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.

[skylark-10.livejournal.com]

if ayn rand had worn pants, would you still be a crossdresser?

[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.

[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.

[inefficient.livejournal.com]

As ad hominem attacks go, this one is witty, yet irrelevant.

[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.

[trinker.livejournal.com]

Have you tried "pay as you go" ?

I have. I have because I can't get health insurance right now, but I also can't get public assistance.

Nice theory, yours.

I wish it reflected reality better.

[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.

[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.

[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]

Since my father couldn't get insurance as I grew up, yes I did try pay as you go. When the doctor we wanted to use wouldn't work with us as far as payment plans or anything like, we found a new one. Maybe that's changed in the 7 years since I have been getting my own insurance.

[bcholmes.livejournal.com]

In any event, health care is a business transaction between an individual and his physician.

We see things extremely differently here. I believe that health care is a human right. That there must be a business side to health-care is a necessary evil.

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?

I think that you're conflating a lot of concepts here. First up, I think in most countries -- including the US -- governments are already involved in some amount of control. This could be as simple as licensing doctors, minimum standards programmes, etc.

I think that Bush's comment is intended to mean that when health care is socialized, then there is more interference in people's health care. I radically disagree. I think that my American friends (including friends who moved to the States during the brain drain years) have the most interfered-with health care I've seen because their private insurers are constantly trying to reduce their costs.

Your argument, I understand, is that they have choice to go it alone, but I disagree that that's really choice when it's not really viable for so many people.

Also, questions about listing and/or not listing certain things as "covered" by government programmes is pretty orthogonal to whether or not people will offer such things. For example, in Ontario, the government doesn't list certain forms of alternative medicine or certain fertility treatments as government-sponsored. One can debate whether or not those are valid exclusions, but there are still numerous organizations that offer those services.

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.

Health care is not a purely individual matter. You are worse off if your neighbour is not having an infectious disease treated (or even diagnosed) becase he or she can't afford to do so.

The U.S. has the most expensive health care in the world. (Canada is the second-most expensive, I'm sorry to say). The U.S. has a horrible infant-mortality rate (lowest among first world countries, if memory serves). 6.6 per 1000 births. Cuba is better than that. Canada is 4.8 per 1000 births. And yet, George Bush would have us believe that the U.S. health care is enviable. That's risible.

[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.

[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.

[purplepaisley.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 thank you, thank you for this. I did not have the nerve to say it to someone I've never spoken with before.

I would prefer not to have my tax dollars going to build new highways for libertarians to drive on, but there we go. You give up some things to gain others.

[persephoneplace.livejournal.com]

yep, i don't get a country where its ok to spend money on a wild goose chase through Iraq but not on health care.

[daniluxe.livejournal.com]

That's what I meant wrt power.

I don't think that power resides in the private sector of business

I think you're wrong about that; consider the "company town" USA circa 1870 to 1937 -- In many company towns employees could only read newspapers and literature that passed company censorship, and could have their mail censored as well. The Senate LaFollette committee declared in 1939 that the company town "is an autocracy within a democracy..." We don't have to worry much about that type of tyranny anymore thanks to gov't regulation; I doubt many ppl would really be very happy if human rights were distributed via an unfettered market.

I'm getting somewhat off topic with that but I was trying to use an example to point to the split between right libertarianism and left libertarianism and why some ppl such as myself don't think the market necessarily offers a panacea for health care probs or whatever. But despite my contrary tone I've taken thus far I do agree with some of the things you've written about markets here.

[trinker.livejournal.com]

I have found that I get significantly worse care, and the difference between "you have insurance, you can be in this nice trauma center", and "you have no insurance, we don't believe you'll pay us, go to the crap place on the other end of town" is something that I am still suffering the aftereffects of EIGHTEEN YEARS after the fact.