Okay Then: Health Care

So, I’ve been avoiding talking about the health care thing all August long, but let’s go ahead and talk about it a bit, just so that decades from now my biographers (i.e., the great-great grandniece assigned to do a high school project about that ancestor of hers who wrote those spaceship books — how funny!) will know what I thought about all of it.

I know a number of people on the left have been beating their head against the wall wondering why Obama et al haven’t been aggressively hammering down the idjits on the right who are screaming about socialist death panels murdering grandma by slapping her to death with the president’s uncircumcised penis which proves that he’s not from America by the way, but I have to say personally that I’m somewhat more sanguine about it.

Maybe Obama and the Democrats are indeed so disorganized that they’ll be defeated by a bunch of froth-flecked ignorami, but I think it’s also entirely possible that they recognize that the best way to deal with these people is not to yank on their chain but to give them enough rope to hang themselves. August has been a long enough time for it to sink in that many of the people screaming about the proposed health care changes in town halls are, to put it charitably, crazier than a river-bound bag of cats, and know nothing that wasn’t read to them (slowly) by people who are perfectly happy to lie to them for the purpose of ratings and/or counting political coup. Even people who have reservations about the proposed changes in heath care come away not wanting to be associated with anything those people are yammering on about; it’s embarrassing to be lumped with people who scream about keeping the government out of Medicare.

And this is where Obama comes along and does his thing, because in fact he’s not a socialist grandma-killer, he’s the dude who doesn’t get excited or flustered and focuses on threading the needle and getting most of what he wants done. After crazy, foamy August, Obama’s September will feel like a cool breeze of sanity, and I suspect people will come around. Why do I believe this? Because if you can harken your memory back to last year, he’s done this act before, in around the same time frame. Obama, whether you like him or not, doesn’t strike me as someone who wastes much energy; he’s saving his effort for when it matters, i.e., when Congress is back in session and when the right has revealed itself to be insensibly nuts on the issue to a large chunk of moderate Americans.

But I think there’s more to Obama lying relatively low in August than just letting the right embarrass itself in front of thoughtful, non-ignorant people who actually want solutions to health care issues. If you read lefty blogs at all, then you know that at this moment they like Obama only slightly more than the right does. They feel the man is too inclined to compromise, too slow to address issues they feel should be addressed right now, not forceful enough in directing the Democrats in Congress and so on and so on. Essentially, they fault him for not doing what they hated the Bush administration for doing, which is using a majority in Congress to ramrod through partisan policies.

Leaving aside the fact that Obama did in fact score a number of very quick legislative victories, there are two things going on here. First, anyone who at this point doesn’t realize that Obama’s plan is to actually lead from the center, with just a hint of a tilt to the left, is an idiot. That’s where he’s been since he left the primaries last year, because that’s where most Americans are, and that’s who Obama sees himself as the steward of: a huge chunk of center-ish people who nonetheless have three decades of rightward-sloping inertia.

News flash, lefties: The right is still better at political guerrilla warfare, and most voters are still vaguely worried about “big government” and see such a thing as a lefty construct even though the right has done excellently well at the big government thing over the last 30 years. The fact that Obama’s popularity dropped by double digits through the right’s use of lies and absolutely insane rhetoric regarding heath care suggests that people still default vaguely right, and need time to recognize that the talking points there are too wacky to deal with before swimming back toward the center. I think Obama understands what he has to work with and also gets that there’s only so much he can tackle.

Second, I think Obama and his pals also used August to remind the left of the salient fact that the right did not in fact roll over and die when he got elected, and that given the opportunity, will be more than happy to stab the Democrats and other liberals right through the eye, so what the left really needs to do at this juncture is just STFU and get with the program, which is what Obama says it is. The folks on the left, bless their hearts, are not like the folks on the right: They are incapable of walking in step until and unless they think zomg the world is going to end and we’re all going to die. This was not where they were at earlier this summer when it came to the health care debate but may be where they are now, having had a full month to watch the right spew and kick and gain mindshare. I think it’s a little bit sad that the left has to get to that point in order to function as a unit, but, well, that’s part of being on the left, isn’t it.

Again, I could be wrong about all of this: Obama and company may in fact be flailing about and I’m just constructing a neat alternate reality in which they actually know what they’re doing. But until and unless health care fails despite Obama having majorities in both the House and Senate, I’m going to go with the idea the dude knows what he’s doing with all of this.

The other thing I think Obama knows that lots of people on the left seem to be clueless about is that the goal here for Obama is not creating the US equivalent of the UK’s National Health Service, or even any other specific program — it is codifying into the laws of this country the proposition that every American must have access to basic and comprehensive health care. If he gets that — however he gets that — then essentially it’s game over, and everything from that point forward is just haggling over details.

Certainly those on the right understands this; it’s why they’ve spent so much time trying to terrify people who would very likely benefit from changes in the way health care is run in the US into thinking that this is the worst thing since 9/11. The right needs to kill the entire concept to have a win scenario, because it knows that once people get used to the idea that health care is effectively a right, they’re never going to give back that right. I’m continually confused by why the left can’t seem to grasp that this round of the battle is about the big idea of universal health care rather substantially more than it is about the specifics of said care. The specifics can always change, once the big idea gets accepted.

As for where I stand on it, well, you know. From the point of view of a productive and well-functioning society, I think everybody in it needs to be healthy, and as a taxpayer, I would rather spend money on preventative care, which is relatively cheap, then on emergency room care, which is always expensive. Personally, if I were in charge of health care, I would mandate universal care for every American under 18 and over 70, and make everyone in between purchase their health care from insurance companies who then turned over a certain percentage of their revenue to subsidize basic, comprehensive health care for Americans who could not otherwise afford it. Off the top of my head, it seems like a reasonable middle ground between the governmental interest in a basically healthy society, and the good old fashioned American belief in the primacy of private profit and the right to fine tune what one is willing to pay for, in terms of health benefits. I have no doubt someone could pop holes in this particular plan of mine, but, hey, it’s a paragraph long.

The point here is that, morally and competitively, I believe the United States is better when its people are healthy; I also believe as a citizen it does me no harm and in fact does me good, to subsidize, either through taxes or though my insurance payments, those fellow citizens who have no health care. Better to find a way to keep them healthy, than to wait for them to become ill and deal with the mess then. How we do this I’m cheerfully agnostic about, which is why I’m not exactly losing my mind if, say, the “public option” doesn’t pan out. But at the end of the day I want people to be well, because that’s one less national crisis to have.

I do suspect most people are more or less where I am on this, which is why when the smoke clears I think we’ll see that we have some sort of national plan on the books. I don’t imagine those on the right will be at all pleased; I equally imagine a large number on the left will be annoyed by what the plan doesn’t have. But in the center I suspect we’ll have a feeling of, well, let’s see how this works for us. I think that’s a reasonable place to be.

551 thoughts on “Okay Then: Health Care

  1. Some kind of public option would harm Big Health Insurance, which frankly is enough to recommend it in my book.

  2. It’s interesting that life expectancy in the United States rises as moaning about health care increases.

  3. Aaah, the cool voice of sanity. It’s been a while. For my two cents, I think you’ve summarised the situation wonderfully and I too hope your interpretation of the president’s stance is correct. Froth on the right and foam on the left – let the center hold!

  4. Walt:

    When you factor in the fact that 49 other countries in the world have a higher life expectancy for its citizens than the US (and that many of those have some sort of universal care), and that in general life expectancies have been increasing around the world, no, it’s not really that interesting.

    I do think it’s interesting that people like to trot out irrelevant/misleading facts and then seem to believe it conclusively settles the discussion, however.

  5. On the contrary, my take is that Obama has overcorrected from Clinton’s tack with health care and left the entire thing to the Congress, to their staffs, and to the policy wonks.

    The problem is that now only these people know what is or is not in the “reform” bill. For the rest of us, it’s a black box. The thing seems almost deliberately structured to be as opaque, vague, and difficult to understand as possible. (I tried to “skim” it but gave up after the first 50 pages when I ended up having to have multiple browser windows open so that I could see the text of the bill next to the U.S. Code Annotated and Code of Federal Regulations from Westlaw to mentally figure out how each clause would be changed. It just gave me a headache.)

    That’s why the attacks about – among others- end-of-life consulting (AKA “death panels) and government getting back-door access to your financial accounts have been so effective. There is no way for the authors of the bill to prove that the bills can’t be interpreted to allow these short of Jedi mind tricks. People are not interested in “trust us” from the feds anymore. Not when doing so will, by the OMB and CBO’s own admission, result in yet another multi-billion dollar pig in a deficit-financed poke.

    But Obama has committed to passing something. My guess is that he will offer a scaled-back that gets rid of the most egregious insurance company practices like “pre-existing conditions” but leaves the asinine concept of employer-provided health insurance in place. Then he will declare victory and get off the topic.

    Meanwhile, the real problems with health care – too much focus on insurance, too much regulatory bloat, and too much buck-passing from consumers – will go unaddressed.

  6. …I’m still stuck on the fact that we know the state of the President’s penis. How on earth was that knowledge ever deemed necessary and who said so?

  7. I would like to be optimistic but frankly I think you are indulging in the all-too-common “Obama works in mysterious ways, he’s really rope-a-doping them” thinking. There is something about Obama which leads people to project their wishes and hopes upon him. Thus, Bill Maher is convinced Obama is a closet atheist; countless progressives are upset that Che Obama isn’t the lefty revolutionary which they imagined him to be; and so on.

    Fact is, fear works. Fear was used to sell a war which in hindsight was as obviously a fool’s errand as it seemed to us DFH’s when it was first proposed 7 years ago. Fear of socialist slavery and government-mandated euthanasia has been used for over 40 years to defeat national health care proposals. Fear was used to sell virtually every Bush administration proposal that could be even tangentially related to national security. Fear was used to elect Republicans in 2002 and 2004. Fear helped elect Bush in 2004.

    Sadly, fear works as a propaganda tool and even more sadly, it sure seems the Obama administration and their pro-health-care-reform partners just didn’t see this coming. As if they’ve never seen this playbook before…

  8. Julia:

    We don’t, actually, and it’s not in the least relevant, but apparently the some people seem to think it is. Which is to my point about these folks falling over the crazy cliff, making others less inclined to follow.

    r€nato:

    “Fact is, fear works.”

    Meh. Sometimes it does, sometimes it doesn’t. And fear is hard to sustain, which is why having people lose their shit in August doesn’t mean they won’t have recovered it in September.

    As I note in the entry, we shall see. But as I also noted in the entry, Obama’s had both the left and right losing their shit around him before, and seemed to handle it just fine, which is why he’s the president now. Past performance leads one to leave on the table the idea he knows what he’s doing.

  9. “the idea that health care is effectively a right” I don’t understand how you figure that health care is a right. I also wonder what the limits would be on this right. We have the right to free speach but there are limits to this right. How long before this right is used to try and control behavior? One example that jumps to mind is HIV AIDS. Should we have to pay for treatment of a disease that is 100% preventable? Treaments that are not a cure? Treatments that are very expensive?
    What about tobacco use? Here in CA there are big taxes on tobacco products. Where does the revenue go? A bunch of it goes to preschools. Why isn’t it spent to help people quit smoking or on health care for smoking related illness?
    The funny thing is that we have already cast our ballots. Now we get to live with the results of those decisions. Screaming and moaning at this point shouldn’t matter. STFU until the next election.
    I guess it’s like the weather. It is out of our control but we sure like to talk and bitch about it.

  10. I agree with Scalzi. During the too long election of 2007 and 2008 we heard from lefties how badly Obama was doing, how Obama had to, “Hit back hard,” how Obama was blowing it, ect. We also heard from righties how Obama was, well, who cares, the righties are almost always wrong/crazy/silly and deserve to be ignored. The critics on both the right and the left were wrong; Obama knew exactly what he was doing. The health care debate, if it can still be considered a debate, is following the same pattern that the election did. Obama is doing what needs to be done while America’s pundits and newsreaders run around like hyperactive children strung out on crack.

  11. In many ways, the healthcare debate isn’t about whether we’re paying for healthcare; it’s whether we see the bill. Consider:

    The lost productivity of the uninsured who get sick;
    The nonmedical debts (usually money lent for “normal” things like housing) wiped out in bankruptcy when the uninsured get sick;
    The cost of treating illnesses and conditions that are “spread” through the absence of preventive care (or, at least, not prevented by);
    The increased fees charged “insurers”* by hospitals, etc. to cover the “cost” of care provided by those hospitals, etc. to the uninsured;
    The increased litigation engaged in over relatively minor medical malpractice because the consequences of the malpractice scare the hell out of the victims;
    The administrative costs and pitfalls of workers’ compensation systems, which would be entirely unnecessary if medical care was of right and otherwise covered;

    I won’t go on. I don’t think I need to.

  12. John,

    Do you really think life expectancy is unrelated to health care policy? I think the trends show a lack of urgency in passing perhaps ill-considered legislation right now.
    For the record, your suggestion is better than anything likely to be presented to Congress although I wouldn’t vote for it myself.

  13. The persistent habit on the left of assuming that all protesters are insane birthers obsessed with the president’s penis, and calling them “teabaggers” or “un-American” and claiming that they’re carrying swastikas, is not endearing the left to moderates.

    My lefty friends are claiming that anyone who doesn’t think the government needs to take over health care is delusional and not worth listening to. When you start believing that almost half the country is insane and not worth speaking to, your movement tends to fail.

  14. PS “reform” scares the hell out of me. Look at how well the last immigration reform worked out. They have an agenda based on what they think about cause and effect of a given subject. I am not impressed by their record.

  15. Scalzi @9: Now I really HAVE seen it all. This is the problem with a bad economy–people who are laid off spend way too much time thinking up strange crap and tying it into their favourite conspiracy theory–when The Price Is Right isn’t on, that is.

  16. I hope you’re right, John. I really do.

    I fear, however, that we won’t get any substantial change out of this debate. Fearmongering works all too well. (When I say “I fear,” I mean “my worst fear is,” not the usual “I think you’re wrong and I’m going to be sarcastic about it.”)

    I think we on the Left need to take a page from Barney Frank’s playbook: when someone is being a stupid loon (or, alternatively, a crazy idiot), we should call them a stupid crazy idiot loon, and walk away. Humiliate them to the extent possible, then ignore them.

    I’m so tired of people being stupid and of being too polite to ridicule them as they deserve. I’ve had it with that strategy. It just makes other non- or less-stupid people think being stupid is somehow OK. No, I’m not going to catch as many flies with that vinegar, but I’m no longer interested in converting the stupid, the crazy, and the wicked. I’m only interested in preventing them from having an influence.

    As for the health insurance companies: fuck them and the horse in on which they rode. I think they should be nationalized. Or maybe just threatened with nationalization unless they clean up their act. Watch them ensure universal coverage then, filthy bastards that they are.

  17. Your take on things gives me hope. Because yeah, that IS how Obama does things — hang back, be mellow, let the other guys make the first mistakes. (Usually also the second, third, and fourth given the Loyal Opposition we’ve got these days.) And it did work before.

    A Canadian friend of mine who visited recently said that she feels her (largely uninsured) American friends are being held hostage for our lives in all this. Let’s hope we can at least get them talking and maybe demanding pizza from the cops instead of escape vehicles and piles of unmarked bills.

  18. Brian @14: “The persistent habit on the left of assuming that all protesters are insane birthers obsessed with the president’s penis, and calling them “teabaggers” or “un-American” and claiming that they’re carrying swastikas, is not endearing the left to moderates.”

    Well, if the moderates were seen protesting intelligently and doing their best to take attention away from the people who have been photographed carrying all kinds of crazy crap and spouting ignorant nonsense, maybe we on the left wouldn’t think what we do. Silence is tacit agreement, you know.

  19. Do you really think life expectancy is unrelated to health care policy?

    Um, did you read John’s answers…because it’s not clear that you did.

  20. Walt:

    “Do you really think life expectancy is unrelated to health care policy?”

    I think as part of the overall picture of health care policy it’s not very useful, no, because as a stat all it tell you is how long people are expected to live — it doesn’t really tell you their quality of life while they live, which is a major portion of the discussion to me, nor does it tell you the cost of keeping them alive to that point, which is another major issue of the discussion.

    It’s also mute on how the dynamics of the stat was created. One of the greatest boosts to life expectancy early on, for example, was not that older people were living longer, but that infant and childhood mortality declined significantly.

    So, yeah, in terms of the discussion re: health care, it’s not what I would call the most salient of stats.

    Brian:

    “The persistent habit on the left of assuming that all protesters are insane birthers obsessed with the president’s penis, and calling them ‘teabaggers’ or ‘un-American’ and claiming that they’re carrying swastikas, is not endearing the left to moderates.”

    Likewise, the persistent habit on the right of assuming that anyone on the left is a socialist who wants to kill old people and are committing treason by holding different political opinions, is not endearing the right to moderates.

    We can play the “your side is crazier than my side” game as much as you like, Brian. At the moment, however, the rightish crazies are getting more airplay on every channel that is not Fox News, so as a matter of PR, it’s more problematic on their end.

  21. Eh, from my perspective my distate for what Obama has been doing has more to do with the whole being worse than Bush on state secrets and so on. And the inaction on Guantanamo. Also, his secretary of the interior sucks on wildlife issues, but it’s not like either candidate gave any indication they gave a crap about that, so it’s not suprising.

    Healthcare I didn’t want a single payer anyway, but that doesn’t mean Max Baucus hasn’t been looking like an incompitent fool giving concessions to people who clearly aren’t going to be mollified by anything, while fashioning a bill with a group of 6 people, everyone of whom is to the right of the majority of the Senate.

    Just because something is a “reform” doesn’t mean it’s a good reform – see the Prescription Drug bill, which due to excessive bipartianship costs too much and does too little.

  22. Julia@19: Then I take it you weren’t bothered by the claims that all anti-war protesters were Muslim sympathizing anti-Americans, then? After all, the moderates were silent. Same thing for the “Muslims are anti-American” thread–after all, the moderate Muslims were silent.

    It also doesn’t help when people do come up with moderate alternatives to Obamacare, and it results in outrage and boycott (as in the case of Mackey and the Whole Foods boycott).

  23. Julia – There is a trend among Republicans to fixate on Democratic Presidents sexual organs. Who can forget the Clenis? I don’t know why the Republicans have an ingrained penis envy; most likely they feel inadequate for a reason. What reason? I could guess, but won’t. Whatever the reason it probably explains their near pathological love of guns and their susceptibility to fear mongering. I often wonder if the GOP might get behind health care reform 100% if it included a pump or pills that would enlarge Republican sex organs. Then again, do we really want the Republicans to be even bigger dicks than they already are?

  24. Sure hope you’re right, John.

    If we just got a provision saying insurance companies can’t refuse coverage based on pre-existing conditions, that would be huge.

    Also, anyone interested should check out Paul Kruggman’s blog. He’s got fairly strong opinions, but he’s a smart guy, and has studied enough of the history of the social safety net and the partisan back and forth to have interesting points.

  25. Brian:

    “Same thing for the ‘Muslims are anti-American’ thread–after all, the moderate Muslims were silent.”

    No they weren’t and aren’t — quite a substantial number of American Muslims expressed outrage and sorrow after the initial 9/11 attacks and have been active since, and it’s deeply disingenuous to suggest they weren’t.

    Please focus on the current discussion and don’t bring up misleading or irrelevant data points from unrelated discussions, Brian. Thank you.

  26. On the subject of foamy protesters of either flavor. Let’s accept the fact that the press thinks they make good TV so we see more of them than we do of reasoned debate.

  27. Brian @24: “Then I take it you weren’t bothered by the claims that all anti-war protesters were Muslim sympathizing anti-Americans, then?”

    No, I barely noticed. I had better things to do at the time. I was too busy protesting the war. Insert further implications about silence meaning assent, of your choice, here. I prefer to be an activist over a pundit.

    nisleib @25: I am SO GLAD I wasn’t eating or drinking anything when I read your reply. I already hobbled my spacebar this morning, further keyboard damage would have been BAD.

  28. #10: if the word ‘right’ upsets you, try ‘necessity.’

    Everybody needs food, clothing, and a place to live. Most of us can fulfill these needs pretty well with a reasonable income.
    Everybody with kids needs education available to those kids. We as a country have decided that this is enough of a common good to pay for with taxes.
    Everybody needs medical care at some point. And there, it collapses. Anybody at any time can fall out of the middle class into abject poverty _from medical expenses alone_. One pink slip, or one piece of bad luck, or one drunk driver going the other way. It _is not possible_ for the non-rich to accumulate enough private savings or buy enough private insurance to be sure of getting medical care for themselves and their families without the twin bastions of work-provided insurance and dumb luck. The first of which is getting rarer and more expensive. “Everybody gets sick eventually” should not equal “nobody’s finances are ever really secure” but here, it does.

    Other countries treat health care as the kind of necessity, like fire departments and public schools, which is worth making available to everyone even if some people get more than they pay for. (I live in a fireproof house, and yet I pay taxes so my wooden-farmhouse neighbors down the road don’t burn to death. I am weirdly okay with this tax burden.)

    This seems to save them both lives and money, without killing Stephen Hawking or losing all their doctors or becoming Stalinist Russia. Why do you assume we’d screw it up when they haven’t?

  29. Rembrant: I actually haven’t dared watch the new Price Is Right. I’m scared of a Bob-less PIR. :(

  30. rembrant @10:
    Healthcare is a right if we decide it is. Same reason free speech is a right, etc… Despite limits to keep one another from infringing on someone else’s right.

    I.E. I don’t get a heart transplant if it’s your heart I want and you’re still using it.

    “One example that jumps to mind is HIV AIDS. Should we have to pay for treatment of a disease that is 100% preventable? Treaments that are not a cure? Treatments that are very expensive?”

    Yes, yes, and yes.

    If you invert the question, it would be
    “Should we allow people to die if they’re poor and have a disease that’s preventable, not curable, etc…”

    Hope you’re playing devil’s advocate here.

  31. John@28:

    And quite a substantial number of American conservatives have expressed outrage and dismay over the birther idiots polluting their side–see, e.g., National Review online.

    My point is simply that condemning the entire anti-Obamacare movement based on the actions of a few wackos is about as fair and effective as condemning the anti-war movement based on the actions of a few ANSWER wackos was.

    I am interested in what you think about the pair of “boycotts” going on right now–the Whole Foods silliness and the complaints about Shadow Complex because it’s somewhat related to an Orson Scott Card book, though feel free to ignore this last paragraph as off-topic.

  32. Well put. I very much agree that a good part of the reason our nation got into the mess we’re in isn’t just because the GOP steamrolled us the past decade but that the Dems are categorically unable to ever organize cohesively and mount any semblance of a resistance. GOP has got their focus back now and the Dem’s wasted precious time thinking the GOP was out of the picture.

    Half the reason this healthcare debacle has spiraled to where you’ve got degenerates spouting comparisons to Nazi Germany and roving bands of Gestapo Death Squads suffocating sick grandmas is because the Dems just threw their hopes on Obama’s charismatic lap and went on vacation as they always do, not realizing they’ve got a crucial role in passing legislature.

    I agree though that Obama is clearly letting the hyperbole wash downstream so that when the real time comes, he’ll be able to focus on the real issue at hand and not waste his time trying to convince a bunch of paranoid idiots that the sky isn’t falling.

  33. Rembrant@10 “The funny thing is that we have already cast our ballots. Now we get to live with the results of those decisions. Screaming and moaning at this point shouldn’t matter. STFU until the next election.”

    Umm. When did the freedom of speech change so it only applies one day every two years? We don’t just turn over the nation to our elected officials to do with as they want unchecked for 2 (or 4) years; the role of being a citizen is much broader and more continuous than the biennial punching of chads. There’s nothing wrong with people voicing their opinions, even loudly so. You’d think liberals of all people would know this, unless they have selective memory or a profound misunderstanding of the US constitution.

  34. Deron @38
    “There’s nothing wrong with people voicing their opinions, even loudly so.”

    Um… yeah.

    I think there’s a difference between voicing your opinion loudly and screaming down an opportunity for rationale discussion. Imagine if I came to your table at a cafe, and interrupted your conversation by shouting in your face for 1/2 hour.

    Constitutional? Maybe. It would still make make me a jerk.

  35. Brian:

    “My point is simply that condemning the entire anti-Obamacare movement based on the actions of a few wackos is about as fair and effective as condemning the anti-war movement based on the actions of a few ANSWER wackos was.”

    I would agree, but the problem is that a few of these “wackos” are actually in Congress — it’s not just people standing up in Town Halls blathering on about death panels, is it, nor misrepresenting the current discussion. I’m not sure you can argue that pointing out the dishonesty of the debate is limited to outliers when it’s pretty clear the rhetoric is being used by the party members themselves, up to and including elected officials.

    Re: The Whole Foods boycott: I found it interesting that people were surprised a CEO might be interested in a market-based solution. As for the boycott, I typically have no problems with anyone boycotting anything for whatever reason they choose; it’s a personal action.

  36. Orson Scott Card should be boycotted for ruining a perfectly good thing (the Ender world) TWICE due to sheer bad writing, Brian. It’s what I’m doing. I’ve heard he’s going back for a third try with another character…I can’t bear to watch. I will simply cling to the books I KNOW are good writing.

    *will stop being offtopic now*

  37. Personally, if I were in charge of health care, I would mandate universal care for every American under 18 and over 70, and make everyone in between purchase their health care from insurance companies who then turned over a certain percentage of their revenue to subsidize basic, comprehensive health care for Americans who could not otherwise afford it.

    To some degree, that describes what was done with the telcos. That did not work out so well, did it?

    I’m not saying it’s inherently a bad idea; the problem is that the companies involved are greedy, lie constantly, and are able to bribe or otherwise influence lazy, short-sighted, or just venal politicians. (And have a court system that, right now, generally sides with them.)

  38. What worries me is the evidence that The Powers That Be (including Obama and his team) are more focused on producing legislation that makes the insurance/drug companies happy than actually coming up with the best solution that can pass. The secret meetings with insurance companies (that Obama previously promised would go on C-SPAN, however misguided that promise was), the fact that mandated insurance without substantial reform to drive down the cost of insurance (i.e., a public option or similar) is an incredible boon to the insurance industry, these all point to the Democratic party being focused with funding their next election (and not funding the Republicans), not on the actual issue at hand.

    Also, I think you’re misstating the problem that many on the left have with Obama right now. Many of Obama’s policies have worked to actively reinforce what many viewed as the worst abuses of the Bush era: treating lawbreaking as a political decision, arguing and lobbying for the right to detain someone indefinitely without evidence, claiming that “national security” issues cannot be prosecuted in court, defending DOMA… The list is long and varied. It was clear (after the primaries were over) that Obama wasn’t actually a progressive, but even in the debates with McCain, Obama was arguing against some of the policies that he is now actively continuing. Fair or not, the healthcare debate is just seen as a continuation of that, and much of the anger about it is a proxy for the general anger at Obama’s policies.

  39. Sean Eric Fagan:

    “To some degree, that describes what was done with the telcos. That did not work out so well, did it?”

    I don’t know. I get my DSL service from one provider, my home phone service from a second and my cell phone service from a third, and then also have VoIP service from two unrelated companies. And my overall service is rather better than when it was all just AT&T.

    So I’m note entirely sure this is a good comparison, at least from my personal perspective.

  40. The lies aren’t limited to the right.

    My only question is still not answered: how are we going to pay for this?

  41. I wish I could think that – unfortunately I suspect it’ll turn out much like the bailout, where there was a lot of uninformed noise, a ton of money went to the industry involved, very little reform or oversight was put into place to prevent the problem from coming back, and Congress now wags its finger quarterly at some executive.

    Here’s hoping you’re right and I’m wrong. I’d really like to see beneficial reform for this country.

  42. Ben:

    Which is better than “spend but don’t tax,” which was a nice bit of magical thinking but didn’t do wonders for our deficit when we were fighting a war with two fronts.

    I should note that I am not allergic to the idea of increasing tax rates, especially on the higher income folks, and I should also note that if such a thing happens, I’m more likely than most to see my tax rates go up.

  43. John@40

    Again, wackos, even in Congress, are not something unique to the right. Cynthia McKinney was yelling about mass graves and government ordered slaughter of blacks in Lousiana after Katrina, which is far, far nuttier than anything Congressional Republicans have come up with here. Michael Moore was given a prominent seat at the 2004 DNC!

    Thinking that the right wing is uniquely bad in this case requires forgetting a lot of recent history, or a pretty bad double standard.

  44. John,
    Thanks for an insightful post. Here’s to a healthy debate (pun definitely intended). I must admit to being a moderate “right” person, myself. I’m cool with Obama, I don’t believe the internet rumors people say “the right” is spreading and I think he has a good head on his shoulders. I’m fine with changes to health care – we need a simpler, more efficient system, and if by some miracle the government can help that to happen, then that’s great. But what I am afraid of is the rhetoric I’m starting to hear concerning this idea of a “right to health care.” Perhaps we can take on a responsibility for the health care of others, but if people start thinking that they have a right to health care, they stop assuming they have the responsibility to take care of themselves. The fact remains that a lot of the “preventative” health care that we are all fans of is the responsibility of the individual. Eat right, exercise, don’t smoke, etc.

    Why should I pay for a portion of the lung cancer treatment for the homeless man that spends every other dollar he gets on cigarettes? He has made a choice, why do I not get one?

    Health care is a very personal matter. Quite literally, it has to do with your person. My parents paid for my insurance when I was young, and I pay for it now that I am a grown woman. Someone has assumed responsibility for me.

    I think that’s the key. If the government & the populace can realize that health care is not a right, but in fact a responsibility, then we can take giant leaps forward, we CAN reform health care and insurance.

  45. “I believe the United States is better when its people are healthy; I also believe as a citizen it does me no harm and in fact does me good…”

    Especially in light of the coming Zombie Apocalypse

    (ducks barrage of glares)

  46. I don’t necessarily disagree with everything you’ve said. While I do agree America is “center-ish” I don’t believe they tack to the right on many of the issues important to us. Until Obama and Democrats starting losing the war of words on health care reform there was a large majority of Americans across the political spectrum who supported not only health care reform but a strong public option.

    Yes, the president has had some successes since taking office, but those successes have been lessened by his lack of leadership. Nearly 40% of the stimulus was a giveaway for Republican in tax cuts that’ve proven not to work; and no Republicans voted for it anyway. The administration has made huge mistakes in handling DOMA and DADT. And thanks to the Blue Dogs, it now looks like whatever health care bill comes before the president may be a giveaway to the health insurance industry. I mean, one version has every US citizen being required to have insurance, but without a public option; and tax credits are not going to alleviate that cost.

    I’m certainly not going to abandon the Democratic Party or President Obama (what option do I have!), but I think there a legitimate concerns about the president’s lack of leadership on key issues that could jeopardize Democrats in 2010. Americans can turn on a dome and just because the Republicans are looking crazier than ever doesn’t mean people won’t vote for them.

  47. Relative to the need for reform, Britain, Switzerland, Japan, Taiwan and Germany (commies the lot of them) all spend around 6-7% of GDP on health care and get 100% coverage. We spend about 15% of GDP a year, have incomplete coverage, and medical expenses are the predominate reason for bankruptcy. That 8% of GDP is a hell of a lot of money for quality service, poorly and inconsistently delivered. While a 50% profit margin seems a bit of an overstatement, a substantial amount is, industry claims of 2.4% notwithstanding. All of the afore mentioned countries have issues with their programs, but seems like nothing an extra point or two of GDP wouldn’t fix; still a bargain!
    Litigation is a factor, the problem with the rule of law is those icky lawyers – but it’s the cost of doing the rule of law. If everyone is guaranteed medical coverage, well there goes everything except pain & suffering, and punitive damages; it takes only a little tort reform to go a long way.
    Concerning death panels, unless you are paying for service out of your own pocket, someone is in control of the cash disbursement, and they will have rules to follow. Who to pick hmmm…insurance company employee incentivized to reduce cost and provide share holder return or government employee managing public policy – is there really a question here, cui bono folks.
    As to the public option, I always thought one of the best ways to regulate is through competition. Any true capitalist worth his/her salt should be able to pit their market efficiency and profit margin against government waste and inefficiency. But maybe there is a little too much gravy on the table for that kind of thing. But with up to 8% of US GDP up for grabs it is no wonder that someone is frothing up the wing nuts, you’d fight dirty too for that kind of paycheck.

  48. “I would mandate universal care for every American under 18 and over 70, and make everyone in between purchase their health care from insurance companies who then turned over a certain percentage of their revenue to subsidize basic, comprehensive health care for Americans who could not otherwise afford it.”

    This almost describes what we have currently, between Medicaid, Medicare, and various state and federal children’s health insurance programs. Subsidies for the uninsured come from hospitals which then overcharge for services and procedures to compensate for uninsured patients who legally can’t be turned away from the emergency room. I think we would all be happier if the system of subsidies made a little more sense and didn’t give everyone ulcers.

    The problem is that the system we have isn’t even free market. As consumers we can’t even shop around for the best deal, best customer service, whatever because laws and regulations make the entire system opaque and our employers control the shopping, not consumers. Case in point, my husband’s employer found us a “better deal” on health insurance. Between various minor illnesses and injuries, that’s going to cost us about $500 more this year than we expected. Gee, thanks, husband’s employer, for saving yourself a few extra bucks at our expense. Sure would be nice if we could take that money and buy our own damn insurance, but we can’t.

  49. Wow. Brian really has drunk deeply of the “the other team is worse/my team is blameless” kool-aid, hasn’t he…..

    Apparently, nobody has told him that “I know you are, but what am I” stops being a valid debate tactic, circa age 9 or so.

  50. Brian:

    “Thinking that the right wing is uniquely bad in this case requires forgetting a lot of recent history, or a pretty bad double standard.”

    I agree Cynthia McKinney was nuts; I also know that her being nuts neither excuses or exculpates Republicans from being dishonest about the health care discussion today. Nor given the prevalence of the talking points re “death panels” (Sarah Palin, Charles Grassley, Glenn Back, Cal Thomas, etc), is there any reasonable equivalence to McKinney going off the rails, and what the Republicans are doing re: their presentation of the health discussion.

    Brian, what you’re trying to here is excuse or mitigate bad action with an “everybody does it” argument. This is where I channel a sitcom mom and ask if Cynthia McKinney throws herself off a cliff, whether the entire GOP should follow her.

  51. Brian @ 36: Can you provide a link? Because I go to NRO and all I find are articles that say ‘are birthers really crazy, compared to truthers?’ and ‘look, liberals can be birthers, too!’ and ‘a few silly folks on the ‘responsible right’ are acting like ‘looper liberals’.

    Any NRO article that mentions it features attacks on the left and the president and attempts to deflect the crazy as either being kinda reasonable, a minor silliness or the articles try to shift the discussion to other straw men and away from the topic at all. And then tries to start equating birthers as actually been lefties and and crazies and irresponsible journalists who tell lying lies to sell airtime.

    http://corner.nationalreview.com/post/?q=ZGZiYmQyODZiMzFkNTdhMzBiYTVmOTFjODg2YjZlMzQ=

    http://article.nationalreview.com/?q=ZTRjMTFhMzQxYmEzNjA2YWIwOTU4YWVjNzRmODE2NTI=

    This is the first time I’ve ever visited NRO…and between that and the madness of my one visit to Daily Kos, I’m convinced that rational discourse between extremist pundits is probably unlikely.

  52. John @50: Sorry, lack of sarcasm transmits over the web just as well as sarcasm does.

    I think taxes could be raised (And I make enough that I would definitely pay more, you’re welcome). I don’t think we have to go back to Eisenhower levels of 90% off of the upper class, though some of them make so much, they wouldn’t even feel that.

    So when I say Tax and Spend, I mean it. I just hope we spend it on something worthwhile (not war, not oil company subsidies, [continuing list of conservative minded policy pariahs].

  53. Hilary @56

    Has there ever been a comparison of governmental health care for a nation that’s comparable in size and population to the US?

    US population: 304 million
    Canada population: 33 million
    UK population: 60 million
    Germany population: 82 million

    (all compliments of Google.)

  54. re: #56 Hilary–I used to favor tort reform. However, we have tort reform here in Michigan and when my mother suffered an egregious case of malpractice in 2005, we were turned away by a malpractice lawyer, because with a $250,000 cap on punitive damages, the lawyer would not have been able to make money litigating the case. Expert witnesses have to be paid and are very expensive, and then quite a lot of hours go into it before it’s done. If we had been able to ask for more in punitive damages, our case would have been strong. So tort reform basically means that regular people cannot get any justice for malpractice. Most medical malpractice suits now involve birth injuries, where damages for a lifetime of lost work and productivity can add up to many millions of dollars. It turns out that malpractice suits are not really the reason that health costs are so high. I know here in Michigan nobody went around and lowered the price of, say, an MRI because “Yay, tort reform!” Somehow the cost of services just kept going up along with the rest of the un-”reformed” country.

  55. This is where I channel a sitcom mom and ask if Cynthia McKinney throws herself off a cliff, whether the entire GOP should follow her.

    From your lips to God’s ears…

  56. Also, John. Don’t know if you’ve been following, but Charlie Stross opened this particular can of worms on his blog last week, and the comment war is still raging over there past 400 posts.

    Just a heads up.

  57. # Brianon:

    “Again, wackos, even in Congress, are not something unique to the right. Cynthia McKinney …”

    Was one rep, who didn’t even get re-elected.

    Meanwhile, the last count I saw on the Birther Bill was 11 GOP Congressmen.

    (re – Michael Moore getting a prominent seat at the Dem Convention):

    For every Michael Moore, I give you whole host of GOP whackjobs, from Rush to Beck to Coulter to Althouse to Palin to Gingrich to Armey have all been caught lying through their teeth.

    Plus the frickin’ chair of the GOP national committee.

  58. And that’s not even going into the GOPly ranks of the GOP’s direct connection to heaven, such as Huckabee.

  59. ben@39 “I think there’s a difference between voicing your opinion loudly and screaming down an opportunity for rationale discussion. Imagine if I came to your table at a cafe, and interrupted your conversation by shouting in your face for 1/2 hour.”

    Well, it might not be pleasant, but that 1/2 hour would be a very effective means for you to communicate to me what your position was.

    And it’s not as if everybody on the left was always completely civil and only ever debated issues during the 8 years from 2001 to 2009 and didn’t just do disruptive screaming. Why are there somehow different “rules of conduct” now that the outrage is coming from a different set of people? Robert’s Rules, Mason’s Manual, or other parliamentary procedure doesn’t apply to the citizenry in public. Give me a break.

    Some things to consider before labelling 150 million people “idjits” [sic]…

    * There is a place for “debate”, but there is also a place for outrage or instruction or demands or any other manner of expression. The First Amendment doesn’t restrict itself only to debate. It is perfectly reasonable for the citizenry to attempt to make their opinions heard…they don’t have to follow a framework of debate. The whole “its not debate” whining is just an attempt to suppress free speech.

    * Despite the selective culling of news reporting, there is also an expansive expression of constructive ideas and rational argumentation occurring. If you don’t see it, perhaps you need to poke your head outside the protective ideological bubble that the “mainstream” media provides.

    * Just because you don’t agree with it doesn’t mean that an expression of ideas is “not rational” or must be spoken by an “idjit”. True, some cases may be so. But to just blindly label half the population as so just proves who the real idjit is.

    * And no, I don’t agree with everything that is being spouted by the so-called “idjits”; but I do defend their right to express their views. And if they feel they have a right to be angry, I’m not going to call them an idjit for not raising their hand. I even defend the right of the “leftist idjits” to express their views too.

  60. I just had a chance to read your thoughts regarding the ongoing healthcare debate, and there is much that I have to say we agree on. I will agree the Republicans have handled the issue badly, and the folks in the town hall bring far to much emotion to the table. Despite this I believe the Democrats have really screwed the pooch in presenting this program, and have muddled it with ideas that simply don’t fit within our countries social framework. The Democrats lost the initiative and it is going to cost them dearly, it might even cost them the game.

    Where I differ from most, and apparently you as well, is that for me ultimately the “healthcare debate” has nothing to do with healthcare. The issue itself is nothing more than a bright red herring. This makes any associated points, such as discussions on life expectancy or infant mortality, to be little more than further digressions from the real issue. The real issue here is a simple one: Individual Liberty.

    Even if I was to be the recipient of this new healthcare, I cannot in good conscience justify making you pay for it. It simply is not, and cannot be, your responsibility. I am not willing to enslave you to my needs in this fashion, because that is what I would be doing. Taxing you to pay for my healthcare is nothing more than the coercive use of your labor to support my needs. Charity is one thing, it is noble and it is grand. I support charity, and I support you choosing to help your neighbor (especially if that neighbor is me *smirk*), but taxes are not charity – they are coercion.

    Now, since both of us know that many people will value your freedom less than my healthcare, or perhaps their own, we have a problem. This is where democracy fails us. It is always easy to support tyranny when it is in line with your opinions, but what happens the next time when you are the minority? We have the neo-cons and the neo-libs each chipping away at their target liberties. My question is what will remain when they are finished?

    Whenever I review a policy or program being presented by government, I think of three things:

    “In every generation there are those who want to rule well – but they mean to rule. They promise to be good masters – but they mean to be masters.” ~ Daniel Webster

    “You cannot build character and courage by taking away a man’s initiative and independence.” ~ Abraham Lincoln

    ”Rightful liberty is unobstructed action according to our will within limits drawn around us by the equal rights of others. I do not add ‘within the limits of the law’ because law is often but the tyrant’s will, and always so when it violates the rights of the individual.” ~ Thomas Jefferson

    I apologize for being so long winded, and I hope I made some sense.

  61. A few thoughts:

    1) You might be right about Obama, but he’s done a poor job of leading on this and the fairly swift “we could compromise on the public option” is seen as caving. I get a little tired of the “suck them in, let them exhaust themselves, present a solution” tactic. Lead, dammit.

    2) we’ve had this debate for 25 years. If Obama was going to raise it, raise it and DO something. The fixation on being bipartisan with an insanely partisan Republican party is stupid. Listen, sure. Take good ideas, yes. But many of the most far-reaching, key reforms in the last century were done with partisan majorities by Presidents who knew what they wanted and went and got it. You don’t reward your political enemies, you drive over them.

    3) To this topic, we fixate on payment methods far too much but we fail to ask what we want the system to provide. The discussion of life expectancy above misses the key point which is that even if you use it as a proxy for quality of care we fall in the lower middle of the developed nations but we pay twice as much as other developed nations. In other words, the market is delivering a less efficient solution here by providing about the same level of care for twice the cost. Why should we live with that system?

    For a look at this, check out http://blogs.harvardbusiness.org/haque/2009/08/how_effective_is_american_heal.html and the previous article, http://blogs.harvardbusiness.org/haque/2009/08/how_to_think_constructively_ab.html

    4) As to health care as a right… are we seriously debating this? Isn’t one of the basic reasons for a society to safeguard it’s members? For all of the asinine talk about death panels, we’re letting people die *right now* in the current system. People who are turned away from lifesaving treatments that some insurance company doesn’t want to pay for to maximize its profits. People among the uninsured who sicken and die because they can’t go to a doctor until it’s too late.

  62. John@59 and others

    Not quite the point I’m trying to make. You’re trying to justify condemning the entire anti-Obamacare movement as nutjobs based on the opinions of a few marginal nutjobs. You would rightly insist that the left should not be condemned by its nutjobs.

    Both sets of nutjobs should go away, and the left’s craziness doesn’t excuse the right’s craziness (or vice versa). But when you dismiss the legitimate concerns of about half the population because a few wackos are involved, it’s not a very effective strategy.

  63. Deron Meranda:

    “And no, I don’t agree with everything that is being spouted by the so-called ‘idjits’; but I do defend their right to express their views.”

    Deron Meranda wins the thread prize for “The Person Trying to Make an Issue of Something No One’s Arguing About.”

    I too defend their right to make their views known: I like my idjits plainly marked.

    That said, there’s a difference between protest and going to a down hall with the intent to shout down actual discussion of an issue, which a fair number of folks intended to do — we have the memos. Intended suppression of other people’s right to speak and discuss may or may not be a legitimate application of one’s First Amendment rights (I tend to lean toward expansiveness when it comes to that one myself), but there’s no doubt it makes you an asshole.

    Brian:

    “You’re trying to justify condemning the entire anti-Obamacare movement as nutjobs based on the opinions of a few marginal nutjobs.”

    The problem with your argument, Brian, is that Charles Grassley isn’t a nutjob. Nor is Cal Thomas. I’d give you Glenn Beck and Sarah Palin, but I know people who seem to be under the impression they’re not nutjobs either. Which is to say that a) you’re trying to minimize the extent to which these rhetorical bits pervade even the highest levels of the health care discussion on the GOP side, b) you’re trying to minimize the arguments of those pointing out a) by repeating that it’s just a few “nutjobs” even when that argument’s fallacies have been pointed out to you.

    It’s a nice try, but it’s not going to work and you’re going to have to make a different argument now, because the one you’ve been using is bad.

  64. Chris @69

    “I am not willing to enslave you to my needs in this fashion”.

    I’d be a little more circumspect about throwing around the word “enslave”. elevating the 20% that comes out of your paycheck to “slavery” is a little grand, and probably isn’t appreciated by people who are still dealing with it, or living in it’s shadow.

    I assume you’re coming from a libertarian point of view, because I’ve never heard any other theory of justice refer to governance as “enslavement”. Perfect, total liberty isn’t as great as it sounds, (Nozick believed we should be free to sell ourselves into slavery if we chose, I don’t see how that could be desirable to anyone.)

  65. Hi John,

    Until Friday, I agreed with you, then I read this article (http://www.theatlantic.com/doc/200909/health-care), which pointed out the insanities of an insurance-based healthcare system in general.

    According to this analysis, which is worth seriously considering, the health care system’s customers are the insurance companies and medicare. We customers are effectively the product, and we’re used to milk money out of corporations to pay insurance companies to pay the hospitals and doctors.

    That’s why hospitals resist simple hygiene (see article) even though it saves lives: because the longer you stay in the hospital, even if it’s from a hospital-borne infection (i.e. the hospital screwed up in caring for you), the more money the hospitals make.

    That’s why it’s impossible to get an honest answer on how much it’s going to cost in advance: because you’re not the customer, you’re giving money to the customer.

    That’s why my partner, who works in a hospital and prescribes pain meds, asks patients to rate their pain on a 1 to 10 scale, not to rate their pain on a financial scale: $1 painkiller (i.e. aspirin) vs. $1000 (the newest opiate wonder drug). If you knew you had to pay $500 more to go from a 9 to a 10 on the pain scale, you might decide you only hurt an 8. This is made-up because she doesn’t know how much the hospital’s going to charge for her care, so she can’t tell her patients. I won’t even mention the company that’s in the process of pulling a <$1 quinine pill (for good ol' restless leg syndrom) for a slightly more effective new medicine that costs $100/pill. That's where we are right now in terms of improved treatment.

    That's why health care is probably the only industry where we use insurance to pay for ordinary care. Can you imagine using your car insurance to pay for gas? What would the price of gas be then, and how about your insurance costs?

    Anyway, I like Goldhill's proposals:
    1. Restrict health insurance to catastrophic insurance, and make it universal.
    2. Get people to pay for ordinary care. In addition to this, get hospitals and doctors to be competing for their patients, not playing games with the insurance companies. Experience has shown with LASIK (not to mention most other tech areas) that when customers pay, the providers are much more open about what they're providing and how much it costs. There's no reason we can't extend that to the entire health care field.
    3. Take that big chunk of money we pay for insurance, strip out the cost of catastrophic insurance, and the rest of it back to us, in the following form:
    3. Health savings accounts: Bush may have been on the right track, much as it pains me to say it. You know you're going to have certain expenses in life: births, end-of-life care, yearly physicals, probably high blood pressure meds, and the like. Why not save for those costs? Goldhill calculates that an ordinary worker will have about $1.7 million of his lifetime salary given to insurance deductables. If most of that is given back to you, you could afford to save up for pregnancies and the like, especially if you had a good idea how much it would cost up front. The only caveats would be that you should be able to pass on unused health care money to your kids, and to use it for other emergencies as needed. If your medical costs go above what you budgeted for due to emergencies, well, that's what the insurance would be for.

    Neat ideas. I think in the short run they have about a 0% chance of influencing the debate, but it's nice to see that someone's actually doing a sane business analysis of how to fix the system, rather than a political analysis.

  66. The other thing I think Obama knows that lots of people on the left seem to be clueless about is that the goal here for Obama is not creating the US equivalent of the UK’s National Health Service, or even any other specific program — it is codifying into the laws of this country the proposition that every American must have access to basic and comprehensive health care. If he gets that — however he gets that — then essentially it’s game over, and everything from that point forward is just haggling over details.

    I’m surprised that nobody’s pointed out the obvious flaw here. Many of the current proposals codify that by simply mandating coverage, and the “just haggling over details” involves — among many other issues — who pays for it, and how, and what it is that people get for the money.

    The insurance industry loves the idea of a mandate. “Millions of people forced to buy our products, woo-hoo!”

    What they dislike is the possibility of losing any of their current ability to pick and choose who they’re willing to cover, even after the fact. They hate with an oily blackness the idea that might have to compete with an entity that doesn’t by definition maximize profits by not paying for healthcare.

    And “haggling over details” is, unfortunately, all-too-often thet part of the process when a sensible lovely-sounding piece of legislation has its core liquified and sucked out on behalf of corporate lobbyists.

  67. Ben @ 73

    I agree. As a thinking individual you should be allowed to sell yourself into slavery. I do not support laws that are intended to protect me from myself.

  68. Just a few things:

    1. The proposal on the table is not a “takeover” of health care. It is merely introducing another option for insurance, one that is run by public funds, and NOT run for profit. It is, in short, introducing competition into the market, which is always healthy, yes?

    2. I see a lot from folks on the right who say they shouldn’t “have to” pay for others’ health care, and that being healthy is a “responsibility.”

    First off, a healthy populace, like an educated populace, is a productive one. If we were to gut public education the way we currently gut health care, we’d be in deep shit, economically. Just as not everyone can afford private schools, not everyone can afford private insurance. And, just as what happened before public schools, those who could not afford it simply do without–with all the consequences that follow.

    Second, it’s a myth–and a dangerous one–that merely by not smoking and eating well, we’ll all be perfectly healthy. Billions of people every year contract illnesses and get injuries that have nothing whatsoever to do with behavior. Not every case of lung cancer is smoking-related, for instance. And tell some poor kid with cystic fibrosis or leukemia that it’s all their fault. No, really. Go do it.

    3. The far right is both smaller in number than many assume, and more dangerous. To most of us, yes, they seem like whackos who get their current events news from Art Bell and Miss Cleo. But they speak a language that many on the not-so-far right understand, and they are pulling more into their flock every day. Glenn Beck’s ratings keep going up despite his overdose of crazy, because he’s using a lot of rhetoric that seems almost sane if you’re already predisposed to “anti-government” thinking.

    Because of this, the ONLY way to manage these people is to ignore them. Giving them soapbox space, in an attempt to get them to make themselves look foolish, isn’t working and is in fact counter-productive. A “patriot” movement that started ~30 years ago and was largely underground is now getting airtime–and followers–in unprecedented amounts. And the more attention they get, the more legitimate they become.

  69. Cassie @62
    You also need to take into account relative GDP…
    US: $14,264,600 Million for 304 million people
    Canada: $ 1,303,234 Million for 33 million
    UK: $2,230,549 Million for 60 million
    Germany: $2,910,490 Million for 82 million
    Source (http://bit.ly/wwyvA)

    This reduces everything to per capita, which we can then effectively compare.
    Per capita GDP
    US: $46,923 (15% runs $7038 on health care)
    Can: $39,491(7% runs $2764 on health care)
    UK: $37,175 (I think you can finish the math)
    Ger: $35,493

    If anything, economies of scale should come into play for the US, but, oh yeah, we don’t negotiate with drug companies (for one) in the same way they do…

  70. Chris (#76): “Healthcare is not a right, it is a luxury, one of the many rewards of being successful.”

    This is social darwinism.

    (And, just in case someone else was thinking of catching that wind, the natural world is not a template for human morality.)

  71. Chris @76-77:

    “Healthcare is not a right, it is a luxury.”

    It is if we decide it is. I don’t think that’s scribbled on the ten commandments or anything.

    “As a thinking individual you should be allowed to sell yourself into slavery.”

    Aye, there’s the rub. Who’s “thinking?” should a ten year old boy be allowed to sell himself into slavery? How about an 18 year old boy who’s never been “enslaved and forced to go to school”? Is he more of a thinking person than the 10 year old or less? How do we determine who has sufficient agency to allow themselves to be considered a “thinking person”?

    John: sorry for the tangent, if you ask, I’ll shut up.

  72. I would second the words of Nick@44. Normally I think your analysis is pretty spot-on, John, but this time I think you’ve missed some pretty major dynamics. I suspect most on the left are pretty well aware of Obama’s competence by now, and the issue is rather more that he does know exactly what he’s doing, it’s just not what he told them when he wanted their votes and their campaign contributions. Obama’s popularity did indeed drop by double digits, but it wasn’t because of the crazy rhetoric of the hysterical right. The majority of that drop was among Democrats, whom one would think would be immune to that sort of thing by now.

    Much has been made of the concessions the White House has been making, to both the Republicans who are never going to vote for this and the Blue Dogs who are ostensibly Democrats, as evidence of Obama’s incompetence. But a) no one thinks Obama is so dumb as to trade something for nothing with Republicans and b) Obama has shown he knows exactly how to deal with recalcitrant Democrats. During the Afghan war funding bill, he simply told anti-war freshman Congressmen that if they wanted any help at all from the DCCC getting re-elected, they had better vote for the bill. Yet I’m unaware of any such pressure being placed on the Blue Dogs. I don’t think any concession has been made that Obama did not want to make in the first place. Right now the Democrats are eating the Republicans’ lunch in terms of corporate donations, and so long as they appear to be working in the corporate interests, they will continue to do so. This has nothing to do with governing from the middle (polls show broad support for an optional public plan). It looks a lot more like governing from the pocketbook.

    Now, I’m not trying to argue that corporations are inherently evil. Corporations pay most of the middle class their salaries, a fact the left sometimes forgets. But when a bill comes up that a) mandates coverage (new customers) and b) provides government subsidies for it without c) guaranteeing any real competition and d) expressly forbidding the government from using its massive leverage to negotiate prices, it starts to look an awful lot like a bailout of the same proportions the financial industry received rather than anything resembling “reform”, or guaranteeing any kind of “right” to health care.

    Given all that, it’s no wonder Obama’s popularity among the left has dropped. I agree the right thinks it has to completely defeat the idea of reform to get a victory. But I think the far left is waking up to the fact that they also have the power to defeat it, and that maybe they shouldn’t be giving Obama something for nothing, either.

  73. Scott @ 81

    Yep. I believe a people can evolve. My grandfather used to say if you treat someone like a child, they will always act like one. I expect adults to be responsible, and I hold them accountable for the results of their failure to do so.

    When I see a man starving in the street, I question two people on the issue:

    1. I question the man who is starving, and I ask what he did to avoid this.

    2. I question myself, and I ask what I did to avoid this.

  74. Also, I really wish more folks who are against the idea of health care as a right would simply admit what their real position is:

    They believe that suffering and death is appropriate punishment for not being industrious, and that everyone who suffers and dies must necessarily not have been industrious.

    What’s sad to me about this is that it almost always comes from people who are convinced that fear of pain and death is the only way to motivate anyone to do anything. They threaten their kids with spankings. They threaten criminals with the death penalty. They threaten unruly foreign powers with devastating bombs. They threaten sinners with the fires of eternal damnation.

    And yet fear as a motivator simply does not work. Just as torture has never been shown to elicit useful intelligence, threatening people with violence doesn’t make them productive citizens.

    How truly miserable must someone’s life be that only the fear of pain and dying is what keeps them going to work every day and not robbing convenience stores.

    Religious people sometimes ask me how I, as an atheist, don’t go out and rob and murder because I have no fear of God to keep me from doing so.

    And I always answer: Why do YOU need God to keep you from robbing and murdering?

    My question here is the same: Why do YOU need the fear of losing health care to keep you going to work every day?

  75. heteromeles @ 74:

    That’s why hospitals resist simple hygiene (see article) even though it saves lives: because the longer you stay in the hospital, even if it’s from a hospital-borne infection (i.e. the hospital screwed up in caring for you), the more money the hospitals make.

    Um, wow. No, that’s not how it works, and as someone who actually works in a hospital I can tell you that hospitals do not “resist simple hygiene”, nor do they make more money from longer stays. In both cases the reverse is true: hygiene is a priority, and longer stays due to infection have a clear negative financial impact on the hospital. To say nothing of the impact on morale.

    (BTW, the link was broken. But either you misunderstood the article, or the author doesn’t understand the topic.)

  76. Ben @ 82

    This is true. A right is nothing more than a privilege that we as a society choose to mutually protect. Nothing more, and nothing less.

    As far as the 10-year old and the 18-year old sellin. The answer is simple: One is an adult, and one is not. This may be an arbitrary line, but it is the one we have drawn as a society. At 18 we have said this uneducated adult can make choices for themselves. They can even vote for a terrible POTUS, which might be seen as very similar to choosing slavery :)

  77. chris @84:

    “I expect adults to be responsible, and I hold them accountable for the results of their failure to do so.”

    changed out “responsible” for “privileged”.

    Look up “Prosperity Theology” on wikipedia, and explain why that’s not what you’re talking about.

  78. Chris and ben:

    You’re drifting away from the general topic and more toward a general discussion of libertarianism/objectivism/whatever. If you want to have that philosophical discussion, take it into e-mail, please.

  79. C.Rader @ 79

    Yes, those facts need to be be considered, but your information doesn’t answer my question which is specific to population.

    Is there an example of governmental health care for a population that’s 10 times the size of Canada, 5x the size of the UK’s and 4.5x (roughly) of Germany’s? Does this nation’s health care succeed? Is there significant difference in life expectancy? Is the medical research coming out of that nation at all comparative to what the US does?

  80. chris @87:

    You’re just omitting the bits you don’t like.

    “One is an adult, and one is not. This may be an arbitrary line, but it is the one we have drawn as a society.”

    We also, as a society, decide that one has been educated, and one has not. I doubt your position thinks mandatory public education is a good thing, so how would this happen otherwise?

    You can’t remove half of a system and still expect it to function.

  81. Cassie: Why does population matter? Once you get beyond a few million, the mechanics of administrating large-scale public services don’t change much.

  82. John @89:

    Sorry. I’ll stow that for now. Though, if you ever care to tackle Objectivism in your blog, that would be a good time :)

  83. Cassie: Can you prove otherwise?

    I fail to see how mere population alone makes us critically distinct from, say, Australia in how our public health insurance option would necessarily be administrated.

  84. Ben @94 Though, if you ever care to tackle Objectivism in your blog, that would be a good time :)

    Be careful with what you say, there, bub! I hear that if you say “Ayn Rand” three times, her dessicated corpse arises and creates havoc.

  85. Tal@85

    You are really missing the point with that one.

    Death and suffering are definitely a price you might pay. Failing to make good decisions, or to be industrious does come with a cost. So what you say is true.

    But that is only half the issue.

    Sure I may have once had concerns about being homeless, or lacking other bits, but that is not why I go to work. Rather I am motivated by the rewards, the freedom my industry and hard work brings. By working for those things I want the negatives of necessity resolve themselves.

    You also fail to understand another point – true charity. If I choose to help my neighbor that is one thing, forcing you to help my neighbor is something very different. I say the members of a society SHOULD help one another, but that should be a choice made by the individuals within that society. I am also willing to accept the consequences of allowing others to make that decision.

    I know I can choose to be charitable. I know many of those posting to this list can choose to be charitable. So why do so many believe we must legislate such behavior?

  86. Chris (#84): “I expect adults to be responsible, and I hold them accountable for the results of their failure to do so.”

    Which doesn’t preclude even a public option, especially if the private sector has already failed in providing coverage to individuals. If the private sector fails, then the public may as well decide to get the government to either enforce coverage (which the private sector brought about upon themselves) or directly pay for the coverage (which absolves the private sector).

    Someone else used the word necessity, above, and I think that’s the best term for it. It is not a right, it’s deeper than that; it’s a need. If the market refuses or fails to fulfill that need, the government may as well step in, or else be guilty of failing to ask that second question.

    Social darwinism permits those who are already on top to feel absolved from any responsibility to help anyone else. It is not a good argument to use against enacting healthcare reform.

  87. Chris: You may fancy yourself an island, but I assure you: You are not. There’s no such thing as a self-made man. Everything that you have now you do not owe only to your own labor, but to the privileges of your birth. Labor is not the cake of success, it is merely the icing.

    And because these privileges don’t happen in a vacuum (nor do they happen solely by the voluntary generosity of others), a civilization that is in favor of continued growth and prosperity must necessarily ensure that every citizen has at least the basics necessary in order to survive and thrive.

    We are a tribal species. We cannot exist without the assitance and support of others. And that means requiring some level of cooperation from each individual to ensure the survival of the tribe as a whole.

  88. “There are two novels that can change a bookish fourteen-year old’s life: The Lord of the Rings and Atlas Shrugged.

    One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.”

  89. Cassie @ 93: Only by trying it. Given the massive fail in the current system, I’m not seeing that as a bad thing.

    Besides which, damn few people have seriously suggested “governmental health care” for the US. The most “radical” suggestion under active consideration involves a publicly-run health insurance option.

    Even after a month of lies and screaming, the public option still polls well. (At least when it’s not presented as a how-much-of-your-precious-bodily-fluids question.) That’s true even among Republican voters, actually.

  90. Chris (#97):”I know I can choose to be charitable. I know many of those posting to this list can choose to be charitable. So why do so many believe we must legislate such behavior?”

    Because it fails to be enough, often enough.

    Because charity isn’t retroactive, and is therefore poorly timed with respect to prevention.

    And because charity is more effective for dealing with emergencies, than for day-to-day essentials.

  91. Guys:

    Reminder: General objectivism/libertarian discussion here is off-topic. I’ll be snipping out the next reply to it that’s not directly on target to the current health care discussion.

  92. John,

    The idea that we can mandate coverage of pre-existing conditions without blowing up the whole system is wishful thinking.

    If an insurance company has to take you with a pre-existing condition, then why wouldn’t you wait until you get sick to actually pay for coverage?

    In that scenario it ceases to be a “risk pool” type of set up and becomes a very expensive installment payment plan.

    If you counter that by forcing everyone to pay into the plan all the time then you have the far left socialism that the moderates and independents in this country do not want.

    Under one of the current proposals, many of the “working poor” who are currently uninsured, will still be uninsured but they will also now be fined for being so. nice.

    The obvious first place to start if you want to reduce costs and increase coverage is tort reform. However we all know why that isn’t even on the table.

  93. It seems to me that the opposition tends to fall into four camps:

    -People who don’t want to pay for any government services at all (including roadwork and fire protection, one would assume)

    -People who specifically don’t want to pay for healthcare because they misunderstand the proposal and think they’ll be forced into choosing the government-run option

    -People who specifically don’t want to pay for healthcare because (as I mentioned above), they think all health problems are solely the fault of someone who didn’t take care of themselves, and they don’t want to pay for someone else’s smoking and cheeseburger habit.

    -People who don’t like it because it’s a Democrat thing, and they’re morally opposed to anything Democrats propose, even if it were something like setting tomorrow as “Yay for Breathing Day.”

    Each one of those groups is going to need a different approach.

    The first and last ones can be ignored. They’re philosophically opposed in general, and no argument made on this specific issue is going to change that.

    The middle two, however, need education, and they need it fast:

    -They need to be educated that this proposal does NOT turn health care entirely over to the government in any way whatsoever, and is, basically, just an expansion of Medicare.

    -They need to be educated that fate can hit any of us at any time, no matter how hard we work and no matter how well we take care of ourselves. None of us are completely safe from illness and injury no matter what we do. And thus supplying everyone with a basic health care option is simply the compassionate and sane thing to do.

  94. Tal @100:

    It’s also worth noting that no-one is an island when it comes to health. Essentially, all health is public health, therefore it is in a society’s best interest and in the best self-interest of the individuals of that society to take steps to provide real healthcare to all.

    Similar reasoning informs my support for public schools (and fire departments and so on). Even if I didn’t support such things on humanitarian grounds, it’s in my own best interest to support them. The nature of such things is that the net effect is improved by providing them for everyone, whether they can afford to pay up-front or not.

    If that smacks of socialism, well, so be it, comrade.

  95. Paul @105:

    “…tort reform. However we all know why that isn’t even on the table.”

    Yes, because it’s less than 1% of the problem (Paul Kruggman, economic nobel prize winner’s numbers, not mine.)

    In response to the first part of your argument. There are two ways the system can be gamed. The insurance companies can choose not to treat sick people, and sick people can decide to get insurance only once they’re sick.

    What a problem! How do we deal with this. If only we had some collective way of paying for everyone’s insurance. Some large entity that could act on our behalf… Hmmm

  96. Also, at the moment citizens have the choice to pursue or not pursue care on their own terms. The jehovas witnesses and christian scientists are easy examples. They don’t believe in modern medical care and would rather die than have a blood transfusion. Does your plan infringe on their religious freedoms and force care on them, or do you just want them to have to pay for something that they believe to be immoral and will never use?

  97. “then you have the far left socialism that the moderates and independents in this country do not want.”

    For those of you reading this outside of the US, a helpful bit of translation: When he says “far left socialism”, that should be read as “slightly right-of-center moderate common sense” in the rest of the industrialized world.

  98. Paul @ 105:

    If you counter that by forcing everyone to pay into the plan all the time then you have the far left socialism that the moderates and independents in this country do not want.

    Actually, that turns out not to be the case, both in terms of it being “far left socialism” and in terms of it beings something that moderates and independents don’t want.

    The obvious first place to start if you want to reduce costs and increase coverage is tort reform.

    This is evidently one of those obvious things that happen to be wrong. Tort reform has been tried in various states in various ways, and the difference made is uniformly minimal.

  99. Much of the problem with not conflating people who object to a public healthcare option as total whackjobs for me is how many of the GOP perpetrates the”Death Panel” nonsense. It’s not jsut that there’s insufficient GOP objections, it’s that any GOP member calling it nonsense is drowned out by the sheer volume of elected GOP officials, from the top down, who’re pushing that nonsense. And from there, they jumped to the “death book” on the VA’s web site.

    And yes, if you go on about “death panels” being something to worry about you’re nuts. As nutty as the “birther” movement, even.

    Chris @ 97 – If your house catches fire, how about you refuse a publicly funded fire brigade, and count on your neighbors to help?

    I know I can choose to be charitable. I know many of those posting to this list can choose to be charitable. So why do so many believe we must legislate such behavior?

    Because without it, people will literally die of poverty. And because, in the US, taxes to promote the common welfare are part of the law.

  100. Paul @109: do you just want them to have to pay for something that they believe to be immoral and will never use?

    Catholic tax dollars currently go to pay for executions.

    Shall we stop subsidizing the criminal justice system on those grounds?

  101. Cassie @62: Has there ever been a comparison of governmental health care for a nation that’s comparable in size and population to the US?
    Hilary @56 and C.Rader @79 are also part of this subthread.
    Looking around a bit, the only countries that can reasonably said to meet both of those conditions are Brazil and the European Union (if the latter counts as a country).
    Life expectancy:

    US: 78
    Brazil: 72
    EU: 79
    (Source: CIA world fact book & Wikipedia)

    Not going to dig up money figures right now, sorry.

  102. Bearpaw @107: Yep. And not just in the infectious disease sense (don’t get me started on the anti-vaxers, though.)

  103. The folks at WhiteHouse.gov have been taking the social networking angle, with an honest-to-god Internet quiz on healthcare!

    http://www.WhiteHouse.gov/realitycheck/quiz/

    There are also .pdf flyers you can download and distribute, if you’re so inclined.

    Meanwhile, some folks are going to be organizing ‘protests’ against ‘socialist fire departments’ as a sort of reductio ad absurdum of the arguments against health care reform.

    http://angrytownhall.com/

    Will it work? Couldn’t tell you. But it certainly isn’t something you can easily measure against previous attempts at healthcare reform since this sort of thing hasn’t really been done before.

  104. Ben,

    I fail to see your point.

    Scalzi’s post states that the country is centrist with a conservative tilt and that hard left socialism won’t fly. He suggests that Obama is biding his time and will spring a center right compromise on the congress this fall and they will see the error of their ways and fall in line.

    I point out that the only way to achieve his goals is with a socialist solution and you agree.

    At which point did I get smacked down?

    The American people do not want universal health care because they don’t trust their government to get it right. Obama’s suggestion that it will be just like the Post Office wasn’t his finest argument.

    The fact that Medicare is bankrupt and poorly run doesn’t help either. Ditto for the VA system and the Indian health care set up.

    Add in the fact that most Reps haven’t read any of the bills and can’t explain them when sections are read out loud at meetings and it isn’t just republicans yelling out in the meetings.

  105. Paul @117:

    I was responding to your complaint that the sick will game the system.

    The VA system is a mess because the Bush administration mandated draconian cost cutting in order to make the war seem less expensive.

    As for “Medicare is bankrupt” you have a lot of convincing ahead of you.

    When polled, most people actually rather like our postal system.

    As for throwing around the word “Socialist”, Please describe a 1st world nation besides ours with a functioning healthcare system who isn’t “socialist” by the definition being implied.

  106. The obvious first place to start if you want to reduce costs and increase coverage is tort reform.

    No, that’s the obvious first place to start if you are philosophically opposed to lawsuits against insurance companies. They do nothing to reduce costs or malpractice.

    The goal of ‘malpractice tort reform’ is to make lawsuits so expensive that hurt patients can’t get lawyers to represent them. That’s what caps on non-economic damages are for.

  107. I’m from Western Europe. Here, every country has public healthcare. It is good quality healthcare for everybody. Far better than most paid medical services in U.S.A.

    Every European citizen takes this for granted. We pay taxes so our governments can provide us with this kind of service.

    To be honest, when we read about the ongoing debate in the U.S.A. about this issue, we are astonished at the things some people dare to say, like comparing public healthcare to comunist gulags.

    I’m not very fond of Michael Moore, but his documentary “Sicko” is absolutely right. You should pay close attention to the scenes in France and UK.

    Maybe the americans that are against public healthcare should visit Europe, they will learn a couple of things that will open their minds.

    Just an example: cancer treatment, for instance, is top quality and free for everyone in every EU country.

    Go and get cancer in America, if you are poor, you’ll probably die miserably and leave your family in debt.

  108. Paul:

    “He suggests that Obama is biding his time and will spring a center right compromise on the congress this fall and they will see the error of their ways and fall in line.”

    I’m not aware of suggesting it would be center right. I rather think it will be center-left, which will be too far left for the right, and not far enough left for the left.

    Also it’s incorrect that the American people don’t want universal health care; it’s more correct to say that people respond to the question depending on how it’s put to them.

    And speaking as someone who has a close relative in the VA system, it’s rather dramatically improved from what its reputation seems to be, in part because it’s revamped much of its back-end to avoid redundant tests and care.

  109. @Samhain 120

    You touched on one of the dirty little secrets in this debate. I suspect most of the people who are “scared” of this have never been out of the country, and they imagine that the rest of the world isn’t that dissimilar from a middle eastern refugee camp.

  110. And I see that Catherine Shaffer actually touched on this at @63, so if I can tangent on this –

    The patient’s lawyer in malpractice cases works, essentially, on contingency. (This is actually a good system for weeding out dumbass cases, because the lawyer is putting his/her income on the line, not merely billing by the hour regardless of result.) What this means is that when deciding to take a case, the lawyer must ask “What are the odds that, in the years it will take to get a final result in this case, taking into account the very high costs I will have to front, that my share of the recovery will allow me to make a profit?”

    The goal of tort reform is to stick a finger on those scales such that the answer will be “Sorry, I can’t afford to take your case” even when there is terrible malpractice. It is not, as most people think, to keep damages to a ‘reasonable’ amount. It is to keep there from being any damages, ever.

    Additionally: We think of non-economic damages as ‘pain and suffering’, but really they mean ‘damages for which you can’t produce a receipt’. This is because we think that human suffering is worth something other than any out-of-pocket expenses incurred, and people are worth more than their net earning capacity. If

  111. Ben @108

    Yes tort reform is a small portion of the overall budget, but it has an extraordinary effect. Because of the cost to a Doctor of having a primary care business, there are less doctors entering that field. This results in longer waits and less service. This results in people bypassing their primary care doctor and going straight to the emergency room when they want service now. This in turn drives up everyone’s cost since ER care is the most expensive.

  112. Pretty much everyone I know getting care from the VA is happy. And pretty much everyone I know who’s retired is glad they have Medicare, and not no care if they couldn’t afford it. Which was the Republican suggestion at the time it was rolled out. The problem with Medicare funding isn’t that it’s run out of money already, it’s that, if medical costs continue to rise at the rate they’re going, it will eventually run out of money.

    It’s like seeing a cliff miles ahead on a freeway. There’s still plenty of time to turn your car in another direction. Republicans seem to think that jumping out of the car and watching it go over the cliff is the only solution.

  113. I can’t add too much here. I agree with you.

    The problem is that your solution reeks of common sense, reason and – heaven forbid – humanity. You go too far.

  114. I’d like to propose my alternate to John’s plan, which I call “Steal the NHS Wholesale and Don’t Change Anything Else.”

    It turns out that the UK government spends less on health care, per capita (~$3k), than the US gov’t. Not US health care in general, the*US gov’t alone* (~$3.3k). [1]

    The USA could in theory afford socialist medicine for *everyone* on *less money than the government spends now*. Anyone who wanted to stay private could, because no private money is needed at all. (Note the UK allows private plans in addition to the NHS.)

    This is, of course, an impossible plan. There’s no good road from here to there. The USA might be able to put a man on the moon with 1960′s technology, or stare down the USSR at the height of its crazy, but it can’t do this.

    [1] Numbers nicked from Wikipedia; took the cheapest estimate of US spending; used NHS (England).

  115. Some kind of public option would harm Big Health Insurance, which frankly is enough to recommend it in my book.

    As I understand it, the argument is this: Government run health care is callous, inefficient, and will lead to mass death. However, private insurance cannot compete with it. Say what?

    The increased litigation engaged in over relatively minor medical malpractice because the consequences of the malpractice scare the hell out of the victims;

    Not just malpractice. I used to practice with one of those big Personal Injury firms that advertise on TV. I’d say 80% of the client base was people who were uninsured who’d been in minor fender benders. They’d only been to the ER, to “get checked out” but they were suddenly hit with a thousand dollar (at least) medical bill they had no way on earth to pay, and they were worried out of their minds. If I heard it once, I heard it a thousand times: “I don’t want a million dollars, I just want these bills paid.” Take that worry away, and that pool of worried Plaintiffs dries up.

  116. JimF @124

    “This results in people bypassing their primary care doctor and going straight to the emergency room when they want service now.”

    I was under the impression that people were ending up in the emergency room because they couldn’t afford a primary care doctor to begin with.

    I want to make clear that I am sympathetic with the idea of changing the way we think about malpractice. A doctor who is practicing in good faith, and taking all the nessecary precautions against infections and the like, shouldn’t have to be afraid that he’ll lose his practice if a patient’s spouse blames him for an inevitable bad outcome, or if the doctor says “I’m sorry” in a moment of compassion. That’s an American attitude that needs to go.

    Unfortunately, “tort reform” as it’s being proposed is kind of a scorched earth tactic, as mentioned above by mythago. The people proposing it are not negotiating in good faith

  117. Hi all,

    My only point to this whole discussion will be on the right verses privilage part of the discussion.

    We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

    The part I want to emphasize is “promote the general welfare”

    A healthy population is part of promoting the general welfare and that puts me squarely in the “right” category along with the Founders IMHO. We can argue apples and oranges and which group is more nutjob than the other till the cows come home. Let’s just start SOMEWHERE and adjust as we go.

    Thanks for your time.

  118. Tal @ 95

    I’m not interested in arguing with you, I’m looking for facts.

    I’d like to compare apples to apples, as it were, based on population. Not on income, not on percentage spent on health care.

    I hypothesize that larger populated nations may not have as successful nationalized health care programs as do smaller populated nations.

    You said that you fail to see that a larger population is an issue, therefore you’re not addressing my question. Your opinion, apparently without substantiation, is that the size of the population will not make a difference because the bureaucracy supporting it won’t have to be significantly larger.

    I’d like proof of your opinion. I’ll wait.

  119. I’m baaaaack. Still no job.
    JS@31 Even Discovery,The Learning Channel and the History Channel are putting out drek. “Pawn Stars”?WTF? Of course they are all owned by one corporation. Not all drek, mostly drek.

    Julia@34 Well Bob-ful PIR was pretty scary too.

    Ben@35 Nope, I am not playing anything. I think these are very important questions that will have to be answered. The point of these questions is how much coverage do we get for our tax dollars. Is everything covered no matter what? If not where do we draw the line?

    Deron Meranda@38 Where in the law does it say that the politicians have to listen to anybody once they are in office? Scream and moan all you want, nobody is listening.
    “You’d think liberals of all people would know this” You callin me a liberal boy? Them’s fight’n words boy! Hehe. I am not a liberal. If I could get the liberals out of my wallet and the conservitives out of my bedroom I think I would be much happier.

  120. A doctor who is practicing in good faith, and taking all the necessary precautions against infections and the like, shouldn’t have to be afraid that he’ll lose his practice if a patient’s spouse blames him for an inevitable bad outcome, or if the doctor says “I’m sorry” in a moment of compassion.

    No, he shouldn’t. Because that’s not how it happens. Malpractice suits cost so damn much to pursue (money, as pointed out above, that comes first out of the law firm’s pockets) that a lawyer who takes on a case for no other reason than “a patient’s spouse blames him for a bad outcome” or ‘the doctor said he was sorry” is on his way–literally–to bankruptcy. And trust me, these are smart people. Occasionally venal as hell, but smart.

  121. JimF, I think you left your facts there in your other pants.

    Cassie @131, offsetting the hypothesized costs of a large bureaucracy would be the relative buying power. You can see this in the private market now, where BigCo can negotiate a good deal from a health insurer – because it has a lot of employees and a large pool – while SmallShop LLC can’t afford to offer its employees health care at all.

    ben @129, the doctor doesn’t need to be afraid of that now. What malpractice insurance doesn’t cover is punitive damages – which are darn hard to get, Chamber of Commerce propaganda notwithstanding. As for “I’m sorry,” the University of Michigan hospital has had outstanding results with a program where they apologize to patients for mistakes – BEFORE they get caught – and offer to make good on their mistake. According to their chief risk officer, “malpractice claims against his health system fell from 121 in 2001 to 61 in 2006, while the backlog of open claims went from 262 in 2001 to 106 in 2006 and 83 in 2007. Between 2001 and 2007, the average time to process a claim fell from about 20 months to about eight months, costs per claim were halved and insurance reserves dropped by two-thirds.”

    Just for apologizing and making things right. As one plaintiffs’ malpractice attorney of my acquaintance said, if everybody did that we’d be out of a job.

  122. Cassie @131:

    “I hypothesize that larger populated nations may not have as successful nationalized health care programs as do smaller populated nations.”

    That’s right, you put forth a hypothesis. That means you’re making a claim. That means the burden of proof lies on you.

  123. Cassie@54 Yes I am an American Citizen. And there is no D in my name. It’s pun of sorts. What made you ask? My bad grammer? She was an evil old… JK.

  124. Cassie @131

    Japan has roughly half the population of the U.S. and a nationalized health care system. It seems to work well for them. The overall life expectancy is 82 years.

    I haven’t lived there for a while, but when I was there I had great health care. Visits to the doctor were very affordable (around $30 for a 3-day stay with appendicitis) and medication was all but free. All the powdered medicines were a bit weird, but other than that it was great.

  125. Thanks Mythago 108, that is exactly right. My mother is profoundly disabled and has been since 1976. Her future income earning potential before the malpractice incident was nil. Because of the malpractice, she went from being unable to support herself and contribute to society to being a vast pit of need into which many other able and productive people have poured their time and energy, getting nothing back, and into which also the GOVERNMENT has poured hundreds of thousands of dollars in medical expenses. Because of tort reform, my mother is unable to ask for even a “reasonable” settlement for her injury, and the crater that her situation has created in the social landscape around her remains nothing but scorched earth. I will say this. One of the doctors responsible did call her to apologize. At least she had that much.

  126. @Rembrant #10:

    Of course health care is a right: Article 32, “The Republic safeguards health as a fundamental right of the individual and as a collective interest.”

    Or do you really think that something is “a right” only if it is as such defined in your outdated Constitution?

  127. “It’s also worth noting that no-one is an island when it comes to health. Essentially, all health is public health, therefore it is in a society’s best interest and in the best self-interest of the individuals of that society to take steps to provide real healthcare to all.”

    What Bearpaw said @107.

    When uninsured low-income families can’t get decent care, they end up in the emergency room getting treated at a much higher cost. When they can’t pay the bill, the hospital eats it, which means the hospital passes it on to the rest of us in the form of higher costs for services.

    When people get sick or become disabled and can’t work, they often collect government benefits, paid for by our taxes. If inadequate access to health care causes them to get sick or become disabled sooner, we pay more.

    When someone declares bankruptcy because they cannot pay their medical bills, due perhaps to a horrendous automobile accident or serious illness, those debts come back to haunt all of us. One way or another (tax write-off, higher charges to solvent customers, etc.) the banks and credit companies are going to get their money back.

    Access to affordable health care is important, and when many of our fellow US residents don’t have it, we all end up footing the bill. I’d rather pay it up front, and have a healthier populace, than pay it later.

  128. Even with “reasonable” health care costs, there’s always a chance you’ll loose your insurance in the current system, and if you suffer a catastrophic injury or disease, you’ll be in debt for the rest of your life, or bankrupt (which passes the costs back to the hospital).

    The most reasonable, least expensive, easiest to implement solution is a public option.

  129. When someone declares bankruptcy because they cannot pay their medical bills, due perhaps to a horrendous automobile accident or serious illness, those debts come back to haunt all of us. One way or another (tax write-off, higher charges to solvent customers, etc.) the banks and credit companies are going to get their money back.

    700,000 bankruptcies in the US each year due to medical related reasons. None in France, Japan, England or South Korea.

  130. RembraNT @ 136 – not your grammar, but the STFU comment about the election. I had to wonder if you were a native – surely you know that an election never means we have to stop complaining between elections.

  131. Eric@137:
    Japan has roughly half the population of the U.S. and a nationalized health care system. It seems to work well for them. The overall life expectancy is 82 years.

    Um… yes and no. I don’t know if its on the radar in the US, but the Japan’s LDP (which has ruled Japan virtually uninterrupted for fifty years) was thrown out in a landslide. Japan only has a “nationalized” health care system in the broadest sense of the word, and there are serious (and under-reported) issues with patients being refused emergency treatment or financially crippled by costs not covered by the state or insurance.

    In this kind of debate, I don’t know how useful it is for either side to point at other countries that operate in very different social and political contexts, and face their own challenges. (Japan, for example, is in the position of a lot of First World countries that are facing the challenge of a rapidly ageing population that is coming to expect highly expensive and specialised geriatric care, while not being sure how it’s going to be paid for.)

  132. John,

    I think you are wrong about this being a case of Obama initially holding back and waiting to ‘do his thing’. I think it started that way, but then the debate and media focus quickly spun away from the Democrats. Congressional Democrats went into their traditional defensive mode (eg spluttering and flailing about).

    By late July it was obvious that Obama’s team should have taken a stronger hand in promoting and selling the idea of health care for all. Its a toss-up opinion if they should have had a stronger hand guiding the legislation, but as you said its Obama’s style to hang back a bit and let people own their work. I think he should have had a slightly stronger hand on that tiller, but opinions vary.

    What I do know is that the has only been the last 2 weeks that his team (finally!) retooled the netroots election machine in order to sell health care reform. This has all the hallmarks of a reactionary response. If it was planned it would have kicked into full gear at least 2-3 weeks before the congressional recess. We saw a similar mad-scramble reaction during the 2008 primaries when HRC’s campaign went hard-negative. It took him time to regroup and respond then, and it looks like a similar situation with health care reform now.

    I think we started to see him get back into his classic ‘rope-a-dope’ form when Kathleen Sebelius made her comment about the public option not being mandatory. That ignited the netroots just about the same time his team started turning up the volume on selling health care reform as Health Insurance Reform. I think that was a tactic to light a fire under the more liberal Democrats and get them working for him again. If he did ask Sebelius to stir the pot, then good on him and her.

    My only real disappointments with the reform discussion is that Obama didn’t come out stronger earlier. I expected that he would use the netroots machine his team built far earlier to build support. That they waited tells me this is reactive instead of proactive.

    Still, I agree with you. The key thing is to get the idea of universal coverage enshrined in law. Once that happens, the rest can be refined and improved.

  133. Japans aging population is in a problem we’re not likley to see in the US – our population is growing at a reasonable rate. Japan’s is not growing fast enough to keep up with an economy that will support an aging population. We’re at .97% growth, they’re at .02%. Of course, America has reasonable immigration policies. Japan’s are ass-backwards, and they’re not as welcoming to mixed race marriages either.

    Australia is a much better model for our health care system.

  134. Cassie at 62 asked “Has there ever been a comparison of governmental health care for a nation that’s comparable in size and population to the US?”

    The US Census gives the following up-to-date population figures:
    1 China 1,338,612,968
    2 India 1,156,897,766
    3 United States 307,212,123
    4 Indonesia 240,271,522
    5 Brazil 198,739,269
    6 Pakistan 174,578,558
    7 Bangladesh 156,050,883
    8 Nigeria 149,229,090
    9 Russia 140,041,247
    10 Japan 127,078,679

    How many of those do you consider comparable in size to the US? How many of them have conditions similar enough to make a comparison useful?

  135. I have tried to stay out of the health care debate, also, because I just don’t know enough. When people ask me to take a side (because you are both a communist and someone who wants little orphans with cancer to be shot out cannons for Cheney’s hunting pleasure if you don’t Take Sides), I ask simply if they’ve read the bill.

    I don’t care about necessity of health care or the horrors of so-called socialism. All I care about is what the Congress of the United States is voting on. Really that’s all that matters because that is what will be law, but I cannot find someone who has read and understands the bill. That scares me because they are pulling their info and position from Obama, Pelosi, Beck, Limbaugh, Grassley and even the only person to make me think the First Amendment is a bad idea, Ms. Palin.

    So, I fall on the side of hoping my elected official reads and understands the bill. Until they do, I’m against anything that is voted upon without being read. It smacks of the Bush administrations strong arm tactics. Rushing to do something is rarely as good as thinking the situation through.

    Once they read it, they should do what they feel the citizens of their states elected them to do, not the party they belong to, or who sits in the Oval Office. But, let’s face it, that’s way too naive.

  136. So, I fall on the side of hoping my elected official reads and understands the bill. Until they do, I’m against anything that is voted upon without being read. It smacks of the Bush administrations strong arm tactics.

    As I understand it, most members of Congress have staff to provide executive summaries of bills for them. More often than not, CEOs of major companies don’t read the entirety of a contract. they pass it on to lawyers who they trust to catch any unacceptable language.

    I’d like it if more people in Congress read the entirety of the bill, but reading a well crafted and comprehensive executive summary ought to be acceptable.

  137. I would like to take this opportunity to express my appreciation for John Scalzi. John, you are one smart dude who makes counter points that make me laugh out loud at work. Like just now.

  138. Arrrg. I got to John’s post at 104 befor my brain melted. How the hell do I tell fact from opinion? My problem with debate is that you can be a briliant debater and still be totally freaking wrong.
    How do we predict what the lawyers will do to/with any given law once it is passed?
    John says he thinks the rich need to be taxed more to pay for this. I hate that idea. The problem with taxing the rich is that the tax code is so damn complex that there is a whole industry built around manipulting it so the client won’t have to pay as much in taxes. That is all CPA’s do. How did it get like this? By using taxes to manipulate behavior and to help out major political contributers.
    This health bill is how many pages? How am I suposed to figure out what it means to me? I am 45 years old and the only major health issue I have had was my appendix. I was insured at the time so it was no problem. What would it have cost me if I didn’t have insurance? What would it cost everyone else if I didn’t have any means to pay for it.
    HMO? I went in a number of times for a physical/checkup. They looked at me like I was nuts. The PA’s weighed me and checked my blood pressure. Then the doctor asked me what was wrong. I told him nothing that I was just in for a checkup. Then he asked me what was wrong again. I said nothing. He looked at my blood pressure and weight. Told me I should quit smoking and that was it.
    Am I the only one who thinks there is something wrong with the fact that Ted Kennedy was in the Senate longer than I have been alive? Is politics really public service? Should it even be a career?
    Can you tell that I am frustrated by this whole freaking system? The truly scary thing is that it is the best system humans have come up with so far.

  139. I can see the argument that the government should be subsidizing health care for people who are too poor to afford it. Actually, we have this now…it’s called Medicare. But why should the government (or an insurance company) be paying for my health care if I can afford to pay for it out of pocket? The bottom line is this: as long as health care costs are paid for by third parties (like government or insurance companies) costs won’t be coming down anytime soon. I fail to see how a government run system would fix this.

    What we have right now is not exactly health insurance, it’s more like health insulation. The goal is not to insure people against catastrophic illnesses that are highly improbable. The goal is simply to prevent people from paying the full costs of their health care. Insurance, by it’s very nature, is only profitable for the company selling it when the events that you are insuring people against are unlikely. What are the odds that every driver in the U.S. with State Farm insurance makes an insurance claim in a single day? Or a month? Not very likely. If we expected our car insurance to cover oil changes, it would be a hell of a lot more expensive.

    Added to this is the fact that our health care system right now tends to overuse expensive medical technology and expensive specialists. Because the customer doesn’t directly pay all of the costs involved, there is no incentive to be cost effective. We actually have a pretty large shortage of general practitioners at the moment. How does the Obama administration plan to address this if they’re going to expand access to over forty million people?

    An interesting fact to keep in mind: in 2002 Americans paid, on average, 14% of their health care costs out of pocket. Canadians, on the other hand, paid 15%. If your goal is to prevent people from paying the full costs of their health care, there are only two industrialized nations in the world that do a better job of it than we do: France and Germany.

  140. To amend my statement above: selling insurance can also be profitable if you simply deny claims left and right, as our health insurance companies today tend to do.

  141. Cassie@144 Didn’t you see the next line in the post? Here it is
    “I guess it’s like the weather. It is out of our control but we sure like to talk and bitch about it.”
    I am going to go read some scifi. Reality is pissing me off right now.
    Sorry about the rant @152

  142. Rembrant- If all your PCP does with an annual checkup is to weigh you and check your blood pressure, you’re going to an incompetent doctor. You should be getting at least 2 blood draws and tests for liver function, blood sugar, cholesterol, etc…

    Can you tell that I am frustrated by this whole freaking system?

    I can tell you’re confused and uneducated about it. I can’t for the life of me tell what’s bugging you if you’re covered already, you’re not worrying about loosing coverage, and you’ve got no major medical problems.

    Your appendectomy, BTW would have set you back anywhere from $5,000 to $20,000. More if there were complications. This doesn’t include the $1,000 or more if you needed an ambulance and tests to determine what the problem was.

    A bad car accident would cost you about $100,000. Childbirth is about $7,500 naturally. More if you require a C-section. Prostate removal? $10,000. Kidney stones can run from $2,000 to $30,000.

    If you didn’t have the means to pay then, you’d still be paying now.

  143. Thank you, John, for a sensible statement about health care reform. (Thank you also to tall the commenters for a quite reasoned -for the Internet- discussion.)

    As a person in Public Health, I would love something like what they have in Germany, but I understand that you can’t always get what you want. I hope that this is just the first step on a path of further reform.

    I am lucky that when I was without health insurance I was able to get a check-up at the local Planned Parenthood, and I didn’t get really sick/hurt.

    I think that the world would be a better place if luck was not an element in the treatment of disease/injury, since luck is already a major factor in one’s health anyway.

  144. What this discussion reminds me of (again) is that even though I “talk for a living” (or most of it, anyway) I NEVER, EVER want to get in a debate with J. Scalzi (OR Prez Obama) over anything at all serious and about which I couldn’t afford to lose.

  145. I can tell you’re confused and uneducated about it. I can’t for the life of me tell what’s bugging you if you’re covered already, you’re not worrying about loosing coverage, and you’ve got no major medical problems.

    Your appendectomy, BTW would have set you back anywhere from $5,000 to $20,000. More if there were complications.

    Then there are the aggravations caused BY the insurance company….

  146. @86 Bearpaw: sorry, the problem isn’t with the link, it’s with this website, which incorporated the closing parentheses into the link automatically. For the record, the link is:

    http://www.theatlantic.com/doc/200909/health-care%29

    Direct quote: “About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.”

    Since my father also suffered from hospital-borne infections that almost killed him, I’m not partial in this case. I’d suggest that you check with the doctors at your hospital to see what their standard of hygiene is, and whether this Dr. Provnost is a nut job.

    I’d also point out (@156) that the question is: why is it $100,000 for a serious car wreck? How much of that is unnecessary scans to prevent lawsuits, how much is for drugs that are the “gold standard of care” (when drugs that are 95% as effective are a tenth the cost), and how much does the rate vary depending on whether it’s paid by Medicare, private insurance, or out of pocket?

    That’s one of the huge problems today: the cost structure is largely invisible, just like in any other monopsony situation. One of the things that will help drive medical costs down is accurate information on real care costs. Another thing that will drive it down is when care cost is factored into decisions about effectiveness.

  147. heteromeles – $100,000 is the cost of the surgery alone, not “gold standard” drugs. Just the medical team, the operating theater, equipment cost, and so on.

    how much does the rate vary depending on whether it’s paid by Medicare, private insurance, or out of pocket?

    Depends on who’s negotiating and what hospital it is.

    That’s one of the huge problems today: the cost structure is largely invisible, just like in any other monopsony situation. One of the things that will help drive medical costs down is accurate information on real care costs.

    So much of this is because we’re applying market pricing to something that, in an emergency, you can’t comparison shop for. If my appendix bursts, I’m not going to take time to comparison shop, because if I do, I’ll die. Price negotiation is best handled by large groups. Hospitals can tell an individual to kiss off. Thy can’t if it’s going to be a large portion of the patients they see.

    I don’t think transparency is the cure you think it is. It will help, but not as much as a public option that has a good preventative care incentive.

  148. Damn I can’t stop!
    Josh Jasper@156.
    I was laid off, outsourced to india buh by coverage.
    Self employed for a couple of years and couldn’t afford coverage.
    Got another job and coverage until I was laid off again, outsourced to Michigan this time. I am currently unemployed and uninsured.
    Regardless of my current situation I am concerned because I will have to pay for this whether I am insured at the moment or not. Whether I am healthy or not.
    First you wonder why I am concerned about this then you tell me I had an incompetent doctor? Was it the doctor or the HMO’s fault? What better reason to be concerned?
    As for your comment about me being uneducated about it? Well that is a pretty rude and arrogant statement. What do you do for a living? I suspect it would be very telling about your opinion. Which is just that, an opinion and nothing more.

  149. Scalzi,
    Although I don’t expect a response this late in the comments, I shall still post. As someone who is somewhat right of center on economic and legislative issues, and mostly agrees with you on health care, I find it distracting and detrimental to reading your opinions when you classify all “righties” as “froth-flecked ignorami”. Frankly, it’s not something I would expect from an open-minded, socially-progressive individual; I would expect it from a “froth-flecked ignorami”. Arguments tend to be accepted when you don’t treat those you argue against (be they real or straw-men) with blanket disdain.

    Pete

  150. Rembrant – Regardless of my current situation I am concerned because I will have to pay for this whether I am insured at the moment or not. Whether I am healthy or not.

    So, what you’re concerned about is that you’ll have to have insurance, even if you’re “healthy”? Well, if you’re not aware of your cholesterol levels, you can’t be sure you’re really healthy, can you? This si why preventative care is important. Health issues you have now that might not be a big deal (or even noticeable) will snowball, and kill you if not treated.

    First you wonder why I am concerned about this then you tell me I had an incompetent doctor? Was it the doctor or the HMO’s fault? What better reason to be concerned?

    You’re not articulating *what* you’re concerned about. So far, nothing bad has happened that you know about.

    But take this as an analogy – you walk across a street with faulty stop signals. the following week, someone tells you you were nearly killed, but you didn’t notice. You’re not sure why. Could be the driver, the traffic lights, or something else. Now, a politician is talking about spending money to fix the lights, and you’re saying you’re worried about how much it’ll cost you.

    To me, that worrying about paying for fixing something that’s almost broken, and could kill you if you have to go without it is foolish.

    As for your comment about me being uneducated about it? Well that is a pretty rude and arrogant statement. What do you do for a living?

    I’m currently a professional blogger. If I’m uneducated about a topic, I look it up.

    I don’t see “uneducated” as rude, as it’s something you can fix. It’s like telling you that your tie clashes with your shirt.

    Most of your questions can be answered by good research on your part. You’re not asking anything that a few minutes on google couldn’t offer answers for. And I’m not offering an opinion that’s somehow magically equal to anything anyone else can say no matter how ill-informed. I’m offering an informed opinion. Informed opinions are more valuable than uninformed opinions.

  151. Oh just wait until I get my dander up about racefail, feminism or some other such radical political issue. You’ll be wanting to smack me in no time.

  152. The problem with introducing a “public option” for health care is that, while it’s easy to say “hey! More competition is good!”, that’s not what is actually happening here.

    Private insurers have to compete within the constraints of profitability. The public option doesn’t – it can charge less to the end user for medical services and bill the taxpayer for the difference. In fact, this is what it is designed to do. (What’s the point of a public option if it’s not cheaper? It’s not like people are saying “gee, if only I could purchase more expensive insurance!”)

    At the same time, the public option will not enjoy a lot of the normally-touted benefits of socialized health care so long as it’s just one more option out of many; it’s just a different insurer with its own set of forms to fill out, requiring just as many administration costs as any other insurer. So no cost-curve bending happens that way.

    But it’s difficult to price the public option when it comes to allocating funds, because there’s no telling how many people will sign up. Specifically, there’s no telling how many companies will say “hey, now that the government is in the health care business, we’re getting out of it; here’s (a portion of) the money we were spending on your insurance, buy your own and don’t talk with us about it.” (If the company is taxed because it is not providing health insurance, it will happily do that if the tax is cheaper than what they’re spending – and if you were going to tax them so much that offering private health insurance is preferable, what do you need a public option for?)

    This makes for a really scary spectre of underfinancing; if enough people join the public option, or are forced to join it as employers exit the health insurance racket en masse, what happens when the money allocated by Congress runs out? (Or will we be “bailing out” the public option shortly, as well?)

    There are real benefits to moving to socialized medicine, as well as real costs. But to realize those benefits, we actually would have to move to socialized medicine. The reason we are hearing about “public options” and “insurance mandates” is simple – the administration doesn’t have the gumption to take on the established interests that would oppose such a move, not wanting to re-fight the ’94 mess. However, a halfway shift threatens to leave us with all of the disadvantages of disruption to the current system without providing the advantages of cheaper care (or universal care, for that matter) – not an optimal situation.

  153. Pete:

    “I find it distracting and detrimental to reading your opinions when you classify all ‘righties’ as ‘froth-flecked ignorami’.”

    I don’t, and I invite you to show me where I have said that everyone on the right is such. Certainly I believe there are some who are, and they’re definitely making a lot of noise at the moment, but “some” is not “all.”

    Indeed, there’s ample evidence in this blog that I make the distinction between ignit morons on the right, and thoughtful Republicans and conservatives. For example, this quote from a couple of weeks ago:

    I’m sad for the Republicans, conservatives and others with actual, substantive objections to the current health care plan wending through Congress that a genuine debate is off the boards in favor of a strategy of uninformed tools making asses of themselves for the benefit of television cameras, but this is where that side is at right now.

    What may be confusing you is that I don’t go out of my way every single time I discuss politics to note that not all righties are, in fact, credulous tools. But I don’t feel that it’s necessary to say every single time, any more than I think it’s necessary to say that not everyone on the left are pathetic whiners who have the political equivalent of ADHD when it comes to advancing their agenda. But neither do I generally say “All Republicans/conservatives are X” or “All Democrats/liberals are Y,” etc, so I think that’s pretty well dealt with.

    If you think that when I say something like “the idjits on the right” I mean “all people on the right are idjits,” that’s your privilege, of course. However, if I thought all the people on the right were idjits, I’d say it unambiguously. You might notice I don’t have a problem saying what I think.

  154. What’s the point of a public option if it’s not cheaper?

    Availability.

    Cost doesn’t matter if nobody will underwrite me because I have a ‘pre-existing condition’ or appear to be at risk of getting sick, say because I have the temerity to be a middle-aged man.

  155. Cost doesn’t matter if nobody will underwrite me because I have a ‘pre-existing condition

    Like pregnancy.

  156. He’s like Muhammad Ali fighting George Foreman, just keeping his guard up and playing the endurance game, waiting him out, then walking over him in the final round.

  157. Wow. One hundred percent spot on.

    As I told some friends recently, Obama isn’t a liberal to anyone but the wingnuts who want to discredit him with that label. He’s a left-of-center moderate. Fine with me–that’s why I voted for him.

  158. I’m late to the party, and I wasn’t going to scroll through the comments to see how many were saying “Scalzi, you suck”, but I think you’re spot on with the observations about lefty thinkers, and bloggers. Whenever I read someone’s complaint about how Megan McArdle can be such talentless hack but get to write in prime journalistic real estate such as The Atlantic, I have to remind myself I’m reading someone who doesn’t understand that, for whatever reason, she’s pulling in eyeballs who might see the ads and that’s what the publishers really are concerned about. A fifth grader who did the same thing could be on the masthead.

    Along the same lines, I agree with you that the conservatives are better at political warfare. They’ve learned that if it sells, if you yell it loud enough, and if enough people start repeating it, it becomes the truth, regardless of what the facts really are (I can’t take credit for that analysis – see Charles Pierce). Of course, conservatives’ enhanced skills at political warfare come in part from them being better liars and better at being outrageous. But maybe there’s the germ of a lesson there for liberals.

  159. The exact same rhetoric was used by Republicans, insurers, and far right activists to battle the establishment of Medicare. Reagan appeared in ads explaining how Medicare would lead to socialism in the U.S. People argued about why should they have to pay for old people’s healthcare in Medicare, and for that matter certainly, why they should have to pay for very poor people with Medicaid, because they are unable to understand that A) that most of them aren’t paying for it because they don’t have the income level; B) the cost is considerably smaller than the cost we spend on other things like defense; and C) paying for it saves us tons of money in healthcare costs and resources for the government, thus improving government services and the economy, providing more jobs and businesses and other nice side benefits.

    It was the exact same debate. And now we have people who are on Medicare yelling about how the government should not give them health benefits because it will destroy the universe because some lobbyist paid them money to go to someone else’s town hall meeting. And these folks were around when the exact same debate occurred for Medicare, which got passed despite the “fear” campaigns, a service they now use and seemingly have amnesia about.

    I loved Barney Frank’s responses, but I’m waiting for a Democratic congressperson confronted with this at one of these meetings to say, okay, we’ll just have the government stop doing Medicare for all of you, good luck with the insurance companies. That would be way more effective for getting rid of old people than a “death panel,” as has been noted.

    My mom’s doctor told her that Medicare didn’t cover physicals. And of course, it does. The doctor just doesn’t like what Medicare tells him he has to charge for the physical. This is the sort of abuse that regularly occurs in the system when profit is always more important than patients. The only way to make sure patients get anything is the government making and enforcing laws and regulations. Historically, that’s been the only way ever to get a population to have any shot at regular healthcare.

    Where the right is effective is not in scaring the center that there will be socialism and death panels, but on the idea that the Democrats are making large mistakes in the bill and that some care will be restricted. Certainly that’s not an unreasonable fear, as like my mother’s doctor, the insurance companies would try to claim that their hands are tied by the government as a way of not paying some health benefits. But with the government reform, you can call them on it. Right now, you can’t, which is why the insurers can death panel you.

    And the danger there is that if the center stays silent about wanting reform because they’re not sure that what the Democrats say they’re doing is what they are doing, then the center Congresspeople may waffle. Which is why pro-reform groups are activating. It’s all down to the politicians and the people in the center — reasonable folk who sometimes have dumb notions and short memories. And Obama is good with those folk, I agree.

    The thing to remember is, after Medicare, the healthcare industry entered a long period of obscene profits, growth and prosperity. Healthcare reform will probably continue the streak, not end it. Which is why a lot of the doctors are now coming on board with it.

  160. Ben @ 135

    I just taught the scientific method. Collecting data is the 3rd step. Proof follows after examining the data. I’m asking around for data, not making any conclusion yet.

    I’m still on step 3.

    Giacomo @ 139 – what document are you quoting?

    Erik@ 137 – thanks for the data.

    Mythago @ 134 – a good point about buying power. However, will the savings be enough to offset the management of this system?

    I tell you why I ask: I have several friends who are battling the Social Security system. It takes YEARS to get SSD. Several had to engage the services of an attorney and still waited because the SS system is, as we’re told, grossly understaffed, so a claim will wait in the system for 3 months before a real person looks at it. Then the approval, if given, takes years.

    (Not so when they decide that they paid out wrongly. They demand their money right now, but stall when proof is submitted the the claim was not fraudulent.)

    I do not understand how a new bureaucracy can be big enough to manage millions of people’s health care finances, and yet costs will be cut.

    Essentially, as I see it, if there’s one buyer for a product, he can name his price, but if that price is unrealistic, the supplier will go under (see Walmart and Rubbermaid.) Is this a possible unintended consequence of nationalized health care?

    I’m open minded about Obamacare only as far as someone can explain how it can be paid for.

    The predicted deficit next year is 7 trillion dollars. Adding another trillion and expecting to pay for it with taxes – we can’t afford this. I don’t see how we can afford it.

    Capt. Button @ 114

    I don’t think the EU is underwriting or managing the nationalized health care in any country – are they?

    Thanks for Brazil.

    Azara @ 148

    Thank you.

    Of those listed, only Indonesia is close in population. Does that country have nationalized health care? Does the system work effectively for the population? How is it funded, managed and judged? Is medical research financed and is it at all comparable to what other nations produce?

    Now that my homework is done, I’ll have time to do the research. Thanks so much for your help.

  161. Josh Jasper. You never said what you do for a living.
    I just deleted a nice long rant because of thread drift.
    The reason I want to know your occupation is because in my experience it goes a long way to explaining an opinion.
    Any group of people behave like an organism. Organisms want to grow. Idea stolen from Heinlein.
    Why is law enforcement almost always in favor of tougher drug laws?
    Why is it that everytime there is a failure by a bureaucracy we make more bureaucracy?
    I just deleted more foamy rant. I have never been any good at debate. My mind likes to drift because I suspect that everything is interlinked yet I can never describe it well.
    Why did the Catholic church hide pedophiles? Because they thought it was the moral thing to do or to protect the organisim? See? Drifting yet it ties back to my point on groups. Sigh.

  162. Rembrant –

    Josh Jasper. You never said what you do for a living.

    I did. Right after the text I quoted where you asked.

    Cassie – If *anything* is well managed in Indonesia, it’s news to me, and a lot of Indonesians.

  163. Cassie, #177: A question: how would size impact delivery? What would prevent a scaling up of the various systems? I understand the concern that there isn’t a parallel in a country of similar size, I think it’s a bit of a red herring without considering the factors that would hinder a scaling up–and really, it’s those factors that we should be concerned with, not merely the size. We’re more interested in the factors that would hinder a conversion a la Taiwan more than anything else. That’s comparing apples to apple.

  164. “The other thing I think Obama knows that lots of people on the left seem to be clueless about is that the goal here for Obama is not creating the US equivalent of the UK’s National Health Service…”

    Yes, John, yes! Thank you for pointing this out. As a UK citizen who thinks the NHS is a fantastic idea executed fairly badly due to bureaucracy too complicated to get into here, I concur entirely. Learn from our mistakes, but learn that universal medical coverage *is* the better option, and essential in a modern society. There are a myriad of ways to do it, and it can be done far more efficiently that we did in the bloody forties.

  165. I’m late to this conversation (having a job is rather new to me) and I’m not about to win any friends, but here’s my 2 cents:

    PLEASE stop confusing a right with a moral obligation.

    Health care is a service, provided by professionals. It’s not a right.

    Health itself may be a right, but that only translates to society paying for your health care when society causes you to lose your health.If your own idiotic habits get you sick, or if random chance strikes you down, you don’t have a right to having someone else pay for it.

    An argument that can be made, and one that I could actually buy into, is that a wealthy society has a moral obligation to give the gift of health care to those who cannot afford it – basically the argument that it would be so easy to do that it’s wrong not to.

    BUT IT IS STILL A GIFT. The recipient has no right to it. They haven’t earned it. I’m all for giving that gift, I’m not for telling people they’re born with a fundamental right to someone putting some burn cream and a bandage on them when they put their hand in the toaster.

    Maybe it’s semantics, but it matters to me.

  166. Cassie @62 & Captain Button @114 Sorry about getting back to the thread so late been a long day. Why does absolute size matter? I may be missing the point but proportional scaling (percentage) is a valid comparison methodology. Economists’ compare per capita GDP and other numbers proportional number all the time. If France, the EU or Liberia is able to deliver X loaves of bread daily to N% of their population is that not a valid comparison of bread delivery capacity? It says nothing about the quality of the bread that must be defined by further criteria. In the case of heath care birth mortality, longevity and a host of number are used to determine the quality of care delivered, and we are way down on the list.
    There are other artifacts of the system that are harder to characterize. My experience was that I developed a 1 CM umbilical hernia in my 50’s. No big deal, a little lump of fat would bump out at my navel and I could push on it and make it go away. I chose not to treat it. Later my insurance circumstances changed I applied to several carriers (side note, just try to find out what is actually covered before you spend hours filling out the forms – they won’t give you the details unit you are accepted). I was told that once I had the hernia fixed they would be happy to entertain the notion of insuring me, but until then forget it. No exclusion of prior condition, just plain get this treatment for a trivial condition or you can’t play at any price.
    @ Catherine 63 – Not all reform is good reform tort or otherwise. When each Dr. in practice has to kick out middling 5 figures on an annual basis for malpractice insurance there is something wrong with the system. When they have to CYA with unneeded tests there is an issue. My point is that (and those who have expert knowledge please correct me if I’m materially off base) If you remove future health care costs and other burdens of diminished capacity haven’t you covered a significant portion of all but the most egregious malpractice settlements? What do you have left but diminished future earnings and punitive damages? Keep the former in the legal system and lets figure out a better way for the latter.

  167. If your own idiotic habits get you sick

    The very best thing about this attitude is that you can always find some way to blame sick people, since nobody is 100% perfect and health-oriented all the time, so that we can pretend depriving them of health care is actually a just, moral act. Back-patting all around!

    Cassie @177 – the scenario you describe is awfully familiar to anyone who has tried to get a for-profit health insurance company to explain why they denied a covered claim, or asked for “additional documentation”….again. I really doubt Social Security’s lapses have much to do with understaffing, although Mr. Mythago once talked to an Aetna phone rep who admitted to him they deliberately understaffed their customer-service phone lines.

  168. Cassie, I’m looking at an article by the UN (on ReliefWeb) from Aug 6 2009 re the Indonesian health-care system which they say is “failing millions.” Health care is inaccessible for the poorest. The wealthiest go to other countries for health care. There is little uniformity of care. Many (i.e., the poor) avoid seeking medical care, “afraid of the bills and the bureaucratic system.” The gov’t is looking at a universal healthcare option.
    I found myself mentally substituting “U.S.” for “Indonesia,” and found that I would not have found such an article surprising about our own situation. So at least for now, I suggest that Indonesia makes an apt comparison.

  169. PJ: The problem with this idea is: Who gets to decide whether a given person is sick due to their own failings or due to forces beyond their control?

    Do we decline to cover pregnancy, as it’s supposedly a preventable condition?

    Do we decline coverage for a child who is ill due to a genetic problem because her parents should’ve known better than to breed?

    Do we decline coverage for an athlete with sports injuries?

    Do we decline coverage for volunteer firefighters who get injured on the job?

    If you’re going to ration coverage based on whether we deserve it, then surely we shouldn’t have police coverage for people without security systems installed in their homes, or fire coverage for people without smoke detectors.

  170. The very best thing about this attitude is that you can always find some way to blame sick people, since nobody is 100% perfect and health-oriented all the time, so that we can pretend depriving them of health care is actually a just, moral act. Back-patting all around!

    I thought they gave out bonuses and called it recission.

  171. I don’t know why Cassie is asking, but I *do* know that systems do not always scale evenly. A simple (and probably totally flawed) analogy is food shipment— covering an area twice as large has different concerns, due to the limited shelf life.

    I suspect the major scaling issue with the US is the heterogenous nature of the country. Coal miners in Kentucky need a different basic structure of health care than urban Manhattanites, and there’s a reason the best accumulation of asthma doctors is in the Willamette Valley of Oregon. This does not mean that a health care plan cannot be scaled— it just means that there are serious concerns about a one-size-fits-all system that might work in a country with one general climate and allergen profile, but falls flat when comparing Arizona to Maine.

    To properly scale, a system must be flexible.

    Incidentally, my problems with the current plans* do not mean I think the health care system is fine. I like mine very much and I would like people to have access to care like it. I personally feel that the best suggestions include decoupling health care from employment.

    *Long version short: I don’t like the way Congress writes laws, see CPSIA for an example (especially the bit where they gave the major reason for the law a waiver from it.)

  172. Mythago @199 There are probably gazillion agencies or businesses that are deliberately understaffed to keep the consumer too frustrated to press for their benefits or services. My point is that a government system that is essentially an insurance program for disabled and retired members is failing to serve in any kind of timely manner. The same government is talking about taking over medical insurance – which requires a far more immediate response. How efficient can a bureaucracy be when it is big as it would need to be to cover 40 million people? Chris Billet @ 186 says the British NHS doesn’t work well for 60 million people.

    And when my husband’s government job decides it’s going to go with the government health care – this will be my health care.

    John is right: this is the battleground. Once a “right” (although I agree with PJ the Barbarian) is granted, it’s not rescinded. I don’t want that “right” given at the expense they propose – even the CBO says the WH has grossly underestimated the initial costs by trillions.

    I am the quintessential American you want to convert. Today I had to decide if my daughter or I was going to get dental care because I can’t afford both. I’m not going to spend money I don’t have. Nor am I going to ask someone else to pay for it.

    If you can’t show me how Obamacare is going to be paid for, you can’t convert me.

    gwangung @ 194 – this is why I’m asking about population and size. Canada has an area roughly the same as ours, but the availability of machines we expect in every hospital seems to an issue there. We hear stories all the time of how long it takes for diagnostic tests and what is considered to be acceptable waiting times before treatment for diseases like cancer to be treated. All I can think is there simply isn’t sufficient equipment and/or trained personnel to manage. If we switch to a nationalized program, will there be adequate equipment and personnel? Medicare already doesn’t pay enough to cover the costs of these tests. Will the new system?

    What I was really asking you was to talk more about this point: We’re more interested in the factors that would hinder a conversion a la Taiwan more than anything else.

  173. I try very hard to be as sanguine as you are, John, then my sainted mother sends me another “death panel” email or treats me to a lengthy Glen Beck quote over dinner. I don’t like reminding the woman who raised me that name-calling, temper tantrums and bald-faced lies are not appropriate ways to resolve a disagreement. The role-reversal is more than a little unsettling.

    For the sake of my own sanity I hope this circus leaves town soon.

  174. Just an observation regarding waiting times.

    For most uninsured Americans, the waiting time is effectively infinity. So when people talk about American waiting times being better on average than some other country’s times, they are throwing out ~1/6th of the data before averaging.

  175. Cassie @197 – I think your concern could be addressed by examining programs like the U.S. Cencus. I assume most other countries must have a similar program, and finding out their budgets should be a matter of some Googling. If the budget scales linearly with the population, you have your answer. Admittedly, there is a lot of hand waving there, but its the closest you are going to get to a definitive answer.

    I suspect the cost issues you raise fall into the “lies, damn lies, and statistics” category. Ultimately, any budget numbers based on incomplete legislation are so much chafe. No one can cite you credible numbers, because they simply do not exist. Anyone who does is trying to scare you or sell you something. The CBO report you mention was in fact a preliminary estimate, and they released a follow up 4 days later stating the net increase would be only 65 Billion. A big number, but given the total budget not that bad:

    http://cboblog.cbo.gov/?p=332

  176. Josh Jasper@156
    Upon further consideration I have come to the conclusion that you are making these numbers up.
    After a little google work I found all kinds of numbers for an apendectomy. List price vs insurance company price, lapro vs slice and dice. An insane variation. Yet you threw out $5000 to $20,000 without any info as to what procedure was done whether there were complications. Had it burst yet? How long was I in the hospital.
    Then you throw out $100K for a car crash. How can you put any kind of a price on a car crash? Without some specifics about the car crash any number would be total fiction. $100K for a broken nose from the airbag what a rip off. On the other hand $100K for multiple brain surguries and other surguries for internal issues would a bargain.
    I won’t bother with anymore because once I decide someone is blowing smoke I quit listening.
    Thus my frustration with debate. You can sound like you know what you are talking about and still be totally wrong.

  177. Cassie, if you’re going to quote me, don’t warp what I said, and spell my name right. I said that the NHS is a conceptual role model, not the a health service executed (ok, bad choice of words!) in a perfect way. It has plenty of plus points (the very idiology, the price, the, err, not leaving people to die on the doorstep because they don’t have a coverage plan) but it just has some flaws, ‘cos it was hammered together in 1948 and as such can’t be expected to be entirely more efficient than a computer the size of a house from a similar era. What it is, though, is the correct thing to do. The day I think there’s really a two sided argument on health care (rather than two groups of polarised people who both have good points, but are largely split into the camps of selfish and empathic) will be the day that an unensurable person steps up in defence of the current system.

  178. I am Canadian. I live in Canada. I follow US politics alot and this debate.

    In Canada Health Care can not even be debated… in fact many recent elections have been faught on the idea the more right wing conservative party is against medicare…. and wants for profit health care… that they are “American”.

    However in reality all federal politcal parties are pro medicare… in fact in Canada it is kinda silly to debate medicare because that is a provincial juristiction not federal.

    But it is worth noting to Americans… health care is always the number one issue in every eklection federal or provincial…. it cost alot to have government health care… and we debate the details and nuances of it… how to make it better. No one even considers not having it.

    We debate things like the Ontario government saying we will have to pay $50 or $60 for an eye test…. and always waiting times for surgery for things like knees and hips. We.. in some areas have too long of a waiting time n cancer treatment…. not in all cities or provinces but in some jurisdictions. That is where the right wing brought Canada inot your health care discussion… but it is not entirely fair what they have been saying.

    In most places in Canada if you have a heart attack you will be treated immediately by the most competent doctors and you don’t pay a cent.. if you are a bum or a rich person. If you have cancer… you get treated… probably not unlike you do in the USA… unless you are uber rich or have some kind of platinum health care plan most people do not have even if insured.

    No one (or few do) ever go bankrupt because they get sick…. people live longer….

    Canada has 33 million people…. if we had the US system 8 million would have no health care…. several more million would get dicked around.. pay much out of pocket due to crap insurance.

    There are many problems in Canada with our helath care system.. there are not enough doctors… or nurses in some areas… esspecially family doctors.. many go to the US to work.. but it is also inherant in Canasda because we do not accept enough into medical school.

    In Canada… even those that love the USA are puzzled and shocked by your healthcare system… Even if you are insured you dick around…. We go to the hospital give our health card and get treated… no paperwork.

    We constantly debate health care in Canada… there are flaws and problems…. it is nothing compared to yopur system… and you only debate it now… the last few months… in Canada it would be debated everyday for the last several decades. Health care is #1 for us.. and we spend half as much per person as you do and have better end results…. though I admit the top end of helath care is the best in the world in the USA… for the average guy… not just the uninsured.. I don’t think it is bettet thsan it is in Canada.

  179. Adding another trillion and expecting to pay for it with taxes – we can’t afford this. I don’t see how we can afford it.

    Of course we can. We’re the richest nation on Earth.

    What it would take is the political will and a public willingness to pay for these services. There also has to be a public willingness to deal with the inevitable downsides of whatever system we implement.

    In Canada, the government bargains for lower rates. Also, doctor’s offices have one, maybe two people handling their billing–everyone knows what will be paid for, there’s no denials that have to be resubmitted. No pre-auths. But they also have to wait for elective procedures. Sometimes, depending on your province/territory, it’s a long wait.

    In France, doctors are paid less than they’re paid here–so much less that they struck for better wages not too long ago.

    In Japan, costs are kept very, very low–so low that many doctors complain about reimbursement rates and office visits can be lightning quick.

    In the U.S. we had 18,000 medically preventable deaths last year, according to the Urban League. Our infant mortality rates are shameful. We had over 700,000 medical bankruptcies. Last year, twenty-five percent of the population didn’t get treatment/medications because they couldn’t afford them.

    How do you calculate a “wait time” for a person who didn’t go to the doctor when they were sick? What number do you give that? Infinity? Or maybe just life expectancy minus current age.

    We are the richest nation on Earth. Who’s kidding who about what we can afford?

    Frankly, people talk too much about the public option (quick note to Avatar: the public option will only be available to people entering the private market–the current bill has employer mandated coverage). The public option is great and I’d sign up for it, depending on the details, so I could quit my day job and write full time.

    However, what’s more important is subsidies for people who qualify for Medicaid.

    Also, the health insurance exchanges are going to be vital. Some parts of the country are virtual health insurance monopolies. A national exchange–or even a multi-state regional one–that can’t pick and choose patients, practice recission or overcharge based on medical history would open up this country to entrepreneurs and start up businesses like you wouldn’t believe.

    It would be even better if the public option were part of that.

    And John, I wish I believed that Obama was letting the lying windbags of his opposition scream themselves hoarse. In truth, he knows that lies have a powerful effect, even after they’ve been disproven.

  180. My two cents: there ought to be a law that disallows health insurance companies from being for-profit. That would solve a whole lot of things, I think.

  181. The one group (or set of groups) that haven’t been mentioned so far are the health insurance industry, the Pharma industry and the astroturf creating agencys they hire.

    I believe, if the reports of the back door deals are correct, that Obama believed that those groups would stand by their part of the deal (sucker) and stay out of the discussion. When they started leaning on the politicians (on both sides of the isle) that have already been bought and astroturfing healthy chunks of the audience at the town halls, Obama realized that he needed to respond. Ooops.

    Astroturfing? Yes, Dick Army’s history and slime trail over the last several months are just the first example. If they carded at the doors and only let district residents in, you would have only seen 12% to 18% of the shouters yelling their paid-for faux outrage.

  182. Weena –
    I found myself mentally substituting “U.S.” for “Indonesia,” and found that I would not have found such an article surprising about our own situation. So at least for now, I suggest that Indonesia makes an apt comparison.

    Indonesia’s economy has been ravaged by colonialism, massive systemic corruption on a scale the US has never experienced, ethnic tensions that resulted in the exodus of a large portion of wealthy Chinese citizens, military coups, and a vicious dictator who regularly “disappeared” political rivals.

    An apt comparison? Just because it has a lot of people? Please stop embarrassing yourself.

    Rembrant –
    Upon further consideration I have come to the conclusion that you are making these numbers up.

    Nope. I googled a bit for the average costs of common surgeries, and those are the ranges that were given. The figures for the “car crash” case came from major surgery due to trauma to several locations.

    A broken nose form a car crash would probably be about $2000-$3000 – Ambulance, hospital bed fee, cat scan costs, and doctors consultation, possibly setting the nose, an incidentals like painkillers. Cheaper if you drive there on your own. And of course, ambulance fees vary form state to state.


    I won’t bother with anymore because once I decide someone is blowing smoke I quit listening.

    You accuse me of bad faith, of lying? Look, there’s a big huge internet right in front of you. If you don’t like my research, do your own if you can figure out how. Next time you ask a question that a few seconds and a search engine can solve, I won’t be so polite.

  183. Josh I am pretty sure that Weena meant that remark to be humorous and critical of our current health care system. Maybe the embarassment is on the other foot this time.

  184. Nargel, “you would have only seen 12% to 18% of the shouters yelling”

    I’m not so sure about that. The political landscape didn’t change with Obama’s election (we’re still roughly divided the same as before). What you’re seeing is people who for a long time felt the country was going their way. It no longer feels like it is to them. This makes them confused and unhappy.

    Then comes sophisticated marketing (of which the various blowhards are a part of) which tells them, “this is why you’re upset and angry, it’s them.” So, while the same points keep coming up only to be shot down (or reinforced by representatives who know nothing of their jobs, or at least can’t explain them very well) it’s mostly because they’re provided the script from the afore mentioned blowhards, not that they’re paid stooges.

    This is what’s known in other quarters as viral marketing.

    But people are upset. They feel something has gone terribly wrong in their world and they’re scared of the change. It’s those people who fall for the marketing program because it gives them answers.

    The rest of how they behave is psychology.

  185. As an outside (Canadian) observer, all I can say is: My god, a thoughtful, calm, litterate opinion on the healthcare reform? This man can’t be American. Because honestly, the more I watch coverage about what’s going on on your side of the border, the more I think of moving to Europe, just so the crazy has that much more distance to go before it rubs off…

    I think what I mean is, man I wish we had more of this kind of analysis and discussion in mainstream US media, it just might give us some hope that America isn’t on its way to some post-apocalyptic nutjobs running amok in the streets with guns future.

    Kudos, Mr Scalzi. Ever thought of starting your own political news show? It’d be a welcome change of style in the genre.

  186. The question of whether the government should be involved in healthcare (through such programs as Medicare) is one that’s usually ignored.

    It’s not at all clear to me whether the people who want government not to be involved in Medicare want that, or are unaware that Medicare is a government program. Given the ambiguity in reporting, it could be either.

  187. PalookaJoe@198 – I am sorry to say that I am in a very similar situation with my extended family. Unfortunately, the minute this circus leaves town another one will arrive. I try my best to make reasonable arguments but never seem to make any progress. (This includes discussing religion, or politics).

    I really want to contribute constructively to the interesting and important dialogue taking place here but I think my boss would feel that my time is better spent working.

    Lets just say that I am for a national health system even if it means higher taxes. I would rather that my tax money be used to create a system designed to care for all citizens.

    I really don’t know how we can get to a realistic, sustainable, and accessible National Health System (much like inventing a perpetual motion machine – it sounds good on paper but other factors seem to get in the way).

    Rabid

  188. As far as political maneuvering goes, the other thing I think is going on is that Obama tends to spend his political capital only when a bill reaches the conference committee between house and senate. That’s where he has the greatest leverage, since he only has to deal with the members of the committee, and not the members of the 5 or 6 different committees that are currently putting bills together, plus the congress-critters as a whole. That’s what he did on the stimulus bill, and his inaction on healthcare up until August echoes that strategy.

    Another reason to wait until conference is that just about any amendment that has a chance of passing can get put into a bill during conference. So he could end up with a bill that is further to the left of either the house or senate bill coming in. I doubt this will happen, because he’d have a hard time whipping the blue dogs into line, but I do expect that whatever bill comes out of conference will generally take the more “liberal” portions of the incoming bills.

    I’m not sure if there was a strategy to have the president play the calm, rational leader after he’d given the right enough rope to hang itself or if that was developed as a tactical response to the mind-share that the right was gaining. I’m not even sure if he has responded forcefully enough to counter all the hyperbole. But I suspect that things will be a lot more polarized on the issue when congress comes back from recess, and the dems will be forced to abandon both bi-partisanship and the pretense of it.

    As far as my view: I have a very real fear that what will come up will be a half-assed bill that raises costs to consumers, rations payments to doctors even more than they are, and doesn’t do enough to wring administrative and eligibility costs out of the system. Part of the savings in countries that are fully socialized (UK) or single-payer (Canada) is that there is only ONE claim form, one processing system, and no denial of eligibility. This also eliminates the whole collections expense for unpaid medical bills, or at least reduces it to collecting the co-payment. The only gaming that goes on in single payer is claims for treatments never given or exaggeration of treatment into more expensive payouts, i.e., out and out fraud by doctors or doctors in collusion with patients.

    If we come out with a half-assed system that doesn’t work the way it’s planned, “How do we pay for it?” is a very real question. Even with tax increases, the whole thing could get abandoned by 2016 and the US would be scared out of public health care for at least another generation.

  189. Chris Billett@186 and 202 Mea culpa on the name. I should just copy names instead of going from memory.

    However, I will stand by my interpretation of what you said in 186. “Executed badly” can be understood as “doesn’t work.”

    PeterP @200 given the total budget Yeah, that total budget takes my breath away. People say that we’re the richest nation, we can pay for anything we want. The GDP is $13 trillion – we’re anticipating a $7 trillion deficit.

    That scares me. I remember the malaise of the 1970s.

    Melendwyr @ 213 I don’t want the government involved in my health care. Period. I also don’t want my husband’s employer involved. It seems to me that when a third party enters a transaction, the costs to me go up. That includes private insurance as well. Suppose we went back to a system where insurance was used for catastrophic medical events and not for every visit, blood test and x-ray? Would the marketplace drive those prices down? If I had to pay for those out of pocket, would doctors and labs drop prices?

    Bozo @ 215 In this political debate, no one seems to know what’s coming. I’ve contacted both of my senators and asked “Have you read the bill?” and neither answered the question. I do hear people reading the bill asking serious questions that aren’t getting answers from the people who will be voting on it. I fear we’ll have another pork-ridden mess that will be voted on long before anyone has a chance to read and think about the consequences, intended and unintended.

    The resulting half-assery of any law passed won’t have just the possibility of crashing and burning national health care for just the next generation. It’s going to effect me now. This will almost certainly become my health care because my husband is a government employee.

    Off to the county fair.

    John, another enlightening and reasonable discussion. What are we going to do if we get used to this? Who else is going to provide it?

  190. My partner is completely uncovered by any insurance and has some chronic health problems. The cost of keeping him going has put me so far into the red that if my rent is increased at all, we are likely to end up on the sidewalk with 2 kids and a pile of household goods. My credit has been so bombed by the bill-juggling and slipping that we will probably never be able to buy a house or new car, but that is far past the horizon and I am too numb to care much. I am more worried about groceries between now and the next paycheck.

    I am a federal government employee and have good insurance for myself and the kids, but he can’t be covered because he is not legally “family” to the federal government. The leave time I’ve burned up taking care of him means I will go into leave without pay if any of us gets the flu and has prevented me following up on a treatment I should get because I simply can’t take the time off work and because the bills for his medical expenses make me choose between meds & food or copays that can be deferred. (I can only pray I keep going until I can eke out a little leave and cash.)

    If he were legally family, I would only get unpaid family leave if we were legally related, so that doesn’t get me anything but tidier bookkeeping anyway. None of his significant health expenses would be covered by my insurance for the first year, because they are for pre-existing conditions. The only real change for that first year is that I would be on the hook for his emergency room bills, because we would still have to go to the ER whenever he has an episode.

    As far as I’m concerned, the current system is already a death panel that has decided we should just go away and die (but out of sight because being homeless on the street is illegal, too). People could argue I got here by my own choices and don’t deserve their money. You may be unmoved by an appeal to simple human kindness and decency. But you need to understand that we are you after one or two unforeseen bumps in the road.

    The politicians can argue all they want over details, but as Our Scalzi points out, the fundamental question is “Do we commit to providing everyone health care? Or not?” Do we condemn millions of people like us and like you to needless suffering, or do we step up and do something about it? “That which is hateful to you, do not unto another: This is the whole Torah. The rest is commentary — [and now] go study.” If Obama can get just enough passed so that all that’s is left is commentary, it will be a real victory.

  191. Cassie @197, but if the argument is “we should not rely on this huge, inefficient, uncaring bureaucracy for our health care,” that knocks just about every private insurer out of the running. What you’re describing – one’s employer switching to an awful plan with nothing you can do about it – is exactly what happens to people who have health insurance not provided by the government.

    So as somebody who is facing this right now, and who has had single-payer insurance (in Canada), I’m really willing to take my chances on this one. The worst result is “they are as bad as a private insurer”? Hey, I’ll risk it.

    I’m especially willing to play those odds because what drives insurance-company evil is the profit motive, and that (for good and bad) is absent in a government plan. Private insurance companies have changed their profit model from ‘underwrite wisely’ to ‘take premiums, don’t pay claims’.

  192. mythago:

    Cassie @197, but if the argument is “we should not rely on this huge, inefficient, uncaring bureaucracy for our health care,” that knocks just about every private insurer out of the running.

    I keep seeing this error. Insurance companies cannot be a way for a society to pay for society-level health care, because the concept of insurance doesn’t permit that.

    Even if I thought creating a “right to health care” was possible or desirable, implementing it that way is neither. People talk about insurance companies as though their function were to pay for medical claims, instead of offering insurance against the possibility of medical claims.

  193. cassie

    gwangung @ 194 – this is why I’m asking about population and size. Canada has an area roughly the same as ours, but the availability of machines we expect in every hospital seems to an issue there. We hear stories all the time of how long it takes for diagnostic tests and what is considered to be acceptable waiting times before treatment for diseases like cancer to be treated. All I can think is there simply isn’t sufficient equipment and/or trained personnel to manage. If we switch to a nationalized program, will there be adequate equipment and personnel? Medicare already doesn’t pay enough to cover the costs of these tests. Will the new system?

    I think you will need to compare wait times under US systems to these quoted numbers from other countries (which are, after all, maximum wait times). My impression is that we are already at those wait times with our current system; there is no difference.

    Rembrant:

    Josh Jasper@156
    Upon further consideration I have come to the conclusion that you are making these numbers up.

    Myself, I’ve quoted at least one instance where the cost of an appendectomy is in the upper range of the numbers quoted by Josh Jasper.
    And the other numbers are not out of line of other cases I’ve seen.

    Upon further consideration, I COULD conclude that you’re not worthy of further debate, but, after all, ignorance is curable.

  194. Mythago@218,

    What you said! i’ve gotta admit, I’m a little tired of the ‘faceless, evil govermment employee’ rap. I’m a government employee myself, and I not only have a face, but I care about my customers and do my best to assist them. Nobody’s giving me bonuses to deny them service, unlike the recission bonuses given by certain for-profit insurance companies.

  195. melendwyr @219, we have a health-care system set up with “insurance will pay” as the baseline. It’s as if not having comprehensive auto insurance meant most repair shops wouldn’t even look at your car, and an oil change would set you back $500 out of pocket; or after getting $25,000 worth of repairs done to your engine, your insurance company informed you that because you listed the car’s color as ‘red’ rather than ‘magenta’ they were retroactively canceling coverage.

    I’m also confused by your distinction about paying for medical claims. The function of an insurance company is, in return for premiums, to pay non-fraudulent claims covered by the insurance policy. Again, as our health-care system is set up, ordinary, everyday medical care is supposed to be a claim covered by insurance.

    Pam @221, I do want to be clear that I was not dissing Cassie or defending government slothery; but ‘they’re slow except when they want your money’ is, as far as I can tell, not a unique government characteristic. Also (and to be clear again, I am not attributing this point of view to Cassie), I am eternally baffled by people who complain about government employees’ salary and benefits, then complain that government employees are uncaring or incompetent. Why, that would be the market at work, wouldn’t it?

  196. @222: melendwyr @219, we have a health-care system set up with “insurance will pay” as the baseline.

    No, which is precisely why so many people cannot afford health care – which is why there’s so much clamor for a government system!

    @222-2:Again, as our health-care system is set up, ordinary, everyday medical care is supposed to be a claim covered by insurance.

    If you have it, then yes. But how do you imagine scheduled, predictable costs like yearly checkups are paid for? Saying “the insurance covers it” is meaningless, as insurance cannot pay for costs that can be reliably anticipated.

    Even if we imagine a magical insurance company that had no interest in profits and did everything for free (somehow), the money going out must equal the money coming in. Which means that if everyone who’s part of the insurance plan gets regular checkups and the like, everyone has to pay for them.

    Insurance exists to mitigate risk. When there is no risk because the cost is a certainty, insurance cannot and does not handle it. Our system doesn’t work that way because we no longer have actual insurance. ‘Insurance’ has mostly become a middleman method for employers to pay for health care costs for their employees.

  197. ‘Insurance’ has mostly become a middleman method for employers to pay for health care costs for their employees.

    I actually agree that this is a problem. The solution is for health care to be affordably out-of-pocket except for catastrophic costs. I don’t think the AMA will go for that.

  198. At a Texas-Wants-To-Secede-From-The-US rally:

    protestors at the rally were carrying signs of Obama with Joker makeup and the word “Socialist” underneath. At one point, a counter protester shouted “Healthcare for anyone who can’t pay for it.” To which a protester with a Obama-Joker poster walked up to him and said “Health care? You know… Get a job! Just get a job! Get a job!”

    This same logic from people arguing that the federal government is “oppressive” only a few months after accepting 17 BILLION dollars in federal stimulus money.

    The short answer seems to be that these people are flat out insane and immune to logic.

    http://www.warhw.com/2009/09/01/texas-wants-to-be-a-third-world-country/

  199. You’d have to break the guild monopoly for that to be possible.

    Not a lot of people recognize that the field of medicine is essentially the last surviving medieval guild system. Doctors decide who’s offered the opportunity to become a doctor, and the legal system is set up to give them all sorts of special privileges – including the criminalization of anyone attempting medical care outside of the system. So they control the supply of a valuable resource, even if that resource exists only because of legal fiat.

  200. Melendwyr@223: “Insurance exists to mitigate risk. When there is no risk because the cost is a certainty, insurance cannot and does not handle it.” Too true. In the real world, insurance adds overhead and inefficiency to predictable costs like checkups. Yet, everyone thinks of the healthcare funding debate as a debate about public vs. private insurance.

    The real ideological debate here is two questions: 1) “Should we have a health care funding system that provides a minimum level of service for predictable costs to all people in the US, regardless of their individual ability to pay?”
    and 2) “How do we share the risk of unpredictable health care costs to minimize the impact of these costs on individuals?”

    No one is really addressing the contradiction between a regulated “free-market” “insurance” system and the desirability of covering predictable medical costs. The current debate is really centering on #2, which means we are going to end up with an inefficient answer to #1 regardless of whether it’s a free-market solution or a “socialist” solution.

  201. Melendwyr@226: Lawyers and Professional Engineers have the same sort of system with criminal penalties.

  202. “Maybe Obama and the Democrats are indeed so disorganized that they’ll be defeated by a bunch of froth-flecked ignorami, but I think it’s also entirely possible that they recognize that the best way to deal with these people is not to yank on their chain but to give them enough rope to hang themselves.”

    How’s that working out so far?

  203. “Your take on things gives me hope. Because yeah, that IS how Obama does things — hang back, be mellow, let the other guys make the first mistakes.”

    Yeah, like when he tricked the other guys into likening universal health care to the United States Postal Service. Go get ‘em, Barack!

  204. melendwyr@226: Not a lot of people recognize that the field of medicine is essentially the last surviving medieval guild system.

    Oh good lord.

    yeah, get rid of medical licensing and the FDA and all that and just let consumers regulate doctors and medicines based solely on which doctor and medicine they pay for. Deregulate everything and the invisible hand will make it all work out perfectly.

  205. give them enough rope to hang themselves.

    Jim@229: How’s that working out so far?

    This one was pretty hilarious:

    http://www.warhw.com/2009/09/01/olsons-very-brief-town-hall-meeting/

    At a town hall meeting, a republican representative tried to tell a story about “Britney” who was having trouble getting treatment for her unborn child’s heart condition. He then used that as a case example for why he opposed health care reform.

    People in the audience started calling him on his bullshit and pointed out that “Britney” was turned down by private insurance, not some government plan, therefore she should be an example in support of why we should have a public option.

    The representative shut down the meeting within 47 seconds.

  206. Cassie:

    1) As Mythago pointed out, the insurance companies, of which there are only a few giant ones, are also big bureaucracies that can take forever to approve you as insured, take forever with claims, lose your claim information, refuse to pay claims, require you to hire a lawyer to deal with them, and instantly demand that you re-pay them anything they overpaid. (Had that happen to me with my insurer.) Anything large moves slow. But the odds are a lot better that you can eventually get money due you from the government than from a private insurance company. You get an enormous number of services from the government on a regular basis, which they’ve so far managed to provide without collapse. The same cannot be said for many private insurance companies.

    2) Social Security is funded by payroll taxes, which is only one kind of tax, which is facing a decrease as younger generations are smaller than Social Security withdrawing generations. Social Security has also been consistently raided of its cash by Republican-controlled Congresses for decades, so of course it’s under-staffed. And why they’re trying to fix it. Healthcare is a completely different type of program and not funded purely by taxes or one kind of tax, nor could it be raided for budget needs, and comparing healthcare to Social Security is the same pointless enterprise as comparing procedure wait times to a ten minute line at the DMV.

    3) The cost of the plan is estimated at a trillion over TEN years, not up front all at once — and that’s one estimate. There is data that it might end up being less. That’s $100 billion a year or so, which is a big number — until you compare it to the fire sale financial bail-out that happened in a matter of weeks last year. A lot of that bailout money went to AIG, one of the biggest health insurers to whom you may well be paying your insurance premiums. But they took your money and played with it in derivatives and almost went under. They could only get the U.S. government to help them — since Goldman Sachs was calling in their loans, but unlike them, the U.S. government has a number of ways to make and raise money, taxes being only one of them. Overall, if we can afford defense contractors and a financial bailout once a decade — which we’ve been doing — we can afford healthcare.

    4) We have 47 million uninsured people in the U.S. and it’s going to get worse. These people are a huge financial drain on the economy and the government, both directly (lost taxes, emergency healthcare, serious illness costs, social services and unemployment insurance due to poor health, etc.) and indirectly (bankruptcies and mortgage foreclosures due to medical bills, homeless shelters, small businesses losing people and profits because they can’t afford to give healthcare benefits, etc.) In effect, you currently ARE paying for them and have been for decades. And they cost us trillions. And the more poor and sick we have, the worse our economy, which right now doesn’t exactly help recovery.

    5) Healthcare reform is not putting everyone in the care of the government. It’s putting millions of people whom the private insurers don’t want to insure on basic preventive and early healthcare. And it will force private insurers to take those who do qualify and not throw them off policies, lower their premiums to more reasonable profits, pay claims, and get the healthcare industry to lower its over-inflated costs. In everything from dealing with diabetes and heart disease to infectious diseases, we’ll be potentially saving money by reducing the need for care and the cost of care.

    6) Universal health care countries like Canada and the U.K. have private insurers, because those who can afford it, usually through their employer, get supplemental policies to pay for uncovered things like prescription drugs, dental costs and lab tests. So not only are they not the boogeyman, but their systems are not that far away from our own. We can take the things from theirs that seem to be working and avoid some of the obstacles they’ve already faced.

    7) Most Americans, by and large, are not going to be funding healthcare reform. It’s designed to come mainly from well-off individuals and wealthy businesses who have been getting routine tax cuts for the last decades of Republican-controlled Congress, for far more lucrative capital gains and investment income, rather than just job income. By repealing some — not all — of those tax cuts, healthcare for all does become doable. Essentially, they lose a free lunch in return for potential long-term profits for all.

    We can’t afford not to have healthcare reform. It’s costing too much and getting worse. It’s eating up too much of our GDP for not enough in return. Having one-sixth of our population not have workable access to healthcare is a disaster.

  207. that every American must have access to basic and comprehensive health care.

    Everyone has access to that right now. You cannot ‘not’ get health care. Everyone can walk into an emergency room and get treated. The problem is that it is prohibitively expensive, and can easily bankrupt an individual. To folks with money it has less impact than those who have little, or nothing, That’s where we need reform.

    A right is not granted by anyone. It exists by itself.

    Furthermore, a right doesn’t exist if it has to be confiscated FROM someone else. It exists without support.

    I’d suggest that food is a singularly more significant item to sustain existence than health care. Why isn’t food a right then? Because it is someone’s property. You cannot take from me without compensation that which I own, or have created. Property rights are the first “Rights” prescribed in the Constitution.

  208. Regarding “how we’re going to pay for it” it’s worth pointing out that we’re already paying more per capita than any of the other first world nations.

    The real question should be “How can we pay for it now”? Medicare costs are skyrocketing, but you know what’s going up even faster? Private health insurance costs. Wages are flat but employers are paying more and more for their workers–it’s just that the new funds are being funneled to Aetna, Cigna and the rest.

    “How can we afford to cover everyone?” Here’s an answer: if we were to copy the British NHS and implement it here–we won’t, not ever, but let’s pretend–the benefit would not be that every American would get health care. It’s that every American would get health care and four thousand dollars to spend every year. Why? Because of reform.

    We’re not going to get that, of course, because our political system to too vulnerable to big money, FUD, and mistrust of the officials we ourselves vote for.

    But don’t say we can’t afford reform. It’s the system we have now that we can’t afford.

  209. Let me clear up a commonly held fallacy

    Everyone has access to that right (*) now. You cannot ‘not’ get health care. Everyone can walk into an emergency room and get treated.

    Walking into an emergency room and getting “treated” is in no universe in which sane people inhabit an acceptable form of “health care”. Actual health care (not emergency care) involves a preventative checkups, long term care if needed, and a whole host of other things.

    ER services != Health care.

    Are we all clear on that? If you think otherwise you are wrong. It’s that simple.

    (* access to basic and comprehensive health care.)

  210. Greg @232, I don’t think the argument was for getting rid of medical regulation – only that the closed system is in part designed to keep fees high by limiting the number of people who can provide services.

    juanitocabrone @235, that’s a little bit like saying everybody has enough to eat because they can Dumpster-drive.

  211. juanito@235: Property rights are the first “Rights” prescribed in the Constitution.

    Actually, the phrase is “life, liberty, and the pursuit of happiness”, which came from John Locke’s “Life, health, Liberty, or Possessions”

    Locke assumed that the sole right to defend in the state of nature was not enough, so people established a civil society to resolve conflicts in a civil way with help from government in a state of society.

    Pretty bright man. Bright enough that Jefferson cribbed from him.

  212. juanitocabrone:

    “A right is not granted by anyone. It exists by itself.”

    Sorry, that’s stupid. Rights are created; in the United States these rights were created and protected by the US Constitution initially, with state constitutions enumerating other rights, and so on down the line.

    “Why isn’t food a right then? Because it is someone’s property.”

    This is also stupid. Food existed before the concept of property, as evidenced by one and a half billion years of life that existed before the advent of humanity and its ability to conceptualize.

    Juanito Cabrone, I suggest you not try to express any further deep philosophical thoughts that are not directly on point to the discussion of health care.

  213. John Scalzi: “When you factor in the fact that 49 other countries in the world have a higher life expectancy for its citizens than the US (and that many of those have some sort of universal care), and that in general life expectancies have been increasing around the world, no, it’s not really that interesting.”

    Why do people never note that those nations are largely homogeneous, almost always much smaller, and contain people who live healthier lifestyles? Do any of those nations have tens of millions of poor, undereducated immigrants distorting the data? If nations with healthier, homogeneous populations cannot provide universal care without rationing services, how is the US supposed to pull this off? Is ignorance as blissful as advertised?

  214. We’ve created programs such as food stamps, soup kitchens, and others to try and keep people from starving to death.

    The thing is medical care is fundamentally different from food. You need food every day. It only costs a little bit a day to eat, but it’s fairly consistent.

    Medical care is like a reverse lottery that you’re forced to play. If your number comes up, you get cancer and a shit load of medical bills. If your number doesn’t come up, you stay healthy and don’t spend any money at all.

    The problem is that idiots start to invent fallacies of causation. They start to believe that people only get sick and have medical bill problems because they deserve those problems. The texan secesionists who shouted “get a job!” to the people supporting health care reform, they think the problem is simply that people are lazy, and they can’t fathom that private insurance might throw them under the bus or that they might get laid off or whatever.

    The opposition to food stamps is often the same though. It’s the argument that people on foodstamps must be lazy, that they must deserve to go hungry. And then they portray the gummint as upsetting this natural balance where the lazy are allowed to starve to death.

    What’s just so unbelievably amazing is how the health care reform debate is boiling down into purely political lines. Conservatives are opposing government health care as wrong and immoral even if they happen to be over 65 and on Medicare themselves. They feel they deserve medicare for whatever reason, but that those under 65 can’t possibly deserve it.

    So, yeah, food is a “right” to the extent that the government tries to help those who are starving. With medical bills, it’s not a few dollars a day, it’s more like a completely random inverse lottery. If your number comes up, you’re screwed. It’s just that people aren’t looking it as something random, they think people deserve what they’re getting.

  215. Jim Treacher @ 230, the USPS delivers billions of pieces of mail and tons of packages every year quickly and for a good price (think $.47 is too much, send the same letter FedEx) (a href=”http://www.usps.com/financials/anrpt08/pg62.htm”>from their yearly report). And for a much maligned part of the federal government, people are making an awful stink about them going to five day delivery. Doesn’t sound like so much of a failed business to me. Private companies could only wish they could match that level of performance.

  216. stickeenotes: tens of millions of poor, undereducated immigrants distorting the data

    Is anyone else catching a wiff of racism or is it just me?

    homogeneous populations

    (sniff) (sniff) there it is again.

    If nations with healthier, homogeneous populations cannot provide universal care without rationing services

    “rationing care”! ooh, ooh, buzzword bingo.

    First of all, please let me know which countries you’re accusing of “rationing care”. Who is “killing grandma” to save money.

    Specific nations, please.

  217. StickeeNotes @242, you obviously haven’t been paying attention what’s been happening in Europe, especially France and the crossings from Africa.

    (sorry for the double post John).

  218. StickeeNotes:

    “Is ignorance as blissful as advertised?”

    You tell us, Stickee.

    Otherwise, what you’re doing is making my point, which is that in itself, this statistic is not particularly useful in the overall discussion, because in itself, it doesn’t say anything about underlying factors.

  219. @ Jim Treacher – Given that the study was for a single type of diabetes, it’s not at all applicable to different preventative measures. Increasing cervical cancer screening to include more women who don’t get regular tests because of having no insurance, for example, is a no brainier. Money and lies will be saved if we screen more often among people who don’t get regular checkups.

  220. First of all, please let me know which countries you’re accusing of “rationing care”. Who is “killing grandma” to save money.

    Hm. Isn’t stickeenotes talking about the countries that usually have longer life expectancies than the US?

    Sounds like we’re commenting on a post that isn’t internally consistent….

  221. I was just playing buzzword bingo on that one. “Rationing care” is like, center square, or something, I think, right next to “killing grandma”.

    I’m just trying to get five in a row here.

  222. @Jim Treacher #237: The savings would come over the long term, much longer than the 10-year window that the CBO uses.

    About preventative care: Denying citizens preventative care is definitely “cheaper.” It’s very cost-effective for a person to fall down dead in the street from a heart attack. The ambulance picks them up, takes them to the hospital, they’re declared dead. Very cheap.

    You know what’s more expensive? Seeing a doctor, who does lab tests, who informs you that you have heart disease, then prescribes medication and schedules followup visits.

    Of course, going the more expensive route means the patient still has a job, pays taxes, raises their kids, and waves swastikas as town hall meetings. It also means they’ll probably die when they’re much older, probably of a more expensive disease.

    I’ll take preventative care for every American, thanks.

  223. @ Jim Treacher: as Josh says the study only shows the Diabetes savings. There are a lot of other chronic conditions like asymptomatic hypertension – because when your BP is high enough to feel it, you’ve more problems.

    You can run for years at 140/90s or higher and notice nothing. I was up to 160/105 (work related stress) without noticing a thing. Run that for a few years and the first symptom will be a Myocardial Infaction and a serious spell in ER with probable surgery and a nice ICU visit. That’s bankruptcy there and then for anybody without a few hundred thousand spare.

  224. John: Thanks for continuing to respond to all the arguements even if I don’t agree with much of your points.

    People are denied health care in every corner of the world every single day. US private health insurers deny certain medical care. US government health care denies certain medical care buy limiting options available through Medicare/Medicaid. So do Canada/UK/France, etc.

    Private insurers do this so they either don’t go out of business or so they don’t charge everyone a 300% increase in their premiums. The government-run insures do this because they can only raise so much revenue and because they have limited (or plain run out) of supply.

    You will only fix (or at least mitigate) this problem by reducing the cost of health care itself — not the cost of health insurance. If insurance was needed to cover procedures that only cost ten dollars as opposed to ten thousand dollars (exaggerating to demonstrate the point) the insurance to cover that would be quite small.

    Because this problem can’t be fixed overnight or even over 5-10 years, let’s start with a few things that are almost guaranteed to reduce costs. Tort reform and allow insurance to be purchased out-of-state.

    (My apologies if this next point has been stated before. 255 comments at this point.) Preventative care for everyone does not save money for the entire system. Some people just never get sick no matter what. Therefore, any money spent on preventative care is essentially wasted. For example, somehow not everyone who smokes dies as a result. So smoking cessation programs sound nice but would cost more in the long run. The CBO has said this, as has everyone else who stops and thinks about it for a few minutes.

    And to Katg@234 the Republicans controlled congress from 1994 to 2006. Both parties have raided the SS surplus practically since it’s inception. Although it was while they were in congressional control the last time the budget was balanced (still raiding though).

  225. By the way, which part of taking over GM and throwing 200+ years of bond holder law is a slight tilt to the left?

  226. gwangung@256, zomg. You just got bingo.

    I’ll keep saying it. people are opposed to health care reform for political reasons. They’re republicans. Or they’re Libertarians. They’re racists. They hate democrats. and they specifically hate Obama.

    It’s no wonder that those who hate Obama so much want to stop calling it “health care reform” and call it “Obamacare” instead. Associate any sort of health care reform with a black president and whip up your fellow racists who will oppose anything Obama does because he’s a Democrat and because he’s black.

    This is what I’ve got on my bingo card so far:

    government accessing bank accounts

    death panels

    government takeover

    killing grandma

    rationing care

    Get a job!

    abortion!

    Obamacare

    Taxing your healthcare benefits

    Waiting time

    Socialism!

    Did I miss any juicy ones?

  227. Awww, Johnny. You dislike the criticism, so you resort to banal responses. That’s just precious. You could have just said that life expectancy data wasn’t pertinent to the discussion, but you then felt the need to site the fact that those nations had some sort of socialized care. This was your backhanded attempt to have your cake and eat it too. I’m sorry I noted this and bruised your ego. Hug it out?

    As for GregLondon. It’s absolutely precious how you resort to accusations of racism, when I’m simply noting a pertinent fact that directly relates to life expectancy data. If you would prefer me to describe rationing as “cost reduction measures” or the “strategic denial of services” I’d be more than happy to use those. How about the denial of potentially life saving drugs in the UK as one example. By the way, NICE, is cute acronym.

    Stephen, I have been paying attention to Europe. I have noted the immigration they are seeing from Africa, and other nations. The significant influx is relatively new and not nearly as significant as the immigration the US has seen over the last few decades. I am a big fan of legal immigration, but it’s naive to believe it does not come with consequences.

    Gwangung, there is no inconsistency since rationing aka the denial of cost prohibitive services has absolutely nothing to do with the overall more healthy personal lifestyles of the homogeneous populations. It does, however, have an impact on those unfortunate enough to get sick in such nations.

    The cutest responses come from those whose intelligence you insult. I imply that John is ignorant and he responds as predicted. It’s adorable how so many of those on the left have their entire sense of self worth wrapped up in their own sense of intellectual superiority. You guys truly brighten my day.

  228. The State must raise the level of national health by means of mother-and-child care, the banning of juvenile labor, achievement of physical fitness through legislation for compulsory gymnastics and sports, and maximum support for all organizations providing physical training for young people.

  229. Greg London:

    You win a pie!

    Stickee:

    “You dislike the criticism, so you resort to banal responses.”

    No, you got a banal response because the criticism was stupid and the snark was mediocre, and that’s what it rated. You can come back when you’re not reading off a right-wing bingo card list, though, and see if you do any better. But you already seem to think you’re pretty darn clever, so, well.

  230. John @ 169

    ‘froth-flecked ignorami’”

    Given their usual habits, it might be as accurate to refer to them as froth-flecked ignoRanti’.

    melendwyr @ 222

    What you ignore is the point that inexpensive ‘wellness’ processes, in the long run, reduce costs by catching problems while they are cheap to fix. Of course this requires that the same firm cover the care for a nonminimal time frame to receive the benefit. Not something you see a lot of in today’s world of new, better-for-the-ins.-company policy (and maybe new company) every year.

  231. “Preventative care for everyone does not save money for the entire system. Some people just never get sick no matter what. Therefore, any money spent on preventative care is essentially wasted.” –John Bear

    So how exactly do we identify those people who never get sick? If there was a way to do that, you might have a point… But unless your doctor’s got a magic wand that isn’t being shared with the rest of the profession, there isn’t a way of telling who’s going to escape serious illness or not — and so preventative care covers some people who might not have needed it, to be sure that it catches those who do.

  232. stickeenotes: It’s absolutely precious how you resort to accusations of racism

    What’s precious is you invoke racism and pretend it isn’t. Actually it isn’t precious. It pretty much stinks.

    What’s cute though is in that long and rambling post at 263 you didn’t list a single country that Let Grandma Die. You make the accusation that all these countries do it, but you don’t list them.

    It’s cute because it makes me think of little kids who shout “Not me!” when accused of doign something wrong, but then hem and haw when asked “Well then who did it?” because they know if they say “Alice”, the first thing the parent will do is check Alice’s alibi and find out she couldn’t have done it.

    What’s the preponderance of data say about Medicare? Are we rationing care there? Are we killing grandmas on Medicare? Because if we are, it’s funny that such facts never came out until Obama wanted to reform health care.

    I’m sure if anyone dug around, they could find some singular case of incompetence or bureacracy that would apparently reinforce their position that government-run health care is a death-sentence. But I don’t see any seniors complaining about Medicare. I don’t see any old folks demanding that the government remove Medicare because it’s killing Grandma and Grandpa.

    What I see, though, is Grandma and Grandpa’s who are on Medicare who are arguing that no one else should get the same benefit they’re getting.

    Grandma and Grandpa aren’t saying no one should have government health insurance including them, and thereby surrendering their medicare. They’re clutching to their government run health insurance while telling others they can’t have any themselves.

    That fact right there, the complete absense of a mass exodus of Grandmas adn Grandpas from Medicare, disproves any invented fantasy you care to whip up about government run insurance.

    If we’re killing grandma and grandpa on government run health insurance, then we should already see that happening on Medicare.

    We’re not. Therefore, you’re wrong.

  233. Ben: So how exactly do we identify those people who never get sick?

    Exactly. It’s reverse lottery. But people in Vegas swear all the time that they’ve got a “system” to beat the house.

  234. John@272, sorry, I was writing 270 while you had deleted 268. sync problem. You can delete 270 if you want symmetry.

  235. @264. Tort Reform = buzz word. It also equals a term that most people can understand instead of speaking in great detail.

    Health care providers carry malpractice insurance. That cost gets included every time you need to see a doctor, get a procedure, etc. The higher the malpractice insurance the more health care costs. You can reduce this insurance in at least two ways. One is to have doctors and medicines that are even better than they are now. (That’s not tort reform though.)

    The second way is to reduce the number of lawsuits and the overall amount awarded through those. That’s were tort reform comes in. The United States is a particularly litiguous society and a decent number of people will sue for any reason for any amount of money, justified or not.

    As a result of this behavior everyone pays more for their health care (whether or not that is paid with insurance). Doctors practice defensive medicine, somewhat out of fear of lawsuits; pharmaceuticals and medical devices cost more to factor in costs of lawsuits; hospitals have higher prices to factor in costs of lawsuits.

    So this buzzword that frightens you so, could mean things like reducing lawsuit awards in general; allow people to waive or reduce their rights to sue (I can already do that with my car insurance).

    Please feel free to contribute any facts to the discussion. As evidenced above, not everyone has them.

  236. 269# Ben T-Gaidin

    “So how exactly do we identify those people who never get sick?”

    You can’t. I never said that you could. That’s why preventative care doesn’t save money for the system as a whole.

  237. GregLondon:

    No worries.

    I’ll note otherwise that stickeenotes met the Loving Mallet of Correction largely because there wasn’t a single post here where he wasn’t gratuitously being a snide dick. I feel being a snide dick here is a privilege, not a right, and he hadn’t leveled up to that point. So, out he went.

  238. “So how exactly do we identify those people who never get sick?”

    You can’t. I never said that you could. That’s why preventative care doesn’t save money for the system as a whole.

    Sorry, but that a) doesn’t make sense, and b) is not true (and really cant be true; it’s like saying preventative maintenance doesn’t save money in cars and planes, when it’s clearly not the case.)

  239. 277 # John Scalzion 01 Sep 2009 at 4:32 pm

    GregLondon:

    No worries.

    I’ll note otherwise that stickeenotes met the Loving Mallet of Correction largely because there wasn’t a single post here where he wasn’t gratuitously being a snide dick. I feel being a snide dick here is a privilege, not a right, and he hadn’t leveled up to that point. So, out he went.

    Pot. Kettle. Black.

    Then I demand snide dick reform! Health Care isn’t a right, and neither is Snide Dickdom! But I want it reformed. And Free!

  240. So, if preventative care doesn’t save money, presumably it’d cost the same (or save money) for everyone if we all gave up on yearly checkups, especially ones that were covered by insurance.

    I’m not the only one finding that idea to be really stupid, right?

  241. John Bear@275 The only thing I would say is that you can not sign away liability.
    The example I would use is the late skate board park industry. You or your parents had to sign a waiver to get in. Yet the parks ended up going out of buisness from litigation and insurance costs.

  242. 279# gwangung

    Sorry, but that a) doesn’t make sense, and b) is not true (and really cant be true; it’s like saying preventative maintenance doesn’t save money in cars and planes, when it’s clearly not the case.)

    It makes perfect sense. Let’s look at everyone that smokes tobacco. Over the course of history do everyone of them die as a result of the smoking? No. So if the smoking doesn’t kill them, then spending money on them to stop is wasted.

    Now repeat with things like obesity. You’ll get the same answer each time.

    Preventative care works only when all or practically all benefit from it.

    And comparing people to cars and planes it what doesn’t make sense.

  243. I would like some evidence that tort reform a) brings down insurance costs in general or b) medical costs in particular. Several states have instituted tort reform of one sort or another and some empirical results should be in.

  244. 282 # John Scalzion 01 Sep 2009 at 4:40 pm

    Clearly – your joint, do as you please. But if you foster snide dickdom, nay, even promote it, then deny it to others, why that’s just not cricket.

    And that is why I plead for snide dickdom reform. Others have it, I am denied it. I haven’t earned it. I want it provided to me by the largess of others. So I shall insist that government take some from you, so I may enjoy it.

    Isn’t that the argument?

    Ah, well, you run a fun joint. Have fun storming the castle.

  245. Preventative maintenance involves the replacement of parts before they can become worn or undergo so much stress that they’re statistically likely to fail catastrophically. They also involve ensuring that things are in the proper condition and thus reduce the chance of problems building up.

    ‘Preventative’ medical checkups don’t prevent anything. They only help identify problems before they become major – some of the time – which may or may not reduce net expenditures.

    Also, when objects and equipment wear out, we replace them. When people start to wear out because of age, we end up throwing lots of money and resources at them keeping them going.

    Comparing preventative maintenance of equipment and preventative health care for human beings isn’t really possible.

    Besides, our medical system absolutely sucks at prevention. Pretty much all it can handle well is major trauma.

  246. 283# Rembrant

    Sounds like that wasn’t particularly good waiver. Also sounds like the lawyers (the crux of this particular problem) are the issue, not the skate park.

    My car insurance policy reduces my premiums because I gave up the right to sue for pain-and-suffering as the result of a car accident unless the other party involved was grossly negligent (like drunk driving).

  247. It makes perfect sense. Let’s look at everyone that smokes tobacco. Over the course of history do everyone of them die as a result of the smoking? No. So if the smoking doesn’t kill them, then spending money on them to stop is wasted.

    No, sorry, this is absolutely wrong and nonsensical.
    It runs counter to medical studies where getting people to stop at some point results in a) longer lives (though not as long as non smokers) and b) results in fewer medical complications.

    You are not making sense at all.

  248. When people start to wear out because of age, we end up throwing lots of money and resources at them keeping them going.

    And this is a problem…?

  249. ‘Preventative’ medical checkups don’t prevent anything. They only help identify problems before they become major – some of the time – which may or may not reduce net expenditures

    Evidence, because this doesn’t pass a prima facie sniff test.

  250. 285# gwangung

    Good point. Provide this evidence and I’d be happy to reconsider. However, a credible report say from a medical journal or government agency.

    I fail to see though how it can’t reduce costs.

    (Anyone wish to argue the point about out-of-state insurance purchase? I only hear this proposed by republicans such as Rep. Paul Ryan.)

  251. juanitocabrone:

    “But if you foster snide dickdom, nay, even promote it, then deny it to others, why that’s just not cricket.”

    As noted, it must be earned, through repeated substantive posting. The more I someone is not here just to be a snide dick, the more leeway they get. I feel this is an eminently fair set-up, but even if it weren’t, it’s still how I would do it, because relatively substantive 200+ comment-long threads are their own reward.

  252. johnbear@275: So this buzzword that frightens you so

    Yeah, it doesn’t frighten me. It’s a red flag for “stupid about to follow”.

    Please feel free to contribute any facts to the discussion.

    Gee, I don’t know. The last time the phrase “tort reform” got a lot of play was when some little old lady got burned by coffee at McDonalds, sued, and won.

    After which point, all the “tort reform” ditto heads started chirping their nonsense and screaming “Coffee is HOT! She got what she deserved!” with all manner of frothing at the mouth.

    Except that the facts are that McDonalds had burned several people with their coffee, they had exceeded the temperature ranges they were supposed to maintain their coffee at, and they did it to save money. The woman suffered third degree burns, down to the muscle. But previous burns didn’t get McD’s to correct their behaviour, so the jury decided to award the woman something that would actually cause McDonalds to alter its behaviour.

    But the libertarians, the captitalists, the laissez faireists, and the objectivists, all screamed bloody murder. murder I tell you. They demanded Tort Reform! and this stupid lady who should have known coffee was hot was their stellar example of how badly tort reform was needed. It’s just that they presented the case with all the facts removed and their own version of reality inserted.

    If you think you can say “tort reform” without reserrecting the ghosts of these morons and all the lies that get packed into any “tort reform” debate, then well, I’m pretty sure you can only do that by cherry picking which facts you want to pay attention to.

  253. @241, Mr. Scalzi:

    Sorry, that’s stupid. Rights are created; in the United States these rights were created and protected by the US Constitution initially, with state constitutions enumerating other rights, and so on down the line.

    Actually, you’ve got that backwards. Traditional thought on the matter is that rights are inherent, we waive certain inherent rights in order to establish a society, governments must explicitly be given power to override rights, and it’s prohibited from doing so in certain ways.

    The Constitution doesn’t grant anyone rights, it’s a restriction of the federal government’s ability to act against people’s rights, regardless of what laws are passed either at the state or federal level, until the Constitution itself is altered.

    That’s precisely why it acknowledges that any rights and powers not explicitly granted to the government belong to the people.

  254. Hey Mr. Scalzimon: How do I tell my current snide dickdom forgiveness level? I’m not used to this interface.

    Oh, and is there a good topic to grind it up?

    Ob relevant: One thing that a lot of the Left want really badly for health care reform is for the current batch of insurance companies to be as royally screwed over as their customers are (or are perceived to be by the left).

    The insurance companies have encouraged this somewhat via entertaining practices like giving bonuses based on amount of claims denied, recission, and other entertaining ways of making profits by increasing human suffering.

    The Right is in general confident that free enterprise/free market is the way to go, government organizations (except their faves) always suck, and deeply resent this assault on the American way of doing things.

    Me, I’ve seen some pretty convincing arguments that health care cannot really work as a free market, but on the other hand some of the “socialist” programs in other first world countries work fairly well with moderately regulated private insurance companies. Perhaps some moderate regulation is all that is needed, but as “Regulatory Capture” is a favorite game amongst large US industries, I’m dubious.

    I’m quite convinced the current setup is a mess, however. The numbers are unambiguous.

  255. I’ve been out of the loop for awhile and haven’t caught up on all the comments but it’s time for a vote on the preventative care being cheaper than waiting till it’s ER time.

    I’m a Type II diabetic. I was diagnosed 12 years ago when I asked my Dr. to run the tests to determine risk factors. Why, cause all four grandparents, both parents and my sister are insulin dependent diabetics and I figured sooner or later I would be also. Genetic issues do repeat you know.

    So here we are 12 years later, I’m controlling my diabetes with diet, exercise, and a generic ($5.00 a month) medication. I don’t have neuropathy in my feet, no eye problems or cardio problems related to diabetes.

    I have insurance, which meant I could be proactive with a problem I knew I was going to have and not have to go to the ER and die from the inevitable deep vein thrombosis or maybe lose my eyesight or any of the other diabetes related organ break downs like renal failure requiring dialysis. Do I need to point out that bi-weekly Dialysis treatments are very expensive?

    With basic coverage for preventative care you can catch it small, control it and everybody saves money. Diabetes is not the only example, it’s just the one I know something about. You could probably substitute strep throat and get a cost savings.
    It’s not rocket science or a big mystery. You don’t even need an Economics degree to figure it out.
    Allow people the means to take care of themselves and they will. I don’t think that is a “Pollyanna” viewpoint, if anything it’s severely practical.

  256. Good point. Provide this evidence and I’d be happy to reconsider. However, a credible report say from a medical journal or government agency.

    If it’s #285 you’re referring to, I’ll gently point out that I was the one who asked for the evidence concerning tort reform.

    If it’s #289, consider the American Cancer Society who’s quoting the 1990 Surgeon General’s report.

  257. melendwyr:

    “The Constitution doesn’t grant anyone rights, it’s a restriction of the federal government’s ability to act against people’s rights, regardless of what laws are passed either at the state or federal level, until the Constitution itself is altered.”

    However, defining the rights the government is not allowed to act against is from a practical level the same as enumerating and granting the rights. The Founders may have posited that rights exist outside the Constitution (thus Amendments IX and X) but without the Constitution as the agreed-upon operating system for the nation, I don’t see those right necessarily being recognized or granted by other potential governments.

  258. Melendwyr:

    Couple of issues with your recent posts:

    ‘Preventative’ medical checkups don’t prevent anything.

    Sorry, not correct. Spotting hypertension and high cholesterol and taking steps to reduce one or both of those does prevent Myocardial Infarctions (Heart Attacks). It’s true that for conventional age onset diabetes the best you can do is slow it down, but that can still save a tidy packet. Likewise with the hypertension etc… you can prevent strokes. A cervical smear can detect a cancer early enough for a simple and relatively non-invasive procedure to fix. Likewise regular mamograms for “at risk” groups of women. Then we can get onto the whole vaccine route…

    Preventative Medicine works, it works really really well.

    Traditional thought on the matter is that rights are inherent…

    They are? Inherent from what?

    A right is irrelevant without a substantive legal and societal framework to back it up, otherwise it’s words on a piece of paper.

    I understand the USSR had a lovely constitution…

  259. melendwyr: The Constitution doesn’t grant anyone rights, it’s a restriction of the federal government’s ability to act against people’s rights

    Libertarian? Objectivist? Both? Come on, fess up. You’re in one of those categories, aren’t you?

    rights are inherent, we waive certain inherent rights in order to establish a society

    governments must explicitly be given power to override rights

    No, they don’t. If the bill of rights weren’t part of the constitutional congress, we would have no right to free speech. And if the government had limited speech, there would be nothing to stop them from doing so.

    People create rights because they work together to put them into existence. You working in your libertarian survivalist camp demanding free speech in a world that didn’t grant it, would be little different than the muck-raker in this monty python skit having an argument with King Aurthur about the divine right of kings.

  260. 298# gwangung

    Glad you can provide a reasonable debate. I hope others (and there are some) follow suit. I’ve tried so far.

    I am unable to provide evidence one way or the other regarding affect of tort reform. I’m willing to bet the implementation would required to be nation wide. Even so, I might not be able to find it because the studies don’t exist yet.

    Prolonging one’s life is not a cost savings per se. I live longer I may contract other medical issues such as alzheimer’s that I wouldn’t have had I died much earlier.

  261. @304:

    Prolonging one’s life is not a cost savings per se. I live longer I may contract other medical issues such as alzheimer’s that I wouldn’t have had I died much earlier.

    Precisely. And quite frankly, a tremendous amount of our medical costs come about from the treatment of people who are extremely old and dying. Such people generally do not contribute more in premiums than they consume – far to the opposite extreme.

    Whether extending such treatment is a universal good, or why it tends to be extremely expensive, are worthy questions – but not ones that are most immediately relevant.

    @303:

    Libertarian? Objectivist? Both? Come on, fess up. You’re in one of those categories, aren’t you?

    I’m afraid my high-school civics teacher would have eaten you alive, GregLondon. Your virtually complete ignorance of the political doctrines of the late-18th-century American architects of state would be shocking for a citizen if our educational system weren’t so awful that it’s become standard. Are you perhaps foreign to our (virtual) shores?

  262. I do think we’re experiencing drift a bit here re: general discussion of rights and the constitution. Let’s try to swim back to the primary topic of health care, please.

  263. Prolonging one’s life is not a cost savings per se. I live longer I may contract other medical issues such as alzheimer’s that I wouldn’t have had I died much earlier.

    However, these are costs that are QUITE bearable. Consider the alternative.

    I am unable to provide evidence one way or the other regarding affect of tort reform. I’m willing to bet the implementation would required to be nation wide.

    Given that insurance is regulated on the state level and as far as I can tell, the effects are contained on the state level, I’m not sure why implementation would have to be national in scope. You should be able to see affects on insurance on the state level.

  264. Ah, actually, this explains something. some people think rights exist outside of human experience, as if they could be dug up like gemstones from a mine. And if we dig enough, we’ll uncover all the rights buried in the earth. And if some right cannot be found it must be because it doesn’t exist.

    They can’t find “right to health care” laying about on the ground anywhere, so they think it must not exist.

    More accurately, people say “we want to create this right”, and others agree or disagree, and it either becomes a new right that never existed before, or it doesn’t and remains the idea of a few.

    But if someone is suggesting the creation of a right that you don’t support, say health care, or say racial equality, then it’s a handy response to use the buried gemstone approach, to say it isn’t “natural”, that it doesn’t exist so we can’t create it.

    It’s a fallacy known as “appeal to nature”, but it is often embraced by those who want to maintain the status quo. homosexuality isn’t “natural”, some will argue in order to stop gay rights.

    Those arguing that health care isn’t a right so it can’t be made a right are using circular logic of sorts without acknowledging that people can create new rights by agreeing to them.

    Healthcare isn’t a right as of today, but it could be made a right in a few months if we want it to be so, if enough of us were to agree to it.

    But then, libertarians and objectivists tend to think of human interactions as something that can somehow be boiled down to some objective set of rules of right and wrong that all must abide by whether they agree to it or not.

    Which is kind of funny given that most objectivists will cling most desparately to their own individual choice. You can’t make them pay taxes against their will, they’ll cry. But they can impose their set of morality, their constitutional rules, on everyone else.

    I’ve yet to see a libertarian or objectivist who has a method of ammending their constitution. They have their dogmatic rules of what the government can and cannot do, and that is it.

  265. Beyond this, snide dickdom doesn’t need to be reformed; it just needs to be earned. Hard work, my boy! That’s the ticket!

    Work hard enough, m’boy, and you’ll get to be snide. The true American dream. Brings a tear to my eye.

    John Bear: saying preventive care isn’t worth it because not everyone dies of such or such disease is completely false. Even if only 10% of smokers were to have died of lung cancer, it is perfectly possible that nicking the cancer in the bud would generate savings well beyond the cost of the preventive care required for the whole at-risk population.

    As for the simile of equipment maintenance, I’d submit that noticing your brake cables (or whatever, I’m no mecanic) are threadbare and about to snap, then replacing them, will be a lot more cost effective than crashing into a ditch because they snapped while driving. I think this is the same with preventive care: noticing a tumor early will allow to fix the problem at much lesser expense than trying to heal it once it’s spread all over.

  266. John Bear @ 304: I live longer I may contract other medical issues such as alzheimer’s that I wouldn’t have had I died much earlier.

    Well, clearly, we should all choose to die at the peak of health, so that we may never burden others with the need of paying for our care.

    Ahem.

    Anyway, this only notes one side of the equation. True that the longer one lives, the more resources one may consume. But also the more overall productivity and benefit one may generate. And this benefit can be generated even if a person isn’t capable of working. Merely being around in a loved one’s life can increase their quality of life and therefore their work productivity.

    I find that strict cost-benefit analyses never take into account how human beings really thrive. I don’t know if the bean-counting folks are merely ignorant of the reams of psychological literature on this subject or if they reject them out of hand (perhaps as a “soft” science that’s entirely conjecture, unlike the… hard science of economics, yes?) But nonetheless, there’s a great deal of sticking of fingers in ears on this matter.

    The established fact is this: When citizens are healthy, educated and happy, they are productive. When they are unhealthy, uneducated and depressed, they are not. If the goal is to grow the economy as a whole–to grow civilization as a whole–then the best way to achieve that is to ensure that workers on every level of the economy are able to achieve their highest productivity. This must include ensuring their health and education.

    Only people who are abjectly detatched from the realities of how human tribal society functions would deny this, and assume that fear-based motivation actually works.

  267. I’m afraid my high-school civics teacher would have eaten you alive,

    Ah, so you’re “special”. Can’t be pegged. Not registered to any party. Above all of us “ignorant” masses. Got it. That clears up some things.

  268. Someone earlier brought up allowing multi-state insurance as a needed reform. To counter that let me hold up the credit card and banking industry. Two states for the most part have the least restrictive laws, Delaware and North Dakota. Guess where most business are located. And for them it only makes sense it’s cheaper to operate out of those states. I don’t want the same thing to happen with health insurance. For profit corporations will go where the cost of doing business is cheapest, that’s what they are supposed to do.

  269. For profit corporations will go where the cost of doing business is cheapest, that’s what they are supposed to do.

    If they’re public corporations, they’re usually legally required to maximize shareholder profits at all costs. There are actual laws requiring that.

    Making your stock options public doesn’t logically require that you become stupid, short-sighted, and evil. It just seems to work out that way. See also: Google.

  270. Yes, preventive care does help. Like Jeff S. above, I am Type II diabetic. My blood sugar is controlled by 1) oral medication and 2) the diet/exercise combo. Because my sugar levels are in good control, I am less likely to have a stroke, amputation, or other extremely expensive medical problem. Instead, I am able to work, pay taxes, and contribute to society. My health plan (Kaiser Permanente) sees preventive care, such as regular testing and informational classes to teach me how to manage my disease as important and leading to lower costs over the long run. I agree, because I saw what happened to my mother. Her poorly controlled health led to 1) a major stroke, 2) congestive heart failure, 3) major surgery due to poorly healing wounds, 4) 4 months in a nursing home, and finally, 5) a final 3-day stay in intensive care before she decided that since her health was not going to measurably improve, she was quitting the game. Finish up with a week of hospice care before her death, and tell me again how much preventive care would cost society.

  271. While we’re talking diabetes, I’d like to just throw this out, in case anyone out there has the wrong idea:

    Diabetes canNOT be prevented or treated solely by living a “healthy lifestyle” (which supposedly costs nothing.)

    Diabetes is a fundamental flaw in how the body processes glucose. It’s genetically linked, and even people who see relatives suffering from it and who are working their tails off to try to stave it off can still develop it.

    Eating carefully and staying active are part of an overall treatment plan, but many–most, actually–will still need medication and glucose-monitoring supplies, etc. (AKA professional health care.)

    This, by the way, is the same thing as many other conditions such as hypertension, high cholesterol, etc. Lifestyle is only part of the management plan. It is not a cure or innoculation that will keep you out of the doctor’s office and pharmacy.

    Also, I feel that heart disease and diabetes are, really, straw men in this debate anyway. Yes, they affect millions and cost a lot of health care dollars to treat, but they’re far from the only illnesses and injuries that can strike anyone at any time, no matter how “healthy” you think you live.

  272. It’s kind of sad that someone has to point out that people with diabetes didn’t “deserve” it. But I think that’s what is at the heart of a lot of the opposition to health care reform.

  273. John @300, when you paint people who disagree with you as claiming that “people should be allowed to sue for whatever amount and whatever reason”, you appear to be begging the question rather than seeking facts. We’re talking about lawsuits over malpractice.

    I refer you, initially, to Catherine Shaffer at @63 and my follow-up at @123 and @134. The thirty-second version is that truly frivolous malpractice claims are already weeded out, because lawyers don’t make money on such and almost nobody can afford to file a malpractice claim pro se; and the goal of tort reform is not to limit damages, but to keep lawsuits from ever being filed.

    At @275 you propose that the cost of malpractice insurance is a) directly related to tort reform and b) a significant portion of health-care costs. You don’t offer any facts to support these hypotheses.

    Here is a blog post from an attorney who handles malpractice cases, explaining why he rejects 95% to 98% of the malpractice inquiries to his office (and goes on to explain how doctors can put him out of business).

    I’m not even going to pretend that this is a neutral source, but an insurance-reform group has published a study showing that malpractice insurance premiums do not track health care costs.

    The Congressional Budget Office likewise compares malpractice insurance premiums to health care costs, and notes that malpractice costs (not insurance premiums; costs) accounts for less than 2% of health-care spending.

    Regarding “pain and suffering”, please see my earlier comments. I suspect what you really signed away is your right to pursue non-economic damages.

  274. 307# gwangung

    I’m not sure why you would find such costs QUITE bearable. Would rather die instantly from a smoking-related heart attack, or over a period of several expensive dehumanizing years from something like alzheimer’s? (That’s merely one example, btw.

    And for several others up there, please read the cbo report or the Washington Post article that are more articulate than I.

    310:
    I wouldn’t set a health care policy based on what might happen if people lived longer. Imagine if the average age of people was 110 through the “miracle” of preventative care. New diseases/health issues could arise; you’d have even fewer people working to provide for the retired (or retirement age would need to be around 90).

    Note that no where did I say that this wasn’t a good idea. It just isn’t a way to save money for the government. Now if plans were held and paid for by individuals, like they should, and not by companies or the government, like they should not, we are talking a different story.

    I might choose to spend a few bucks to limit my potential future costs. But why should I force the 20 year old next to me that feels invincible and would rather spend their money on another expense cell phone plan.

  275. Greg @ 317: Yep.

    A lot of people don’t like to acknowledge that bad things could happen to them through random chance or the luck of genetics or whatever. They take comfort in the idea of an ordered and predictable universe, and so they assume that bad things only happen to bad people (where “bad” can = anything from being a sinner to having imbalanced karma to not being industrious enough.)

    They like to tell themselves that as long as they’re being “good,” they’ll be safe. They assume that they’re entirely self-sufficient or that god or their family breadwinner will always provide so long as they eat their spinach and pray every night.

    Only reality just doesn’t work that way. Bad things happen to good people, and good things happen to bad people. We’re not totally powerless, of course, and there are always things we can do to try to tilt the odds in our favor, but there’s only so much of that that’s really in our hands. The rest is just chance.

  276. I’m not sure why you would find such costs QUITE bearable.

    Then we are not arguing on shared bases. You certainly believe you are rational, but I see nothing except an irrational fatalism not rooted in a sober look at reality.Good day.

  277. Tal @321: also known as “defensive attribution”.

    An acquaintance of mine was once selecting a jury in a medical malpractice case where the alleged malpractice had happened while the patient was under full anesthesia. He asked the jury if anyone was nonetheless, having heard what they heard so far (a five-minute summary of each side), would be inclined to say it was the plaintiff’s fault.

    One woman stuck her hand up. When the incredulous lawyer asked her why she believed that, the woman angrily replied “Well, she didn’t have to pick that doctor!”

  278. John Bear @319: Would rather die instantly from a smoking-related heart attack, or over a period of several expensive dehumanizing years from something like alzheimer’s?

    Point: Smoking is far more likely to kill you via lung cancer or emphysema than a heart attack. Both of which are extremely long, drawn-out and painful ways to die. (As I’ve seen first-hand, TYVM.)

    But why should I force the 20 year old next to me that feels invincible and would rather spend their money on another expense cell phone plan.

    Because the costs and benefits of relative public health are not limited to the individual.

  279. @318: Thanks for the links. There’s a lot to read particular the footnootes and assumptions so I’ll have to think on it. I’d like to see later numbers than 2004. Perhaps this will make it easier to find.

    I’m disinclined to believe any points arguing in favor of trial lawyers, particularly when I see phone books and talk shows filled with their advertisements. And most of what I’ve seen in the above 300+ comments appears to be individual cases.

    @324: If I understand you believe it’s perfectly fine to force someone to do something against their will. Perhaps because you feel they aren’t smart enough to know better. Therefore, you must force them to understand.

  280. @324: Point: Smoking is far more likely to kill you via lung cancer or emphysema than a heart attack. Both of which are extremely long, drawn-out and painful ways to die.

    While this is generally true, I do know someone that died quickly after being diagnosed with lung cancer (under 6 months). I was giving merely an example. As people get older they tend to get some illnesses and many of these can be expensive to treat.

    (Apologies if this was discussed above) I feel bad for people that have gone bankrupt or close to it because they got sick and would rather it not ever happen. However, the alternative would be death. And in some over government systems, you are not offered the care that would have saved your life. That’s because these governments decide for you what can be provided and what can’t.

    Not everyone comes back from bankrupcy, but no one comes back from death.

  281. John Bear @326,

    So what is the difference between the government deciding that they can’t cover certain care or my for-profit insurance company deciding the same?

  282. John Bear @326 If I understand you believe it’s perfectly fine to force someone to do something against their will. Perhaps because you feel they aren’t smart enough to know better. Therefore, you must force them to understand.

    If one wishes to live with the benefits of civilization, one must pay for them. So yes, I do believe in forcing pay for services rendered. And I don’t just mean direct health care services for that particular individual, but the greater benefits that a healthier populace brings to society as a whole.

    One does not have the exclusive right of control over one’s money if one is using goods and services that have a price.

    Just because a given individual is not consciously aware of the benefits they may be getting doesn’t mean they’re not responsible for paying for them.

    If you don’t want to live in a civilized, technologically advanced culture, you’re certainly welcome to go buy your own chunk of land in the middle of nowhere and feed and clothe yourself solely by your own effort. But if you want to live here among the rest of us, you have to pay the dues for that.

  283. John Bear@326

    I don’t think we should be focusing on how other government systems work. It works in trying to understand some of the problems with state run systems but doesn’t work in trying to repair an obviously broken system (profit not patient driven care). I think we ought to be deciding how to provide the best care for the greatest number of people. If a government system for health care is the outcome then I would hope that all people needing proper care would receive it (at least in its conception).

    I think offering a choice between death and bankrupcy doesn’t really allow for an ideal outcome. Lets add death, Bankrupcy, and government sponsored treatment… I think all of us would choose door number 3.

    Rabid

  284. Hmm. What else do you think we should force people to do against their will? And how would you accomplish that?

    I believe that most people are actually inheritently good and will try to contribute to society. And most of those who don’t, won’t contribute no matter what you do.

    @327:
    The only difference is whether you believe the government’s one-size fits all plan can do that for everyone (which I don’t), or you believe that private companies can do this better (which I do).

    Seems that people above have argued that either doctor’s are only in it for the money; lawyers are only in it for the money; insurance companies are only in it for the money; drug companies are only in it for the money. In this country if you can’t make money on something you won’t provide it. Note that most of the world’s medical advances come from this country. I’m willing to say the profit motive has something to do with that. And that’s fine with me.

    I just don’t see many examples of any federal government program that saves money or is run efficiently, even remotely so.

  285. John Bear – (Apologies if this was discussed above) I feel bad for people that have gone bankrupt or close to it because they got sick and would rather it not ever happen. However, the alternative would be death.

    What alternative world are you living in in which everyone gets health care irrespective of debt load? People die because of lack of health care in the US, and people get pushed off of private care because of cost to the insurance company, and *then* die.

    You keep talking as if government care had to be better than private care. It is, but not in the sense that it’ll pay for anything ever. It’s better because (a) everyone has access (b) if you can’t afford it, you’re covered and (c) you can’t get dumped if your condition gets too expensive.

    In the UK, the NHS doesn’t have a “lifetime maximum payout”. In the US, insurance companies do.

  286. Rabid: My html skills might be weak. You’ll see how the government know as the State of Oregon refused to provide potentially life saving medicine. So door number 3 doesn’t exist.

  287. Again, John Bear, health insurance companies have no problem doing exactly the same thing as Oregon. So why are you talking as if the only option for publicly funded care has to be better than private care, or it’s not worth having?

  288. The NHS has a lifetime maximum payout called, “The government is quickly running out of money.” The NHS won’t provide the same level of health care as is offered here and it will only get worse there.

    See @260 where I said the only way to fix the problem is to reduce the cost of medical care in the US. Suggesting that the US government can do that seems to be the wrong answer. Medicare waaay in the red. It will only get redder.

  289. John Bear@332

    I think I understood the article (The Oregon Health Plan will only pay for a cure and not an expensive measure that prolongs life). What I am failing to see is how this relates to fixing the current health care system. You are trying to use a problem with a (state) government health plan to argue against reforming a broken system.

    I was also pointing out that in your argument you offered two choices. I would like to think that as a society that we should be moving towards another and more desirable outcome.

    Rabid

  290. John Bear: “Both parties have raided the SS surplus practically since it’s inception.”

    Which further indicates that it’s a poor program to compare to healthcare reform, and that it needs to be fixed. Unfortunately, Wall Street needing all that money didn’t help with that.

    “Private insurers do this so they either don’t go out of business or so they don’t charge everyone a 300% increase in their premiums.”

    No, private insurers do it to make obscene profits, while hiking insurance premiums anyway. Employees get bonuses for turning people away and denying claims. There is a basic problem with private insurers taking people and business’ money for premiums, then refusing to do what they were paid for. Reform isn’t just about covering the uninsured, but making sure that private insurers can’t scam their clients and increase the number of uninsured after taking all their money.

    http://www.huffingtonpost.com/alison-rose-levy/we-cared-about-numbers-no_b_230535.html

    “Preventative care for everyone does not save money for the entire system. Some people just never get sick no matter what. Therefore, any money spent on preventative care is essentially wasted.”

    Except that the percentage of people who “never get sick” throughout most of their lives is exceedingly small. Children, particularly. Whenever preventive care comes up, opponents always focus on obesity to heart disease and smoking to lung cancer as if they are the only two things in the world. But preventive is a wide field — flu shots, vaccines, basic nutrition and monitoring for kids, having people able to go to a doctor so that wounds don’t become infected or a case of bronchitis doesn’t become pneumonia, or someone who has been food poisoned doesn’t spread that to their entire school or office, detecting lumps in breasts early, detecting skin moles that are cancerous. Time and again, the medical community has stated and shown in studies that preventative medicine lowers costs. And schools insist that kids get regular well check-ups because it’s proved valuable to them for the overall health of their student body.

    People who don’t receive care don’t just quickly die on the streets. They frequently take a long time to die, developing many conditions, spreading diseases, overwhelming ER’s and clinics, taking government money because they can’t work, living in tent cities on public property — endless ripples that stretch to their employers, relatives, neighborhoods. Stopping that process saves money.

    Old people you aren’t going to stop from dying forever, though since they live longer, they are also working longer, contributing taxes and income to the economy. Old people are currently covered by Medicare, so aside from trying to improve Medicare, healthcare reform isn’t primarily about them, but about the 20-year-old who is perfectly healthy but gets hit by a car.

    You’ve got Michael Steele saying on air one minute that he wants to make cuts to Medicare, and the next in an ad saying he will defend Medicare from any cuts from Obama. Opponents talk about death panels and killing grandma in healthcare reform, and the next say why should we pay for grandma’s healthcare, let her die. It’s getting ridiculous.

  291. Apparently I’m not making my point clear enough to the recent group of people here.

    The US (country not government) has a finite amount of money. It can’t be spent all on health care. Proposing that everyone get the best of care will only ensure that either everyone will get marginal care or everyone will get no care because there is no money to pay for it.

    So why not find a way to reduce the cost of health care in the first place? A government-run program will not do that. I defy you to list a current government run program that can provide the same service cheaper than the private sector. If they could I’d be all for it

    (The Huffington Post is not a resource so that link doesn’t count @336. Also, I was responding to @234 regarding SS. I didn’t bring it up. However, SS is another failing government program.)

  292. See how we can run out of money so quickly:
    Hawaii

    Japan
    Japan (again) [You have to read to the end to see when the hospitals are running out of money and doctor’s make money up on things like parking.

    UK This is another reference to limiting available services due to the government running out of money.

  293. I think using GregLondon’s logic KatG is expressing racism when she disagrees with Michael Steele.

    KatG only wants Michael Steele to fail because he is black.

  294. Bear@325: If I understand you believe it’s perfectly fine to force someone to do something against their will. Perhaps because you feel they aren’t smart enough to know better. Therefore, you must force them to understand.

    The US invaded Iraq back in 2003 against my gaddamn will. No one ever forced me to understand. Lets pretend that you supported the invasion. And I opposed it from the day after 9/11. You’re telling me you made me understand why we had to invade based on bullshit intelligence and bullshit WMD’s and bullshit confessions from bullshit torture sessions????

    I find it hilarious that people who screwed over an entire country by electing Bush now decide that now that they’ve lost the presidential election suddenly everything has to be done by a fricken unanimous decision. Hillarious.

    Gore won the popular vote. The Bushites took it as a “mandate” for the right. Screw that.

    The short of it is, yeah, the government gets to do shit against people’s will. It’s just that right now, you’re looking at something that might be potentially done against your will. So now you want the Democrats to work with the Republicans. Well, tough. That’s how democracy ends up working sometimes.

    You want unanimous? Go live on the moon by yourself.

    Bear@326: I was giving merely an example. As people get older they tend to get some illnesses and many of these can be expensive to treat.

    How is the problem any different under private fricken health insurance? It isn’t. This is a red herring.

    Private insurance can’t solve the problem either. So, private insurance is no better in this situation. It’s completely irrelevant to whether private or public is better. And what is being proposed anyway is BOTH, so if public somehow fails and private somehow magically figures out how to solve this problem and public magically can’t do the same thing, you still have that option if you want.

    Bear@330: The only difference is whether you believe the government’s one-size fits all plan can do that for everyone (which I don’t), or you believe that private companies can do this better (which I do).

    Great. People who want it will take Medicare. People who want it will choose the public option. Poeple who want it will stick with private health insurance. Everybody’s fricken happy.

    Except you decided you dont’ want to pay the public option. why? Any reason you can come up with could be used as an argument against Medicare too. So if you oppose the public option, you should lobby to kill medicare too. By all means, go for it. I dare you.

    Bear@334: The NHS has a lifetime maximum payout called, “The government is quickly running out of money.” The NHS won’t provide the same level of health care as is offered here and it will only get worse there.

    Show me you forwarding the same logic that shows that we can’t afford to conquer Afghanistan or I call hypocrite. Selectively invoking cost only when it suits you is a no-pass.

    Medicare waaay in the red. It will only get redder

    How would private insurance handle medicare better? By booting grandma off the list? Letting her die when it got too expensive?

    You’re implicit premise in every single argument is that the government can’t do anything cheaper than private industry. Wipe out medicare and replace it with private insurance and show me how they pay for it so easily, and then we’ll talk.

    Bear@337: I defy you to list a current government run program that can provide the same service cheaper than the private sector. If they could I’d be all for it

    The United States Marine Corps versus Blackwater Corporation.

    United States Post Office versus Fed Ex.

    Fire Department versus We-Douse-You-For-Dollars Corporation!

    Police Department versus Omni Consumer Products.

    PBS versus Fox News

    And lastly:

    Medicare versus any fricken private insurance plan you could possibly come up with.

  295. Good God, the invisible hand is getting hairy palms right now. It’s all mastabatory pornography whacking off to Ayn Rand and Alan Greenspan doing it on top of some articles of incorporation. yeah, pizza delivery girls want to do it with you. Yeah, private enterprise will always find the better solution. Bow-chicka-bow-wow. lets get the money shot and change channels already.

  296. Oh, a while back a number of forward thinking cities had the idea of installing public WIFI everywhere so all the people in teh city could use it for free.

    The cable companies and private sector wifi provider shit a bunch of legal bricks and halted it because they could make money from it even though the city could do it cheaper.

    There’s another example for you.

  297. Federal Deposit Insurance Corporation versus any private insurance/bank that you could possibly come up with.

    Every bank can have a run. Every insurance company can go bankrupt. There is no way you could ever have a private corporation have the same security that the federal government could provide bank depositors.

    It simply cannot be done by the private sector.

  298. John Bear @325: What you just said is that because advertisements by plaintiffs’ attorneys irritate you, you have already made up your mind on the subject, and fully intend to interpret, discount or minimize any facts that might suggest plaintiffs’ attorneys are not fully in the wrong on tort reform. Is that actually what you meant to say?

    (“Trial lawyers”, by the way, is a buzzword I’ve never figured out. If the plaintiff’s side has a trial lawyer, who’s that guy in the suit at the defense table? I’m pretty sure he’s a lawyer, and he’s at trial…)

    @330, doctors, lawyers and insurance companies are all bound by a code of ethics. While there’s absolutely nothing wrong with wanting to make money, I assume you would agree that should be limited by ethical behavior; for example, it would be wrong for a doctor to order a battery of unnecessary tests just because she owns the testing facility and profits from every test conducted there.

    Likewise, the problem is not that insurance companies make a profit; it is when they do so unethically. For example, intentionally rejecting valid claims on the first submission on the hope that many claimants will give up and not try again. Or recission, where the company retroactively cancels a policy for reasons other than fraud.

  299. I skip the ad hominem section of that go down to the part about health care.

    The problem with the so called public option is the way the current public option works.

    Medicare fixes the rates it will pay doctors and hospitals. In turn private insurance has to pay out higher rates so the doctors and hospitals don’t go bankrupt. Medicare simply has to continue increasing the health care cost burden to the private option until the private option is forced to collapse. Maybe if this were disallowed and they paid the same rates it’d be a fair fight. Which the public option would lose.

    Eliminating Medicare at once is a stupid idea suggested by no one. Over time would be reasonable to me.

    Not sure why you think USPS is cheaper than Fedex. USPS operates at a loss. And it’s required by the US consitution anyway. Fedex, UPS, DHL are around because they do it better.

    US Marine Corps and the remaining forces are also required by the constitution. I’m not a constitutional scholar, but I believe trying to provide the equivalent is illegal. However, the armed forces are not the paragon of low-cost or efficency. I’m guessing you would agree.

    Most fire deparments in this country, including mine, are volunteer and not run by the government. Brave as they are, public firefighters tend to retire earlier and therefore, are more expensive.

    Amusing reference to RoboCop. However, there is no tenable alternative. Surely you wouldn’t prefer that anyone that wishes to, can carry guns.

  300. The NHS has a lifetime maximum payout called, “The government is quickly running out of money.”

    Sorry old chap you don’t get that one.

    The British Government is spending LESS than any other comparable nation on healthcare, go on, you can look it up. I’ll wait.

    And part of the problem there has been a decade on under investment that the current government has been trying to deal with.

    And I’ll take a side order of CITATION on exactly when the British government is running out of money for the NHS…

    And I’ll say in advance if it’s an article from the Daily Mail, Times or similar I’m calling shenanigans on you.

  301. GregLondon is useless and lacks useful information. Maybe you should review comments of others such as ‘mythago’ that can actually provide information and without insults.

    Federal Deposit Insurance Corporation versus any private insurance/bank that you could possibly come up with.

    FDIC is partially funded through insurance paid by the private banks. I’m done arguing with you.

    For mythago, you’ll notice above (buried amongst all these bytes) that I said I was disinclined to believe lawyers aren’t a large part of the problem. However, I did say I’d read your links further as they are detailed and not necessarily the whole story. I’m pretty sure my distrust is in line with most of the US as lawyers are perennially towards the bottom of Gallup polls.

    *tags out for the night*

  302. The point being that certain things are better when the profit motive is removed. A mercenary force like Blackwater charged far more than any government troops cost. You don’t want OCP running your police force based on profit. And there’s no possible way you can have the FDIC replaced by some private company. It’ll work until the first bank run and then it’ll fail. Some things run better when the profit motive is removed. Money still has to balance out, budgets still have to add up. But money isn’t the motivating factor.

    When the US first invaded Afghanistan, we offerred 10,000 dollar bounties for anyone who was Taliban. A bunch of the war lords there picked up anyone unclaimed by a local village and handed them in for the reward. We tortured them for years and many ended up in Guantanamo. Out of the thousand or so prisoners who went through Gitmo, about 800 were released without being charged, but only after years of confinement and ofter torture.

    That’s what the profit motive gets you sometimes.

    And don’t tell me the only reason we have the Marines is because the constitution says so. Mercenary armies like Blackwater did a great job of getting paid lots of money to kill Iraqi civilians.

    And in some circumstances the only way to operate and get the best quality result is to remove the profit motive completely.

    But if you worship the invisible hand as dogmatically as you do, I wouldn’t be surprised if you missed that point.

  303. Sorry, I missed this one, otherwise I’d have put the two posts together.

    Fedex, UPS, DHL are around because they do it better.

    BZZZT. Sorry, apples and oranges comparisons aren’t allowed either. FedEx, UPS and DHL do things differently and one thing they don’t have to provide is a national daily delivery service. It makes life easier and more profitable if you can cherry pick the services that you have to offer.

    Oh, and for fun, do you know who owns DHL?

    Hint: It’s not exactly a private company…

  304. FDIC is partially funded through insurance paid by the private banks. I’m done arguing with you.

    What? The program has to be paid soley by taxes with no user fees or it doesn’t count?

    Hm, I guess we can’t compare the post office to any other carrier because it isn’t paid for by taxes alone. It charges people for stamps.

    yeah, nice little ad hoc rule you just threw in there.

    Dogma. Pure and simple. Worship the all powerful invisible hand.

  305. #208 Josh Jasper, you said
    “Indonesia’s economy has been ravaged by colonialism, massive systemic corruption on a scale the US has never experienced, ethnic tensions that resulted in the exodus of a large portion of wealthy Chinese citizens, military coups, and a vicious dictator who regularly “disappeared” political rivals.”

    Oh, nuts.
    You are right.
    We lack all those excuses for why our health system bears more than a passing resemblance to that of a third-world country.

    Truly, as you say, one should be embarrassed . . .

  306. *stays up later than he should*

    Dave: Post office comparison was not mine it was the other genius. I’ll have to find you a link regarding the Britan bankrupting statement. Don’t have one one hand. As I’m not familiar with the leanings of the British press I’ll try to pick something that doesn’t sound sensationalized.

    Josh: Don’t understand your comment.

  307. Oh, speaking of user fees, Medicare has deductibles. Which means user fees are very much allowed to be part of the government process. Which means FDIC and its bank fees is still better than any private insurance could ever do. Which means this is your dogma speaking:

    Bear@337: I defy you to list a current government run program that can provide the same service cheaper than the private sector. If they could I’d be all for it

  308. John, you went through the door and mentioned them. I’ll help you out. DHL is owned by Deutsche Post… which isn’t quite a private company…

    Doing well though.

    As for the NHS bankrupting the UK. Go for it. I’d love to see it. I suspect it’s a fair amount of hype.

  309. John Bear @345: Medicare fixes the rates it will pay doctors and hospitals. In turn private insurance has to pay out higher rates so the doctors and hospitals don’t go bankrupt.

    I think I’m confused. The way I’ve seen Medicare assignment work is: Medicare fixes the rates it will pay doctors and hospitals. The doctors and hospitals accept those rates (under some duress, of course, since if they don’t accept Medicare assignment they simply can’t do business with Medicare, and that’s a large part of their business, usually). Medicare then pays some percentage of the assignment–not, usually, 100 percent. If the patient has supplemental private insurance, the private insurance company then pays the rest up to the point of Medicare assignment. So far as I know, the private insurance company does not pay “higher rates,” if by “higher rates” you mean what the hospitals and doctors would have charged if they didn’t accept Medicare assignment.

    So . . . what was your point?

  310. With regard to the “Prosperity Doctrine” as it applies to health care (if you do the right things you will stay healthy, not lose your insurance, and all good things will come to you) Barbara Ehrenreich just published a new book called “Bright-Sided”. In it, she examines the notion prevalent in the US that if you just have a positive attitude and work hard, you’ll be rewarded. She points out that this philosophy is often used to put blame on those who suffer misfortune, because obviously they must have done something to deserve it. Maybe they didn’t think positively enough or work hard enough or something else enough. This ignores the obvious truth that no one can control everything. But it makes it easy to blame those who have problems instead of having sympathy for them or trying to help them-obviously they deserve no help.
    I’m interested to see how well this book does. In some ways, it’s rather grim to acknowledge that no matter what you do, you could end up screwed. But this idea rings true to me. I don’t subscribe to it enough to feel hopeless, dreading the next catastrophe. Isn’t it narcissistic, though, to believe that all good things that happen to you are due to your efforts while the bad things are due to your lack of effort? Seems like the next thing to animism to me.

  311. I agree that health care does cost too much here.

    But it’s not because of high malpractice insurance costs. It’s because it’s run as a profit industry, same as health insurance is.

    Though it’s essentially impossible, what I’d love to see along with a choice to buy cheap insurance from the government is a series of reforms that make it illegal to operate any health-oriented business at a profit. No shareholders or BoDs to be responsible to. Any income over operating expenses has to be reinvested in some approved way (expansion of facilities, new training and equipment, etc.)

    Right now, people make scads of cash off the sick and dying, and that’s the core of what’s really wrong here. Until we accept that health care should not be bought and sold just like any other commodity, we’re still going to have problems no matter what system we adopt.

  312. Jaq @ 358: I don’t subscribe to it enough to feel hopeless, dreading the next catastrophe. Isn’t it narcissistic, though, to believe that all good things that happen to you are due to your efforts while the bad things are due to your lack of effort?

    (Apologies for the sidetrack!)

    Perhaps, but I also think it’s a fairly normal human psychological response.

    It’s an extremely scary proposition to acknowledge that one is not in complete control over one’s environment and experiences. One of the biggest things that (IMHO) draws people to religion is the idea that there’s a benevolent dude in the sky who has everything all planned out, and there’s a reason for everything that happens. If it’s all just random, and you know you have little control over it, it can seem pretty bleak.

    But it doesn’t have to be that way. As the saying goes: hope for the best, but plan for the worst. You do everything you can that actually is in your power to create a happy, healthy and stable existence, and you also create contingency plans for when shit (inevitably) happens. And then you let go. Serenity prayer and all that.

    Acknowledging where our limitations as mortals lie is a key part of gaining wisdom, IMHO. Whether one puts $deity in that space or fate or chance or whatever doesn’t matter. Just knowing that there are some aspects of your life–and the lives of everyone else–that are not controllable by mortal action is in itself wisdom.

    But equally important is acknowledging the things that we DO have power over, and accepting the responsibilities we have to use that power wisely. We may not be able to control whether some kid gets leukemia, but we can damned well do something about whether he gets treatment. And I’d say that we have a responsibility to do so.

    Bad shit is going to happen in everyone’s life, no matter what you do. But there ARE things you can do to help mitigate it when it happens, and participating in a civilized system of mutual support is one of those things.

  313. Heh, that’s what I said back at #206, Tal.

    And today I’ve learned that we need a working health care system so that health insurance companies can go back to providing insurance.
    Melendwyr made a good point back around #223. And I can understand and agree with the concept that having people pay for basic care out-of-pocket would be an improvement over what we have now, if only because most of the time I’m paying a lot in premiums and it would actually be cheaper for me if I just paid for my annual exams myself instead. (Not taking into account that rates are often negotiated between medical care providers and insurance companies, though.)

    On the other hand, not everyone can afford to pay, but it still benefits us as a whole if everyone is healthy, happy, productive, and contributing – so making that “free” with a govt-run system also makes sense. Call it an improvement over the previously described improvement of paying directly for care out-of-pocket.

    About paying for old people care. Can I just point out that they weren’t always old people? They presumably made valuable contributions before they were old, and might still be making valuable contributions in a non-economic sense. (Someone somewhere farther up pointed that out.) You presumably like your grandma because of all the things she might’ve done for you in the past, even if she’s a financial burden now; other people’s grandmas are not that different.

    Anyway, good discussion. I’m especially enjoying Cassie’s posts, because her views seem diametrically opposed to mine.

  314. If this wasn’t the same Barack Obama who has kept BushCo torture, rendition, Afghan and Iraq policies in place, handed out a sizable chunk of the Commons to privately held corporations, and made Bill Clinton look less like the shifty triangulator he most certainly was, I’d mightily wish to agree with the worthy Mr. Scalzi.

    For what it’s worth – and mayhap it’s worth nothing – but this process focus ignores actual liberal history, and liberal successes: FDR got social insurance done in Congress (yes, by arm twisting and public narrative defining) and up and running between the months of April and September, 1935. From proposed to Congress to occupying offices, hiring staff and working on programs: five months.

    It also operates on the unstated assumption that Obama is a God Among Mere Mortals, and not just a guy who ran a great campaign, and then grounded his ship on the easily mapped shoals of Republican obstructionism…

  315. John Bear @347, you’ve made a claim (tort reform will meaningfully reduce health-care costs) with absolutely no facts to back it up. You invited facts on the subject. In response to the presentation of facts, you’ve stated first that you are disinclined to listen to any because you don’t like lawyers’ advertising, and next that this is a reasonable approach because lawyers are unpopular.

    The way a hypothesis works is not that yours is true until somebody disproves it; or that it’s true because you don’t like people who disagree with it. If you have some evidence backing up your claims, I’d be interested to hear it.

  316. I would like to offer an alternative hypothesis to “malpractice insurance!” as to why America’s health care costs are going up faster than the rest of the world’s:

    Doctors order unnecessary tests because that reduces the chances the insurance company will be able to deny coverage of the already clearly-necessary treatment, which means the doctor will be more likely to actually get paid.

    Also, the person who claimed preventative care can’t cut costs because not everyone gets sick … let’s run a possible scenario, hmm?
    Imagine that there’s a condition which costs $50,000 to treat if detected “late” (that is, when it is obviously wrong to the average individual), but only $1000 if detected early. Such problems DO exist, although maybe not with the specific numbers. Now further, assume that one in a hundred people will suffer from this condition, and it costs $100 to test for it.

    That means if we test everyone, we’re spending $11,000 for a hundred people, as opposed to $50,000.

  317. Jack@362, no one is claiming health care reform is Obama’s baby except for those who oppose it. Kennedy said it was one of his life long goals. Pres Clinton tried it. No republican president would ever push it. So now we have a Democrat as president and its a possibility again.

    The people who are trying to tie health care reform directly to Obama, the people who are calling it “Obamacare” rather than health care reform, are the people opposed to it.

    If you’re a republican opposed to health care reform, the first thing you’d do is call it Obamacare or something to tie it to a Democrat president, rather than allow it the possibility of being some sort of bipartisan, universal, everyone-wants-reform, approach. Tie it to a Democrat and then all the republican voters in your area will automatically oppose it.

    The main opposition to health care reform is republicans. simple as that. Not because of anything else than it’s a democrat president who will look good if he gets it passed and look bad if he fails to get it passed. So, every republican politican is opposing health care reform because if they can make it fail, then Obama and the other Democrats will have a harder time come reelection.

    No one is opposing health care reform based on facts. The only “facts” you’ve got are nut jobs shouting “DEATH PANELS!” at town hall meetings. The only “facts” you’ve got are people like the Republican Congressman of Texas telling the story of “Britney” who got rejected by private insurance and trying to make it a story about the evils of the public option.

  318. @363 mythago:

    I read your cbo link for 2004 along with this one from 2006. I would agree with you that savings from reduced malpractice insurance premiums is small relative to overall health care spending. However, as noted in this report they don’t take into account “utilization.” First reference to that is on page 2. CBO says that have a hard time quantifying such costs and therefore, don’t.

    So I leave this as for one to interpret. I choose to believe that utilization costs would be reduced. You and others are free to think there is little to no effect.

  319. John Bear @366: you can “choose to believe” anything you like. Heck, some people “choose to believe” that they are really dragons or unicorns trapped in human bodies.

    But back at @275, you were still pretending that you wanted an evidence-based discussion, and that your views on health care reform were grounded in facts: “Please feel free to contribute any facts to the discussion. As evidenced above, not everyone has them”, was the gauntlet you tossed down.

    If you’re saying that you’ve made up your mind and you’re going to now invent facts where even the Congressional Budget Office fears to tread, that is certainly your prerogative. I’m just unsure why you believe they would be persuasive; “let’s talk about the facts OH WAIT LET’S NOT” is rarely convincing except to the predisposed.

  320. In that same 2006 CBO report they include the following:

    CBO did not, however, assign savings to effects on utilization. By contrast, the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services, for example, has estimated that a cap on noneconomic damages alone would reduce costs to the federal government by between $25 billion and $44 billion per year, an effect approximately 20 times as large as CBO’s estimate

    So you have to choose which facts/statistics to believe. Does it save ~$3-5 billion a year (2006) or ~25-44 billion a year (2003)?

    CBO says they can’t put a number on utilization affect. Others do. To the tune of ~$100-178 billion per year.

  321. Yowza. A long ways late to the ball, toasting the the cleaning crew clearing the tables I guess, but still. Dig your books, awesome you feel strongly about left o’ center political beliefs, but damn your post is a pristine version of ‘Very angry partisan pretending to be anything but a very angry partisan.’ If this post was trapped in amber you could clone Paul Krugman from it 100 years in the future.

    Cue Bob Barker introducing ‘Spot that Hoary Trope!’

    -”Secretly, everything is going our way” : You state that the legions of doom at town hall meetings will drive the great, silent majority to the tender mercies of Obamacare. But this was the point from both the Left and Brooksian Republicans in early August…and polls have shown the exact opposite.

    -”Obama as a mix of Sherlock Holmes, Chuck Norris, and Gregory Peck playing Atticus Finch in ‘To Kill A Mockingbird’” Really? Is this where reasonable people are? Obama as magical, super-cool miracle worker whose mistakes are really master-strokes the uninitiated are just to un-hip to see? Maybe, perhaps just a Gertrude Hawk smidgen, Obama is a relatively green politician whose fast rise was framed by letting certain social classes project themselves onto him. And he’s pretty raw at big-time politics. And bitten off, in unwise fashion, more than he can chew, much too quickly.

    I don’t want to (over)bloat the post, but all the greatest Trope hit’s are here:

    “My position is actually the Center, and all reasonable people agree with me”, and it’s doppelganger “Obama is a centrist, it’s just that centrist’s don’t know they should be more Left-leaning”

    “Even though Left opinion dominates the young, the entertainment community, the media, and a good portion of Higher Education, the Right is totally better at message warfare!!!’

    “The Left needs to stop being do darn perfect and peaceful and start fighting!”

    “Our problem is our candidate/president/etc. is too quick in compromising”

    -The folks on the left, bless their hearts, are not like the folks on the right: They are incapable of walking in step…-

    This is a statement that just needed to be out there on it’s own, bravely letting it’s freak-flag fly. This in one fell swoop undercuts your argument that you’re really not pigeon-holing everyone on the right and has the dubious distinction (or audacity of hope!) of arguing the Left doesn’t have a history of group-think. Okey. Dokey.

    Your post reads as if someone shoved every classic Left-leaning prop Mad-Libs style into one narrative. What should be done about health-care? Beats the partially-digested food out of my large intestine. We all would like something better. However, a lot of folks are hip to the fact that so far Healthcare reform proposals have been extremely vague and shifting. It’s more of a ‘Just accept it and trust us vibe.’ That’s not winning many Americans outside a segment of Left die-hards (and I don’t mean that everyone on the Left is on-board). and politically/fiscally interested constituencies.

    Maybe instead of the usual routine about dirty tricksters and their oh so dirty tricks, too noble for their own good lefties, and the ever magical silent center, the issue is that the White House has advanced an extraordinarily vague bill that covers a very important area of peoples lives during the worst economic stretch in living memory, with the main rallying point being ‘Just Shut Up and Trust Us, We’ll Figure It Out Later’.

  322. @359. I don’t see profit as the problem. Lasik surgeries, which are less likely to be covered by insurance that most procedures, continue to get cheaper and yet more reliable. And yet they still make a profit.

  323. Federal and state Income taxes.
    Medicare taxes.
    State disability taxes.
    Sales taxes.
    Gas taxes.
    Vehicle registration fees, they are taxes.
    SSA taxes.
    Property taxes.
    Sin Taxes, alcohol and tabacco, coming soon to CA soda pop taxes.
    Fees on my phone bill, taxes.
    Fees on my electric bill, taxes.
    Fees on my cable TV bill, taxes.
    Capital gains taxes.
    Estate taxes.
    They tax me when I earn, they tax me when I spend, they tax me when I sin and they will tax me one more time when I die.
    And still the local, state and federal government are spending more than they collect in taxes.

  324. Bear: I don’t see profit as the problem.

    Of course you don’t, that’s the dogma of the invisible hand. All hail the invisible hand. Profit is never a problem.

    Oh, unless it’s lawyers making a profit off of lawsuits that should be prohibited by tort reform. That profit is bad.

    So, you support tort reform because greedy lawyers ruin everything for everyone. But you oppose health care reform because greedy insurance companies, well, they’ll just sort it all out and always come up with a solution that’s always better than any government ever could.

    Uhm, yeah.

    Interesting on how your purely “fact based” analysis ends up falling exactly along standard political party lines.

    That would be the dogma coming through, in case you missed it.

    did you take the McCain/Palin sticker off your car yet?

  325. I see a lot of people asserting that we have a responsibility to, say, treat poor children with leukemia.

    For the sake of the argument, let’s grant that point. Now: do we have any particular reason to think that a government program will be the best possible way to deal with that responsibility? Or even an acceptably good way?

    Which was better at getting aid to the people hurt by Hurricane Katrina? FEMA, or the Red Cross?

    There’s a reason organizations like the Underwriters’ Laboratories and the Red Cross are great at regulating the safety of electronic products and dealing with disasters (respectively).

    Why aren’t other ways of addressing our responsibility to treat the ill being examined?

  326. @ Kingtaco #369: However, a lot of folks are hip to the fact that so far Healthcare reform proposals have been extremely vague and shifting. It’s more of a ‘Just accept it and trust us vibe.’ That’s not winning many Americans outside a segment of Left die-hards (and I don’t mean that everyone on the Left is on-board). and politically/fiscally interested constituencies.

    Actually, health care reform isn’t all that vague, and people support it, once they hear an accurate, specific, neutrally-phrased description of it.

  327. do we have any particular reason to think that a government program will be the best possible way to deal with that responsibility?

    You’re kidding, right? 375 posts into a thread about healthcare and you spout off a standard right wing opposition trope as if no one brought it up in Health-Care-Reform-101 yet?

    This is what I mean by dogma. You cannot possibly fathom that the government could do a better job than private insurance, so even though people have point you to stuff like THIS, you look at those statistics and you turn and ask, “no really, do we have any reason to believe that government run healthcare is better?”.

    The facts don’t matter when it’s all based on dogma. Next you’ll be asking about death panels or something.

    I know John just asked me to play nice, but come on this is ridiculous.

  328. @ 375 I’m sorry, did I miss a non-government funded program that dealt with life threatening epidemics? Like the non-government funded program that, say, eliminated smallpox? Eliminated most of polio? Keeps hundreds of thousands from dying from things like measles or mumps?

  329. josh@378

    Don’t worry Jenny McCarthy is hard at work making sure these diseases have a chance…

    Thank you celebri-scientists and other quacks for making sure that people are afraid of vaccinating their kids…

    Who needs facts when you have fear?

    rabid

  330. Sorry for double-posting, John, but #375 melendwyr cross-posted.

    melendwyr, what “government program” are you talking about? Current health care reform in the U.S.A. focuses on using mainly on the insurance companies we already have.

    If the family is very poor, the child would qualify for Medicaid or S-CHIP (as they do right now).

    The only new government program being proposed would be available to people forced into the individual markets, and it would be only one of many options in a health insurance exchange.

    So if you don’t think your child would be well-served by a government program, you don’t have to sign up for one.

    The most significant policies in the reform bill deal with regulating insurer behavior and creating more competition in the private market through insurance exchanges.

  331. You know what? If you’re rich enough to be hit by the estate tax, then go buy a congressman and stop complaining on blogs.

    Meanwhile, I’ve been living off my savings for the summer since my pay was less than my rent (specifically, it was $760/mo take home); and now that I have less than $120 left in my bank account, I get a chance to buy health insurance! But if I don’t buy it in the next two weeks, I can’t have any for the entire year.

    But if I don’t spend my money on my car insurance by the 7th, then I’m screwed anyway.

    I do have 14 packs of ramen, so I won’t quite starve, and I could use losing a few pounds, I guess.

    … but I sure as hell am not buying my health insurance this year, and it’s not even because of cost – it’s only $240 for the year – but the time. I literally cannot pay it this month; I could probably pay next month if I postponed other matters, I could maybe even pay if I could pay monthly, but I’m not allowed to do that, so I’m going to go without health insurance for the year – because the only time I can pay for it is right now, when I am broke.

    How is this smart? How is this sane?
    I am “voluntarily” refusing to seek health care this year, and will declare bankruptcy if I suffer any kind of serious injury – forcing whatever hospital gets unlucky enough to treat me, in such a situation, to eat the costs – because I’m not allowed to buy insurance except during the one specific month in which I have no money. The last time I saw a doctor he said my blood pressure might be high and I should get it checked again – but I haven’t been able to, because I can’t see a doctor. I had bacterial bronchitis earlier this year – and if I had had it a week later than I did, I would have been unable to afford any treatment. I was lucky – I had it during finals week at the university where I work, so the health center was still open – I only had to pay twenty bucks for my antibiotics, and was better soon. But if I had had it one week later, I wouldn’t’ve been able to seek help until it was severe enough that I would have been willing to enter into bankruptcy to seek treatment. That is literally the situation I am in – I can’t afford health insurance when I’m allowed to buy it, so if I ever get seriously sick, I will not be able to seek treatment until I’m ready to go to the ER and then declare bankruptcy.

    I mean, I don’t have much to lose by doing so, except for any future chance of anything that requires credit – after all, I don’t have enough money to buy much in the way of “stuff”. But it’s still a really really stupid choice.

    Taxes aren’t even remotely close to making the top one hundred list of things I’m worried about.

    ps: I’m exactly the kind of person people are saying would never use the public option – I’m 25 and healthy! – but if I could pay my premiums in November or so, well, that alone would be enough to get me to do so, even aside from being able to ignore that nagging fear that having been (mis)diagnosed with ADHD as a child would be enough for a private insurance company to drop me if I ever made a real claim.

  332. @378:

    I’m sorry, did I miss a non-government funded program that dealt with life threatening epidemics?

    Actually, yes, you did. But they tend to work with the Third World, rather than the places you probably live.

    When there are both private charities and government programs trying to do the same thing, the government program tends to be inferior. How should that affect our estimation of how well government programs work in areas where there’s no basis for comparison?

  333. Criticisms of Canadian health care include wait times. But as the wikipedia article points out, if no one waited for anything at all, that would mean massive overutilization of resources. Way too many doctors. Median wait time for an MRI in Canada is 2 weeks. That’s a lot faster than I had to wait a couple years ago.

    Comparing the price of healthcare between canada and US, shows that the Canadian government spends about 2,100 dollars a person. The various levels of government in America spends about 2,700 dollars a person, but in teh US, that only pays for less than half of all health care costs.

    Prescription drugs are much higher in the US (Yeah, Free enterprise!). Canada spends about $500 a person. The US spends about $700 a person. And Canadians use more drugs. (maybe because Americans can’t afford it and don’t buy them)

    The cost of malpractice litigation is miniscule in both countries. In the US, less than half a percent of the total cost. Or about $4 dollars a person in Canada and $16 dollars a person in the US.

    So, anyone pushing Tort Reform is aiming at a political target and not something that statistically will make a significant difference.

    Per person total is about 2100 in Canada and 5000 or more in the US. Tort reform would save about 12 dollars a person. Switching to a canadian medical system would save thousands of dollars per person. And yet, the right wingers push $12 tort reform as their solution to medial costs, instead of actual health care reform.

    Someone tell me that isn’t politically motivated instead of motivated by the facts.

  334. Why aren’t other ways of addressing our responsibility to treat the ill being examined?

    Let’s look at the evidence then…

    We have a dozen or more examples of successful varients of the single payer model with varying degrees of market interaction that manage to provide 100% coverage to the populations at rates of 10% of GDP(ish).

    We have the US as an example of a distorted attempt to let profit making businesses do the same and failing (insert 8 to 40 million un or underinsured). We also have evidence that the primary cause of bankruptcy in the United States is medical bills – something not heard of in any other developed country.

    We have NO examples of a successful market based system for providing healthcare in an industrial economy.

    I’m not sure there actually are ANY alternatives that haven’t been explored at this point unless you start from the position that there is a moral problem with universal healthcare provision.

    Which was better at getting aid to the people hurt by Hurricane Katrina? FEMA, or the Red Cross?

    It’s true that you can’t account for genuinely incompetent government meddling in things like FEMA. There really was no excuse for the Bush administration to give a job that important to an unqualified chrony. The question is if FEMA actually had somebody who knew what they were doing running the show, would things have been different?

    For example: who were the most effective people on the ground after the Pacific Tsunami? Charities, or the US Navy and other government forces?

    Hint: It wasn’t the charities.

  335. Michael@381: I will not be able to seek treatment until I’m ready to go to the ER and then declare bankruptcy.

    Obviously, many right wingers would say that in addition to tort reform, we need to tighten bankruptcy laws so patients can’t get out of paying their bills, and that would really fix up health care nice.

    sorry the shit is hitting your fan so badly.

  336. When there are both private charities and government programs trying to do the same thing, the government program tends to be inferior.

    No, the government might be *slower* but there’s no private organization that has the capacity to organize on the scale the government does. Or at least did, until Bush gutted FEMA and put a drooling moron in charge.

    Actually, yes, you did. But they tend to work with the Third World, rather than the places you probably live.

    Most vaccination programs in third world countries are funded in part by your tax dollars. The WHO and UNICEF are not “private” in any sense of the word.

  337. When there are both private charities and government programs trying to do the same thing, the government program tends to be inferior.

    Examples please – you don’t get to play that card and declare victory in these parts.

    Which charities are doing better than government programs exactly?

    I’m not saying that some aren’t, in fact I’m sure many are. But what I am saying is that if we did into the examples I don’t think we’ll end up where you think we should.

    For example, while there might be charities out there doing Polio vaccination work, they weren’t the people who did the bulk of the work to get to the point where a charity could actually take over.

    It’s like the poor example of private companies delivering letters better than the post office. That’s a distortion because private companies don’t have to run a daily delivery service and can pick and chose the things they can afford to do for profit while the government is left carrying the can for the rest of it.

  338. We have the US as an example of a distorted attempt to let profit making businesses do the same and failing (insert 8 to 40 million un or underinsured).

    Um, no. No rational person considers private insurance to be an attempt to cover everyone. Insurance cannot provide coverage for everyone except in the most trivial sense – someone who has to pay the entirety of a medical cost isn’t really being ‘covered’.

    Please refer back to earlier statements about the importance of distinguishing between insurance and payment methods, and how this distinction has been hopelessly muddled.

    The WHO and UNICEF are not “private” in any sense of the word.

    Certainly. I wasn’t talking about them.

  339. We can’t rely on charities. Charities do good work, and they help people, but charities are insufficient. There was a time in the not-so-distant past when we relied on charities–old people died shivering in hovels and children starved on street corners.

    We used to have private fire-fighting companies. They were profit-driven. The consequences were awful and they were phased out.

    We shouldn’t be trying to make a buck off a grandmother’s heart attack or a premie baby’s first struggling breath any more than we should be trying to make a buck off a burning city block.

  340. Michael Ralston: “Doctors order unnecessary tests because that reduces the chances the insurance company will be able to deny coverage of the already clearly-necessary treatment, which means the doctor will be more likely to actually get paid.”

    That can happen. But what also happens in a greater range of health plans is that doctors don’t order necessary tests because the private insurers won’t pay for them. It’s not the best way to cut costs.

    JohnBear: “The Huffington Post is not a resource so that link doesn’t count @336.”

    Says who? If you have a problem with the news site, go to the New York Times and other media publications or Bill Moyers Journal on PBS that interviewed the guy, who worked in the insurance industry as a major executive and who says the companies have turned into a mess and are essentially cheating their clients. You can chose not to believe the guy, but I find him more reliable than say Glen Beck.

    “I don’t see profit as the problem.”

    Neither do I. It’s price-gouging and profiteering that are the problem. And the private insurers and health care industry have been doing plenty of that, which is a problem healthcare reform is attempting to fix.

    “The US (country not government) has a finite amount of money. It can’t be spent all on health care. Proposing that everyone get the best of care will only ensure that either everyone will get marginal care or everyone will get no care because there is no money to pay for it.”

    It isn’t and won’t be all spent on health care. You are arguing that the government can’t afford to pay for the healthcare it’s proposing. The CBO has already figured out that it can. It’s not a proposal that everyone get the best of care, but a proposal that everyone get basic care.

    Your argument is that the private insurers can handle things better than the government and reduce health costs. But that’s what we have now. They’ve had years to fix it, and they haven’t. They don’t want to fix it, and they’ve made it worse chasing extreme profits and reneging on their contracts with clients. More to the point, rather than try to drive down healthcare costs, they just don’t want to insure a significant portion of the population. And those people cost the government far more uninsured than they would with basic care and harm the economy. The private insurers don’t have to worry about the state of the economy unless it effects their profits; the government has to.

    The government has to deal with all these people whom the private insurers ignore. You’re saying that the government, unlike the private insurers, can’t afford to give basic care to all these people and can’t drop healthcare costs. You’re saying that the private insurers are better at low cost, even though A) they haven’t shown that they are in the past, even though they have enormous leverage over the for-profit healthcare industry; B) they won’t insure the uninsured who are the main problem; and C) they are worried they will lose customers to the government because the government can do lower cost healthcare than they can (i.e. they don’t agree with you.)

    What the private insurers want — if they can’t keep the status quo they’ve got now — is for the government to pay them to insure the uninsured, instead of the government covering the uninsured. (If the government is going to insist on basic care for the uninsured, then the uninsured become potentially profitable and then the private insurers want them.) Which is about as anti-capitalistic and anti-competition and anti-lowcost as you can get. It’s a proposed government handout to an industry that is flush with cash and doesn’t need it. An industry that claims, as you do despite not wanting to get rid of Medicare, that they are really good at providing healthcare, when the data shows they are really lousy at it, and again, shaft their paying clients at every opportunity.

    “Also, I was responding to @234 regarding SS. I didn’t bring it up. However, SS is another failing government program.”

    No, you addressed me specifically as KatG, regarding my response to another poster, and pointed out that when the Democrats controlled Congress, raiding of Social Security also occurred. Which was kind of irrelevant to the point I was making about it, but I acknowledged it anyway.

    “I think using GregLondon’s logic KatG is expressing racism when she disagrees with Michael Steele. KatG only wants Michael Steele to fail because he is black.”

    I’ll let Scalzi decide if this is a mallet-worthy issue, but I’ll just say that I don’t appreciate the joke. My point also wasn’t that I disagreed with Steele, though I do. It was that Steele is continually contradicting himself, as are most of the opponents of healthcare reform.

  341. @389: “There was a time in the not-so-distant past when we relied on charities–old people died shivering in hovels and children starved on street corners”

    Um, that’s the same time when government charities were nightmares as well. Poorhouses aren’t very good models for how charities should be run, government or otherwise. Or we could talk about how incredibly effective government charity was in, say, Ireland during the Great Potato Famine. (Hint: it was an absolute disaster.)

    As for who funded polio research: Hmmm. What produces more new drugs and therapies: government agencies, or big scary pharmaceutical corporations? (And they are terrifying, believe you me.) Who actually sponsors more research to determine whether approved drugs are really worthwhile?

    It’s neither gov. nor the pharm. corps. – it’s insurance companies. The FDA does diddly research itself and has so little enforcement power that it didn’t catch pharmaceutical companies reporting positive results and sitting on the negatives for decades. Why do you think there are so many drugs that were supposedly superior in trials yet were shown to be no better yet more expensive than existing therapies in studies of actual clinical practice?

  342. I think we all can agree that the current health industry in the United States is not working properly. People at all levels, except apparently the insurance industry, from patients to hospitals are having problems.

    I am incredibly disappointed that the Republican party has decided that instead of trying to fix things they are pursuing an entirely partisan strategy of killing health care reform to damage the Presidents election chances.

  343. melendwyr: Please refer back to earlier statements about the importance of distinguishing between insurance and payment methods, and how this distinction has been hopelessly muddled.

    It’s your own invented distinction. It’s a red herring. Private insurance pays for regular checkups and unexpected emergencies. The public option being talked about would cover both too. No one but you is trying to force “insurance” to mean “covering only the unexepected”.

  344. John Bear @368, your “others do” is an op-ed piece by an orthopedic surgeon who is chair of a political action committee. Are you really interested in facts, or are we playing my-partisans-are-better-than-yours? Would you be equally receptive towards a similar op-ed piece penned by the president of the AAJ?

    If we read the entire CBO 2006 report, it’s not as simple as the quote you cherry-picked (without explaining ‘utilization’), it notes that the effect of limits on malpractice suits varies enormously depending on what kind of spending you’re talking about and what other measures are implemented; in some cases “tort reform” actually increases spending, and in others the effect disappears if other measures are in place.

    (Interestingly, it also notes that malpractice premiums are generally not adjusted on the basis of the individual physician-insured’s claims history. Hmmmm.)

    So, again, you appear to have an opinion that you did not formulate in response to facts, but in response to your dislike of lawyers (everybody’s doin’ it!) and of lawyers’ advertising; you’ve challenged those who disagree with you to provide facts, apparently in the secure belief that they can’t do so.

    I’m not, actually, optimistic that you may reconsider your position. But you shouldn’t bring a rhetorical challenge to a fact-fight.

  345. Or we could talk about how incredibly effective government charity was in, say, Ireland during the Great Potato Famine. (Hint: it was an absolute disaster.)

    Hint: It was over 150 years ago.

    What produces more new drugs and therapies: government agencies, or big scary pharmaceutical corporations?

    So you’ve never stopped to ask who funds a lot of the work the big scary pharmaceutical corporations do? Especially the stuff that isn’t profitable?

    Have you not noticed that there are also a lot of medical innovations that still come out of the UK? Funny… even Stephen Hawking is still alive…

  346. jimf@392,

    Listening to NPR my commute they interviewed several people who hypothesized that the GOP doesn’t want healthcare reform to attributed to Obama. It would be a huge “win” for the country and therefore the democrats.

    I am naive enough to think that the GOP and other elected government officials would have the best interests of their constituents in mind when making these decisions.

    I would hope that something as beneficial as healthcare reform would be decided on how it would benefit (or be detrimental) to society and not its political capital…

    Rabid

  347. No one but you is trying to force “insurance” to mean “covering only the unexepected”.

    Greg, but this comes back to my eternal problem with this. Insurance can’t cover things that have already happened otherwise it’s not insurance. Which brings us back, neatly, to the elephant in the room: chronic conditions (genetic or otherwise) and pre-existing conditions.

    Insurance can’t be expected to cover either of them.

    The best you can do is share a risk pool across a large enough population that some people have to essentially pick up the tab even if they’re healthy. Anything else won’t work, unless you want formerly healthy and productive members of society dying in their economic prime or being forced into bankruptcy due to things that could have been easily treated.

    I think it’s a moral imperative that we provide such cover to a modern rich society.

  348. What produces more new drugs and therapies: government agencies, or big scary pharmaceutical corporations?

    Government.

    …if you really trace back where the seminal discoveries come from on which new drugs are based, it is federally supported research, usually funded by the National Institute of Health, and frequently conducted at universities or academic medical centers.

    Also, about poorhouses–yes, government aid to the needy was awful, but that doesn’t change my original assertion: charities are insufficient to provide services our society needs. They couldn’t handle the burden then and they can’t do it now.

  349. melendwyr: we could talk about how incredibly effective government charity was in, say, Ireland during the Great Potato Famine

    Holy crap. Did you just invoke the Irish potato famine of 1845 as a serious argument regarding the US health care reform debate of 2009?

    Rabid: I am naive enough to think that the GOP and other elected government officials would have the best interests of their constituents in mind when making these decisions.

    I see no evidence to support that belief. I think a recent poll said 56% of americans support health care reform.

    On the other hand, if Obama pushes on healthcare reform and the Republicans can force it to fail, they can hurt Obama and all Democrat’s reelection efforts.

    The fact that Senator Grassley from Iowa presented himself publicly as wanting the Democrats to work with him but several weeks ago quietly sent out a memo to his fund raisers that he intended to kill any health care reform bill, I think, shows quite clearly that republicans are only asking for “bipartisanship” to make them look good on TV to the general public while telling their base they’ll kill any bill that comes before them.

  350. South Carolina Republican Sen. Jim DeMint recently said that derailing Obama’s health care overhaul would be like “Waterloo,” Napoleon’s most famous defeat.

  351. Woot! I’m rich!! ROTFLMAO. About $30K last year. It will be less next year thanks to getting laid off. $22K is poverty level here in San Diego.
    Suprise there are lower middle class rightwingers!
    But you miss the point. Whether I personally pay estate taxes (a sin tax for working hard and saving?) isn’t the point. If I spend at 110% of my earnings at some point that behavior will come home to roost.
    Same deal for governments. Government local, state and federal should be cutting and cutting deep until the books balance. Not coming up with new ways to spend more.

  352. GregLondon@399

    Sometimes its fun to pretend that I am naive rather than cynical.

    Truthfully I have very little faith that most (I am making a generalization) politicians are keeping the best interest of their constituents in mind when making any decisions, healthcare included.

    Special interest groups? yes… media perception? maybe? John and Jane Doe… probably not…

    Rabid

  353. @390: Sorry for the misattribution on SS. Huffington Post is comprised of columnists reporting the way-to-the-left slanted opinions. I would not rely on Glenn Beck as a resource either as he is expressing his right-wing opinion. I’ve tried carefully to get the most objective source for the arguments here.

    @394: That CBO report doesn’t consider utilization when it takes into account the affects of tort reform, or lack thereof. The link I gave for that was the quickest I could find. However, that same information is in the CBO report through footnotes to the original 1996 study. I’m just going to agree to disagree with you on this one point. But I do appreciate correctly pointing out that malpractice insurance costs are quite small comparitively speaking.

  354. @395:
    What produces more new drugs and therapies: government agencies, or big scary pharmaceutical corporations?

    So you’ve never stopped to ask who funds a lot of the work the big scary pharmaceutical corporations do? Especially the stuff that isn’t profitable?

    Have you not noticed that there are also a lot of medical innovations that still come out of the UK? Funny… even Stephen Hawking is still alive…

    Can’t tell if you are being facetious with your comments. Do tell more please.

  355. Here’s a clip (starts about 1:30 into it) of a woman at a townhall meeting with Senator Tom Coburn (R-OK), she explains her husband has traumatic brain injury and insurance won’t cover it.

    Coburn, a senator, says he’ll get his office, his senate office, to try and help her personally. He then says that “the other thing missing in this debate is us as neighbors helping each other. The idea that the government is the solution to our problems is an inaccurate statement.”

    The cognitive dissonance ought to render the audience unconscious. A senator uses his OFFICE, his PUBLIC OFFICE, to help a woman who got turned down for medical help, and then immediately after oftering her public-based help, he says the government isn’t the answer.

    Well, then don’t help the woman, you fucking asshole. Let her and her husband suffer like you think they deserve. Don’t be using public money to help someone who you say would be best helped by private enterprise.

    And then the whole “neighbors helping neighbors” thing goes, what the fuck is government other than people coming together and helping each other. To quote an old document some people might know, “That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, … organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”

    To secure the rights of life, liberty, and the pursuit of happiness, neighbors come together and institute a government to work on their behalf, deriving their power from all neighbors.

    What are they supposed to do, have a fucking bake sale?

  356. I wonder what Sweden/canada/UK would say if someone were trying to take medical asylum?

    http://www.immi.se/migration/control.htm#refugees

    I don’t see a provision for medical assistance…

    If I could not insure my family and one of us got sick then the first thing I would look into is emigration…

    No bake sale, car wash, or charity massage parlor needed…

    How many cookies would we need to sell to treat someone with brain cancer?

    Rabid

  357. My grandmother has an interesting theory about “neighborliness” and “empathy” that ties directly into the healthcare debate.

    She thinks people stopped knowing their neighboors around the time air conditioning really caught on. Thus people stayed inside more, thus they didn’t know their neighboors that well, thus not being exposed to real people with real opposing points of view as opposed to charicatures on your favorite news show, etc…

    No frigging clue if there’s anything to that, but it’s interesting.

  358. John, Why do moderates always assume people on the right don’t read things for themselves but instead only plug in to the latest nonsense their leaders are telling them? smug enough? These people read the idiotic bill. Yes, they have looked at other countries. They look at any place gov’t is involved and come to the conclusion that maybe it’s not such a good idea to give control the health system to a bunch of politicians who love to plan, but are so bad at it and always subject the rest of us to the unintended consequences. Why are you so sure they can improve anything?

    The problem with the health care system is it’s too expensive. free market reforms that give the consumer more power will help control costs:

    1. Allow individuals to purchase insurance across state lines. This opens up markets (in South Dakota, I think, one insurance company controls 80 percent of the market).

    2. Allow individuals to choose a la carte pricing. If I would rather pay for office visits out of pocket and save on a lower premium, why shouldn’t I be able to? This is precisely how car insurance works.

    3. Give individuals who purchase their own insurance the same tax break as those who get theirs from their employer. Employer-based insurance is not counted as income. Whatever I spend on health insurance myself shouldn’t be treated as income either.

    4. Allow small companies to pool with other small companies so they can get the same discounted insurance rates that large companies get.

    5. Provide a refundable tax credit that individuals can use to purchase their own insurance. This will put the individual in charge of his health instead of being dependent on government or an employer, and thus he will be more responsible with his health and his health care spending. And it will put more buyers on the market, which will increase competition and innovation in the insurance industry. It will also allow all of the people without insurance to buy it.

    No. 5 is the most important because it helps de-link employers and health insurance, which is a big part of the problem

    National health systems harm those they seek to help: the sick, the poor, and the elderly. Mediocre healthcare for ALL, excellent healthcare for none is not a good solution. In national health systems, people make sure they get everything they can out of the system, because it’s “free.” Watch Absolutely Fabulous when Eddy stubs her toe….funny.

    Here’s an excellent illustration of the “difference between health “care” (i.e., going to the doctor’s every month to no purpose) and health treatment — and on the latter America is the best in the world.”
    healthcare and http://tinyurl.com/l5rh9k

    Please read it – it also addresses your comment about life expectancy.

    ps the UN study that concluded our life expectancies to be so awful included deaths from war and homicides, neither of which have anything to do with health care, nor do other countries have as much of that going on.

    Beatrice

  359. Beatrice: I’ll doubt anyone will both to read that once they learn the source. Sadly.

    In addition to the life expectancy, the left try to point our high infant mortality rate. This higher rate is due to the fact that the US includes prematurly born children in this number. Such births are not included in other countries counts.

  360. Bingo!

    Bea, a couple points: 1) Allowing individuals to buy insurance across state lines would create a race to the bottom. Every insurer would incorporate in whatever state offered the least regulation and oversight, and the American people would be screwed.

    Yes, there would be “competition,” but only the sort of competition that bankrupts families and denies coverage.

    3) That’s been in place since 2006.

    5) Sure! De-couple health insurance from employment! I’m all for that, both personally and as a citizen.

    But how are you going to make it affordable? An individual health insurance market already exists, and it’s a DMZ for American citizens.

    What are you going to do about people with pre-existing conditions? What are you going to do about recission? What are you going to do about plans that routinely reject everything the first time and rely on patients not to challenge it? What are you going to do about plans that raise the rates on an employer’s policy when one of the employees gets seriously ill?

    Well, apparently you aren’t planning to do anything.

    Thanks, though, for suggesting I inform myself on health care policy by watching a sitcom. Thanks also for linking to NRO, which is just another kind of sitcom.

    Free market principles are great when I need to buy a TV. They’re great when I want to restock on pens, or buy oatmeal. But they don’t benefit people with broken bones or heart disease.

    By the way, you hear a lot of anecdotes that compare one nation’s care with another’s. I’m not sure why you linked to that story about British care, since we have nothing like it in the current proposal. Here’s mine:

    I was on vacation visiting friends in Canada. My son started vomiting, so we took him to the nearby clinic. The doc checked him out, he was fine. Full charge for the entire visit? $60 CDN.

    I work for a doctor’s office here in the Pac NW. We see patients w/out insurance all the time, but they have to pay a $125 deposit just to walk in the door, and they’re billed for the balance later.

    Also, we operate at a loss.

    But hey! I’m sure those other nations will soon come to their senses and start copying our health care systems soon, right?

    John, over 400 comments! But you expected that, I think.

  361. 413: The nice thing about competition in this country is that people migrate to the best companies, not ones were they might risk getting dropped at any random moment.

    Or would you rather the federal government also provide your fire, auto and life insurance as well.

    (The continuing bingo comments are pointless and useless.)

  362. Bea: Why do moderates always assume people on the right don’t read things for themselves but instead only plug in to the latest nonsense their leaders are telling them?

    Because they quote National Review Online as if it were an unbiased source, rather than the frothing rightwing nuttery that it is.

    That’s why.

  363. These people read the idiotic bill. Yes, they have looked at other countries. They look at any place gov’t is involved and come to the conclusion that maybe it’s not such a good idea to give control the health system to a bunch of politicians who love to plan, but are so bad at it and always subject the rest of us to the unintended consequences.

    Where rates of increase are lower in the US? Where there are NO medical bankruptcies? Where the costs are lower? Where there is more coverage?

    There obviously looking at something I’m not. Elucidate. Compare to the Kaiser Foundation’s study on health care.

  364. By the way…

    Can’t tell if you are being facetious with your comments. Do tell more please.

    Try clicking on the link. Very informative.

  365. 397: You’ve hit the nail on the head, Mr. O’Neill.

    413: “Free market principles are great when I need to buy a TV. They’re great when I want to restock on pens, or buy oatmeal. But they don’t benefit people with broken bones or heart disease.”

    They did, once. Then people started fiddling with the system, introduced some tax-funded programs for selected subgroups and got a lot of votes in exchange. The guaranteed payments screwed up the amount of money going for health care costs, and so the price of everything went up. Basic increased-supply inflation. People charge what the market will pay, and guaranteed payments mean higher charges.

    We haven’t had a free market system since the New Deal, and it got worse with the Great Society. So now we’re paying the price for meddling – and people start screaming that we have to meddle even more to deal with the consequences. Sheesh.

    Another thing: those of you snidely referring to the “invisible hand” don’t know what you’re talking about. Like any other ecological balance, things aren’t perfect in the equilibrium state, just as good as they can realistically be under the circumstances. We can no more artificially force economic systems to do better than we can artificially control ecologies from the top-down.

  366. We haven’t had a free market system since the New Deal, and it got worse with the Great Society. So now we’re paying the price for meddling – and people start screaming that we have to meddle even more to deal with the consequences. Sheesh.

    Well, no. I think it’s arguable that the real damage has come from the retreat from the Great Society, as measures of poverty, problems in health care and so forth, and the concentration of wealth in fewer hands takes economic power out of the economy and into more speculative areas.

    And, again, this focusses on just this country, without reference to other countries’ system. This seems myopic to me.

  367. Wealth is concentrated into fewer and fewer hands as the middle class dies.

    Political liberty is strongly associated with the existence of a healthy middle class. There are examples from ancient China to King John and the Magna Carta. It’s the relatively wealthy but non-noble merchant classes that put limits on absolute monarchy for a time.

    Without a strong middle class, there are only two effective ways to be politically powerful: be one of the few people on top, or give up your individual power to a gross collective.

    And no, this isn’t topic drift. These health care problems have roots going way into our history.

  368. Oh, no! Let’s not adopt a British system!

    Instead, let’s adopt one that lets people keep the health insurance they have, if they like it, and brings much-needed regulation to the individual market!

    And let’s create health insurance exchanges that will let people choose which insurance they want! For people who *want* to be in a government plan, let’s give them that option as well!

    Great idea, Adam! So glad to hear you’re pro-reform.

  369. Actually, I am pro-reform. Just not this one. And not one that utilizes as much health insurance as our current system does.

  370. What private ‘insurance’ companies could possibly compete with a government program offering equivalent-or-better services and with a quasi-unlimited amount of funds?

    Subsidies did terrible damage to agriculture, and did a lot of harm through programs like Medicare. I hate to think what an even large subsidy program would result in…

  371. What private ‘insurance’ companies could possibly compete with a government program offering equivalent-or-better services and with a quasi-unlimited amount of funds?

    Could you check with your Canadian, English or Swiss compatriots and see how they do it?

  372. For all of the talk of the dangers of profit and free enterprise that I hear these days, I sometimes wonder why this administration feels the need to keep up the charade that their public option would be “competing” with private companies. How can one group of people claim, at the same time, that the problem with our system is that it is a competitive, free enterprise system (which it is not) and that it must be made to compete with a public insurance option (which it will not)?

  373. As a Brit I am not qualified to talk about US politics, but I am reasonably qualified to talk about public health care. By all means adopt it in the States, but please don’t adopt it as an imagined blueprint for the ‘improvement’ of society.

    If it works (and there are plenty of examples to draw on of places where it has worked to a greater or lesser degree), it will prove increasingly expensive. It will, whatever the benefits of improved health for everyone, begin to eat money. It will require greater and greater amounts of cash because it will require more and more managers and organizers. It is entirely possible that US healthcare will sooner or later get to the point as it has in the UK where the medical side takes second place to the infrastructure and the demands of maintaining the fabric of the organization.

    Budgeting and the allocation of resources thus becomes ever more important.

    The medical system must then become a tool of politics, and with it issues will dominate that have little do with actual health care. Sure, the principals will be there but perhaps not the practices.

    From our experience here, patients and doctors and nurses have become the fodder of statistics. Targets are set for our NHS to prove that each political gesture is good, even though the evidence of achievement is more a matter of interpretation.

    Over here, in order to achieve targets, some lengthy serious operations are postponed so that smaller operations can allow a hospital to “tick the right box” to show they are processing patients faster. It’s an illusion that an ingrowing toenail needs swifter attention than a heart operation.

    So, by all means promote it and support it, but beware of the monster you are going to create. It will consume both time and money and it may not be halted quite when you think enough is enough.

  374. @stevegle Good points. I recently read that the NHS is the third largest employer in the world, behind the Chinese army and the East Indian Railway Company.

  375. Stevegle: While I’m sure that the bureaucracy you describe is true for some of the NHS, it is equally true for any privately run system that serves a large population. It’s flat-out impossible to run any large entity, whether public or private, perfectly well and perfectly efficiently all the time.

    But the difference between a public and a private entity–especially for something as critical as health care–is that public entities are accountable to the people they serve in ways that private ones simply are not. Only large shareholders have any say at all in what private companies do. Public companies have to be answerable to each individual voter.

  376. @405 John Bear: Can’t tell if you are being facetious with your comments. Do tell more please.

    I am being facetious. Stephen Hawking is a reference to the IBD saying he wouldn’t have survived in Britain, whereas, in fact, since being diagnosed as an under achieving undergrad he’s the longest surviving ALS victim on Earth. And that, despite a terrible socialist system Britain continues to provide medical innovations which, for some reason, didn’t stop in 1948 when the NHS was set up.

    @411 Bea: This is precisely how car insurance works. Except, one thing you’ll note about car insurance is this.

    Claim too many times and they’ll drop you and the best of luck getting insurance to cover you if an accident has already occurred. Oh, and if your car gets totaled good luck with getting a price that lets you get back on the road without incurring out of pocket loses.

    I’ve said it before, I’ll say it again. Insurance is a lousy model. You can’t insure for things that you already have and most people will have something by their 40s that will probably only get worse with time. No matter how well they look after themselves.

    412 John Bear: This higher rate is due to the fact that the US includes prematurly born children in this number. – nice try there but that’s something of an accounting slight of hand. If you google on the CDC studies on this you’ll note that not only does this ignore that the US has more premature births than any equivalent nature when compared like with like, but that these are really unevenly spread across the socio-economic groups. i.e. poor people in the US have more premature babies than poor people elsewhere. Gosh! Who’d have thought eh?

    415 John Bear: The nice thing about competition in this country is that people migrate to the best companies, – seriously, since when? Competition doesn’t mean that people always go to the best company – the purchase decision in a free market is much more complex than that and it also assumes that people are informed enough to make a real decision about what constitutes best – compared to, say, the one who advertises on TV the most but actually has a pretty mediocre service… Is your car insurance the “best”? I’ll be honest, I haven’t a clue if it is or not.

    And, while we’re on this. While the government might not run insurance companies, in most places they do mandate that you have it for certain things and they do regulate it.

    @427 Melendwyr – What private ‘insurance’ companies could possibly compete with a government program offering equivalent-or-better services and with a quasi-unlimited amount of funds?

    Well, BUPA and HSA (to name but 2) from the UK seem to manage it. There’s a lot in Germany, Holland and France too. They also seem to manage it.

    Assuming that the government insurance isn’t perfect, and it’s unlikely to be frankly, there should be an excellent free-market in top up insurance for additional/better/faster services which the better off should be free to indulge in.

    @423 Adam: I’d like to have actually read the original letter because the Telegraph is a lousy news source. Even then, while it says people might die prematurely, the impression the article gives me is we’re talking about days or at most weeks.

    I noted that the model that they were complaining about was developed by charity run hospices.

    Draw whatever conclusions you may.

  377. @433 Dave O’Neill: Not having spent any appreciable time in England, I don’t know which news outlets are among the most respected there. But the BBC News has covered the same story and gives quotes from the draft guidance given by the General Medical Council. Namely:

    “Withholding or withdrawing life-prolonging treatment is in the best interests of a patient when there is no net benefit to the patient of providing the treatment.”

    http://news.bbc.co.uk/2/hi/health/1466254.stm

    The question, in my mind, is not whether or not the above statement is logical but, rather, who is making this decision to terminate life-prolonging treatment?

  378. One more comment before I abandon my computer:

    Assuming that the government insurance isn’t perfect…

    No system is going to be perfect. Every system is going to screw up something. It’ll spend too much or too little. Someone will be misdiagnosed. Someone will take the wrong medications. Someone will die, and their loved ones will grieve and weep and smash things in frustration.

    The real measure of the system (and the society) is which imperfections are we willing to endure. A long wait time for elective surgery or 18,000 preventative deaths? Doctors who go on strike for more pay or 700,000 bankruptcies a year?

    And don’t even try to sell deregulation. That trick doesn’t work.

  379. @434 Adam:

    As a rule of thumb the Telegraph and Mail tend to mis-report to make their point. And, lo!, reading the BBC coverage, this letter was to highlight potential problems with adopting the guidelines in use in private hospices on a national basis.

    Which isn’t what the Telegraph reported, as the guidelines in preparation haven’t been adopted yet.

    However, this actually really answers your question in part that this is a debate internally inside the General Medical Council and NICE the medical committee who set national NHS guidelines about what Doctors should do in terminal situations.

    However, going back to a comment in the Telegraph we can find what the Marie Curie trust, the private hospice charity do:

    The question, in my mind, is not whether or not the above statement is logical but, rather, who is making this decision to terminate life-prolonging treatment?

    Reading the Telegraph reporting [ :) ] – they say the following:

    “Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor. ”

    I’m struggling to find a problem with that myself. Providing it’s the medical team and nobody in administration.

  380. melendwyr@422: Wealth is concentrated into fewer and fewer hands as the middle class dies. Political liberty is strongly associated with the existence of a healthy middle class. There are examples from ancient China to King John and the Magna Carta.

    The tree of liberty must be watered with the blood of tyrants!

    It’s the relatively wealthy but non-noble merchant classes that put limits on absolute monarchy for a time.

    And I have a unicorn.

    And no, this isn’t topic drift. These health care problems have roots going way into our history.

    Yeah, all the way back to the potato famine, the magna carta, to the time when men hunted dinosaurs on the african plains.

    Not to mention health care reform violates the second law of thermodynamics. And we can’t compare teh US system to any other nation in the world because there are simply too many missing links.

    The world is flat. The earth is at the center of the universe.

    water runs uphill.

    This is the right wing tactic isn’t it? Spew complete and total nonsense to drown out any conversation?

    magna carta my ass.

  381. John Bear: “Sorry for the misattribution on SS. Huffington Post is comprised of columnists reporting the way-to-the-left slanted opinions.”

    Actually, no it’s not. It does have Democratic slanted opinion columns that are to the left, but certainly not far left. It also has investigative reporting. But what it mostly has is a news digest service that pulls articles from mainstream media sources such as the New York Times and the, gasp, Wall Street Journal (a hotbed of leftism,) and websites and news station footage. That you don’t know this indicates to me that you aren’t getting information from “objective” news sources but from conservative right ones. As was pointed out regarding your attempt to claim an objective source on the CBO’s report that was not objective news at all but political conservative spin.

    Melendwyr: “Wealth is concentrated into fewer and fewer hands as the middle class dies.” –

    Yep, because deregulation from conservative politicians allowed businesses and the wealthy to hide and hold on to their money through overseas accounts and tax cuts while the middle class still got taxed. We’ve lost the middle class thanks to Wall Street, not the government. The New Deal created a large middle class, allowing many people who could have never achieved middle class status to reach it. Before that, what we had was a small middle class, a small wealthy class, and a huge, poor lower class that had short life expectancies, high infant morality, child labor, were worked to death in factories, massive illiteracy, fatal epidemics, starvation, racism, etc. For you that may be a lost paradise, for most of us, returning to it is unappealing.

    “What private ‘insurance’ companies could possibly compete with a government program offering equivalent-or-better services and with a quasi-unlimited amount of funds?”

    You can’t have it both ways, nay sayers. You can’t say that the U.S. government does not have an unlimited amount of funds and so should not pay for healthcare for anyone but Medicare/Medicaid or maybe not even that, and at the same time claim that the U.S. government has an unlimited amount of funds and so can’t be allowed to offer healthcare services because the private companies couldn’t deal with it (a notion put forth by the insurers, but not backed by any actual data.) You can’t say that insurance should be free market capitalism competition and then say that the private insurers should get special protection from competition by the government and be subsidized by the government. You can’t object to the government spending money on healthcare for American citizens, but feel that private insurers like AIG should be bailed out and supported by government money.

    All these arguments focus on the patients the private companies still agree to insure or partly insure – the fear that the private insurers will somehow lose these people if the government steps partially into the system. The uninsured – many of whom were dropped by insurers — always get ignored, even though they are the main focus of reform. Either opponents want the government to bribe private insurers to take some of them, or feel they should just be left as they are now – without care, and an enormous, sucking hole on the healthcare system and the economy. The system we have now that helped the recession get several times worse.

    Harry Connolly: “Current health care reform in the U.S.A. focuses on using mainly on the insurance companies we already have.
    If the family is very poor, the child would qualify for Medicaid or S-CHIP (as they do right now).

    The only new government program being proposed would be available to people forced into the individual markets, and it would be only one of many options in a health insurance exchange.

    So if you don’t think your child would be well-served by a government program, you don’t have to sign up for one.

    The most significant policies in the reform bill deal with regulating insurer behavior and creating more competition in the private market through insurance exchanges.”

    Notice how this succinct post of yours has been almost completely ignored. Instead, we get arguments that the government is trying to enact a single payer system, which it isn’t., so we should compare the U.S. to single payer system countries, or that the government is trying to wipe out the private insurers, which it isn’t, and so on.

  382. melendwyr@420: We haven’t had a free market system since the New Deal, and it got worse with the Great Society. So now we’re paying the price for meddling – and people start screaming that we have to meddle even more to deal with the consequences. Sheesh.

    that invisible hand is getting hairy palms from all this talk.

    Another thing: those of you snidely referring to the “invisible hand” don’t know what you’re talking about.

    Sure I do. It’s what the world looks like without any government regulation, no safety regulations, no minimum wage regulation, no minimum age regulation, no restrictions on monopolies, no restrictions on anything that business might want to do.

    You know, the good ol’ days, when children worked 12 hour days on the mills, when men fell into the sausage making machine and showed up on your dinner table next week, when people worked in corporate towns, when monopolies were so strong and self-reenforcing that workers who complained were beaten and shot by strike breakers, when the stock market could overextend itself with crazy ploys to the point that the whole thing can collapse overnight, when one bank run would cascade into an entire population in panic with nationwide bank runs, yeah, those were wonderful examples of what an unrestricted market looks like.

    What’s really amazing is that you actually believe your own nonsense about the “good ol days” of free markets.

    But, then again, that’s dogma overpower and choking reality.

    Like any other ecological balance, things aren’t perfect in the equilibrium state, just as good as they can realistically be under the circumstances. We can no more artificially force economic systems to do better than we can artificially control ecologies from the top-down.

  383. @436 Dave O’Neill – I understand that this is simply a draft at this point. I’m not saying that this guidance is currently practiced I’m only using it as a means to highlight the discussion that takes place.

    I think the family should have something to say about whether or not life-prolonging treatment is terminated. Maybe they are involved in the process as well but that isn’t the impression I got from the article. Why would the decision to stop hydrating and feeding the patient be a cause for concern if the family could simply “overrule” this panel of doctors and continue treatment? And if you’re thinking that families in the U.S. have just as little say given that the decision is essentially in the hands of the insurance companies; well, you’re right.

    I think it’s a general truism that those who provide a service work for those who directly pay for it. In my view, there’s little difference between a doctor working for the government and a doctor working for a private insurance company. Either way a third party will bear the majority of the costs involved – as a result their say counts the most. People talk about wanting to put the patients in charge of their health decisions. To accomplish this it must be the patients who are directly paying the costs of that health care.

    I understand that there is a significant portion of the population that could not afford to pay for all of their health care costs out-of-pocket. I break them into two groups: those who are very poor and those who are very sick. I can understand the argument that the government should help people in these groups (I’m not sold on whether or not it’s necessary but I understand it – for this discussion I think we can assume that it is necessary). The point that I would like to make is that these groups are the two extremes and there is a large group of people in the middle: those who are neither very poor nor very sick. I don’t think it’s unreasonable to expect these people to pay for most (if not all) of their health care out-of-pocket. Additionally, I would argue that removing the arbitrary barrier between the producers and the consumers of a service would naturally reduce costs across the board. People would now have the incentive to seek out cost effective medical treatment and doctors would have the incentive to provide it. The argument that this would not happen because health care is a “need” and not simply a “want” holds no water. We need to eat to survive as well but we generally don’t get taken to the cleaners by grocers running up their prices to exploit our need. This is because we can always go to the grocer down the street.

    To take an example from medical care, consider the costs of elective surgeries such as cosmetic surgery or lasik eye surgery. These procedures are generally not covered by private insurance and therefore must be paid for out-of-pocket. The costs associated with them have gone down dramatically over the last decade. It is this real competition (as opposed to the fake competition touted by the Obama administration) that drives costs down.

  384. Adam:

    I think the family should have something to say about whether or not life-prolonging treatment is terminated.

    In all seriousness: why?

    I can agree at a gut level, but having watched my grandmother die after a stroke, I’ll testify that the family are the last people to make a sensible decision, especially at that time.

    The horrible, terrible, truth is that, at the end of the day we’re all going to die and there isn’t a damn thing that doctors or medicine can do about it. Beyond a certain point all you can do is ensure that the person is comfortable.

    An example a Doctor friend gave to me:

    They were asked by the family of an elderly lady to get her a kidney transplant. Is that a sensible request? Should the family make that request? Should, for example, regardless of ability to pay, a kidney go to an elderly lady? Would your decision change if you knew that she already had dementia?

    The family don’t want her to go, naturally, but the family are not in a position at that stage to make a rational decision. Which is why having end of life plans in place should be key.

    Now, onto your other point:

    I don’t think it’s unreasonable to expect these people to pay for most (if not all) of their health care out-of-pocket.

    You don’t? Why not? What do you define as acceptable “out of pocket” expenses for somebody to qualify as “not very sick”?

    My hypertension probably costs about $500 a year – it’s mild and easily controlled. I have friends who probably cost in the region of $2000-$5000 a year – medication, quarterly doctor visits, a specialist once a year. Is that enough or too much?

    How about somebody with clinical depression? That can run to several thousand a year. That’s a pretty heft amount out of an average paycheck – but I can assure you that somebody with untreated clinical depression isn’t as productive as somebody treated.

    In other words, there isn’t a fair nor sensible means to draw that line. And I also have to reject the following statement you make:

    dditionally, I would argue that removing the arbitrary barrier between the producers and the consumers of a service would naturally reduce costs across the board. People would now have the incentive to seek out cost effective medical treatment and doctors would have the incentive to provide it.

    I’m pretty clever, at least I like to think so, and I’m fairly sure that I couldn’t sensibly, and wouldn’t want to, work out how best to medicate my mild hyper tension.

    This isn’t lasik or a boob job. You don’t need those. But I do need to medicate to keep my BP in the 120s/80s rather than the 140s/90s.

    Without that I’m going to have a myocardial infaction.

    It’s that simple.

    I don’t remotely see how a market is going to magically handle diabetes treatment, hypertension, depression and any number of conditions.

  385. Harry, re: 413, as someone who purchases insurances individually, I am well aware that the individual health insurance market is “a DMZ for American citizens.” The reason, however, is *because* of government intervention, not the lack of it. The health insurance market is NOT a free market. I’d like to try a free market.

    You say the free market does not benefit people with broken bones. Well, yes, but that’s a total red herring. Just as with any other type of insurance, the time to buy health insurance is *before* you break your bones when you have buying power. I’d like to give the individual much more buying power.

    And if purchasing insurance across state lines is a “race to the bottom,” why hasn’t that happened with the car insurance industry (or any other industry)?

    Lastly, when the insurance company tries to screw you, you have recourse – whether by raising holy hell (as I have had to do) or by suing or by taking your business elsewhere. When the government becomes the insurer, you will have NO recourse whatsoever. The only person making decisions in a government plan is the bureaucrat. Good luck with that.

  386. Good luck with that.

    Funny that’s what I thought when you talked about suing your insurance company.

    And taking your business elsewhere?

    Having been invited to do so by my household insurance last year for making 2 claims, one of which wasn’t even covered, I don’t think they’ll care.

  387. John,

    You are absolute correct about the way that conservative view the current health care debate. Although this debate is really the Waterloo of the right, not the left. It’s just that the battle is not yet over and for some weird reason, the right still has a slight chance to win. This year anyway. It is only a matter of time. If nationalized health care goes forward in any significant capacity, then it will be enshrined as a right and will be subsequently tweeked into anything desired at a later date.

    In my opinion, such a development will unalterably change the relationship between the citizen and the state in the US. The citizen will become essentially, a ward of the state and our health will be managed by the state. It is a little ironic that leftists are so close to total victory in the US, yet so critical of Obama recently.

    How do you feel about the Constitutional issues involved? Does the argument that massive social programs are not authorized by the Constitution sway you at all?

    How effective will this sudden and undefined expansion of Federal power that is now being contemplated be in actually meeting health needs? Are there any example of a massive Federal program that resulted in success, effectiveness and cost savings? Why should we expect it to have a different trajectory for this massive bureaucracy than, say, our glorious public schools, which are bastions of drugs, sex, violence and underachievement.

    What do you think about the horror stories coming from Britain about poor care, rationing, and widespread denial of services? Why won’t the American model imitate?

    Does it seem reasonable that the members of Congress be allowed to keep their own, private and vastly superior health coverage when the rest of the nation is switch to a different system?

    You seem to dwell on the public comment of Republicans and opponents on the right. But do you have any problem with the incredible rush and bad faith of the Democrat controlled Congress in this matter?

    What about projections of massive debt required to pay for this and other entitlements. I doubt that a couple hundred or even a couple of thousand dollars per year in taxes will even start to cover this beast. Oh, that’s right. There will be no increased taxes for low wage earners. I forgot. Nevermind that question.

    Your comment that health care is a “right” is a moral judgment. I don’t understand where that comes from. Surely, considering, the brutish history of mankind, it has to be a right that has been established pretty recently. When did that right appear and by what revelation was it enshrined as part of basic humanity.

  388. @ KatG #438: Thank you. I wish more people paid attention.

    @ Adam #440: The argument that this would not happen because health care is a “need” and not simply a “want” holds no water. We need to eat to survive as well but we generally don’t get taken to the cleaners by grocers running up their prices to exploit our need. This is because we can always go to the grocer down the street.

    You don’t understand the argument. I’m going to try again, one more time.

    When your daughter has been injured in a car accident, you don’t stand at the ER desk and say “How much do you charge for plaster of paris? Hm. Do you offer other options?” then walk out of the ER looking for a better deal

    When you have a heart attack, it doesn’t matter if you’ve already done the research on which hospital has the best cardiac care–the ambulance is not going to drive you to the other end of town. They take you to the closest place.

    When the doctor says “I’d like to run some blood tests,” you do it, just in case (if you can afford it).

    So yes, food and health care are both “needs,” but you’re missing the point that food is a choice that you make, and health care is a choice that’s made at you. Not for you. At you. Your son turns out to be allergic to corn. Your spouse needs diabetes medication. The doctor wants you to have a colonoscopy.

    It’s not like buying an iPod. It’s a colonoscopy–you’re only getting it because your doc says it’s important, and you don’t want to die.

    And yeah, as Bea says in a comment below yours (missing the point entirely) you need to get insurance beforehand. But you don’t control the spending. Experts do. And what’s more, once you “need” insurance, no insurance company wants you. Not at a price you can afford, anyway. Going to the insurance company down the street doesn’t work.

    Why? Because their business model doesn’t derive profit from providing a good service at a reasonable cost. They get their profits by only covering people who don’t need health care (or don’t need very much, at least.)

    If your idea is that you’ll announce you’ll take your custom elsewhere, insurance companies will hold the exit door open for you.

    @ Bea #443: When the government becomes the insurer, you will have NO recourse whatsoever. The only person making decisions in a government plan is the bureaucrat. Good luck with that.

    As it turns out, I live in a democratic republic. When the government screws up, we sic the media on them and pressure them to change. It works.

    When private corporations screw up, we sic the media and the government on them. Then the corps donate a bunch of money to politicians, and then things get difficult to fix.

    Also, I would have thought last fall’s economic bust would have been the Berlin Wall of deregulation.

    @ David Ferguson #445: What do you think about the horror stories coming from Britain about poor care, rationing, and widespread denial of services? Why won’t the American model imitate?

    Because the proposed reforms have nothing to do with the British system. Next.

    Does it seem reasonable that the members of Congress be allowed to keep their own, private and vastly superior health coverage when the rest of the nation is switch to a different system?

    The nation isn’t being switched to a different system. Whoever told you that is lying to you. All reform will do is regulate bad practices and expand options for people who are uninsured or underinsured.

    Reread the last nine words of the sentence above. If you don’t believe me or don’t understand how that’s going to work, you shouldn’t be in this discussion.

    What about projections of massive debt required to pay for this and other entitlements.

    The U.S. already pays roughly 50% more than other first world nations for our health care. That’s figured per capita and as a percentage of GDP. Massive debt? You’re soaking in it.

    Ugh. I’m done.

  389. Bea: Lastly, when the insurance company tries to screw you, you have recourse – whether by raising holy hell (as I have had to do) or by suing

    I’m sorry, but your right to sue will be removed by the right wing’s insistence on Tort Reform.

    And to all the “Invisible Hand” folks out there doing naughty things in the dark (that’s you, melendwyr, Jack Bear, and Bea), I tell you what, if you say that the only way the Invisible Hand can really work is if we remove all these artificial laws that the government has created which upset the natural order of things, then fine, let’s start by getting rid of one of the earliest government sanctioned artificial contriviance that alters the natural order of how people do business: the corporation.

    Lets start by removing the right for anyone to incorporate. tear down teh corporate veil that sheilds investors and ceos and board members from taking personal responsibility for the actions of their businesses. Your product causes cancer and you knew it? You go to jail for murder. You invest in a business and it borrows a bunch of money and doesn’t pay it back? then they can go after your personal assets to recover the borrowed money.

    Oh, but wait, I keep forgetting, all you Invisible Hand people, you want all the government perks that government creates for business but none of the restrictions that go with it.

    so yes, tell me again about this wonderful and grand notion of this “free market” you speak of:

    The reason, however, is *because* of government intervention, not the lack of it. The health insurance market is NOT a free market. I’d like to try a free market.

    tell me of the evils of “government intervention” and how everything would be just hunky dorey if we got rid of “governmetn intervention”, if we just reverted to the natural state of a “free market”.

    Then explain to me how you get to define a “free market” such that you keep all the “government intervention” that corporations benefit from and remove only the ones you don’t like.

    Dogma. Complete and utter extreme right wing dogma. Dogma through and through. That’s the only explanation as to how people can preach such total nonsense, such utter hypocricy, while simultaneously believing every bit of it as gospel truth.

    melendwyr suggested that the solution to gay marriage was to abolish legal marriage completely. Get rid of any government intervention. Force it to be individual agreements and contracts between people.

    I say that getting rid of articles of incorporation is no different than getting rid of governmetn sanctioned perks for marriage.

    If you truly believe the government should be out of marriage or the market, to the point that you support getting rid of legal marriage for everyone, then you ought to support a completely “Free” market, with no government perks for corporations.

    Come on, all you Free Market shills. Stop wasting your time defending insurance corporations and focus on the biggest unnatural government intervention on the Free Market there has ever been: Fight the concept of the corporation itself. Tear down that corporate veil.

    come on…

    No?

    Ah, well, the truth of your inaction betrays the lies of your words.

  390. The U.S. already pays roughly 50% more than other first world nations for our health care. That’s figured per capita and as a percentage of GDP. Massive debt? You’re soaking in it.

    But that’s only because the US has all these hindrances on private insurance so they can’t function efficiently. If we got rid of government intervention completely, then we’d see our health insurance costs drop like a rock.

    And the only reason these other countries with government run health care has cheaper costs then our private-insurance-with-government-meddling is because those foreign countries are secretly turning patients into soylent green when they turn 65.

    This allows them to ration care, and they make money selling soylent green to third world countries.

    And the reason that all those foreign countries have better health statistics than the US is because after they lie on all the questionaires.

    I saw that on a Fox News report, so it must be true.

    Would you like to hear about my 9-11 conspiracies and how the pentagon was actually hit by a missile launched by a US warplane? It all makes perfect sense.

  391. @445 David Fergusson:

    What do you think about the horror stories coming from Britain about poor care, rationing, and widespread denial of services?

    I’ll make you an offer, I’ll match every single “horror” story you dredge up about the NHS and match it with an excision or similar insurance horror story from the USA?

    What about the lack of stories from France, Holland, Germany etc etc etc…

    Your comment that health care is a “right” is a moral judgment. I don’t understand where that comes from.

    It comes from the same place that all “rights” come from.

    We agree them and, in some cases, enshrine them in law until either something better comes along or we realize that the right shouldn’t have been a right in the first place.

    The alternative is that there is a magic strata of “rights” which, like sub-atomic particles are sitting out there waiting for us to discover them.

    As I don’t believe in God or similar ultimate authority on these matters I have to, therefore, conclude that rights are derived by us for us. In the modern developed world we don’t let people starve or go without housing, water or other similar things – we shouldn’t let them live without access to healthcare.

  392. I enjoyed John’s books but I linked into this site from Instapundit. I read John’s health care rant. Pretty offensive. I won’t argue, his rant does not deserve the time. But I will tell you what I will do as a result of reading it. Won’t be buying anymore of John’s books or any need to visit this site in the future. I will also stop recommending his books. Still don’t understand why someone who seemed rational and intelligent needed to dehumanize those he disagrees with. Sorry to see that. It’s also sad to see someone you respect do something so embarrassing.

  393. I don’t watch a lot of TV, but there was an ad on tonight from AARP in favor of health care reform.

    It was actually kind of neat. It showed an ambulance trying to get through a big city and cars kept pulling in front of it to slow it down. The ambulance was health care reform, and the voiceover identified the obstructionist cars as “special interest groups”.

    Is this a new thing? or has AARP been doing these ads for a while?

  394. Oh noes John, you’ve lost a reader! Now you’re gonna need the free healthcare because you’ll never work in this town again!
    Oh I see, that’s why you supported it to begin with. Oh your a tricky one Mr Scalzi.

  395. I decided to go through the “being poor” comments…. maybe because I want to punish myself… or make myself cry. Maybe becuase they are so pertasnient to the health care debate. I do not cry very often…. except 8 years ago when I ended up having to not live with my daughter.. and I have not seen her since…. I think I cried for 3 or 4 months… then I ended up in a psychiatric hospital for a couple of months… since then I have ended up accepting the situation.. forgiving the mother of my child her family and most importantly myself… but I digress… I normally avoid crying in possibly a non-healthy way.. watching ER on DVD and this Health Care comments thread… and myself getting over a significsant depression.. maxe myslef want to have a good cry… and being poor is a good cry.

    Being poor is hoping the toothache goes away.

    Being poor is a six-hour wait in an emergency room with a sick child asleep on your lap.

    Being poor is a cough that doesn’t go away.
    Being poor is laying down because it hurts to breathe and you are pregnant, but you can’t afford to go to the hospital.

    Being poor means watching your disabled child get worse and worse because you can’t afford the therapies.

    Being not poor means realizing you still can’t afford the thereapy, and there’s no ‘help’ because you’re not poor.

    Being poor is worrying about appendicitis every time you ovulate.

    Being poor is eating no-brand hotdogs and the cheap ramen every day for two months because otherwise you couldn’t afford formula for the baby.

    Being poor means you use the money your in-laws send your kid for his birthday to buy peanut butter and pay the pediatrician.

    Being poor is obviously your fault, even though the biggest, fattest reason you had to file bankruptcy in the first place was because your husband frivolously got cancer while laid off. How silly of him! And then he couldn’t find a new job until he was done with treatment because oddly, employers are shy of hiring bald, vomiting people with IV ports taped into their arms.

    Being poor means selling blood plasma and signing up for every medical experiment they’ll let you into, and breezing past the disclaimer form because, really, are you going to give up $100 just because you may be risking injury or death from whatever they’re giving you?
    Being poor is being happy that your child is disabled enough to get you more government aid.

    Being poor means not being able to afford the $10 co-pay at the free clinic.

    Being poor is throwing up six times a day because you are pregnant and don’t have health care.

    Being poor means that you can’t even scrape together enough change to ride the bus to the neonatal clinic, and it’s the middle of summer and too far to walk.

    I only went just over 100 posts deep into Being Poor… have most of the health care related posts here.

    In love Being Poor.. well I don’t but I do… it is the best use of thge internet.. I have shared it with many others in the past few years.

    Have I ever been truly poor? No I donb’t think I have.. Ihave felty many of these feelings in University… and as a prospective and actual father while I worked on a farm and then at Wal-Mart.. unloading trucks… if your parnter is pregnant.. you don’t have time to look for the right job or even a good job.. you take the job that is available NOW!

    My parents are middle class.. fo awhile my dad lost his job.. he was actually laid off form his aerospace/ defence contracting job on THE September 11th.. ironic… but he had hated his job for years… he wentfrom engineering communications satelites in the 1970′s and most of the 80′s to making defence products in the late 80′s and 90′s. From the engineers (he is one) dictating what needs to be done… to the accountants and lawyers helping mass manufacture goggles to see in the dark… or other defence products.. My dad is no dove… nor is he interested in war at all. He votes conservatively… but he went from working on cutting edge unique soace products to mass manufacturing defence tools…. it was not the same… and he was unhappy in his job for years… over a decade…I was happy he was laid off.

    My brother… was into drugs.. he moved out at 15.. sold and used drugs… was poor in many ways… really poor…. he went to the Salvation Army and Thrift Stores for Clothes. He at one point only ate ast Mcdonald’s lucky if it was more than once or even once a day. He went to rehab… paid for BY THE GOVERNMENT (which is health care IMO) he got clean for awhile… eventually in NA and AA he got his ass together.. he had a grade n ine educatuion as his highest grade…. now he is a multimillionaire form the company he started with my dad.. from my dads…. pension and retirement investements.. he is my employer now and he employs over 20 other people withg very decent wages andf health care in an internet marketing business… and aside from a few 10′s of K on my Dad’s credit cards.. at the beginning of the business.. neverr had a loan.. and has 10+ million inrevenue and 2 millin+ in profit company….

    Anyway my point is health care works, drug rehab works… paying to help others works… and my family whoile now quite wealthy has… all of us felt the pain of real poverty.. not to the extent of many… but to the extent of a lot of people. My dad made really good wagers for well 30 years… he paid a ton of taxes…. he never got anything from it…. eventually both his sons ended up having to go to rehab…. my brother waqs on Welfare for a few years as a teen.. he spent a short time in jail… and now society is paid back a zillion fold as this 5 year old company has paid well over 12 million in taxes… including income tax for the like 50 man years of employment at an average of over 45K an employee per year… with everyone having full medical insurance for dental and eyecare… paid for by their employer…. Employee ends up paying like $8 a month….. 100% coverage.. it costs the company a couyple of hundred a month employee a month. The compan y takes in now about 2 million in revenue a month…. and hudreds of K in profit. My brother… owning the company and being at one point a teen drug addict and a very, very poor person…. is now a multi- multi millionaire… and that is only in $$$ he has taken out.. he still owns the company. My brother is not bleeding heart liberal…. and he does not even vote… he never has… but he does well for his employees… We havce had to let go people because they could not do the job… they got far, far more than was legally required. He has helped some charities.. not a ton but a little.. He does not waste money.. I think because he was poor…. he does not worry about money… but nor does he spend money unless he really wants to do so. He has some decent clothes and he has travelled a lot but he only owns a modest suburban home.. he does not even have a car…. as time goes on and he is not the entrepreneur but a manager andf has stopped workinbg crazy hours… he still does not spend his money crazily…

    My point is curse your taxes.. and the teen on the streets doing drugs….. Maybe just maybe your tax dollars might turn his ass around andf he just might create a ton of tax dollars and jobs and wealth and good.

    And being poor like my brother… or feeling poor like I did.. Or having to work your ass off for a lifetime like my father…. I felt poor though I always knew if I could not afford an apartment or food I could have gone home to my parents… they would have helped me n o questions asked… so I guess I can not claim to be truly ever destitiute.. but I have felt it I have worked at a grocery store… at the worst financial time for my whole family.. I got a girl pregnant… a giurlk I liked but did n ot love.. but nevertheless I was a father and a suporter of a family.. working at Wal-Mart… and at that time… my parents had the least to give me as they ever did. If it came down to it.. My daughter would never have wanted for anything importsant.. and she never did want for anything… and the only reason I could let her mopther take her across the country and live withg her parents is because I knew my daughter would want for nothing.. in food or love or care. As much as her parents… the mothers parenbts did not want me involved….

    Anyway my point is evenb middle class people.. many f them haver been poor or felt poor or felt unable to cope with their financial situation… and sometimes the poor end up getting their shit together and massively contribute to society.. it may not happen all that often but I am sure that my brother is not the onyl teenage dropout drug addict that went to rehab and ended up founding a signifant company thgat employed a lot of people.
    I am sure in the USa there is a ton more families like m ine that had something bad happen to them through ill health and ended up desititute… and I am sure most stories of families are not as happy as mine.

    I just wish there was more compassion…. Life can suck… anyone can get dealt a bad hand from birth or at any time. People are inherantly good. A really poor ass woman… that has two kids and no eduactiobn or skills.. if she turns to turning tricks.. sometimes to pay for her shelter and food for her kids.. is she a horrible mother or the saddest of stories?

    It is crazy and sad that in Canada and the USA… so wealthy of countries…. with so much taxes.. that people grow up actually being and feeling and being so poor….

    I will tell you more about myself.. because this zillion word post is not quite enough… I amn from Ontario..
    . the mother of my child is from Newfoundland. If you know Canada.. you know the difference. She decided to move back to Newfundland with my daughter to be with her family…. InNewfoundland everyone is white.. and a Newfoiundlander.. I am white too… I don’t want to make this about race.. bu8t at Chritmas In went to the biggest mall in the province.. it was packed…. I saw two families that were not blond or redheads.. they were black…. of tens of thouasnads of families…

    I came form a place where Wal-Mart and McDonald’s and a zillion other reatil places.. and actually some decent jobs were advertising to fill poisitions…. and I worked at Wal-Mart and it paid $9.50 to me startting when minimum wage was $6.85. It was not great.. but there was a demand for labour.. I went to Newfoundland… I aplied for a few jobs.. part time shovelling snow… as a janitor at $6.50 an hour.. and I was not a Newfie… they speak with an accent.. a strong one.. at times I could not understand it.. it wass alm ost not even English at times.. I never got a second interview.. even at the crappiest job imnaginable… In Ottawa, In Ontario.. anyone can get A JOB.. I mean a minimum wage or a few bucks more if they asre at all presenatble and somewhat literate and appear bright or at least appear like they wan’t to work. Granted living in “Newfoundland was much cheaper.. but it was near impossible to get a job. At say Wal-Mart.. they would not hqave turnover.. you get hired you stay… In Ottawa or Toronto.. likely in many, many US cites too.. then in 2000 or now evenb inb the recession.. there aqre many jobs available… they might be crappy jobs but they are a job… you can make 1000-1500 a month at worst…. if youy have a pulse anbd an ounce of brains and interest in doing a good job…. In Nefoundland…. there were simply no jobs available.. A job at Tim Hortons or Starbucks would be treasured…. kept for a decade or decades iuf possible.

    Tying this back to health care.. Newfoubdlanbd is in Canada.. but I am sure there arte many towns and cities like this in the USa or the rest of Canada….

    If you can not get a job… even if you want one.. and it is not easy to move with family or other things you need to take care of whaty canb yoiu do if you get sick…. many crappy jobs have no health benefits…. If yoyu are so hungry for a job toi support your family and oner is offered but it dose nbot inbclkude health care… whaqt can you do?

    What if you end up as a poor young person.. pregnant.. withg no health carte.. h0ow much will thast baby cost? The rigth wing wants less abortions.. with better health care and support after the fact there are less abortions as well.

  396. Man I am sorry for that… I am very tired and it is very late.. 5:30 AM…. but I did not proof read that and re-reading it.. I love how much I shared.. about myself and my families various situations.. but the spelling are horrid… there are maybe 50 spelling mistakes…. Please read it as if an intelligent person wrote it… I am used to posting in forums where sometimes I can change the posts after I make them… I wish I could edit my previous post… (can you tell I love the … I know you can tell!)

    Also got a netbook a week ago.. the keyboard is actually not that bad but sometimes I look back at what I wrote.. and realize I missed keystrokes. Anyway please take the previous post wit respect. I said a lot and it meant a lot to me…. but it comes off as kinda dumb because it is so poorly written.

    I will try to never forget to proof read before I post here again.

    Also.. I hope you Americans get real universal Health Care… really today in 2009… I as a taxpayer in Canada would be willing to pay the 4 or 5% more in taxes for everyone in the entire world to have the kind of health care that is available in Canada. And I normally vote conservative!

    I would rather pay for even the poorest in the poorest countries to get North American level Health Care.

    Hey I am an environmentalist… not a hardcore one… well maybe I am but not a traditional one.

    To me the greatest… the absolute greatest threat to the environment is overpopulation… and I love people.. I am a Humanist.. but as Europe and North America, and much of Asia.. and eventually parts of Latin America see their population level off. (I know it is a stretch for Latin America… but parts of it are quite developed)

    Anyway.. carbon taxes… and a ton of environmental issues are missing the goal and the long term point… the end game.. the most important fact in protecting the environment for the next 3 or 4 or 5 generations.. what is the biggest factor in future environmental damage… out of control birth rates in poor countries in Africa. Rampant Aids and poor nourishment and no education…means maybe billions of damaged people…. destoring the environment through having no other choice.

    I know it is cool to care about the Arctic Environment.. But Africa is a far more important place to protect.. they have vast rain forests, still they do. They have millions of impoverished people…. poor and actually starving… to death.. making the poverty, which is real and hurtful, in the first world, not even comparable.

    This is about public health care in the US… but the US is the most important country in the world.. you have a unique President right now. A powerful and smart man who cares about people.. and even has attachment to Africa.

    I say look at even the bigger picture…. Lead the world to public health care in Africa and Haiti and in all the poorest places on earth. Start with the USA and move on from there. I am serious too… Obviously Obama can not do it in the next 7 years… but he can start the movement. And there are many ways this helps the USA. It sells vacinations and other medical technology to billions more people… even at a very low cost… and even if the vast profits being realized in the USA are limited by some form of public health care… some kind of “bail out” and I only say bail out to compare it to what has happened with the banks, is justified. And this would only be US led. The USA need not take on more of the weight on herself than all of the European countries, and Japan and Korea that always want to donate to US led initiatives… and the Saudi’s and other middle East Oil states.

    The fear of terrorism is real. But massively overblown. And it costs a fortune. Spending some of the vast world wide anti-terror budget on health care and social develpment in poor countries would be far more beneficial selfishly to the USA and the rest of the first world. IOt would likely stop pandemics in the future. It would reduce overpopulation in the poorest of countries… and very importantly it would reduce the number of possible terrorists as more wouldhasve something to lose…. it would massively help the US’s image.. and the image of the rest of Europe in poorer countries and among the middle eastern islamic countries where the terrorist movement comes from.

    If the Western (First World) led by the USA truly was determined to institute universal health care.. as a right as a human born on earth.. and supported other social developments…. It would be hard for the Islamic fundamentlaists to gain a hold anywhere. While there are grievances.. huge ones that go back decades and centuries…. a good faith effort.. a truly good faith effort to help everyone in the world is the best defence against terrorism.

    And China is getting more and more control and influence in Africa and other countries.. much of it based on doctors and modern health csre freely provided to poorer countries for several decades.. there are other reasons.. hard cash… weapons sales… but alot of the influence China bouyght was by simply sending doctors abroad.. and not askign for anything in return… until a decade or two later… they get mineral or oil and gas rights in some country.

    Doing this on a large scale either gets China to do the same (good) or makes those poorer countries more favourable to the Western 1st world (good) or actually helps undermine tyhe totalitarianism in Chaina and helpse more liberty develop there.

    To me Health Care is key.. and education and social development. I do not want to appear racist.. because I am not at all… but Health care technology at this point in Africa is hurting humanity.

    It has led to higher life expectency than otherwise would happen… and fewer resources to support the population. There are two ways to go.. an utterly inhumane and horrid Nazi like way of cutting off all support and help to the worst places on earth and let the population drop.. oir more likely the population growth rate drop.. or hardcore intervention… not merely food drops.. but regime change… new farming methods… new laws to prevent Europe and the first world from stopping agricultural imports and pricing African agriculture fairly.. and a massive educastion program for Africans.. so they too acan have factories like in Mexico and Asian countries.. those factories.. while far from perfect are a ton better than the nothing tat is there now. Immigration from Africa should be encourtaged in a huge way to anywhere else…. Obviously education about Aids and HIV should be everywhere and drugs like AZT should, be available free of charge.. as Western governments pay a profitable.. yet limited profit to the drug makers.. to help make up for public health care and also to stop China or India from doing the exact same thing.

  397. I know those are two of the longest comments ever… I find myself unable to sleep because I am do riled up. Also I think by talking to someone or writing stuff out.

    I ask does anyone agree with me that the greatest threst to the environment is not Carbon but overpopulation…. which is only occuring now in Africa and parts of Latin America.. and which any leftist or Environmentalist should find some way to help slow down the population growth there?

    I do not want to make this like the last two posts.. but who is for basic earth-wide public health? Who is willing to spend even 0.5 % more in taxes to them to do it? 1% 2% 4% 5%?

    I hjust got a netbook.. and my Internet Explorer is already acting up… it sucks… however I can deal with it better knowing that Bill gates is, or may become, or recognized as, the greatest philanthropist ever. The dude has got his heart in the right place and his $$$. He is helping the poorest of the poor.. in from what I have seen a really productive and useful manner… He has had billions of people vaccinated. (gotta say thsat to make it relevant to this thread)

  398. Main Entry: dog·ma
    Pronunciation: \ˈdȯg-mə, ˈdäg-\
    Function: noun
    Inflected Form(s): plural dogmas also dog·ma·ta \-mə-tə\
    Etymology: Latin dogmat-, dogma, from Greek, from dokein to seem — more at decent
    Date: 1638
    1 a : something held as an established opinion

    Greg: Trying to find out where the definition of dogma only applies to thought you don’t agree with. Please explain while your boilerplate extreme left-wing socialist view is different.

  399. Ooo! Oooo! Oooo!!!

    The dictionary definition game! Can I play? Please! PLEASE!???

    Let’s see what definition of Dogma that Greg was thinking of… I wonder… is it this one…

    dog·ma (dôgm, dg-)
    n. pl. dog·mas or dog·ma·ta (-m-t)
    1. A doctrine or a corpus of doctrines relating to matters such as morality and faith, set forth in an authoritative manner by a church.
    2. An authoritative principle, belief, or statement of ideas or opinion, especially one considered to be absolutely true. See Synonyms at doctrine.

    or

    3. A principle or belief or a group of them: “The dogmas of the quiet past are inadequate to the stormy present” (Abraham Lincoln).

  400. Oh and John: if Greg is an extreme left winger I am, as they say, a teapot.

    I’m not sure how many “extreme” left wingers there are in the US, nor, in fact what qualifies one as such.

    Certainly in the UK, Barack Obama would struggle to fit in the British Conservative party politically, he certainly wouldn’t be comfortable in either of the centre/centre left parties.

    However, something tells me that you think he’s an “extreme left winger” too.

    Left wing? Go and look up Tony Benn (Anthony Wedgewood Benn) and get back to me. Now THERE’s a left winger.

  401. Harry @ 446 – Also, I would have thought last fall’s economic bust would have been the Berlin Wall of deregulation.

    Sadly, the ability of Conservitavus Americanus for self delusion is greater than that of The Ravenous Bugblatter Beast of Traal. They’re now convinced it was a lack of further deregulation that caused the collapse. And this is despite Allan Greenspan himself admitting that, given more deregulation, corporations will choose the Bernie Madoff model of finance trading as fast as they can.

    The amount of trust given to jacked up boiler room salesthugs (Like the AIG “derivatives trading crew) to somehow do a better more honest job if only we stopped regulating them is staggering and baffling.

    We deregulate, they screw the entire world’s economy. So clearly, the answer is to deregulate MORE!

    It’s the Bob The Angry Flower – Smashing Hand Economics School!!!

  402. I’d would say anyone who espouses socialist views such as he and probably yourself qualifies as extreme left-wing. He seems to think that individuals cannot provide for themselves and therfore, become words of the state.

    Who would say you are a teapot? That isn’t any phrase that I’ve heard before.

    And, again, please explain how what only the right-wing argument is dogma.

  403. John: Greg: Trying to find out where the definition of dogma only applies to thought you don’t agree with. Please explain while your boilerplate extreme left-wing socialist view is different.

    Hm, I believe that’s the “You too” fallacy in logical argument terms. But lets ignore that for entertainment’s sake.

    The question isn’t whether I’m dogmatic. The question is whether I can prove that you’re dogmatic. I asserted you’re following dogma. You challenged the assertion. (Using the “you too” logical fallacy, but like I said, lets ignore that slip).

    So are you are are you not following right wing dogma? Can I prove that?

    How about some objective evidence.

    Did you vote for McCain/Palin? (shot in the dark, yes)

    Did you support the invasion of Iraq in 2003? (shot in the dark, yes)

    Have you done anything significant to stop your government from torturing innocent people in Gitmo and holding them without due process? (write your politicians, go to a rally, sign any petitions that went to politicians, etc) (shot in the dark, no)

    Have you done anything significant to get the US out of Iraq since the invasion? (Shot in the dark, no)

    See, right wing extremism boils down to a simpe concept: hierarchy of power. Chain of command. Might makes right. WHich means right wingers will portray the argument in terms of power. If McCain picks an insane vice president candidate, the extreme right wing will still vote for McCain because chain of command requires it. A right winger of this era never turns down the chance to go to war. A right winger will view violence, torture, and war as acceptable means to an end. They will view due process as government meddling, as a way for bleeding hearts to get in the way of real justice.

    As for the economic side of things, lots of money becomes lots of power. Lots of money defines the hierarchy of power. So, you’ll see right wingers worship corporations and people with lots of money as being somehow better than the rest of us. The rich deserve to pay less taxes. The poor deserve the prisons and work houses and the gutter.

    Everything you’ve written has been in complete admiration of the hierarchy of power that is defined by money. You’ve put yourself in the chain of command of the corporate rulers. You may not be a CEO yourself, but you see yourself as serving these good and noble CEO’s and you defend any attack on the CEO as an attack on those you’ve sworn allegiance to. You are defending insurance companies for gods sake, as if they’re some white knight, and as if the meddling government were some black dragon.

    In short, you have no compassion for your fellow man, other than to hope they take care fo themselves, and maybe if its a next door neighbor (neighbors helping neighbors) then you’ll do some good deed for them.

    That’s the epitome of the right wing dogma.

  404. Once again as eloquent as ever, Harry. And hang in there, Rob.

    You’ve got to kind of admire the logic loops of opponents to reform though. For instance, the going out of state you could get a better health insurance deal idea because of supposedly increased competition. But there are only a few giant national health insurance companies. You’re dealing with the same companies in each state. It’s not like car insurance where only a small percentage of people ever make claims for accidents or theft. People use healthcare regularly, make claims regularly. So you aren’t going to get much in the way of small companies trying to do major healthcare insurance for budget prices. Going out of state wouldn’t increase competition when the competitors remain the same across the country.

    And increased competition doesn’t mean lower prices, because as Harry pointed out, there’s a difference between buying an Ipod and getting care for an infection or a heart attack. For profit means charging as much as people are willing to pay, no matter what the actual cost. People can’t shop around when they are sick, they can’t get all their healthcare long distance, and they’ll pay whatever it takes, including going into debt and bankruptcy. As any uninsured person will tell you, there is no bargaining. If you won’t pay, threaten to go elsewhere, you can leave, because they have no shortage of customers. And if you’re unconscious, as Harry points out, medical treatment is done to you without you getting to choose, and then you owe them.

    I don’t fully trust government, business, or labor unions to always function well or ethically, but these entities serve as a system of checks and balances on each other. Remove too much of those checks and balances and you get an illegal Iraq war that costs trillions and involves torture, and the world financial collapse of 08-09.

    For instance, it always interests me in this idea of a free market — no government, rule of law, regulation, taxes, public services or spaces — that the people advocating this believe that in such a system, workers would be paid and thus able to buy goods and services. But in such a free market, as any illegal operation can tell you, you don’t have to pay workers. They can simply work so that you won’t kill them, you can throw some food and water at them when you want, and cart away the ones who die. You don’t have to supply services. There is no need for schools, hospitals and healthcare, fire trucks, etc. (Or you can pay them whatever you want and then provide services requiring them to give you back their entire wages, but without a government regulating you at all, this would seem rather pointless.)

    But business doesn’t want a free market and it’s Mad Max framework. Business likes government taking care of people, supplying roads, etc — the government perks as Greg calls them. And they like doing business with the government because it is a giant, cash-rich non-profit, rather than a competitor. And that’s what the private insurers are worried about, especially with the public option — that businesses will flock to the government plans. So they are lobbying with ghost stories about rationed care, euthanasia, industry collapse, and you won’t get to pick your doctor (when they already don’t let you pick your doctor.)

    But the government doesn’t want all the healthcare business in the country. It doesn’t want healthy, big corporations dumping their employees on it. What it wants is to provide incentives to get the private insurers to take on the uninsured, to cut waste in the industry and in the government (cutting waste in Medicare will potentially fund about half of the cost of reform,) and to lower costs in the industry for the benefit of the government, businesses and the private insurers, again which can be partly done through eliminating waste, not care, and through preventive care, which reduces the costs created by illnesses.

    When people talk about their fears of rationed care, they don’t mean the uninsured people, for whom rationed care would be an improvement. They mean themselves, who have insurance for the moment. But there’s nothing in the reform plan to do that, and in fact, specific things in the plan to keep the private insurers from doing the rationed care that they are already currently doing to you. Reform is geared to give people more options than they have right now, not less.

    Insured people fear that if the uninsured are covered, either by the government or by private insurers with the help of the government, that this will hurt their coverage and healthcare. But again the uninsured already are hurting their coverage and healthcare — they raise healthcare costs, they swamp hospitals and ER’s, they take up more resources and doctors’ time than they would if they got care earlier. And they cost you in other ways, as the uninsured often work for small businesses that can’t get insurance, and the uninsured employees can’t get insurance, so that vital engine of the economy gets all gummed up. So a main thrust of reform is making it possible for the small businesses to get insurance for their employees at reasonable cost from the private insurers. Which makes those small businesses more competitive, etc.

  405. JohnBear@463!

    Not just the left wing but the EXTREME left-wing! Say it aint so…

    would you care to elaborate the difference between a left-wing and an EXTREME left-wing position?

    Would providing healthcare to sick children make me “left wing” and then providing healthcare for children who are not sick allow me to add EXTREME to my title?

    Just curious..

    Rabid

  406. Greg: I propose that we both subscribe to we follow dogma — just different ones.

    Most people, including myself, have compassion for their fellow man. I just express the result of that compassion differently.

    However, you seem to feel that the response to compassion is force everyone to comply whether they agree or not. That takes away people’s liberty. For which you seem to have no compassion. Ironic.

  407. Actually, I think “extreme” left wing politics involves ramps, motorcycles, and jumping over several helicopters. Like Nick Cage in Ghost Rider. Only with health care benefits.

  408. Rabid-android: Forcing everyone to pay for other’s healthcare, even if it’s against their will is left-wing thinking.

    Right-wing says we’d like for everyone one to have healthcare because it’s the right thing to do, and heck, companies benefit from that as well. However, we go on to say that we’d prefer to find ways outside the government where that can be accomplished.

    There are few people in this country that get a kick out of watching people suffer. Right and left wing included. Shame you don’t (or can’t) see that. Nor can most of the commentors above.

  409. Josh@468

    Well then I guess I am of the EXTREME Left-Wing since I like to think about social programs while riding my mountain bike!

    Rabid

  410. John Bear@469

    I am actually open to hearing about the right wing movement for getting everyone covered by private/non-government insurance. Tell me more?

    Rabid

  411. Doesn’t anyone recognize the importance of keeping government small and unobtrusive? The republicans don’t anymore – but the citizens should. Enough of the “free” talk with regard to health care. It’s not free. It’s redistribution and it’s going to suck. They’ll have people plugged into the matrix from cradle to grave. gives me the willies.

  412. Greg has expressed left of center views and virulently criticized far right views, but he has expressed no views of socialism. He has proposed no revision of the government into a socialist system. People who lean left and who believe the government should provide some services are not socialists. Liberals are not socialists. People who criticize businesses for abuses and far right views are not socialists.

    And independent moderates know that because they know what socialism actually is. Far right conservatives, however, use “socialist” as a buzz word to try and label people arguing with them as far-left nutballs who want to ruin American society and destroy capitalism and whatnot. (Which makes actual socialists just laugh.)

    So from this, and previous posts, it is quite clear that John Bear is not a moderate, but a far-right conservative. Not that this was hard to figure out. But if you’re going to use words that are part of right wing dogma, John, don’t be so surprised that you get challenged on spouting right wing dogma.

  413. Here’s an idea.

    The Veterans Administration, among other things, provides federally-funded health care for US veterans.

    It’s also infamous for shoddy facilities, struggles to get appropriate care, misdiagnoses, and difficulty in making appointments. (Such terrible food… and in such small portions.)

    I think we should do some Googling of the horror stories surrounding VA medical treatment to get a better idea of what the future of health care in this country is going to be like.

  414. Doesn’t anyone recognize the importance of keeping government small and unobtrusive? The republicans don’t anymore – but the citizens should. Enough of the “free” talk with regard to health care. It’s not free. It’s redistribution and it’s going to suck. They’ll have people plugged into the matrix from cradle to grave. gives me the willies.

    It doesn’t give people the willies in Taiwan, Japan, South Korea, Israel, France, England and Canada. They do not think it sucks. They look at OUR system and OUR SYSTEM gives them the willies.

    Do you recognize that people in other countries don’t have the same experience with government and medicine as you do?

  415. I think we should do some Googling of the horror stories surrounding VA medical treatment to get a better idea of what the future of health care in this country is going to be like.

    That’s may or may not be useful. You’re basically telling people to look at the worst aspects of a system and generalizing it to the whole. That’s not useful if these are isolated incidents; they’re more useful if they are more systematic.

    (And, of course, it depends on who’s administrating the system; any system sucks if it’s being run by incompetents).

  416. @428: “Could you check with your Canadian, English or Swiss compatriots and see how they do it?”

    From what I understand, the trick is that they offer significantly better coverage – that the government system is sufficiently screwed-up that those who can afford to pay for additional coverage on top of their already huge tax burden choose to do so.

  417. force everyone to comply whether they agree or not. That takes away people’s liberty. For which you seem to have no compassion. Ironic.

    Ah, yes, “choice”, the last bastion of right wing dogma.

    You live in a republic. You vote for politicians. They implement laws. Some you won’t agree with. (raising taxes, lowering defense spending, restriction commerce) They also implement laws that you happily agree with. (lowering taxes, reducing government services, increasing defense spending, removing restrictions on commerce).

    At no time do any of those laws ever get passed unanimously. Which means when you agree with the laws, you happily embrace the fact that you’re forcing those laws against the will of some people.

    For example, back in March of 2003, when the US invaded Iraq, you happily supported that decision, even though the invasion had to be done against the will of a large number of Americans. torture was secretly approved by a few individuals at the bush administration against the views of many, many americans. But you certainly didn’t stand up for those dissenting opinions to be heard.

    But now, oh, now it gets funny. Because now, you’re looking at a law that you don’t agree with. And now you’re not living in a republic anymore. You’re living in some sort of parallel universe where government is done by unanimous vote. Everyone agrees with a law, or it cannot be passed. We must allow everyone “choice” or it isn’t “compassionate”.

    Contrast that to your earlier gauntlet for a “fact-based” discussion, and it really is quite hilarious.

    And hypocritical. Every right wing nut job law that you supported, was passed against the will of a lot of Americans. Hell, some might even say Bush lost the election to Gore but you and the other right wingers shut down the recount before the results could be found. Did you demand unanimous agreement on the recount? No, you didn’t. You happily concurred with the Supreme Court who voted along party lines to shut down the recount, meaning you happily concurred with the very real possibility that your right wing nut job president Bush actually stole the election from Americans who had legally elected Gore.

    So, please, spare me this faux concern for other people’s choices when you and the right have done nothing but trample people’s choices for the last eight years.

    It’s sickenly hypocritical.

    Also, I note that you failed to answer 4 simple objective yes/no questions that would clarify exactly where you are on the left/right or right/extreme-right spectrum. The funny thing is, you think you’re hiding how extremely right wing you are by not answering those questions, but everything you’ve said on this thread has been nothing but extreme right wing, pure hierarchy of power, chain of command, money is the measure of merit, dogma. In short, you voted for McCain/Palin, you supported the invasion of Iraq, you’ve done nothing significant to stop torture, and you’ve done nothing significant to get the US out of Iraq. Avoiding the answers doesn’t mean the answers aren’t obvious to everyone else.

    That’s why it’s dogma. Because if you follow the dogma, and you John Bear do, then your actions are completely predictable along that dogma.

    As for “compassion”, well, let’s just look at how the right wing dogma works. The right wing version of “justice” is to avoid governmetn due process, to have the individual dispense justice without any of these government hindrances. Miranda rights are for wimps. Due process is for wimps. Laws against torture is for wimps. Real men hand out real justice from the barrel of a gun. They decide who is right and who is wrong. Right wing “justice” is really just vigilantism.

    And what is right wing “compassion” look like? A lot like this vigilantism. The right uses the “Neighbor helping neighbor” bullshit. They don’t want the government helping just anyone. No, the right only wants to help “good” people. They don’t want their tax money going to help the lazy, the people of color, the non-christians, the people who might get an abortion, or might have sex before getting married, or might have gay sex. No. The right doesn’t want the government to help everyone based on need. The right only wants to help the people who need help AND are people of “proper” character. In short, its own form of vigilantism.

    Since you posted the defintion of “dogma”, here’s the definition of “compassion”:

    a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

    You don’t want to alleviate anyone’s suffering unless they subscribe to your right wing dogmatic view of the world, unless their the “right kind” of people. That isn’t compassion, that’s a kind of fascism.

  418. “It doesn’t give people the willies in Taiwan, Japan, South Korea, Israel, France, England and Canada. They do not think it sucks. They look at OUR system and OUR SYSTEM gives them the willies.

    Do you recognize that people in other countries don’t have the same experience with government and medicine as you do?”

    I’ve read plenty of people with the willies from Canada and the UK. Yes, I’m sure there are some good things that happen, of course it’s not all doom and gloom – doesn’t mean I want to hand it over to the Federal Government. If you’re not sick it’s great. I worry about when you can’t figure out what’s going on but you’re 72 and it’s not cost efficient to figure it out – it’s better to give the person the pill as President Obama discussed. Why do you want to hand everything over to a big gov’t entity – they have a proven track record of not handling things well…I’m sorry you at least have recourse with private companies _ I know it’s not perfect. But what kind of recourse would you have if the government runs everything including the doctors? Furthermore where would the Canadians go if we go National Health. At least say no for their sake.

  419. @477: “You’re basically telling people to look at the worst aspects of a system and generalizing it to the whole. That’s not useful if these are isolated incidents; they’re more useful if they are more systematic.”

    Looking at the claims is the first step toward determining if there are systematic problems, wouldn’t you say?

    “(And, of course, it depends on who’s administrating the system; any system sucks if it’s being run by incompetents).”

    Ding ding ding! Which is precisely why there’s no magical solution, free-market or statist, that will make everything better with a wave of a wand and a poof of sparkles: most people are morons most of the time.

    The trick is not to put the people who are morons in charge of everybody. At least when people can choose for themselves, they can only hurt themselves. When people choose for others they *really* screw things up.

  420. JohnBear@463: I’d would say anyone who espouses socialist views such as he and probably yourself qualifies as extreme left-wing. He seems to think that individuals cannot provide for themselves and therfore, become words of the state.

    “socialist”
    “extreme left wing”
    “individuals cannot provide for themselves”
    “wards of the state”

    plus the center (free) square, I get five in a row.

    BINGO!

    John, you’re filling up my right-wing-bingo cards faster than I can daub the spaces. I think I should get a pie now.

  421. melendwyr: Looking at the claims is the first step toward determining if there are systematic problems, wouldn’t you say?

    Hm, but you won’t look at the claims of problems of people getting booted from insurance, who can’t afford insurance, or anything else that would show a rampant problem with the current health care situation.

    It’s called cherry picking.

    But what gwangung at 477 is trying to explain to you is something called a “hasty generalization”. you take one worst case instance of something that happened at the VA and you declare it to be a reflection of what everyone will experience.

    The preponderance of evidence is that people on medicare like the quality of care. The preponderance of evidence is that people in countries like Canada and elsewhere like their government controlled health insurance. The preponderance of evidence is that Americans spend more than 2x money per person on health care, get worse results, and don’t even factor in the 40-some million people who don’t have any coverage at all.

    An anecdote is not a preponderance of evidence. All you’re doing is trying to ignore the preponderance of evidence by cherry picking the evidence you want, this one bad example, and then doing a fallacy called hasty generalization to try and inflate that one anecdote into a pattern that it isn’t.

    You’re doing an extremely poor job of science right now.

  422. I’ve read plenty of people with the willies from Canada and the UK.

    And do you understand WHY they have the willies?

    It is not at all clear that you do.

    You keep on complaining about handing over the administration of health to government who you claim to not have a good track record, yet you keep ignoring the track records of governments in other countries who a) do it more successfully that the US system does, b) do it more cheaply, c) have costs that are rising at a lower rate than the US and d) cover more people.

    And when people keep pointing this out, you keep ignoring these points.

  423. #476: “It’s also infamous for shoddy facilities, struggles to get appropriate care, misdiagnoses, and difficulty in making appointments.”

    You mean when the Bush administration, which vacillated between being anti-healthcare reform and some actual attempts at reform, ignored the VA Hospital, cut its budget in preference to defense contractors, and generally withdrew from a service that, according to you, they shouldn’t provide in the first place, as why should veterans get government healthcare? You mean that it became a problem that healthcare reform should fix, as is planned as part of reform and the proposed new GI bill — the one that you don’t think that they should do, leaving the VA hospital the mess the Bush administration left it in? You mean the VA hospital where they are dealing with veterans who couldn’t otherwise get insurance coverage from private companies because they have war injuries and long-term conditions in the service of our country that the private insurers don’t want to cover? You mean the VA hospital which is experiencing similar problems to many privately run hospitals in the country, which have their own horror stories? Private hospitals that are often overrun with uninsured people? You mean the VA hospital that developed a problem, but we’ll ignore that much of the Medicare system is working just fine for the people on it and they are happy with their care?

    But let’s forget all that, because the main problem is that you are claiming that the U.S. government is planning in their reform to take over all the hospitals and all the healthcare. Which is utterly false.

    Here’s an idea: what if people who believe that veterans — whose illnesses and disabilities often come directly from their armed service — should have to pay out of pocket for their healthcare, quit pretending to care what happens to veterans?

    As for Bea, she’s turned into a character in Monty Python’s Life of Brian. “What have the Romans ever done for us?”

  424. John Bear

    voted for McCain/Palin,

    supported the invasion of Iraq in 2003.

    Has done nothing to stop torture.

    Has done nothign to get the US out of Iraq.

    But claims he isn’t following right wing dogma.

    Are your answers no, no, yes, yes?

    Ah, but see, that wasn’t your question of what makes me a left wing socialist extremist (your words)

    JohnBear@463: I’d would say anyone who espouses socialist views such as he and probably yourself qualifies as extreme left-wing. He seems to think that individuals cannot provide for themselves and therfore, become wards of the state.

    So, here are some of your questions:

    (1) Do I think individuals cannot provide for themselves?

    No, I think people CAN provide for themselves. I grew up on a farm workign my ass off, got a engineering degree, and have made a good career for myself. And I think people can work together to help those less fortunate and to work together to make the world better than as if we were all individuals living alone. I support the idea of food stamps for the hungry, unemployment money for the unemployed, minimum wage, which are programs that help people when they stumble. But I also support the constitutional mandate that congress shall have the power to regulate commerce. I’m pretty sure the founding fathers didn’t put that in there on a drunken binge. So, I support the idea of the FDA regulating commerce, banking laws regulating all banks, pollution laws regulating how much arsenic can go into our drinking water from all mining operations. And at this particular point in time, it seems pretty clear that teh invisible hand of health care in America is severely screwing the pooch. You want to keep private hospitals and private insurance? Fine. But the government should be able to add a public option for those who got booted by the private industry.

    (2) Do I think individuals should become wards of the state?

    Hm. Maybe. If a child’s parents die, I think the state ought to be able to take care of them. I don’t think orphans should be force to live on teh streets, if thats what you mean. If a person is mentally handicapped and has no family able to take care of them, then I think the state can step in.

    But do I think Everyone should be a ward of the state? Hm. That has a familiar ring to it. I believe the phrase you’re looking for is “cradle to grave”.

    (3) do I believe in cradle to grave government care?

    No, I don’t believe in that. Never did.

    (4) Do I believe Tort Reform would have any significant impact on health care?

    No. Apparently the statistics say it would save about $12 a person when medical costs are $5000 a person in the US and $2100 a person in Canada. So, no, Tort Reform is a red herring as far as health care reform goes. Switching to the canadian model would save thousands of dollars per person. Tort reform would save $12.

    In short, I, Greg London:

    thinks individuals can provide for themselves

    Supports the constitutional mandate that congress shall have the power to regulate commerce.

    thinks that individuals shouldn’t become wards fo the state unless something tragic happens to them.

    does not support cradle to grave government welfare

    does not believe tort reform will help health care reform in any significant way.

    So, if that makes me a extreme left wing socialist, then one of us has a really screwed up dictionary.

  425. @463 John Bear:

    I’d would say anyone who espouses socialist views such as he and probably yourself qualifies as extreme left-wing

    ROTFLMAO! Thanks for that! You think I have socialist views because I believe that in a moral, rich society, universal healthcare coverage is a right. You mean like… um… that old lefty Margaret Thatcher? I mean she didn’t like it but she didn’t abolish the NHS either… Or, well, pretty much every member of the British Conversative Party – bunch of lefties the lot of them!

    Do you actually know what an “extreme” left wing position is? Compared to say a moderately centre-right social democractic capitalist position?

    I seriously thought not.

    I am not, and never have been an “extreme” left winger. By British standards I’m a fairly conventional pro-business, centre-right type.

    @473 Bea:
    Doesn’t anyone recognize the importance of keeping government small and unobtrusive?

    Define “small” and define “unobstrusive”. When was this golden age when governments were “small and unobstrusive”? I suspect it’s a period of time when they had bad health care and poor life expectancy for virtually everybody. No thanks.

    @479 melendwyr
    who can afford to pay for additional coverage on top of their already huge tax burden choose to do so

    So, being a Brit, now living in the US – my tax burden, overall, sans discounts, wasn’t really that different from what it is now living in a state with no state income tax…

    @481 Bea
    it’s better to give the person the pill as President Obama discussed.

    I call shenanigans again, or at the very least Dogma, he didn’t actually say that. What he did say was that sometimes rest and a course of pain pills might be a better option for a muscular injury than surgery and a bunch of other treatments. REALLY? Gosh! Who’d have thought that!

    If you’re not sick it’s great.
    What like (rumages through the family medical history) appendectomies (4 of), heart attack (1 of), gall blader removal (1 of), osephogeal cancer (1 of – with 5 years post survival, not bad for a cancer with a 25% survival rate at that time period in the USA), etc… they were all success stories.

    Sure, there are horror stories but I’ll trade you an excision story or a refused insurance story for EVERY SINGLE NHS outlier you find. And I’ll tell you something else:

    I bet we’ll find that the NHS horror stories tend to be systemic outlier failure modes that involve experimental treatment or a chain of cock ups that could be prevented.

    However, I bet the US versions will all be features and not bugs.

    And then you can go and get me some horror stories from France, Holland, Germany, Japan…

  426. (1) Do I think individuals cannot provide for themselves?

    In general no. In specific cases, sure. There’s a lot of people who ought to be in long term psychiatric care who were dumped on the streets through the insane “care in the community” mantra that infected British and American politics in the 80s. They generally can’t provide for themselves.

    But nor do I think that people can necessarily make decisions that are in their best interests everytime. Especially when it comes to healthcare, or even, to a certain extent, financial planning. People are maliable.

    I’ve made a career in Sales, I’ve been fortunate enough to be in high end, high ticket solutions selling and my own businesses, but if you know the tricks of selling, and they’re simple, you can sell people pretty much anything you like AND make them think it was their idea.

    I see there is a valid role for the state in helping defend people from predetors who would prey upon others – be it snake oil salesmen selling anything from fake cures for cancer, or mortgages on poor terms….

    Now, my gut feeling – going back to the dogma discussion – is that you’d say that caveat emptor applies and that people should be free to make dumb decisions.

    The trouble is working out if a decision was actually taken freely or not?

    So, ask yourself, if all decisions are freely and rationally made – why do companies spend such vast amounts on advertising and marketing?

    It’s not purely to inform.

  427. AAAAAHHHHHHHH!!!!!

    ::runs in circle screaming::

    THERE IS NO PLAN TO CREATE SOCIALIZED HEALTH CARE IN AMERICA!

    I’m sorry. There just isn’t. Cower in terror at the very idea, if that gets you off. While you’re at it, protest against some other non-existent plans. Did you know the federal government is also not planning to enforce agricultural rules with giant robots!! ZOMG!! Let’s write thousands of words protesting that phantom plan!

    Did you know that the federal government has absolutely zero plans to install illegal immigrants in every kitchen to make sure Our Families properly sort their recycling!! OUTRAGE!!!

    For God’s sake! Let it sink in! It is, in fact, possible to discuss *real* health care, but only if you can tell the difference between what’s real and what you saw happen to Keanu Reeves on cable TV. (Bea, you might want to get rid of your computer because, you know, SKYNET!)

    Now I begin to understand the utter impenetrability of birthies and their utter inability to admit they’re wrong.

    @ KatG #488 It’s actually Walter Reed Army hospital that had their budgets cut and were infamous for their filth and rats.

    In contrast, the VA offers one of the best, most cost-effective health care systems in America. It wasn’t always so, but public pressure transformed the VA from a slum into one of the best (and possibly THE best) health care systems in America.

    Both Walter Reed and VA are socialized medicine. One sucks and the other is awesome. It’s pretty clear that the problem doesn’t lie with the “socialized” part.

    And for those who doubt that, here’s the results of a survey by the non-governmental American Customer Satisfaction Index:

    “VA medical services received high marks during the annual American Customer Satisfaction Index, which has ranked customer satisfaction with various federal programs and private-sector industries and major companies since 1994.

    Veterans who recently used VA services and were interviewed for the 2005 ACSI survey gave the VA’s inpatient care a rating of 83 on a 100-point scale — compared to a 73 rating for the private-sector health care industry. Veterans gave the VA a rating of 80 for outpatient care, five percentage points higher than the 75 rating for private-sector outpatient care and 9 percent higher than the average satisfaction rating for all federal services.”

    What difference does that make? None, because there’s no plan to create a VA-style socialized medical system in America.

    It doesn’t matter that, properly managed, patients prefer their socialized medicine to private insurance, or that it’s cheaper. It doesn’t matter that Medicare patients are very happy with their federally-funded single-payer system, and that Medicare costs are increasing more slowly than private insurance costs.

    None of that matters. In fact, we can’t even bring ourselves to offer a voluntary single-payer program for people who want to sign up for it, because conservatives and libertarians can’t get past their personal prejudices about it. Just talking about new regulations has them stewing in their diaper gravy, screaming in terror at non-existent proposals.

    Look out! Giant robots!

  428. As they say, deep breaths, Harry. :) Thanks for clearing that up about the hospitals (I knew there was a veteran’s scandal with Bush, but didn’t remember which hospital clearly,) but I don’t think melendwyr particularly cares, anymore than melendwyr cares about the mistakes made by businesses, such as the banks and financial/insurance companies that then insisted the government bail them out on, instead of letting them go under like competitors who’d failed — a group that includes giant private medical insurance company AIG. If the government hadn’t bailed AIG out, millions of people across the country would have lost their health insurance, which is a big part of why they did it, but let Lehman’s go under. But hey, private companies do so much better, you know? And when they make a mistake, they — walk away from it and leave it to others (the government) to clean up usually.

    It’s clearly going to have to be a joint effort of private companies and the government, with the government sitting on private companies attempts to insure only rich people/companies and screw over their customers — checks and balances. The arguments that of course the government will try to take over the whole shebang or destroy the private industry by crippling it — and not bailing it out apparently — are ridiculous and based on nothing. But they make good sound bites, especially on far right media. As do other things that don’t exist like death panels.

    So really we can’t have a decent conversation on healthcare reform because the reform isn’t talked about, just fantasies — that the government will take over everything, kill the private industry and go bankrupt on healthcare. Oh yeah, and the giant robots of course.

    Greg — I’m kind of sad that you aren’t a flaming socialist, but you join Harry in clarity and sense, in my view.

  429. Daveon@490, don’t you lie about health care in the UK. I was in England a few years ago. There’s a documentary about it here.

    Josh@493, I don’t know what the hell that was, but it was fricken hilarious. I’d say start around 6:00.

  430. Whew, long comment thread. Slight topic drift, but it showed up multiple times so I felt compelled to respond:

    Bringing up Hurricane Katrina as an example of the federal government failing is so much a red herring it verges on dishonest. Here’s why:

    James Lee Witt.

    http://www.semp.us/publications/biot_reader.php?BiotID=587

    http://en.wikipedia.org/wiki/James_Lee_Witt

    “James Lee Witt effectively and tenaciously led his organization through a difficult cultural transformation using innovation, persuasion, and a customer-centered approach.”
    (Witt also oversaw effective responses to 373 different national disasters during 1993-2001, including the Northridge Earthquake of 1994, the Oklahoma City bombing, the Grand Forks flood of 1997.)

    When FEMA was run by a Democrat, 1993-2001, it worked well. When it was run by a Republican, 1980-1992 and 2001-2008, it worked badly.
    Some of a more cynical nature have pointed out that when your entire platform is based around “government can’t do anything right,” and then government *does* something right, it interferes with your ability to make arguments and can even cost you votes. Thus, the solution is to set things up so that it is far more likely government won’t do anything right. This might explain how the most important disaster-relief job in the country was filled by an incompetent hack during the Bush administration.

  431. This might explain how the most important disaster-relief job in the country was filled by an incompetent hack during the Bush administration.

    Even granting your argument (which I find implausible, as my experience is that Democrats are no more competent than Republicans, merely incompetent in popular ways), that should be a profound argument against relying on government agencies to any major extent.

    If an effective agency can be rendered uneffective because of the consequences of a majority vote of the populace, and such majority votes can be expected to regularly be so obtusely stupid, then the agency can’t be anticipated to be effective.

  432. anymore than melendwyr cares about the mistakes made by businesses, such as the banks and financial/insurance companies that then insisted the government bail them out on,

    Oh, no. I was outraged that such demands were made, and then incensed that they were met. I think welfare is often a bad idea with lots of unintended consequences, but the people behind it mean well. Corporate welfare is evil conducted by people who intended evil.

    It’s pretty much an inevitable result of assigning lots of power and resources to government. The entities with the most ‘pull’ then take the whole pot. It’s like leaving your car, unlocked and running, with the keys inside, unattended. You should expect that your car might be gone when you return.

    Corporate entities have lots of money, lots of power – and because of America’s absurd laws, all of the privileges of being a private individual citizen with none of the penalties, obligations, or potential risks. And so they have lots and lots of pull.

  433. If a corporation can be rendered ineffective because of the consequences of greed, and such greedy bastards cheating you out of your money can be expected to regularly be such greedy bastards then no corporation can be anticipated to be effective.

    See? With a few tweaks, melendwyr has become a Marxist!

  434. KatG@494: anymore than melendwyr cares about the mistakes made by businesses, such as the banks and financial/insurance companies that then insisted the government bail them out on,

    melendwyr@499: Oh, no. I was outraged that such demands were made

    No, the point was you didn’t care about the fact that businesses made mistakes to the point of ruining the economy.

    Which sort of contradicts that whole “Invisible Hand” fantasy of yours. If the invisible hand was so perfect, why did it go and run the whole economy into the ground.

    I know, I know, government intervention, right? The invisible hand is perfect but it is perfect only if it is completely unfettered by a single government intervention. Put a single retriction on teh invisible hand and it crashes and burns.

    Hm.

    I think that means logically that even if the invisble hand actually existed, that we should never try to use it because it’s never completely unhindered. Unless you live in a place like Afghanistan or Somalia, where there is no government intervention, that is.

    Yes, the world of today and throughout history is full of vivid examples of how wonderful things are when there’s no government meddling in the affairs of people.

    So, melendwyr, tell me, have you started your “Get the governmetn out of business: End Incorporations!” campaign yet? I know some crazy libertarian people who would like to sign your petition.

    Or are you admitting you like government intervetion when it’s a perk and just don’t want any government intervention when it’s a hindrance?

    Because that would be not just a little hypocritical.

    Come on. Get rid of marriage was your idea. SHouldn’t you be trygin to get rid of government creating artificial corporations and legal artifices that upset the natural state of man?

    Yeah, these are the sorts of extremists who are most adamantly opposed to the government doing health care reform.

  435. Oh, no. I was outraged that such demands were made, and then incensed that they were met.

    So you aren’t aware of how close we came to a full on SFnal collapse of the modern financial system then? Because you’d have to replace incensed with wildly relieved then.

    Seriously. When Lehman’s went down the entire Money Market system almost shut down. Most of the reports I’ve read put it at less than 48 hours before the Money Market system stopped trading.

    Now that might not mean a lot to you but money markets are the way that banks, well, bank. It would have shut down credit cards, bank accounts and a bunch of other things including the means by which companies pay their staff.

    If you want incensed, how about the way that a small group of bankers created a series of financial vehicles so esoteric, so insane, that they almost destroyed western capitalism? Oh, and in doing so, made themselves insanely rich.

    Incensed doesn’t begin to cover how I feel about a group of people paying themselves 7 and 8 figure bonus payments for valueless investments, while others got rich selling people mortgages they couldn’t pay.

    The only thing I’m angrier about is healthcare.

  436. “Corporate entities have lots of money, lots of power – and because of America’s absurd laws, all of the privileges of being a private individual citizen with none of the penalties, obligations, or potential risks. And so they have lots and lots of pull.”

    So the government can’t be trusted to run anything, because it can be raided by corporations and may sometimes make mistakes. And the corporations, including the private insurers and much of the healthcare industry, can’t be trusted to run anything because they muck it up, cheat their customers, and then raid the government coffers. (But they shouldn’t be regulated so that they do less of that.) So, like, who is left then to provide or pay for healthcare? Fairies? My next door neighbor who knows some first aid?

    But again, this is irrelevant because the government isn’t trying to run all of healthcare. They want the private insurers to do it, with the government supplementing so that people are covered and have options and access to care. It’s not an either/or.

    The health insurance industry has taken in over $60 billion in profits in the last eight years. That profit has come from denying claims, denying coverage of individuals through claiming pre-existing conditions, making health care decisions for people in place of doctors, and raising premiums four times faster than wages — effectively cheating customers because they have to have health insurance if they can get it. Leaving us with a rising tide of uninsured, a mammoth increase in personal bankruptcy over healthcare costs, a mammoth increase in healthcare costs, etc. It’s a mess.

    But apparently, we don’t bail the private insurers out, we don’t do a reform plan that gets them to change behavior, we don’t fix the problems that their incompetence caused, we don’t help the uninsured even though they help suck up all the government’s (our) money. We’re just to do what, exactly? Let the private insurers not just make reasonable profits, but keep profiteering with people’s lives? Not reform the system at all? Let healthcare costs continue to go up and the uninsured drain the system and the coffers with emergency care? Not eliminate waste in Medicare so that it continues to have funding problems? It’s all just fine as it is, so leave it alone, you obtrusive government, you.

    Except it’s not fine. It’s not anywhere near fine. It’s one of the worst problems we have.

  437. Pfizer to pay 2.3 billion fine.
    No jail time for anyone. The money comes out of the company not out of the pockets of those who perpetrated the crime.
    No penalties of any kind for the Doctors who aided and abeted the crime.

  438. …The health insurance industry has taken in over $60 billion in profits in the last eight years…

    Shall we assume you missed a decimal point there? Otherwise this makes your argument quite lame. $7.5 billion a year is about 30% less than you would get with tort reform per the cbo report.

    Oh. The part about wages is a canard. It doesn’t include benefits, which have increased. One of those being health insurance. Realizing that not everyone has health insurance, but I don’t believe that wage reference separates those with benefits and those that don’t.

  439. Canard:
    1. An unfounded or false, deliberately misleading story.
    2.
    a. A short winglike control surface projecting from the fuselage of an aircraft, such as a space shuttle, mounted forward of the main wing and serving as a horizontal stabilizer.
    b. An aircraft whose horizontal stabilizing surfaces are forward of the main wing.

    I assume you don’t mean the airplane wing definition.

    You do understand that “benefits, which have increased”, have increased because health insurance has gone up drastically, which increases the employers’ burden to provide benefits? So, yeah, we (or our employers) are paying a lot more for the same benefits. How is this a good thing, again?

  440. $7.5 billion a year is….

    You aren’t even remotely troubled by that number are you?

    You don’t think that profits and healthcare aren’t a little bit incompatable???

    If private stuff is so good, why don’t we make them all non-profits?

  441. Well here what was said:

    …That profit has come from denying claims, denying coverage of individuals through claiming pre-existing conditions, making health care decisions for people in place of doctors, and raising premiums four times faster than wages…

    Premiums can rose faster than wages, but how much did they increase the benefits? My health insurance contribution didn’t go up a whole lot. But I’m willing to bet my employer’s contribution did.

  442. GregLondon @ 501

    Much as I agree with your invisible hand points, I do have one minor addendum to the discussion:

    Oddly enough, the invisible fickle finger of fate didn’t run better with the touch of governmental regulation removed. As a matter of fact the Robber Baron Banksters didn’t kneecap the economy until after the governmental regulations that, however lax by now had kept the worst from happening, were removed.

  443. Criminal cartels are governed by a “small, efficient” leadership group. The Nazis “reduced the size of government” rather significantly.

    “Small” government does not automatically equate with “more liberties” or that far more nebulously constructed “more freedom.”

    A small, efficient government with considerable moral sanction (or a population disinclined to resist, for whatever reasons) can do a lot more harm to liberty than a larger one, if its members are so inclined.

    But a digression, for a moment, in addressing the conservatarian and glibertarian tendency to bandy about words such as “liberty” and “freedom” as if they were (a) separable from economic conditions and contingencies (b) operate in a moral vacuum (c) have any reality outside of human decision and environmental contingency, and perhaps most important of all (d) are interchangeable one with the other.

    Liberty is political. Freedom is personal.

    Liberty is the possession of rights and immunities, within a society, won or conceded over the course of historical conflict and development. It is engendered in political compact, preserved by political vigilance, and in human affairs and choices, in constant tension with authority.

    A group of farmers who organize to win concessions to use the common green (or create one) for grazing have won a liberty. It can be preserved or lost, according to the vicissitudes of fortune, circumstance and human apathy.

    Freedom is the degree to which one is not constrained, in choices which may have no relationship to any other human person or party.

    By comparison: while a man is at liberty to use a common sidewalk in a public, he is free to do so at the hour of his choosing only if the social compact provides no constraints. Likewise, in settings without much in the way of the overlay of human compacts, a man is free to wander the woods at his will and leisure, to lay his head down where he please, or to return to his abode within the denser confines of a human city.

    If liberty is fundamentally political, it makes no sense to consider it in a moral or philosophical vacuum, or to treat with it as if it were the freedom of an isolated individual, far from society.

    And this, I think, is what the health care debate is really about: conservative, conservatarian and glibertarian philosophy currently fails to model or allow for the idea of a common liberty, and the Commons in general. It is a conception rooted in an irrational elevation of freedom over liberty, the idea that only completely unconstrained in the curiously narrow field of economic success and self-aggrandizement, can a society then develop political liberties which foster moral goods.

    Liberals, in general, don’t exactly have a good counter-argument, since we tend to elevate compromise and consensus whilst eschewing the challenges and rewards of agonistic political conflict. We don’t, in short, have a coherent (this is not to suggest that it must be full born and fully rationalized) defense of The Commons, and political liberty, with which to counter ascendant conservative-libertarian theology of Self-Referential Freedom.

  444. I hate to jump in on someone Godwinning a thread (remember kids, when you Godwin, everyone looses) but actually, the size and legendary infighting of the Nazi bureaucracy was one of the things that hastened their demise. “Night Of The Long Knives” was not something external to the Nazis.

    Fascist dictatorships are often able to have a few showy things like making trains run on time, but they’re not actually more efficient than democratic republics overall.

  445. From digby

    progressives in congress have sent a letter to Obama saying they will not support any health care reform bill that does not include a public option along the lines of the medicare system.

    I’m trying to think of anything Obama has really made a stand for, and can’t really think of anything. He’s closing Guantanamo but is trying to create a system of detainment that operates above the law to hold people who haven’t even committed a crime. He’s chickened out of any real criminal investigation into the war crimes committed over the last 8 years. Troop levels in Iraq have been lowered, but that was part of an agreement made by Bush. He’s ramping up troop levels in Afghanistan even though the mission of fighting al queda quietly changed to fighting the taliban and trying to squeeze them out of power.

    With all these cries of Obama being a socialist, I can’t think o fanything he’s done that hasn’t been slightly right of center. appointing a minority woman to the supreme court who may very well have center-right views herself isn’t really what I’d call progress.

    I’ve been reading that Obama might come out in his upcoming speech and say he doesn’t require a public option, which would mean he burned up all this political capital and ended up with a bill that potentially makes things worse than they were before.

    Glad to hear that some of the progressives in congress have finally stood up and demanded real reform. I just hope it works.

  446. @ josh

    I didn’t Godwin. I used the most convenient example which required the least amount of historical explanation, since I was already writing a long post. But yes, the Nazis did consolidate departments, reduce the size of the government, cut out the civil authorities from Weimar and the various regional and state governments and generally centralize the state into the hands of a very few. Included in this process was precisely the KotLK.