easily imagine where we'd be without that insurance. It involves a refrigerator box under the overpass.
I have family in Perth, my uncle there had a pace maker put in about 2 years ago. Took 3 days from onset of symptoms to having the pace maker in and cost him $0. I have great insurance here - which costs me about $400 a month and my employer a lot more than that and I still had to pay $350 for life saving work... my uncle says he pays about $60 a month and that's it. Which one is a better system again?
8 August 2009 at 9:20 am
@AdamW:
Thanks for the info. Most of my information about the Canadian health care system came from a BCer who was complaining about his utter lack of any other option. I was not aware it was a per-province kind of thing.
@Stark:
I'm equally mystified by Medicare. I'd almost rather drink and smoke myself to death before I need to know anything about the details of Medicare, but I appreciate your effort. All I know is people in my family who certainly don't need Medicare have taken Medicare. I don't know for sure why they did, nor am I certain that they know themselves. But I don't know anybody who has not taken it, although I do know several doctors who no longer accept Medicare patients.
@The General Topic of US Health Care:
I'm well aware that our current system is borked. I had an appendectomy a few years back, and the bill I got was for more than $14,000 US. The surgery was laparoscopic and without drama. I was in and out in about 24 hours. After my (former) insurance company was done casting their magick spells, I ended up paying about $4,000, with about $1,000 of that coming to me in dribs and drabs as "specialists", like the anesthesiologist (!!), sent their bills.
It was at that moment that I knew something was well and truly fucked. I rather suspect the actual cost was around $4,000, and the rest of it was monkeyshines played on Excel spreadsheets.
But that doesn't mean that I think the government can do better. While there are lots of fine government run and/or regulated public health systems around the world, unless we transport one of the better ones whole to our fair shores, with every jot and tittle in place, what the United States is likely to end up with is a warty behemoth. Remember, this is the same government that ran the Iraq War. For some reason we can't do such things very well. There's not much of a tradition of it here, for one; and Americans are an irascible lot, and there's quite a lot of us.
The current House health care reform plan runs at around 1,000 pages. For those who aren't familiar with the way we do things in Washington, those pages were not written from scratch, starting when President Obama was inaugurated. It was cobbled together from dozens, or hundreds, of pre-written bills, much of which was authored by various lobbyists. I don't mean that in a black-helicopter, nefarious conspiracy-theory way--it's just that's how these things have been done for a lot of years now.
I'm not blindly opposed to a government-run health care system. It certainly can work, and work well. But the devil is in the details, and I have precious little faith that simply by the fact the US government is running it that it will be an improvement.
I've always advocated adopting Britain's NHS, every bit of it, from top to bottom, and importing it here. Sure they have problems, but they're known problems. It would be like forking a source tree--you inherit every bug, but you're not starting from scratch. And most of all, you've already got the test cases in place. One of the biggest problems with any large-scale public sector reform is measuring success. If we adopted a known system we'd have some metric against which to measure progress. But of course that would never fly, and therefore we'll end up with some Frankenplan that may be highly successful right about the time I'm dead from all the cigarettes and booze.
8 August 2009 at 10:17 am
Um, Blood Bowl for the PC is one addictive game. There are injuries. That made this post topical.
/threadjack
8 August 2009 at 12:11 pm
More Bill Maher, on the radical concept that that portion of the USA which believes Republican-funded PR agencies over the actual freely-available text of proposed and current legislation ("keep your government hands off my Medicare!!") may not be absolutely the brightest bulbs on the tree.
I also cannot imagine why it took Sarah Palin - who, if not the President, is definitely a member of the Cabinet of Idiot America - so long to start running with the "the government wants to euthanise my baby" meme.
8 August 2009 at 1:09 pm
Stark I agree with the concept of definig a point where a person is no longer eligible for public health care. I'm not sure on $60,000, it's certainly reasonable if you're paying for your insurance out of pocket entirely is this is quite costly (as it is also if your employer is tiny or a tightwad; I once tried for a job with a firm that had an insurance option that basically ate one entire pay period's salary. A bit pointless, it was.), but the insurance I have from my job is very inexpensive (US$96 a month for the better of two plans, plus a few summary dollars for add-ons like dental and vision, as I wear eyeglasses, and the dental is less than a dollar a pay period so there's hardly any reason not to have it, especially when you consider you'd be taxed on that not-a-dollar anyway). That is my point ENTIRELY. A state benefit is for someone who needs it. I can't call up the fire brigade and say "Hey! Come quick! Squirt some water on my house!" only to respond to the querry of "Is it on fire?" with "No, but it's filthy!" and expect them to turn up. I can't see the slightest reason to make public healthcare available to people who can reasonably afford to look after their own healthcare.
Stark is also quite correct in that Medicare and Medicaid are woefully inadequate and also mind-bendingly barroque in their structure. I think the massive failure of the public systems in place in the US makes many people rightly skeptical of the government's ability to properly look after healthcare in any way -indeed, my own girlfriend spent plenty of time on MassHealth and the run-around you got was insane to a degree that it beat going to the emergency room for some things but just by a C-hair at that, and was usually as good as no insurance at all. A huge part of the problem in the US is that thigns get snuck into bills by politicians worried more about lobbyists, nepotism, and above all, staying in office, that the best they do is do things that only look good but rarely help matters any. Looking like you are dealing with a problem is vastly popular in the US -witness the sudden popularity of Hybrid cars versus Diesels or cars that simply get good mileage without any trickery (which have been around for at least 30 years). The problem is doubled by when you are a politician, if the problem stays around, you can still say you'll fight it, so there is no interest to the politicians in actually solving problems when they can be used to keep getting elected. So hopefully everyone can see why I have absolutely no faith in my government to look after the well-being of a goldfish, never mind my healthcare.
I'll say a bit on taxes since they've come up -in my opinion the only fair tax is a flat income tax -perhaps waived for the very poor. Taxes on sales, transactions, "sin" taxes on cigarettes, alcohol, and the like are all unfairly borne by the poor. Think about it -unless you're mind-bendingly rich, so as to eat $200 meals a night and think nothing of it, a man will eat about the same amount of food, drink the same amount of beer, smoke the same amount of cigarettes, and put the same amount of gas in his car weather he makes the money for those things swabbing out urinals for minimum wage or devising patentable investment schemes for $500/hr. He might pay subtly more for "choice cut" stakes, "top shelf" booze, and imported cigarettes, but the difference is not that big. When you think of the tax on these things, though, the less the man makes, the bigger a chunk of his income these taxes amount to, such that the percentage they make up becomes rediculous. Enough about taxes, though.
8 August 2009 at 4:50 pm
Red: your first paragraph is a giant non-sequitur. You cite a theoretical example in which you should be refused service on the grounds that you _don't qualify for the service_, and then you argue that this means you should be refused service on the grounds that you _could afford to pay for it separately_. The two just aren't linked. When you call up the fire department, they don't ask if you could afford to pay whatever the going rate is for a fire truck roll, firefighter services and cost of water. Sure, they ask if your house is on fire. That's approximately equivalent to the doctor checking if you've actually got a heart problem before breaking out the meat cleaver and opening up your chest cavity. It's not equivalent to him asking how rich you are.
You're dead on with your last paragraph, though the phrase you might be reaching for is 'regressive' - sales taxes are indeed regressive in effect, i.e. they hit poor people proportionately harder than rich people. (You don't even need sales taxes to observe this, in fact - Terry Pratchett once noted that poor people spend $10 on a pair of boots once a year, but rich people spend $50 on a pair of boots once...) Income taxes are 'progressive', i.e. they hit everyone the same or rich people proportionately harder (in theory, at least...in practice, they tend to have very good accountants). I'm not entirely sure why more progressive governments don't try to reduce sales taxes and similar regressive taxes. Possibly they like the fact that sales taxes encourage saving, but I'm not really sure.
8 August 2009 at 9:50 pm
@Red October: you seem to be saying two different things. The first, waaaaaay back at post #50, was that "government run healthcare is a terrible thing". We've spent nearly 40 posts trying to convince you that that is not necessarily the case.
On the other hand, you're saying in #88 that you have no faith in the US system of government to run it in any way that would be better than the current mess. I don't think I can really argue with that... US government almost seems designed to do things in the worst possible way for the highest possible cost. I know it wasn't originally like that, but that seems to be the way it has evolved, with riders & lobbyists & 'campaign contributions' and the like...
The solution is simple. Get out while you still can! :-D
9 August 2009 at 3:08 am
Well it's simple: Universal Government healthcare is a terrible thing for many reasons: It's very expensive and the citizens have to foot the bill. It encourages "Nanny state" regulations and "Big Brother" type spying. (I'm not sure if it went through, but New York was considering a plan to register and monitor all diabetics to make sure they looked after themselves propperly.) It goes beyond the reasonable duties of the state. It does not provide the level of care private healthcare can. The fact that the government has proven itself unable to look after the people already in its care is just one of many reasons.
@AdamW -You just kinda missed the connection: The qualification for needing to be on a government health plan is the inability to pay for it yourself. The qualification for the services of a fire brigade is having an out-of-control fire. The qualification for having the rescue squad turn up is an accident or serious illness -after you're in hospital and stable they'll start talking about payment. In theory, you could almost certainly pay some firemen to come squirt water on your house for any old reason -they do need to run water through the equipment every once in a while. But the free-public-service aspect of a fire brigade is there for people who are in a situation they can't deal with themselves. I'd expect anyone with any health insurance, public or private, to be laughed out of the hospital if they turned up with a paper cut and asked to have the application of a bandaid and some first aid cream covered.
9 August 2009 at 2:57 pm
It's very expensive and the citizens have to foot the bill.
It's cheaper in many, many other first (and second) world countries than your current system is.
It encourages "Nanny state" regulations and "Big Brother" type spying. (I'm not sure if it went through, but New York was considering a plan to register and monitor all diabetics to make sure they looked after themselves propperly.)
New York considering a plan to monitor people with health conditions has barely a nodding acquaintance with universal health care.
Note also that the "big brother" spying/controls you fear hasn't eventuated in countries with universal health care - it's not illegal to eat poorly, smoke, drink to excess etc in Australia or the UK or even freakin' Cuba. Again, the idea that health care is somehow necessarily linked to restrictions of our rights is an unfounded fear.
Now, the "national security" laws, which hit far less opposition in your country, have eroded privacy and free speech. I'd also challenge anyone to defend the net benefit they grant your society in comparison to the benefits resulting from universal health care (hint: it benefits everyone, regardless of whether they use the system or not).
It goes beyond the reasonable duties of the state.
Says you. You could also argue that providing clean drinking water for everyone goes beyond the reasonable duties of the state. I suspect when you say this, your thinking is still coloured by your fears of the above - which don't actually have much to do with health care, and more to do with how your government has treated you of late.
It does not provide the level of care private healthcare can.
Evidence simply does not show this.
See: France, the UK, Canada, Germany, Australia, freakin' Cuba.
The fact that the government has proven itself unable to look after the people already in its care is just one of many reasons.
This is pretty much the one argument you've provided that I can't really refute - your legislative wing sucks these days. It was constructed for the environments of many many years ago, and it's failing in the societies of recent years.
That's bad. But seriously, that's not a reason why public health care bad, it's a reason why your system of government needs fixing.
It seems as though you've latched onto some sound bite arguments and you'll repeat them over and over despite not being supported by evidence.
(seriously, read the damn book, it's entertaining, I promise)
9 August 2009 at 3:49 pm
Ah, Cuba, the favorite example of people who favor government healthcare. The healthcare in Cuba is exactly as shit as everything else. There is some good healthcare reserved for the party heads, high-ups, and of course tourists, so they can tell everyone else how good it is, but in reality the healthcare for the common man is far, far worse than you'd get stumbling into an ER in the States without a penny to your name. Ask some real Cubans. There's a reason they leave the place, y'know. My Highschool Spanish teacher fled Cuba -he could tell some stories to curl your hair.
I never said the current system in the US was worth the powder to blow it to Hell, and it's not. In fact I believe I said that the government is a giant, money-sucking monstrosity. Let's not compare the efficiency of a new Perodua Kelisa to a 30-year-old, ill-maintained Lincoln Town Car with two flat tires, a cracked manifold, running on 7 cylinders, and drinking almost as many quarts of oil as gallons of fuel per mile. Because that's what is being done comparing the State healthcare in other countries to the US plans -the Perodua Kelisa still sucks, but looks better when you factor in the fact that the Lincoln is from a different age, designed to do a different job, and so poorly maintained that you expect it to fail at any moment -in fact you're surprised it still runs. (As a sidenote, I knew a chap with a car almost exactly like that, and yes, it DID still run. Full-size Lincolns are apparently indestructible.)
I will not argue that for probably 40 years the freedoms my countrymen enjoy, and that millions of fought and died for, have been eroded by politicians in the name of everything from "safety" (from organized crime, drugs, terrorism, global warming, pick your boogeyman) to "healthcare" to "equal access for the disabled" and some very offensive attempts at "racial equality" that only pat the minority on the head and say "poor inferior soul, we will help you pretend to be like the white man". Maddening. We do NOT need MORE incentive for spying, curtailment of freedoms, taxes on food, drink, and tobacco, etc. It may not be expressly illegal to smoke in the UK or Australia, but look at the rediculous warnings and high taxes. As if it's some big secret what happens when you smoke? My father is SIXTY-TWO and when he was a kid people called cigarettes "Coffin Nails". Most everyone who smokes today has no excuse for not knowing the possible consequences, and those who fail to recognize them will not be helped by a warning because they are the kind of people who think their cell phone will melt their brain, that there are cameras in their DTV converter boxes, and that "praying" to their invisible friend will bring about world peace or some such drivel. Nevermind how the same people who condemn the tobacco companies from profiting from an adictive drug love it when the government does the same through taxes. Can you say LOBBYISTS???
I also fail to see how paying for everyone's healthcare benefits me. I definitely see the benefit of paying for it for those who can't afford it, 'cause otherwise those people will get sick and spread illness, perform poorly at their job, eventually wander into Emergency Rooms with a much more serious condition, etc. No arguement there, uninsured poor and middle-class people are a disaster waiting to happen. But I just can't come to terms with paying both the healthcare of the bowrey bum AND that of my boss' boss who makes well over $100,000 a year. It's bad enough I have to pay his pension in this country (Social Security -another clapped-out refugee from a scrapyard of a program created for a bygone day. Hint: Benefits kick in at age 65. At inception, the average lifespan was 62. The House won that bet. Now the odds stand strongly in the Player's favor, with the average lifespan approaching 90) -I see no concrete reason to pay his healthcare too, especially when the multinational corporation we both work for is quite willing to foot the thick end of the bill for us both.
Does our government need to be turned upside down and have the cobwebs, dust, slag and detritus shaken out? Hell Yes.
Do we need effective social programs, including free & affordable healthcare options, for the poor and low classes? Hell Yes.
Do we need Tort reform, an end to spurious law suits, and the ability to write and sign ironclad contracts? Hell Yes.
Does our medical system likewise need to be taken by the heels and shaken until its pockets empty of silly laws that ensure we need to visit a doctor for any effective medication (Thus letting them pork the insurance firm or the state); collusion, corruption, and host of other unsavory practices fall out? Hell Yes.
But do we need universal healthcare? NO.
It won't solve any of those problems. If it went through in this country, it would be more of the same, and that wouldn't solve anything except to assuage the conscience of the people who think that it would truly solve problems so ingrained in our culture and government structure that you'd have better luck taking all the water from the sea then you would getting these practices to change for the better. It would, however, give crooked politicians an excuse to stay in office ("Don't vote for him, he'll take away your healthcare!") and even more excuse for curtailment of freedoms and regressive taxes.
9 August 2009 at 5:47 pm
Red: J only included Cuba as the most extreme example. Admittedly the supporting evidence for it is rather thin - it ranks barely higher than the U.S. on one rather simplistic measure of healthcare outcomes, overall life expectancy. It's not the best example, and it'd probably have been best not to include it and just stick to more reasonable ones...like the UK, Australia, Canada, and basically all of Western Europe.
I would refute the argument that the government has done badly at looking after the people in its care, on the basis that Medicare is rather popular and (based on the metrics I've seen) reasonably well-run program. It doesn't exactly knock the ball out of the park, but it's probably better than rather a lot of privately run schemes, and it seems to be pretty popular with those who benefit from it.
Your digression about retirement benefits definitely has some value to it, but you don't give your own country enough credit there. The U.S. has actually been the world leader in highlighting the economic problems that will result throughout the developed world from changing demographics, and it's not at all a problem that's unique to the U.S. Lots of countries have the same problem - life spans are increasing while _effective, healthy_ life spans are not, the birth rate is dropping, and the baby boom generation is hitting the current retirement age - which is a nasty triple whammy on any pension plan, government ones included. The U.S. bureaucracy has actually been rather aware of this for a long time (it doesn't get a lot of publicity, but if you look, there's been plenty of papers published on it), and I wouldn't be at all surprised if you 'suddenly' see moves start in the next few years to raise the age of eligibility for retirement benefits, probably with decent cross-party support - there's really no other way around the problem.
As I said, other countries have the exact same problem; there was a prominent story in the U.K. press a few days ago about a government adviser's belief that raising the age of eligibility for the national pension scheme to 68 (and probably 70) from the current 60 for women and 65 for men is inevitable.
Anyhoo. It's interesting that you say you support free and affordable healthcare options fo the poor and low classes, I don't think that puts you very far away from anyone else in this thread. Sure, some of us happen to think that a fully nationalized healthcare system works well (based on experience or otherwise), but I don't think anyone would go so far as to say that it's the only system that can possibly have a generally good outcome. I don't see any reason an efficient, well-administered means-tested system - providing government-funded options only to those on low incomes - couldn't work.
In practice, what the U.S. will end up with if the proposed reforms go through probably won't be far from that, anyway. I don't think anyone really expects the entire nation to stampede into the public insurance scheme - I think the reform plans work on the expectation that many who have good private insurance will keep it, and by definition those are the people who can afford to pay for their own care.
It's also worth noting again that your suggestion that in a public system - you pay for the healthcare of your boss's boss - and the implication that you don't in a private system - doesn't seem to stand up to scrutiny.
Consider your current situation. It's quite likely you and your boss are members of the same insurance scheme - you work for the same company, after all. If he breaks his leg, you're 'paying' for his care just as much as you would be in a public system, because his treatment is paid for out of the insurance fund that you pay into. And, of course, the converse is true; if you break your leg, he's 'paying' for your treatment.
How's that different from a public insurance system such as that operated in my province in Canada? As I pointed out above, all those with a certain level of income here pay premiums into a medical insurance scheme just like you do. It just happens to be operated by the government, rather than a private company. In other respects it works just the same; we all pay premiums into a fund which covers the treatment for those who actually happen to fall sick. As far as I can see, the principle is the same in both systems. Very few people in either system actually wind up breaking their leg and personally paying the $500,000 or whatever the sticker price is for the treatment. Some people in the U.S. - the ones who can't afford insurance - become officially liable to pay it, but almost universally they don't, they declare bankruptcy instead. The few people who could actually theoretically afford to pay the sticker price never do, because they invariably have insurance...
9 August 2009 at 5:52 pm
Wow, that was long and waffly. Let me try and condense it.
You say that you think the right system is one where those who can afford to pay for their own treatment, and those who can't are supported by the others - "Do we need effective social programs, including free & affordable healthcare options, for the poor and low classes? Hell Yes."
It seems that what you would presumably consider a public / nationalized / whatever system - the public insurance system used in BC, among other places - achieves exactly this outcome. Those above a certain income level pay the premiums which support the entire fund. The 'poor' - those below that income level - do not pay premiums. Everyone is entitled to the same level of care under this plan.
That seems to do exactly what you say is right. Everyone gets healthcare, those who can afford to pay do, those who can't afford to pay don't have to, and no-one who's rich gets a free ride.
10 August 2009 at 4:14 am
I see your point, AdamW, but I just don't think it's the government's job to administer it for everybody, just like it's not the government's job to see to it that I get food & drink, shelter & heating, even though programs exist to provide those things to the needy. We need lesss government regulation, not more, and that which we do have needs to do a specific job and do it well. That's all it boils down to. The government should address the important needs, and after that, step back in defference to the rights and freedoms of the individual.
10 August 2009 at 5:35 am
Red: sure. At that point it becomes an issue of political philosophy versus anything else, I guess. However, I'm not sure how you do it without it being a public program at _some_ level. There's going to have to be government compulsion (real or implied), because out of pure self-interest, no private insurance program is going to offer free access, no hospital is going to offer free treatment, to poor people. So either you set up a public scheme or you have the government fund poor people to join private schemes. At that point you're talking more of a different in the details of administration than anything else...
10 August 2009 at 6:08 am
Exactly. No hospital or insurance firm should have to do charity work. I don't really care if the government subsidizes private insurance for the poor or provides its own, just so long as it's reserved to the needy. Basically you'd get a letter like "Hi! We're from the department of Health, and we see you make less than $XX,XXX a year, so if you like, you can have health insurance for just $XX a month!" or "Hi! We see you're in dire straits! Check here and you'll get free health insurance 'till you're back on your feet. Someone will be round tuesday to see what else we can do." Therefor, no hospital would have to go unpaid, since if someone without the insurance did come in, it'd only be a couple days wait until someone from the Health Department or what-have-you could get to them and get them signed up, since I'm sure they'd much rather get on board than rack up a huge hospital bill.
10 August 2009 at 8:03 am
""Hi! We see you're in dire straits! Check here and you'll get free health insurance 'till you're back on your feet. Someone will be round tuesday to see what else we can do."
I can see you do have (sadly) inflated expectations of government service =) Send someone round to see what else they can do? We don't get that here, never mind in the States ;)
But, sure. Either of those would work. I guess I just don't see how they're massively different from a public scheme. The government's still paying for poor people's healthcare (which means you're paying). Yes, it would be nominally administered by a private insurance company, but...think about it. They're likely going to wind up creating a specific insurance scheme for those being funded by the government. At which point the 'private' scheme's sole (or at least major) customer is the government, and if there's one thing good private enterprises are supposed to do, it's listen to their customers...
Oh well, not much point discussing it any more. But it's good to see that there's really not a huge difference here, once we get right down to it.
10 August 2009 at 12:11 pm
Yeah, I get that a lot. People tend to think I'm some sort of rabid Republican until we shout at eachother for a while and then they go "Huh. I never thought that's what you meant..."
But I truly have no problem paying for the healthcare of the legitimately needy since otherwise they'll go around spreading disease, doing poorly at work, and taking permanently ill and end up a much bigger burden on me than simply paying their healthcare (assuming a non-fucked system to begin with) ever would. I'd much rather shell out a little to prop up an otherwise productive man than tighten my pursestrings until he keels over and ends up a ward of the state.
11 August 2009 at 12:09 am
I think I'm now agreeing with phrantic - I wish we landed on Kirk vs Picard ;)
11 August 2009 at 9:05 am
Mandatory viewing prior to weighing into the Kirk vs Picard debate.
Patrict Steward is/was a Shakespearean actor, Shatner is/was a talentless chump.
11 August 2009 at 10:04 am
-.- Why, even with the comment preview feature, do my posts always come out as though I'm drunk?
11 August 2009 at 4:41 pm
dr_w00t: ah, but has Patrick Stewart released an album of strangely awesome pop songs assisted by Ben Folds? and provided the voiceover for In Love, hilariously brilliant standout on Mr. Folds' 'Fear of Pop' side project?
I believe the answer is that HE HAS NOT!
12 August 2009 at 5:56 pm
I, for one, welcome our new nurse overlords.
13 August 2009 at 7:49 am
Just when this thread looked good and dead, can't resist posting this anti-guvmint-healthcare hilarity:
http://www.theregister.co.uk/2009/08/12/hawking_british_and_alive/
13 August 2009 at 3:42 pm
Wow, I missed out on all the fun in here. Ironically, I was in Australia when most of this discussion happened, but I'm back in the US. (FWIW, Oz is a very lovely country and I wish I could have seen more of it)
Here's my rambling on the situation, and I'm going to avoid much of the politics as possible. There seem to be two divergent perspectives on the situation of national health care in America. Those that have always had an NHS and those who never have had an NHS.
I'll throw my bias up front, I'm in favor of a national health care system in the US. I consider it unthinkable for any number of people in the wealthiest nation in the world to be without health insurance, and I feel it is "unpatriotic" to not help my fellow American in this manner (a phrase I'm surprised hasn't come up before to suppress the level of dissent on this topic).
However, I am not unsympathetic to those who are against the plan. For those who've always had an NHS, our public healthcare plan is an ALTERNATIVE to whatever insurance we may have, not a plan in addition to what we have. If we like our private insurance plan, we can keep it, but we don't reap the direct benefits of a public healthcare plan. From the sounds of how it is in other countries, if you don't like what your private plan offers, you can go with the public route. Right now, that's not an option for us. So right out the gate, things are very different. It's not terribly clear how things will be administrated, but it may very well be that our public healthcare system could be run like a conventional insurance company where there's a benefit to see doctors/go to hospitals that are compliant/have an agreement with the system, and if you "go out of network" you have to pay more. If that's the case, then the question to consider is "How big is this 'public' network?". If it's really small or scattered, then many of the complaints about a public healthcare system may very well be valid.
There are those who are complaining that their current private insurance will become taxable in order to pay for this plan. I'm having a hard time finding evidence of it, but the law that I was reading was extremely dry and I haven't seen it refuted, so let's assume that's true. If you have a good insurance plan that you like, you end up having to pay more to keep it. You can see why some Americans don't like this. I myself don't relish the thought of having to pay more to keep what I have. But I am willing to do my part to ensure that other Americans have some form of health coverage.
So for the rest of the world, just because your NHS works great doesn't mean that ours will.
Now... for my fellow Americans that are buying into the fear mongering and hype. First, it appears this healthcare plan isn't free for the people getting it. It's not clear how the payment is to work, but people do have to pay to some degree to get in. Second, it appears that the public health insurance plan may have alternatives as well. Any private insurance company that is willing to offer essentially a national public insurance plan is welcome and even encouraged to do so. So if the government fubars health care, any private company that can do better is permitted to do so.
Note that this is all based on my interpretation of what my eyes did not glaze over from the current draft of the health care bill. Hopefully I'm accurate about everything I've written above, but feel free to call me out on anything I've messed up on.
13 August 2009 at 5:20 pm
Holy crap.
I just discovered that there's a group called "Remote Area Medical" in the USA, that was created to bring basic medical care to poor communities hundreds of miles from the nearest doctor. To our shame, Australia has remote places where a group like this would get plenty of customers.
But Remote Area Medical were mobbed when they set up in Los Angeles. This is an NGO health-aid organisation, like you expect to see doing dental work, vaccinations and wound care for people in Africa, and they're swamped with patients in a suburb where the average house price is a quarter of a million US dollars.
But never mind that - according to the CEO of Whole Foods, the problem with poor people is they spend their health-care money frivolously!
14 August 2009 at 1:49 pm
Dan,
Funny you should bring that up. Australia does have a similar program like Remote Area Medical. You may have heard of it.
Anyways, I went to visit the little museum/exhibit for the RFDS in Alice Springs and it appeared that if you're an Australian and you require EMS, it's free. They also had a list of countries that they have a reciprocal agreement with Australia for medical service. Most of them were first world countries like Britain, Canada, Germany, etc. Notably and embarrassingly missing from the list was the United States. Sadly, I do not see the plans proposed by Obama as changing that any time soon.
I considered mentioning this fact in my last post, but realized that it wasn't going to change any time soon.
14 August 2009 at 5:34 pm
The Royal Flying Doctor Service isn't very similar to Remote Area Medical. RAM go somewhere and set up a sizeable temporary medical facility with many practitioners, which operates for a straight day or more and serves a whole community.
The RFDS is a rather larger organisation, but they're spread out all over Australia, usually sending individual planes (or 4WDs) to individual patients.
If RAM bought themselves an aeroplane and started trying to do RFDS-type emergency services they'd fail, because the RFDS planes regularly take sick people to distant hospitals, which wouldn't be a very useful service for uninsured people in the USA. It's not physical access to care that's usually the problem in the States; it's being able to pay for it.
26 August 2009 at 8:53 am
Seriously man, learn about the subject before you talk about it.
A large portion of the people fighting Obama's reforms are libertarians, the progressives are left wing authoritarians just as the neo-cons are right-wing authoritarians.
Also, I somehow doubt you even have the slightest grasp of the economics behind the reasons why health care costs so much.
I'm also incredibly blown away by those accusing the blue dogs of being bought out by the insurance company, when Obama's bills essentially give tons of extra business to the insurance companies. You are brainwashed fools if you think Obamacare will help anything. It will only drive up costs further.
The idea of yet another public option (when we already have medicaid) is especially asinine considering we are so far in debt that the federal reserve bank is openly monetizing the debt. 48% of 7 year bonds at fed auctions in late july ended back up in their hands in less than a week.
Oh but you guys probably don't even fucking know what monetizing the debt is, much less inflation, and why government entitlements and meddling causes higher inflation in the areas of medicine and higher education.
The progressives are authoritarians and moral busy bodies just as the neo-cons are. Most of the people protesting this shit are classic republicans and libertarians who do not resemble the authoritarian neo-cons whatsoever. The real authoritarians are those that would tell us what insurance we can and cannot have and take away our free market.
Also, don't forget, the nazis were a national socialist movement. They socialized the financial institutions, the medicine, and industry. You are fools who don't even realize half of what the federal government currently does is unconstitutional. But oh yeah.. you guys are foreigners trying to pretend you actually know jack shit about American politics.
Read some libertarian ideology for once you shitheads, and look at REAL republicans like Ron Paul. Then you might start to understand, but I doubt it.
26 August 2009 at 11:10 am
Uh, "libertarian"? The book. Continues to be. Free.
So's abusing people and telling them they haven't a clue and need to read lots of other stuff before they can graduate to your high level of debate, of course. So, you know, whatever turns you on.
I've read quite a lot of "libertarian ideology" and found it singularly unimpressive, and clearly a very bad way of running things, like health-care, fire brigades, public transport and wars, that can be the source of vast amounts of unnecessary human misery if they're operated by poorly-regulated for-profit bodies.
But I'm sure my terrible misapprehensions are purely the result of not having yet found the One True Libertarian Ideology that'd take care of all of those problems. I congratulate you for not mentioning what this One True Ideology actually is, for surely it is the journey to the truth that is most salutary, not the truth itself.
Thank you, Sensei.
26 August 2009 at 4:14 pm
Uhm, for one, you are confusing anarcho-capitalism for constitutional minarchy. Libertarians aren't necessarily anarcho-capitalists. I believe in government infrastructure such as roads and police. But we don't have the money to spend on yet another public option when we haven't even figured out why medicaid is so wasteful and while we are still involved in pointless wars and foreign entanglements which are also draining us and driving us into debt.
Also, why are many single payer systems failing so hard currently? The UK, Canada? The main proponent for the Canadian single payer system now says it is a failure and they need more privatization. Why is the average wait time for surgery 17 weeks? Why is France no longer single payer and now over 90% of French people have non-government insurance now? Hmm?
Have you even read the bills the progressives are trying to push? Why are some insurance companies lobbying FOR it, not against it, hmm?
Historically most monopolies have formed because of bad government regulation, rarely do "natural" monopolies ever exist outside of sewer systems and telephone companies (before there was an internet).
If public healthcare is so good then why did multiple VA hospitals expose patients to HIV etc? Do you actually think giving the government a monopoly over health insurance or health care is a good idea? It is as bad of an idea as giving a for profit company a monopoly. When there is no competition, whether the monopoly is government run or private run, quality of care will always go down. The last thing we need is more government bureaucracy anyways. The idea the private could ever compete against government is a sham too, it will only lead to a government monopoly. LOOK AT THE DEFICIT, also consider Obama got more money from Goldman Sachs than any other politician in the U.S....
Please, again actually do some real research, and read a few fucking books on economics. Also, don't assume all libertarians are anarcho-capitalists. I personally am a federalist, just a Madison style one.
26 August 2009 at 4:17 pm
Oops. one small error, I meant to say you are confusing all libertarians for anarcho-capitalists when most are really constitutional minarchists.
The difference between libertarians and the mainstream is we believe government is a necessary EVIL, not a necessary good.
Also it is the progressive's continued loosening of the commerce clause over the years which has led to the ability for the government whether controlled by the left or the right to bring about authoritarian legislation and agencies like the DEA.
26 August 2009 at 4:45 pm
We'd be much better off getting rid of medicaid, medicare, welfare, social security etc, and replacing it with EITC and setting a minimum income level.
Using 2008 budget figures if you got rid of all the above listed bureaucracies there would be so much extra money, you could take the average family who makes less than $40,000 a year and boost their income to $40,000 a year.
This is how wasteful our current bureaucracies are, and you are calling me a crazy authoritarian for being against more of this crap which steals money from everyone, puts it into the government footprint taking it out of the real economy where it can do some real good?
At least with EITC you'd be subsidizing the poor in an efficient manner, and you could add extra clauses to the tax code to help with medical expenses and to replace social security entitlements. Also it would stop the extra inflation caused by throwing money directly at health care which removes the consumer from the price mechanism, warps the market and creates artificial demand which is why health care goes up at 4-8x the normal rate of inflation.
The problem is our current idea of "insurance" is a sham, it is like car insurance that pays for your gas and oil changes. Insurance is for catastrophic events, when it co-pays for every single doctor visit when you go in to get a checkup or have a cold it simply isolates the consumer from the price mechanism and breaks the self regulatory forces of price in a market system.
PLEASE read a few books about economics, especially micro-economics dealing with market systems and the many different types of inflation.
One of the biggest problems is the states don't allow their citizens to purchase policies across state lines and over regulate. Which makes it harder for competition to arise. The original point of the "Commerce Clause" in the constitution was to enable the federal government to break down trade barrier between the states.
Great example of how government meddling has created a problem. Allowing people to purchase policies across state lines, and making medical licenses usable across state lines would help a lot, but instead the progressives will misuse the Commerce Clause to create more unconstitutional bureaucracy at the federal level when clearly the constitution delegates these powers to the states individually.
This continued loosening of the original meaning of the constitution will lead to an even more corrupt regime. Centralized control means centralized corruption.
Also, you guy are idiots if only because you would group all opposition to more government as being "authoritarian" wow, you losers really don't know anything about political philosophies. That good ole public education hmm?
The point of having a democratic REPUBLIC is to protect the minority from the whims of the majority in the form of such stupid legislation as Obamacare, agencies like the DEA, and government theft such as eminent domain. You are so focused in your egalitarian foolishness you forger you are the authoritarian tyrants, forcing your one size fits all solution onto an entire country, even those who do not want anything to do with it.
The founders knew pure democracy (mob rule) would always result in the tyranny of the majority which is why we have a constitution we must follow. And, the reason we have such a corrupt government is that the "progressives" have loosened the constitution and ruined the purposeful separation of the powers by the authors of the document. Not to say the neo-cons haven't come in recently and taken advantage of the situation, but Obama is not our savior either.
Also, don't label everyone who disagrees with you as authoritarian when the author of this blog is clearly for authoritarianism in the form of tyranny of the majority and that the government should even have the right to intervene in such a heavy-handed way.
How the AMA (a guild) influenced state regulations killed the non-profit mutual societies and created our current mess:
Further reading:
http://libertariannation.org/a/f12l3.html
http://www.reason.com/blog/show/135161.html#1343623
http://www.reason.com/blog/show/135161.html#1343779
26 August 2009 at 4:56 pm
I was in such a blind rage still from being labeled an authoritarian I might have not been as clear as I could have in the last comment...
I meant to say a correct usage of the commerce clause would be to allow citizens to buy policies across state lines, an incorrect usage would be Obamacare (that or an incorrect Hamiltonian usage of the General Welfare Clause).
26 August 2009 at 5:09 pm
OK!
It's pretty easy for me to stop doing something I was never doing in the first place, of course, but what the heck; at least you're not calling me a shithead any more. Maybe you'll even read the book, and discover what an "authoritarian follower", in this very-well-defined narrow usage, actually is; you can even take the test and see if I actually am calling you one, which I really do not think I am, because you don't sound like one at all.
You've moved on to making flurries of bold assertions about the fine-grained opinions you assume I must hold about how precisely your broken system should be fixed and your far-distant country should be run, when what I actually said boils down to "you guys can pick how any other First World nation does health care, and that'll work better". But clearly you're enjoying the chance to vent, and perhaps your arguments will persuade somebody other than me to some point of view that pleases you.
Good luck!
26 August 2009 at 5:16 pm
Breaking down trade barriers between states is GOOD, creating more unconstitutional federal level bureaucracy is the last thing we need with our rising deficits. If you think the economy is bad now, just wait until the US bonds bubble bursts and the dollar index goes down to 50 or below.
We need less meddling, not more. We need GOOD regulations, not anti-competitive ones that still linger from the days when the AMA was a guild looking to get rid of cheap competition; trying to get the government to take care of the poor so they wouldn't have to do it themselves when forced by real market competition which kept prices low enough for the poor to afford.
Read about what the AMA and over-regulation did to the non-profit mutual societies!
Agian. how in the fuck do you call me an authoritarian for being AGAINST authoritarian programs? Seriously, what the fuck man?
26 August 2009 at 5:33 pm
Anyways, I'll re-read your post when I'm more sober and not in a blind rage. I just got the feeling you were accusing all opposition to Obama's brand of reform as being from "right-wing authoritarians", when it is really non-authoritarians who are protesting it and looking for regulatory reform at the state level and forcing states to allow their citizens to purchase policies across state lines. Forcing the states to do this is a correct usage of the Commerce Clause yet our government has failed to do so! Instead, they would continue with oppressive centralized federal bureaucracy.
Don't believe the mainstream media, which labels us as dubya lovers. Yeah the GOP will "support" the protesters, but that doesn't mean we support them. Most of us HATE the current GOP which silenced the only good presidential candidate offered to us last year with their censorship of Ron Paul at the GOP presidential debates.
26 August 2009 at 5:57 pm
The problem is corporate cronyism in government and not capitalism and the free market. Look at how Obama got more money from Goldman Sachs than any other politician, and how he has been lobbied by the insurance industry to include certain things in his bill.
The corporate interest lobbyists try to regulate each other out of business through legislation that makes it too expensive for the small guy to compete.
For example, why is Wal-Mart lobbying for forcing employers to offer comprehensive health-insurance to employees? and why does the liberal media fail to see that this isn't out of NICENESS on their part, but rather because they know if employers are forced to do so it will drive the smaller ones out of business because they won't be able to get as good of a deal on insurance and don't have the buying power Wal-Mart has.
The greedy capitalists if left to compete against each other in a free market will drive the price down as they fight "price wars", but when they are able to influence legislation then, and only then can they *really* be anti-competitive and drive prices up.
Also, government monopoly over an industry is bad just like a single company having a monopoly over an industry is bad. Any "public" option will simply drive the cost of private insurers up as they will only be able to get business from the rich who want special plans.
How can the private compete against government when the government makes up the rules? It is like a baseball game where the referees are run by one of the teams. It is absurd. The government can steal all the tax payer dollars it wants to keep the "public" option "cheap" (or so you think while you are paying higher taxes and also paying for it via inflation which most people don't even realize is a tax). Plus they will just make themselves exempt from the rules just like they do environmental regulations and how they shield themselves from lawsuits. The U.S. government pollutes worse than any private industry does here, because they are immune to the rules! They don't have to follow the same rules the citizens do, and they aren't held accountable enough! However, they SHOULD have to follow the same rules everyone else does. This is what you should be fighting for, not more incremental government expansion.
26 August 2009 at 6:22 pm
Now Dan, after my last post.. are you really so unimpressed by libertarian ideology?
26 August 2009 at 6:47 pm
Also, the infant mortality rates and even average life span stats are skewed against us because we actually keep honest records.
For example our infant mortality rate is only so high because we count many premature births which we try to keep alive and don't just discard them from the statistics and written off as "still births".
Every country keeps their statistics through different standards and systems, most of the supposed "horrible" US stats are simply due to the fact we don't cheat as much when keeping records. That combined with the fact we are a bunch of fat fucks who don't exercise maybe? Christ... like that is somehow the fault of our healthcare?
Why is it people from all over the globe come to the US for the best treatment available? Why does the vast majority of new medical technology and drugs come from the US? Why do so many Canadians who need heart surgery get sent to the US by their own government?!
*facepalm* Yeah.. our healthcare is the WORST (not). Although, prices are too high, but you can blame the government for allowing that to happen, not the free market.
Read it if you haven't already:
http://libertariannation.org/a/f12l3.html
Also... as far as "access" goes, maybe that is because doctors are so hard to come by because of all the expense and regulation involved in becoming a doctor in the first place. Maybe we could make it easier on them by reforming the tort system so doctors didn't pay 25% of their gross profits in malpractice insurance when most *never* get sued and never have to use yet. Yet most of the time they are FORCED to get it.
26 August 2009 at 6:53 pm
Dan, I'd really like to hear your response on why our healthcare is so horrible when the Canadian government sends patients it can't treat here.
Hmmm....
Why don't you do a thorough analysis of how infant mortality rates are calculated differently and more honestly here than other countries, and how we keep more honest stats on average life-span as well.
26 August 2009 at 6:55 pm
Why is private health care insanely expensive in the UK now? Why do only the VERY rich get quick care? Why does the head of the Canadian system now say it has been a failure?
26 August 2009 at 7:00 pm
Why did Obama try to force his bill through without giving anyone time to read it? This is the real reason there was so much opposition and fear. Why would you try to shove through legislation before anyone in congress or the citizens themselves had time to even read it? And you want to say authoritarians stopped the reform? WHAT?! The authoritarians were the ones pushing for Obama's horrible shitpile of "reform". We need real reform where the citizens can purchase health insurance across state lines, not extra debt our children, and children's children will have to pay off... assuming we don't go bankrupt before then. Why do most people eligible for medicaid never use it, and why do so many eligible for it have private insurance instead? You do realize non-profit insurance companies can't compete well here because they are taxed just like for-profit ones are and regulated out of business.
26 August 2009 at 7:05 pm
Why not fix our current public option, which is medicaid, bring the troops home and use this money to improve/expand medicaid?
Why create redundant bureaucracy and spend our country into oblivion when the above option makes a lot more sense combined with regulatory reform, especially the anti-competitive state laws?
Why is Obama's bill supported by some insurance companies?
26 August 2009 at 7:06 pm
Why is everyone so misinformed on this subject? Why did you write your blogpost to make it like somehow authoritarians were behind the revolt against Obamacare?
26 August 2009 at 8:17 pm
1: You may perhaps be taking more than the optimum dose of caffeine, man.
2: This is undoubtably yet another situation in which the loudest and most "newsworthy" protestors are seen by observers like me as making up a larger part of the protest community than they actually do. I would not be at all surprised to learn that there are people opposed to the Obama administration's proposed changes to health care in the USA for reasons quite different to the Fox News talking points; I could even believe that some of them have some vague idea of what the proposed legislation contains. Since most of the protestors seem to believe there's only one proposed scheme, though, it does not seem likely that they have paid the slightest attention to anything other than their misleading chosen authorities.
Unquestioned acceptance of the assertions of chosen authorities - right-wing religious leaders and Fox News, for instance - has unquestionably produced a non-trivial portion of the protest movement against what you term "Obamacare" (which suggests to me that you, also, believe there's one definite scheme being proposed, which is not true). These protesters believe their chosen authorities' claims about health-care policy changes, like the ridiculous "death panels" canard, for instance, and openly display pretty much the whole of the rest of Altemeyer’s authoritarian-follower checklist, while Fox's assortment of salaried and invited demagogues are of course pleased to take the role of the authoritarian leader.
I find it difficult to believe that all the people who watch and believe Fox News are all actually secret libertarians, skeptical of the claims of the textbook authoritarians who use Fox as a soapbox, but for some reason acting as if they are not.
If Fox were a curious fringe institution like the Westboro Baptist Church then there'd be no reason to be especially upset about all this, but its "news" shows continue to rate their little socks off, it continues to work hand-in-hand with the Republican Party, and Fox, the GOP and the rest of the US mainstream right - which now pretty much includes the Democrats, too - directly tell their audience what to believe. And there's a mountain of hard empirical evidence that the audience does indeed believe them, following the authoritarian-follower blueprint to a T. Authoritarian leaders and their followers have been working hard in the USA for a long time now, which is why the USA's political mainstream is now in such a bizarre state, where a reborn Richard Nixon would be denounced as a Commie.
I'm sorry, but I don't have the time to continue to reply to you. I suggest you redirect your energies to reading The Authoritarians.
27 August 2009 at 6:33 am
I know there are multiple schemes, but there are two main ones. The House bill and the Senate bill, they are both basically the same except one has a public option and one doesn't.
The democrats are only pushing the two dumb ones though, and the republicans making dumb arguments against it. (Instead of the blatantly obvious good arguments against it).
27 August 2009 at 6:46 am
Also, the mainstream Republicans seem to be slowly embracing the libertarians. We already have quite a few "Liberty Republicans" who will be running on basically the same platform Ron Paul does for 12 or so of the House and Senate seats opening up in 2010. Should be interesting to see if the "Liberty Caucus" in the Republican party will end up with more members besides just Ron Paul.
I hate Fox news on a whole, as they purposefully cut out Ron Paul from replays of their GOP presidential debates in 2008, but they have one good show now... "Freedom Watch" geared towards libertarians, you should check it out, it is refreshing to hear some real conservatives who believe in freedom, small government, and non-interventionist foreign policy.
A lot of the libertarians feel like their own movement was usurped by the neo-con authoritarian interventionists... starting since the early 1980s.
Again... a lot of mainstream Republicans are coming around to libertarian ideology now that they realize they cannot hold office w/o adhering to the original platform of the Republican party. (Constitutionalism, small government, and non-interventionist foreign policy). Republicans should be concerned with protecting the minority, as that is the whole point of the "republic" part of a "democratic republic"... to protect the minority from mob rule. Btw.. Lincoln was a Republican...
27 August 2009 at 5:17 pm
http://www.theatlantic.com/doc/200909/health-care
"How American Health Care Killed My Father"
Yeah, we got problems, but a the lack of a public option isn't one of them.
Also.. as far as average life span goes, that stat is totally warped by the fact we have so many deaths of young people in violent crimes. Most of these crimes I do not think would exist without the war on drugs and the gang violence it creates for profits in black market goods.
As far as survival rate goes for people being admitted with specific conditions, our country scores quite well. The problem is looking at stats like infant mortality rate when we don't write off nearly as many premature births as "still births" as other countries; and for average life span there are many reasons for it being lower, like our murder rate being so insanely high.
30 August 2009 at 7:28 pm
Dan, you are a possum-stirrer par excellence. My thanks for the entertainment.
1 September 2009 at 11:57 am
So, 'libertarian', I gather you get your lithium from free market sources?
5 September 2009 at 3:43 pm
And somehow, the great and mighty United States, whose unofficial motto was always "we can do anything we damn well please if we set our minds to it" is suddenly stymied by something that virtually every other industrialized nation has found relatively simple to implement. Instead we listen to (well financed) insurance industry shills claim that it's utterly impossible and we shouldn't even consider it.
11 September 2009 at 8:55 am
http://reason.com/news/show/135976.html
11 September 2009 at 8:57 am
pompomtom: like Canada's piece of shit?
hahahahahahah
11 September 2009 at 8:57 am
Why do approximately 95% of French people have private insurance if their public option is so good?
11 September 2009 at 8:58 am
Oh, I totally forgot the UK.. yeah... their NHS is AWESOME...
lol
11 September 2009 at 9:00 am
So is that all you have to say in response?
Wow.. I'm not very impressed :(((
11 September 2009 at 9:00 am
Oooo yeah also... why is it that the author of this blog is clearly an authoritarian and then goes on to talk about them like he isn't one?