Debate

[bcholmes]

"Our health care is the envy of the world."

What planet are you living on?

Comments

[inefficient.livejournal.com]

That would be earth. Our quality of health care and the advances therein is the best in the world. The COVERAGE of that care is a different case, and one that appears to be confused here. Americans tend to believe that the costs of caring for your health is your responsibility, not that of your fellow citizens. There is a complement of Americans who do believe in socialist health care. I don't think the majority do, and you will see much more resistance to a government overtake of health care than the President bragging about the quality of health care.

The lines I liked in this regard though was "Once health care becomes a line item in a government budget, then government controls set in," and "The best decisions about your health are between you and your doctor."

[bcholmes.livejournal.com]

"Once health care becomes a line item in a government budget, then government controls set in,"

That's baloney.

"The best decisions about your health are between you and your doctor."

Which is why HMOs make sense?

[inefficient.livejournal.com]

The thing about HMOs is that they are not the only choice. Americans can choose to sacrifice customer service for cost and select and HMO. Or they can choose customer service and greater physician choice and select a PPO. Or they can simply choose to pay a doctor as he goes. It is not unheard for an uninsured person to negotiate with a doctor for either a payment plan or a lower price because since the person doesn't go through an insurance company, the risk of lawsuit isn't as high to the doctor so he can afford a discount. In any event, health care is a business transaction between an individual and his physician. Government has no business interfering.

"Once health care becomes a line item in a government budget, then government controls set in,"

That's baloney.

Are you saying that once government takes over a service or program that it is suddenly more efficiently run and allows complete freedom in the usage of such a program? When the government health coverage becomes the only health coverage (since government intervention decreases rather than increases competition) that the government won't decide what is and what is not a valid procedure? That once the government decides that a procedure is not allowed that doctors will be universally willing to perform it know they are unlikely to be paid for it? That is baloney.

The fact is, I don't want my taxes paying for my neighbor's health care when I could have that money in my OWN pocket to use if, heaven forbid, I or my family have health needs of our own, or, even better, if we are healthy and we want to go to Disney World. The fact is that the money I earn is MY money. Money is a token for work. I no more expect to spend my neighbor's paycheck than I expect him to spend mine.

[deepforestowl.livejournal.com]

for real. Japan maybe doesn't have the best healthcare but when it came to coverage it friggin rocked.

[lovecraftienne.livejournal.com]

Part of the problem, I think, comes from an ideological concept that doesn't necessarily work in fact. People think of money that goes to the government as "wasted", forgetting that every single penny a government receives it spends. It is a far more efficient economic engine than any individual with wealth, but not a whit more efficient than a poor person - who, again, must spend every penny taken in on =something=. That's economic efficiency, folks. One cannot say the same for the wealthy individuals who profit from health care, or any other area that government might reasonably take over in the public interest. what the government doesn't do is pad the budget for a profit (well, except =our= federal government, who every year announce a "surprise" budget surplus, while telling us there's no money for social programs).

That there are so many Americans with basically no health coverage is, or should be, criminal. One forgets, too, that for-profit medicine tends to develop cartel-like behaviour; witness the outrageous prices paid for such things as an aspirin in a for-profit hospital, not to mention the vastly overpriced technology that is used in hospitals. There's no good engineering-based reason for an operating table to cost as much as it does; there's a very good profit-based reason for it to cost that much. Yes, you can buy someone else's operating table, but it's a small business (in the number of players), and the prices don't vary =that= much.

To the idea that it is heinous for government to be making the decisions about whether or not a health option is insured, I answer: it's better if that decision is made by a corporate boardroom with an eye on the quarterly reports? Really?

[inefficient.livejournal.com]

In regard to the last question, there are many competing health care insurance providers. They all cover certain procedures (esp. those involved in catastrophic care), but they all have flexibility in the amount of coverage provided for other procedures and prescriptions. If Blue Cross/Blue Shield does not provide Chiropractic coverage, but Humana HMO does, I can change to Humana coverage and get the care I want, or need. The market determines the care that is available and the cost of that care. Other examples of this include birth control pills and SRS.

I think citizens of other countries sorely underestimate the extent to which Americans distrust our government. We distrust our government to do anything better than it can be done in the private sector with the exception of those things enumerated in the constitution and the Preamble (provide for a common defense, form a more perfect union, establish justice and insure domestic tranquility, etc.).

In fact, the biggest difference between our culture and others is the belief that power to govern originates and resides with the people governed. Our power flows up from the masses, whereas, even in other democratic countries, the cultures tends to believe that the government holds the power and distributes it amongst the masses, where they can be trusted to handle it.

A competitive market is self-correcting and allows for the filling of all niches. If one company provides one type of product, but not the exact kind that someone wants, either another company exists that provides that flavor, or someone can very easily start a company to fill that niche. That is the enterprising spirit that drives our economy. And even when that economy is sick, its still stronger than any other. Because of this environment, government best serves the people and the bueinesses that employ those people when it gets the hell out of the way.

[daniluxe.livejournal.com]

In fact, the biggest difference between our culture and others is the belief that power to govern originates and resides with the people governed. Our power flows up from the masses, whereas, even in other democratic countries, the cultures tends to believe that the government holds the power and distributes it amongst the masses, where they can be trusted to handle it.

You use the word "power"; regarding the notion of power, I wouldn't be surprised if most of those who live in the rest of the industrialized world view power as being conducted more democratically in their society than in the US laissez faire capitalist system. The preponderance of power being handled via gov't compared to the free market (i.e., a coterie of corporations) -- the gov't would be considered more open and democratic than corporations which by their nature are autocratic structures.

A competitive market is self-correcting and allows for the filling of all niches.

In the USA every sector of the economy (with the exception of agriculture) is dominated by oligopoly big biz which are in some regards immune to market forces. Corporations place profits ahead of people, and what's in the best interest of people does not always correlate nice & neat with the interests of business beholden to the market: the necessary drive for more profit. This is probably the main reason that some people trust for-profit health care less than they trust regulated health care.

[inefficient.livejournal.com]

big biz which are in some regards immune to market forces. Corporations place profits ahead of people, and what's in the best interest of people does not always correlate nice & neat with the interests of business beholden to the market: the necessary drive for more profit.

It is this need for profit that causes businesses to respond to market forces. Competition is what drives corporations to respond to customer needs. If a corporation wants to make a profit, the choices are to attract more customers or cease losing customers or both. The way to do that is to make customers as satisfied as you can, i.e. respond to their needs. Customers know that if they are not getting what they need from company A, they can always go to company B, and sometimes for cheaper.

I work at one of the top Home and Auto Insurance corporations (a Fortune 100 company) in the US. I see on a daily basis the drive for competition necessary to survive in this business. Believe me, there is no oligarchy in this business. You win with market share since almost everyone needs auto insurance by law. A company that tries to cheat has too much to lose, all that will happen is that your company goes under and your competitors divide up your book of business. It is in the best interest of the company, your customers, and your stockholders to be as flexible and responsive to the customer's needs as possible.

[inefficient.livejournal.com]

As for power, I wasn't referring to power=money or anything like that. I was talking about the power that allows a government to rule. I don't think that power resides in the private sector of business. The power I was referring to is the power that resides in the individual. The individual American has more autonomy to govern his own life than the government has to regulate it. Within the bounds of law, that is.

[skylark-10.livejournal.com]

>Other examples of this include [...] SRS.

yes. unlike just about every medical service you have the privilege to enjoy because you (like myself) pay into and receive benefit from a pooled-cost insurance system, SRS is one of the very few procedures that could be construed as "medically necessary" whose cost in the u.s. is PURELY determined by the market. which is why so many of us who need it go out of the country to obtain it, and feel more than just a twinge of jealousy of those in the UK (or, increasingly, canada) who can get it through their national health care systems.

"the best in the world" doesn't mean fuck-all to me if i can't pay for it, buddy boy.

[bcholmes.livejournal.com]

I think citizens of other countries sorely underestimate the extent to which Americans distrust our government.

I think that's probably true. We've spoken about this before -- and about how I view it as a paradox that Americans distrust the government in theory, but are (to my eyes) stunningly accepting of, say, the current actual government.

In fact, the biggest difference between our culture and others is the belief that power to govern originates and resides with the people governed.

I guess that I believe that the government is made up of people, and that I can participate in government in many, many ways.

A competitive market is self-correcting and allows for the filling of all niches.

During the recent North American black-out, there were some good articles that started to go deeper into statements like that. They pointed out that the "competitive market" has historically done a really bad job about certain essentials such as providing electricity. What these articles suggested was that the market could be self-correcting for things like pens and computers -- where there were largely interchangeable alternatives so that if people decided to go without pens they could. But power availability isn't like that, and I don't believe that health care is either.

[inefficient.livejournal.com]

I don't think Americans trust this government any more than previous governments. In fact, if the polls are any indication, almost half trust this one less. What we trust the government to do is provide for the common defense and create an environment most conducive to independent and individual success. I don't trust the government not to try and take more power and rights than it is allowed to have. I read some of the links you provided me when I did my (aborted) analysis of the USAPATRIOT Act. There are a lot of things in there that are very good and helpful to the law enforcement personnel, but there is some scary stuff in there too. The upshot is that every item in there requires judicial oversight, but I won't be sad to see some of these things sunset.

I don't necessarily like that power companies have had no competition, but I can understand and accept so-called natural monopolies (it is inefficient and messy for each phone company or power company to run their own lines, so everyone uses the same infrastructure). I can see an argument for a government takeover of "infrastructure" needs like electricity, but I don't trust the government to be the best provider of it. They have no financial consequences for failure. Those companies responsible for the blackout have two choices, either clean up their act or go under. If they go under, there are plenty of other companies waiting to prove they can do a better job.

[lovecraftienne.livejournal.com]

I think citizens of other countries sorely underestimate the extent to which Americans distrust our government

No, we don't. We just think you're neurotic and insane for it. We +KNOW+ how much you distrust it; it's why you're all mental cases about needing guns. :)

[inefficient.livejournal.com]

To be fair, we have our share of gun control nuts too. But yes, quite a large number of us enjoy exercising our second amendment rights. A government can't forcibly subdue its populace if said populace is as well armed as the army. Its why totalitarian regimes make the first priority the disarmament of the populace.

[trinker.livejournal.com]

Excuse me, please don't speak for me and those who feel as I do, and not as you do. I think citizens of other countries sorely underestimate the extent to which Americans distrust our government.

I am sure that you mean "many citizens... SOME Americans".

I know what the structure has done for me that private business cannot. Evidently, these things are not visible to you.

[inefficient.livejournal.com]

you're right. I didn't mean to speak for ALL americans. Considering the number of Americans on the opposite side of me in this particular debate, I couldn't help but think otherwise. My apologies to you.

[rivka.livejournal.com]

If money is no object, the U.S. really does have excellent health care. I mean, billionaire oil sheiks come over here to get treatment at Johns Hopkins or whatever. That's the viewpoint from which "our health care is the envy of the world." After all, George W. Bush, if he got sick, would have full access to the same doctors and treatments as the oil sheiks.

There are pockets of really, really good care all over. I have what I would describe as excellent health care, for example. And the impoverished HIV+ patients treated at my university's clinic get world-class treatment from HIV specialists with international reputations. But it would be completely delusional for me to think that either of these examples proves that the "US system" provides excellent care. There are people just down the street with abysmal access to health services. It depends on where, who, and what you are.

I think the biggest mistake people from outside the U.S. make is not understanding how variable things are here. Parts of our public education system are unbelievably great, and other parts are the subject of horrifying exposes. Same with our health care system. Same with state laws, actually.

[bcholmes.livejournal.com]

<nod>

Ian H. from alt.poly once said that the right defines a society by how high some individuals can rise and the left defines it by how low some individuals can fall.

For my part, I wouldn't envy a nation's health care system based on the experience at one extreme.

[rivka.livejournal.com]

For my part, I wouldn't envy a nation's health care system based on the experience at one extreme.

Well, no, me either.

[persephoneplace.livejournal.com]

The fact is, I don't want my taxes paying for my neighbor's health care

I accept that that's how you feel. I think that you should work hard at getting over that feeling.

oh, now that has me spitting diet coke all over my monitor and its only 9:30.... the company does not like it when i spit diet coke on my monitor. This did make me laugh, a hearty belly laugh.

We look so much like our neighbours to the South and we are so different in some ways. I DO want my paycheque helping my neighbour if she is ill. To think that I would rather take a vacation with that money than help someone facing a health crisis is ... horrifying to me.
With all due respect to our very articulate southern neighbour, this is a huge cultural divide.

Some of my experience is formed in a rural community. I am also old enough to remember when people paid their doctors directly in canada. The docs waiting room always had 30 people in it - and he was poor. He never turned anyone away and often did not get paid for his work.

A few years ago my brother (a farmer) had 150,000$ of damage to his house and barn and 40 trees because of a tornado. People were at his house helping within 10 minutes and the next morning there were 30 farmers with tractors and chain saws and strong backs to help clean up the mess. He did not actually even know some of them - certainly not well. Thats how i view our health care.

For GW to say that the American system is the envy of the world, is just his continuing to not be very tuned into the rest of the world.

[lisiblac.livejournal.com]

I've heard the sentiment, "Why should I be paying for *your* kid's health care?" over and over again.

Here's why:

If you're anti-abortion, maybe the newly-pregnant mom who can't possibly afford to have prenatal care or give birth in a hospital in the United States much less give her kids medical coverage *and* food during early childhood won't feel pressured to have an abortion for financial reasons.

Why should my kid's social security payments pay *your* pension?

[lovecraftienne.livejournal.com]

Why should my kid's social security payments pay *your* pension?

Oh, simple simple: because we're all human beings on this rowboat Earth together, and if some jackass decides they don't feel like pulling their weight, they're letting the whole damn side down.

I mean, really: could you look someone in the eyes who's dying of cancer and say, "Sorry, I'd rather go to Disneyland than lift a finger to help you"?

We can say things like our articulate American friend above because we are distanced from the pain such statements cause in people's lives. It's "I'm Alright Jack, Fuck You" sort of thinking, and like persephoneplace, I can't help but find it repulsive (the thinking, mind you, not the person; I can't claim to have any opinion about a person I don't know, but that's a pretty repulsive idea).

I =do= want my taxes paying for someone's health care. I don't care if I ever know who I've helped, but it's good to know that no one else who calls herself a compatriot of mine has to be afraid of suffering or dying for lack of health care. That principle =matters= to me. I =don't= want my money going into some insurance company so the shareholders can get a few extra dollars to go to Disneyworld with.

[inefficient.livejournal.com]

Can I apologize again, B.C.? It never ceases to amaze me how with two sentences, you can inspire an overly long-winded response from me which can then inspire several other long-winded responses from others and thereby generate a 5000% return on comment-words to entry-words. Perhaps I should avoid political discussion in your journal? I will gladly do so if you ask.

Sorry for opening the flood-gates...

[cole-hulse.livejournal.com]

I =do= want my taxes paying for someone's health care.

So pay for it then. Just don't steal from those who choose not to. That is why there exists charitable organizations that are privately funded.

The simple fact is this: I am responsible for NO-ONE'S life or health other than mine and my offspring.

I mean, really: could you look someone in the eyes who's dying of cancer and say, "Sorry, I'd rather go to Disneyland than lift a finger to help you"?

No, I wouldn't do that, it seems you wouldn't either, but there are people who would, and neither you, nor anyone else has the right to steal from them if they choose that course.

[bcholmes.livejournal.com]

I think that perhaps you're not clear on the notion (in law) that taxes and theft are different things.