. . . the claim that America is going to become 'France' 2 if we're not very careful doesn't really hold up. If this kind of change were likely, then the US would no longer have a France to become like.This may require some explaining.There is a thriving literature in political economy on the forces driving convergence and divergence in the world economy. Much of this work sought to discover whether or not countries were converging in the 1990s and the early years of this decade on a single Anglo-Saxon model, given international economic pressures and the success of the US. France was a case in point. Francois Mitterand's efforts to revive and strengthen French social protections when he came to power in the early 1980s led to near economic collapse, and the momentous decision by the French socialists to accept the capitalist straitjacket of liberalized international markets. The succeeding two decades saw the steady erosion of the more social democratic (and socially protective Christian Democratic aspects) of the political economy in France, Germany and other European countries, the withdrawal of the state from ownership of large chunks of the economy and the spread of various more free-market oriented institutions and social practices.
France and other countries faced a profound crisis - a crisis which in some ways was even more profound than that facing the US today. They have faced continuing pressures to 'reform' institutions in a more market-liberal direction over the succeeding two decades. And they have indeed changed in some very important ways. But France did not converge onto the US model despite these pressures. If it had, presumably Crook's and Cohen's criticisms would be rather different than the ones that they are making Instead, it has reformed along a divergent trajectory to the US, with continued heavy state involvement in the economy but of a different variety than previously.
This reinforces a near-universal finding of the relevant literature in political economy as I read it. While there is some diffusion of policy lessons across states, it tends to have limited consequences. Different countries respond to common shocks in very different ways, because of their existing institutional structures. National economic trajectories are quite robust. Even in major crises, advanced capitalist countries tend to tinker around the edges of their institutional systems rather than opt for wholesale reform, let alone converging on a perceived 'better national model' elsewhere.
And this is what is happening in the US. The Obama proposals are not particularly radical departures from existing practice in the US. They are certainly nothing like traditional European social democracy. Even David Brooks effectively acknowledges this, when he says that they are potentially problematic in combination rather than individually. They aren't going to set the US on a different national trajectory, let alone make it 'French' or 'European.' Some of us might like to see this happen, but it isn't going to, even given the ideological trauma that the US is undergoing. And arguing that American individualism is likely to wilt if exposed to nasty foreign influences smacks more of a kind of capitalist-road José Bové-ism than any serious kind of intellectual analysis.
I think he's right: the United States is not going to become France, or Sweden, or Britain. But I also think that argument cuts both ways. When conservatives object to national healthcare, liberals tend to put France front and center. France only spends 11% of GDP on healthcare, patient satisfaction is high, etc.
But, as Henry so ably points out, the United States is not France. We are not going to get the French health care system, because whatever we build will be layered on top of our own institutions. Unless you can meaningfully reform Medicare to do things like control physician salaries and ration care, there is no reason to expect that you will be able to do this under a wholly national system. Medicare cost growth isn't significantly better controlled than inflation in the private system. All of the problems with the Medicare reimbursement structure--and the problems are large--are a result of a historical legacy that has hardened into a nearly immovable system. You can add to it, but no one has so far had much success with the substantial changes that would be necessary to make the system function better. It's like trying to maneuver an aircraft carrier in your bathtub.
If we get national healthcare, we will not get anything like the neat little systems proposed by academics who can assume away many of the political problems. I am aware that proponents would rejoinder, that yes, they know it won't be perfect, but . . . But I'm not making the perfect the enemy of the good. A national healthcare system in the United States will not merely be something sadly less than ideal--it will be nothing like most of the internally coherent proposals. It will be something jury rigged out of Medicare, S-Chip and insurance mandates, ugly and very expensive.
No, we won't be like France. In this narrow instance, it might be better if we were. Instead, we'll be like America, where public institutions are costly, inefficient and generally not very well respected.
that's what i love about this blog. always something terrible going on.
separating health care and employment would be a good thing for this country. Good for business, where it's become a serious drag on the economy, and good for workers.
I don't know how we get there; I'd prefer a Canadian-style system. But get there we must. For the sake of our economy and all the small businesses that can't survive in the face of rising health insurance costs.
The problem in the US is the 15% of the population with no insurance. The 85% who do have insurance are mostly happy with what they have, though many doubtless wish it were more portable from job to job.
Any reform designed to benefit that 15% will need some sort of guarantee that it won't force the 85% out of their current plans and into some Byzantine, rationed, "socialized" system. If it doesn't have such guarantees, the 85% will, via pressure on Congress, vote it down.
In France, needless to say, an entirely different set of considerations apply.
When conservatives object to national healthcare, liberals tend to put France front and center.
Another example of not knowing what you are talking about? It's Republicans/Conservatives that put France front and center. As a way of saying that they don't want America to be like France.
In this narrow instance, it might be better if we were. Instead, we'll be like America, where public institutions are costly, inefficient and generally not very well respected.
Part of this is because of politicians and currying favors. Part of this is also because Republicans hate government(see the last 8 years).
The graph you linked to is deceptive. Perhaps a fairer comparison of private health costs to Medicare health costs would hold median enrollee age constant, hrm?
Er . . . American exceptionalism has a long and storied history that goes back to well before the last eight years, and for that matter, well before the invention of the Republican party.
Farrel is a smart guy, but when crap like this enters into the argument, he's not thinking through things very carefully:
There is something very, very strange in my eyes about this kind of argument. On the one hand. a notion of a healthy American culture of can-do entrepreneurialism, which has survived for centuries and caused America to prosper. On the other, the claim that the combination of broader-if-not-quite-universal healthcare, a slightly easier time for unions, and a return to the relatively mild form of progressive taxation we saw in the 1990s would very probably lead to the destruction of said robust culture. Something here Does Not Compute.
What does not compute is that in the intervening ten years we have discovered that we cannot adequately manage all of the government healthcare we already have, we cannot forge a working relationship between some of America's oldest unions and some of America's oldest industry (GM), and the "relatively mild form of progressive taxation we saw in the 1990s" was pulling in the cream off an expansionary bubble simultaneous to precipitous cuts in defense spending.
There is nothing to go back "to", anymore than we can wake up tomorrow and find construction workers fully employed. As such, there is a legitimate question whether these policies can be implemented to the extent someone like Farrel might prefer, without involving the same social and fiscal policy mistakes that nearly wiped out France's global competitiveness.
We're not looking at the costs--we're looking at the growth in costs. They might be different, but there's no particular reason to think that they would be. Lipitor costs the same for a 50 year old as a 90 year old; they are just more likely to take it.
"Another example of not knowing what you are talking about? It's Republicans/Conservatives that put France front and center. As a way of saying that they don't want America to be like France."
There are liberals who praise France as a positive example (e.g., Megan's former colleague Matt Yglesias) and conservatives consider France a cautionary example, but France doesn't fit neatly into one side of the American political dichotomy. Many liberal francophiles would probably disapprove of France's embrace of nuclear power, for example, or France's strict anti-terror laws, or its expulsion of illegal immigrants, or its perennial military interventions in Africa, if they were aware of any of that. Conservatives, on the other hand, might approve of some of France's recent pro-business reforms (e.g., lowering its corporate tax rate below ours; offering R&D tax incentives, etc.) or of France's banking system, which seems to have held up better than most during the recent crisis (notwithstanding that rogue trader at SocGen).
@Infidel753: I know many people with insurance who aren't satisfied with it for one reason or another. They see it as preferable to alternatives, but not really satisfactory.
As for Megan's argument in her original post, I don't find the "we'll inevitably screw it up" argument very convincing. Other countries with less experience and resources have created decent health care systems, and we don't have to do this overnight, nor should we try to.
In this narrow instance, it might be better if we were. Instead, we'll be like America, where public institutions are costly, inefficient and generally not very well respected.
And yet, inevitable, as even your readers who are zealously opposed to universal health care largely acknowledge.
Rez,
Other countries also ration health care, pay their health care workers a lot less than we pay ours, and free-ride off of the research and development that's funded partly by the market aspects of our current, semi-socialized health care system.
Other countries' health care systems also don't do as good a job at treating patients, as former Canadian physician David Gratzer noted a couple of years ago:
Infidel & David Hackensack:
I'm not happy with my health insurance. It rations my health care while not paying for a single penny of it. I'm one of the millions who are "underinsured," opting for a high-deductible plan to prevent losing my home, and paying for my health care out-of-pocket.
But I can afford to pay for that care; many of my neighbors can't, and go without.
Others are trapped in jobs because of the health insurance; though I guess nobody's complaining about being "trapped" in a job these days.
Joe Klein,
Another example of not knowing what you are talking about? It's Republicans/Conservatives that put France front and center. As a way of saying that they don't want America to be like France.
Sure, Joe. Liberals never, EVER use France as a model in this instance...NEVER. Whatever. Do a search on France at DKos and tell me how many times it has to do with Health Care.
Besides, is this small point really getting to the crux of what the post is about? No. Really, No. It's not.
Part of this is because of politicians and currying favors. Part of this is also because Republicans hate government(see the last 8 years).
Of course. The people who work in the political process are forever an obstacle to getting what you want. It's never the nature the system which represents many viewpoints. Yet, you keep probably continue to believe that the process will eventually do what you want when the "right people" are running it. A better world to meet your standards is always so close...so close.
Liberals do not always cite France as an example. Many would be quite happy with a medical insurance system like the ones in Switzerland, the Netherlands, and the Commonwealth of Massachusetts. I know I would. And since single-payer systems will never pass Congress, why does this blog waste its time attacking them?
That chart doesn't seem very useful if it isn't adjusted for the percentage of older people using private insurance. If it hasn't shifted since 1970, then the chart is fine, but doesn't it seem likely that as insurance premiums have gone up, the percentage of elderly people using private insurance has gone down?
And if that's the case, then the growth rate for private insurance payments is understated.
Stan,
discussing does not equal attacking.
zic: if detaching health care expenses from employment is the primary motivation (and I wholeheartedly support this goal), wouldn't the elimination of all tax benefits for employer-provided health insurance resolve the issue? After all, the insurance companies could just as easily build their pools based on any parameter other than employment...
"Unless you can meaningfully reform Medicare to do things like control physician salaries and ration care...."
Rationing care is issue 1,2,3,4 and on.
The private health care system would be fine, profitable and efficient, if it was just not compelled to treat people who cannot pay. Medicare is the least of it. Medicaid too. Along with those who cannot pay their deductibles.
Until the emergency room can say show me your insurance or credit card limit and credit score when a parent brings in a sick child before treating them then the system will not work. Costs would start to plummet if the payers were not paying for the non payers.
So if the baby is blue and the payment can't be reasonably guaranteed then too bad.
I am sick of 1/2 pure libertarians. Make your case or forgetaboutit.
Zic,
Sorry you don't like the high-deductible health insurance policy you have, but consider the positives: if you get a catastrophic illness tomorrow -- say, cancer -- you'll be able to get the best treatment in the world for it. No one is going to put you on a months-long waiting list for treatment, or send you home to die without treating you at all.
Yes, it would be nice if your every day health care costs were less (or even "free"), and it would be nice if health insurance in America were cheaper. But there are things we can do to make health insurance and health care less expensive without throwing out the baby with the bath water. For example, we could allow people to shop for health insurance across state lines, which would increase competition and reduce the overhead of health insurance companies that need to be domiciled in different states; we could enact meaningful tort reform, which would reduce the need for defensive medicine, and bring down the cost of malpractice premiums, which get passed along to patients in higher health care costs; we could stop mandating that health insurance plans cover things like chiropractic care and psychiatric care, which inflates the cost of insurance as well; etc.
"And since single-payer systems will never pass Congress..."
One doesn't need to pass Congress for us to effectively end up with such a system. All Congress needs to do is authorize a federal insurance program that's open to Americans of all ages (e.g., a "Medicare-for-all") and set the premiums below the program's actual cost. That would drive private health insurers out of the market in short order, and you'd end up with a single-payer system, for all intents and purposes.
"So if the baby is blue and the payment can't be reasonably guaranteed then too bad.
I am sick of 1/2 pure libertarians. Make your case or forgetaboutit."
The vast majority of Americans across the political spectrum are opposed to denying emergency care to those who can't pay, and the law that any hospital emergency room that takes federal funds (which, I think, includes all of them) can't deny emergency treatment to indigent patients.
It is worth asking, though, what percentage of such patients are illegal immigrants. Given that we have (depending on the estimate) 10-20 million or more illegal immigrants, and that probably few if any of these illegals have health insurance, we could reduce the number of uninsured in this country and reduce our Medicaid costs simply by enforcing our immigration laws and sending these folks home.
If the vast majority of Americans are opposed to denying emergency care to those who can't pay then libertarians are just going to have to dictate and enforce it. Sorting out some brown people won't cut it.
Listen, the free market utopia is only going to happen under authoritarian rule. Deal with it. Unhappy daddies are going to be going to the emergency room with a gun when baby dies. As a Humana stockholder and Randian there is only one pure moral choice. Compromise leads to the slippery slope of socialism.
It makes no difference what the majority of Americans, the political market wants, if the economic market wants and needs something else. Take it or leave it. I am sick of 1/2 pure Libertarians.
Until the emergency room can say show me your insurance or credit card limit and credit score when a parent brings in a sick child before treating them then the system will not work...I am sick of 1/2 pure libertarians. Make your case or forgetaboutit.
I applaud this realization. Libertarians: you are already paying for universal healthcare in the form of extremely costly emergency care.
Assuming you cannot make the case to the public that a good portion of them should be allowed to die in the streets while their ability to pay is verified, you should at least be interested in reforming publicly provided healthcare to the most efficient system possible.
wouldn't the elimination of all tax benefits for employer-provided health insurance resolve the issue? After all, the insurance companies could just as easily build their pools based on any parameter other than employment...
Posted by ...Max...
Elimination of the tax benefit would not be sufficient by itself. (1) Health insurance companies are structured to sell to businesses, and it is a massive cost to change. (2) Selling to 3 unit groups is much different and more expensive than selling to 1000 unit groups even after the transition costs are complete. (3) The discounts offered to large groups are a massive income transfer (and thus competitive advantage) for large companies, some of which would therefore try to continue the practice.
So in all probability the government would have to eliminate differential pricing (for non-medical factors) or simply make employer owned insurance a regulatory violation. Either of these options would be preferable to the current circumstance, and vastly superior to likely alternatives. They're both heavy handed, but overcoming government interference often requires government interference. For example Democratic subversion of government to enforce Jim Crow justified other portions of the government stepping in.
rapier: and I'm sick of 1/2 pure communists too. Where is your red banner?
"Listen, the free market utopia is only going to happen under authoritarian rule."
There's zero chance a free market utopia occurs under authoritarian rule. There's also zero chance a free market utopia occurs under non-authoritarian rule. Further, there's zero chance a non-free market utopia exists under any type of government, anywhere, ever.
Recognize this and focus on the best solution possible. In regards to health care, this probably means getting the employer out of the equation and setting up charities to fund policies for low-income earners.
And be satisfied with small gains. Once people see that markets work they'll be more willing to accept more later.
Huh? Controlling physician salaries? Wtf. Do you really think our salaries are a big driver of the health care problem in this country? Put it another way: Do you not realize that increasing demands on the system (for the underclass; for the crazy; for the neurotic, whom the drug companies have tried to convince that their aches/pains/asthenia are illnesses requiring meds instead of exercise or coming down to earth; for the obese and smokers and drinkers; for the very old, who wouldn't be here if it weren't for the success of our system; for preemies; etc) are the drivers here?
Or look: why on earth should talented people go into medicine if they are going to be paid a tiny fraction of what their contemporaries in college are paid, and that after lots of training. You'd have to be crazy! The situation in other countires is different: medical education is not as expensive and one is not in hock for decades. And the meretricous component of administrative capture that afflicts US medicine does not apply.
How dare you -how dare you - as an MBA (sorta) claim that physyican salaries are a driver of the system. Why, to keep from getting sued I have to order gobs of stuff that dwarfs my salary.
Btw: why don't we look at higher ed as the next thing to adopt a social policy wrt? Costs go up every year, and yet our population as a whole is, uhh, not doing so well one worldwide tests. (in part this is bec of the sort of social disparities that lead to equally bad comparative results in health for the population as a whole.) College costs beggar middle class families. (But, gee, what nice big buildings and nice bonding experiences we have for the students. And lots more deans than we used to, and, of course,bargainbasement nontenure track faculty screwed by their employers if anyone ever was.)
Uhh, gee, when will we hear about rollbacks in tuition costs?
Anyway - no rational actor would go into medicine now, so don't blame us for what you're buying into, or what your care will be like in 20 years (except to the extent we can stave this off by importing smart docs from the subcontinenet). This is what a society which values hedge fund careers for talented graduating students ahead of teachers, engineers, librarians, and, yes, doctors, deserves.
Communist! The whole point is I hate ideology.
(going off into the weeds) It is not a coincidence that so many leaders of modern conservatism in the 40's and 50's were former communists. The habit of thought behind all ideologies are the same.
The biggest problem with American health care is the need to pretend it's a free market system.
Profit is way over rated. Look at our financial system.
rapier: I hate ideology too, and collectivism is one.
"Listen, the free market utopia is only going to happen under authoritarian rule."
You seem a little confused equating "free market utopia" with letting sick people die in the streets. Sick people left to die in the streets is something you might see in the shabbier parts of India or China -- hardly anyone's idea of "free market utopias". Singapore, on the other hand -- the closest thing to the authoritarian free market utopia you describe -- has a comprehensive social safety net, including a sort of quasi-private, quasi-governmental universal health care system. A difference between Singapore's welfare state and ours is that Singapore's is mostly funded through compulsory individual savings, rather than through transfer payments.
"I am sick of 1/2 pure Libertarians."
Fine with me: I'm not a Libertarian.
"Uhh, gee, when will we hear about rollbacks in tuition costs?"
Way ahead of you.
I applaud this realization. Libertarians: you are already paying for universal healthcare in the form of extremely costly emergency care.
Umm, this "realization" has been an essential component of dialogue among libertarians since, like, forever. Only the cartoon versions of libertarians (found only in their critics' heads) are unaware of this.
Similarly, only those cartoons (OK, straw men) are fixated on instituting an idealized, totally unregulated, totally free-market healthcare system in the US anytime in the next century.
Megan - I'm loving you today, what's gotten into you? You were great when you came and talked to my class at George Mason as well.
Very good post Megan, you really nailed it.
I'm constantly baffled about the comparisons with France. There are lots of other countries who are much more similar to the U.S. than France (I would say that it's hard to find one developed country that is as different as France), and there are also other models of universal health much more politically feasible in the U.S.
Somehow, in the American culture France became the earthly equivalent of one of the Circles of Hell. So if you want to bash something, you say that the French do it. What the French also do, of course, is live longer and have a lower infant mortality rate than the U.S.
American media tends to paint the rest of the world as having relatively minor differences in health care systems. Nothing could be further from the truth. There is one amazing program in Frontline that compares various health care systems and their pros and cons. It also makes the case that the East Asian countries, not Europe or Canada, have the most advanced models so far, not only in health results, but also in terms of administrative efficiency, good incentives and low costs. Definitely a must see.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Re: The problem in the US is the 15% of the population with no insurance. The 85% who do have insurance are mostly happy with what they have, though many doubtless wish it were more portable from job to job.
Not true. There's also a substantial fraction of the population whose insurance is really crappy, and in some cases little more than an outright scam (Pay us exorbitant premiums, but we have all kinds of fine print that will allow us to deny virtually any claim). The underinsured are as much a problem as the uninsured.
Re: Other countries' health care systems also don't do as good a job at treating patients, as former Canadian physician David Gratzer noted a couple of years ago:
Maybe, but it's odd the overall mortality figures don't reflect it. If vast numbers of people were dying from treatable illnesses abroad the life expectancy stats would have to show that. Of course when we say that people "survive" a given fatal illness what are we really saying? That they are cured and ultimately die of something else at a ripe old age? That they are diagnosed sooner in the US, but still die, yet the longer interval makes it seem as if they survived longer? Or that they are kept clinging to life a month or two longer on their deathbeds at great cost? The devil here is very much in the details.
Re: For example, we could allow people to shop for health insurance across state lines, which would increase competition and reduce the overhead of health insurance
You can currently buy a policy from a company headquartered in another state. However that policy must conform to the laws of your state of residence. Why should it be otherwise for insurance companies when the rest of us have to obey the state law of whatever state we find ourselves in, even as temporary vistors? If you live in Montana, you will not get out of a speeding ticket in Maryland claiming that where you live you can legally drive 75mph.
Re: Congress needs to do is authorize a federal insurance program that's open to Americans of all ages (e.g., a "Medicare-for-all") and set the premiums below the program's actual cost. That would drive private health insurers out of the market in short order, and you'd end up with a single-payer system, for all intents and purposes.
No it won't. Cost is not the only thing goods and services compete on. Public schools are 100% free but they have not driven private schools out of existence. And riding the bus may be quite cheap, but even in big cities like this one (Baltimore) most people still spend thousands of dollars buying and maintaining their own automobile rather than relying on public transportation. A public health insurance plan would evolve somewhere between those extremes.
For an "opposing view", and in case you missed it, there is always this article from Krauhammer. For greater effect, you can always play the Imperial March as you read this ominous descent into inferno. Yes, it's a cliché. It still works:
I wonder what kind of health care system did they have in the Galactic Empire. Clearly, keeping Darth Vader alive was everything but cheap.
Here's the full article.
"Unless you can meaningfully reform Medicare to do things like control physician salaries and ration care, there is no reason to expect that you will be able to do this under a wholly national system. "
Econ 101 quiz: Price controls such as salary caps cause...
a) surpluses
b) shortages
Are we currently experiencing a surplus of doctors? If not, won't controlling physician salaries make our doctor shortage worse?
wouldn't the elimination of all tax benefits for employer-provided health insurance resolve the issue? After all, the insurance companies could just as easily build their pools based on any parameter other than employment...
Sure, and they do for people that aren't employed. They only give health care to people that aren't sick. What do you propose the sick people do?
This is one area where I break from the Libertarians. Having a health care system that caters only to healthy people seems kind of silly.
"Having a health care system that caters only to healthy people seems kind of silly."
Yes it does, until you start to think about the perverse incentives created by a system that does the opposite.
Bearded Spock
Such as?
I don't think you mean people getting sick on purpose to abuse the system. What do you have in mind?
tsotha said
Tu quoque tsotha? Defending subsidized health care?
(...)
There's something very wrong with this thread. People are acting weird of and out of character. I would be happy if this wasn't scary...
rick, Bearded Spock, thanks for the pro-doc comments. I'm one myself, and so far happy with my choice - it's a right fit for me, personally - but I actively try to steer people away from it for just the reasons you mentioned unless I know that they are, like scientists, willing to accept less income than they could probably earn elsewhere in return for intellectual satisfaction. Actually, from what I've seen, US physician pay is *slightly* higher than most of the rest of the world, but it's small when you compare apples to apples: those with mixed public-private practices, who are responsible for running their own offices, make pretty much the same amount in purchasing-power-parity income worldwide. (Wish I could provide a cite, but I just can't remember where I saw this.)
Rationing care is where savings will come from. The way to spend less money on health care is... to buy less of it. Our system is not particularly expensive for what it does; it's just really expensive to do all the things we do. We are extremely good at diagnosing and treating diseases. We have terrible population stats because we're fat, lazy, and afflicted with crappy genes.
I don't know how anyone can claim that physician salaries are a driver of health care costs when doctors are being paid less and yet miraculously health care costs continue to escalate. I'm just an ignorant medical student and not a fancy shmancy MBA, so maybe I'm missing something, but something seems wrong with Megan's claim. Also I would add that we have a system where doctor's salaries are essentially set by reimbursement schedules established by the govt (with the exception of certain outliers such as elective procedures). As such we have an implicit agremeement with doctors. You work hard as hell and you will be rewarded. Not astronomically rewarded (read MBAs). But well rewarded for providing a valauble and difficult to deliver service. This is offered in exchange for being essentially barred from offering services in the free market like anyone else. I don't think that violating this agreement is in anyone's interests, doctor's or patients. I know that I expect a certain reward for doing something that most people either won't or can't do. I like a lot about medicine, and find a lot of personal and emotional reward in my work/school, (I intend to go into emergency medicine partly to care for people who don't get medical care in other settings) but it's just not worth it if there is not a financial reward as well (and keep in mind we're not talking about wall street levels of compensation, not by a long shot). I've worked in other fields before med school, and there is really no comparison. There may be a comparison to some fields, but those people make a but-load more than doctors. Frankly, given the amount of effort (not to mention the long and crazy expensive training) that doctors put forth we're getting a great deal.
That's all I really have to say.
"Such as?
I don't think you mean people getting sick on purpose to abuse the system. What do you have in mind?"
I mean people not trying hard enough to prevent getting sick because of reduced consequenses.
I mean government bureaucracies that grow larger and get more funding when they fail to solve the problems they were created to solve.
If you don't think that's already happening elsewhere, then how do you explain the Dept. of Education?
That argument is valid on a wide range of issues, but I really don't buy it for health care. I don't believe reckless behavior increases because people know they won't pay the hospital bill if they get injured. Desire to avoid pain or permanent damages to your health really seem incentive enough for the vast majority of people. There is universal health care in a lot of countries and, of the list of typical problems the system faces, I never heard of that one. But if abuse is a concern, universal health care doesn't preclude the existence of co-payments.
Again, I sympathize with the general point, and I believe health care is an exception. A greater percentage of GDP is spent on health care in the U.S. that in other countries, with poorer results. And a greater proportion of those expenses in the U.S. are administrative costs than in other systems.
I don't know how to explain it. But government doesn't have to be the default scapegoat. Almost every country has a large chunk of state subsidized pre-college education, with very different results. There is obviously something wrong with state education here, tough.
Finally, the time has arrived to fix Americas Healthcare crisis, and Americas healthcare knightmare. Hundreds of thousands of you are killed needlessly every year by your healthcare delivery system in a rush to profit. And because of a rush to profit Hundreds of thousands more of you are needlessly dying from treatable illness that people in other developed and civilized countries don't DIE! from. Rich, middle class, and poor alike. Insured, and uninsured. Men, women, children, and babies.
Additionally, thousands more of you are driven into financial ruin, and bankruptcy just because you, or one of your loved ones got sick or injured. And all of this is happening at a time when America spends twice as much of it's GDP (Gross Domestic Productivity) on health care than any other country in the developed world. Individual Americans spend about ten times as much on health care as any other people in the developed world. This is a CRIME AGAINST HUMANITY. AND IT MUST END!
But before we can truly fix this healthcare crisis and disgrace, everyone needs to clearly understand what the problem is. And everyone needs to clearly understand the real enormity of the problem. The problem is that HEALTHCARE AND MEDICAL DELIVERY IN AMERICA IS SEVERELY CORRUPTED AND COMPROMISED BY GREED! AND THE PRIVATE FOR PROFIT MOTIVE. And it is corrupted, and compromised IN EVERY ASPECT, AND EVERY PLACE OF HEALTHCARE AND MEDICAL DELIVERY. Unfortunately for all Americans, compromised healthcare ALWAYS results in needless suffering, injury, disability, and or death. Which is exactly what is happening now in America in shocking numbers.
Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS.
So how do we fix this healthcare disgrace? I believe the fix for Americas healthcare disaster is essentially the same thing that every other developed country in the World has essentially done. "NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL. Essentially HR676 (enhanced, and expanded medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix and reform our current disastrous healthcare delivery system.
All Universal health care systems work best when everyone participates. But I know that the healthcare lobby, and some politicians will try and undermine "Not For Profit, Tax payer supported, Single payer, Automatic, Free Universal Healthcare for all" by falsely claiming that it will limit your choice, and require you to participate.
So, I propose that everyone be included in the national plan unless they choose to opt out. If you opt out and need medical care the national plan will insure your provider that they will be reimbursed under the rules for members in the national plan. But those who opted out, and their insurer will be responsible for the FULL! cost to the national plan for providing your care if you or your private insurer fails to reimburse the provider or the national plan in a timely manor to at least the standards of the national plan.
Including reporting you to credit agencies, withholding of taxes, leans, and garnishment of wages for unpaid medical bills. Just like you have now under private for profit healthcare, and private for profit health insurance.
Further, people who opted out will be required to provide proof of financial responsibility for future illness or be required to participate in the national plan. And everyone with children will be required to participate in the national plan. Or provide proof of insurance coverage on each child to the standards of the national plan. It will be against the law to report anyone in the national plan to a credit agency for unpaid medical bills.
Frankly, only a dope would want to opt out of the national plan and opt to keep our current disastrous private for profit medical, and insurance plans. But they will be free to choose. The most important thing is that the vast majority of Americans that want the protection, benefits, and higher quality of a universal national plan have that choice.
You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan. This is much of what Medicare does now for senors. "Aeger Primo" (The patient first). Unfortunately in our healthcare system the patient comes last. We are just a peace of meat to them. Cash cows to be slaughtered for profit.
So this is IT! my fellow Americans, My fellow human beings, My fellow World Citizens. And my fellow Cyber Warriors. :-) The time has come. D day. H hour. HEALTHCARE REFORM THIS YEAR! Let no one stand in our way. Contact your representative and tell them you want "Not For Profit, Tax Payer Supported, Single Payer, Automatic, Free Universal healthcare for all. And tell them you want that choice now. Tell them you want President Obama's budget passed as is, without delay. President Obama's budget is brilliant. And exactly what is needed now.
President Obama, and his allies will need all the support you can give them. The healthcare lobby will try to take out his people if they can, like they did with Tom Daschle and Nancy Killefer. And they will try to neutralize President Obama's popularity, and political power. Or they will try to take him down someway. Don't stand for it. If they attack him. Go after them ten times harder and remove them from office. We had an election. And you the people chose President Obama's leadership, and change agenda. Let no one in government disrespect the will of the American people and remain in office.
To President Obama, his Cabinet, the Congress of the United States, and the Supreme Court. I have noticed for some time a disturbing tendency for key members of your bodies to come down with illness, or medical problems at critical legislative times. This may just be coincidence. But I can tell you that there are a million subtle ways to medically injure someone just by doing nothing when something needs to be done. Or by doing things to someone when nothing needs to be done except to give them reassurance. I know for a fact that there are those that would have no qualms about hurting any of you to preserve our current disgraceful medical status quo.
So, I recommend as a matter of national security that you enlist the help of a friendly power to regularly review, and oversee the medical care you receive from your local regular healthcare providers. Briton, France and many other countries have excellent medical providers. As well as Canada. Briton, and Canada may be less of a language barrier for Americans.
Let's get this healthcare reform done now my fellow Americans. This year. Take no prisoners.
God Bless All Of You
Jack Smith — Working Class :-)
http://jacksmithworkingclass.blogspot.com/
(http://jacksmithworkingclass.blogspot.com/)
jacksmith,
You don't actually imagine anyone's going to read that 1209-word all-caps-laden screed, do you?
No one seems to be discussing a very key factor here:
France has the outcomes it does because France is full of French people. They take less risks, and they're willing to accept imperfection. Sometimes surgeries give you a little limp - they deal better with it there.
America is a culture full of gang bangers, guys who backflip motorcycles, BASE jumpers, Navy SEALS, and overeaters - and a zero-defect culture in medicine and our military.
Our baseline health costs are set in stone by our human inputs, and our expected outputs. The only thing we can go from there is down.
No one seems to be discussing a very key factor here:
France has the outcomes it does because France is full of French people. They take less risks, and they're willing to accept imperfection. Sometimes surgeries give you a little limp - they deal better with it there.
America is a culture full of gang bangers, guys who backflip motorcycles, BASE jumpers, Navy SEALS, and overeaters - and a zero-defect culture in medicine and our military.
Our baseline health costs are set in stone by our human inputs, and our expected outputs. The only thing we can go from there is down.
Re: I mean people not trying hard enough to prevent getting sick because of reduced consequenses.
The financial consequences of getting sick are trivial compared to the other consequences (you know, things like pain and death). If people aren't motivcated by fear of death it's hard to believe that money will motivate them. Moreovber the majority of health problems are not due to people's behavior, or at least not in ways that can legitimately be blamed on them. We do not have godlike powers after all. And the biggest factor in poor health-- aging-- is all but inevitable unless you wish to die young
Any health care reform needs to preserve the element of competition between providers. Everything that works properly in this country, works properly because of competition -- providers know that if they do a bad job, people can take their business elsewhere. Even with employer-provided health insurance, every company I have ever worked for offers several plans, and there is at least some ability to switch from one to another, so the element of competition still holds.
If there is only one giant provider agency for the whole country, even what incentives now exist to give customers what they want will disappear. Bureaucratic oversight can't replace this.
France has the outcomes it does because France is full of French people. They take less risks, and they're willing to accept imperfection.
Isn't France full of rampaging religious fanatics who regularly riot, set hundreds of cars on fire, take potshots at ambulances venturing into their turf, and generate huge levels of violent crime? How does that factor into it?
There seems to be an impression that emergency room care is free for uninsured patients. It isn't. The patient will be sent a bill after the treatment, and if it isn't paid the hospital will turn it over to a collection agency. What happens thereafter to the bill and to the patient's credit rating depends on the patient's locale.
In reply to DaveinHackensack, get real. The vast majority of Americans already have medical insurance, and those who don't have little political influence. The possibility that Congress would put through any version of a single-payer system is nil. Megan's harping on single-payer, with its vision of the US enacting a European-type social welfare system, is wasted effort. The only thing that could change American attitudes is a complete collapse of the union movement, which would be followed, I think, by drastic cutting of medical insurance benefits to employees and retirees by our manufacturing sector. This is already happening in the auto industry. If it spreads, some form of social democracy in the US is inevitable.
Gee, I wonder how the postings on this topic would change if we were instead talking about the Food Delivery system, something we must count on each and every day?
So much worry about us turning into France. Their health is also a reflection of their diet. As they proceed down the slipper slope of the western diet, their rates of heart disease, diabetes, and cancer increase, too.
So if we really want to take on health care, we need to take on health. One of the best ways to do that is taking on the food lobby and big agriculture.
And don't feed me that crap about not being able to feed the world's growing population without big ag. Nobody need to drink high-fructose corn syrup all day long, nobody needs to eat white flour all day long, and nobody needs to eat canola oil-fried meat all day long.
Plus if there's problems feeding the world's growing population, perhaps the population is the problem. We can solve it with wars, or we can find some more humane ways to solve it.
But denying living folks health care, and feeding living folks diets that make them sick is just plain stupid and cruel. My sarcastic regret is that we don't get sick and die before we reproduce.
Nimed:
"That argument is valid on a wide range of issues, but I really don't buy it for health care. I don't believe reckless behavior increases because people know they won't pay the hospital bill if they get injured."
Sorry. I did just that. I'd planned a risky vacation activity, and SWMBO asked if it was covered. It was, objection withdrawn.
I've decided to move to France because:
1. They have universal health care
2. I won't have to read the opinions of idiotic bloggers anymore (I don't speak french)
Megan, I would like your thoughts on the following:
1. The poor are protected via Medicaid while the wealthy are thru private insurance. The hole appears to be in the middle. I find it remarkable that there aren't more folks pointing this out.
I'm a moderate conservative and I'm not a fan of nationalization of the HC system, but something is wrong morally about working as a middle class person but not getting HC.
I'm sure this is a liberal policy group, but I believe the stats to be accurate.
http://www.cbpp.org/8-29-06health.htm
2. In direct contradiction to 1, employers are paying based on total labor costs. That includes healthcare. So the middle class should accept a reduction in wages for HC insurance. But they aren't.
3. HC costs are going up much faster than inflation and it is a major budget issue in certain states that have tried to enact "national" insurance like MA.
4. I want my HC quick and I strongly disagree with the rationing of Canada and Europe.
So what's the answer?
Just to address the doctors and med students complaining about a prospective drop in compensation: Wah.
If the AMA didn't carefully manage how many people enter and graduate med school each year and allowed a true open market for medical talent to exist (as it does in law), then I might have some sympathy. Instead, the supply of doctors is artificially fixed, meaning they get much higher compensation than might otherwise exist. Additionally, the AMA fights tooth and nail against out-patient clinics in pharmacies and department stores because it cuts into general practitioner business.
Not that the legal profession is perfect (we have the problem of oversupply), but at least the barriers to entry are standard and surmountable. While I am sympathetic to the astronomical malpractice insurance most docs need to carry, expand the medical profession and see if that helps a bit.
I teach school in the poorest county in my state per capita (rural and overwhelmingly white, by the way). Every year I ask middle school kids what's the first question they're asked when they go to the emergency room. They all know it's not about what's wrong but for an insurance card. I don't care how screwed up the system is - I want to live in a country where kids don't feel guilty when they go with their parents to see a doctor.
The Italian System - an American encounter:
I have an anecdote worth considering, although I am fully aware that anecdotal evidence cannot support larger generalities. A while ago, my extended family and I were staying in northwestern Tuscany, a rural area, in fact, when my mother-in-law was bitten by a scorpion. It became infected, she became quite ill, and in the middle of the night we took her to a small town of around 30,000 where there was a 24-hour "clinca," what we might think of as an emergency/triage facility, with four beds and a non-critical surgery. Total waiting time? 20 seconds. Mother-in-law was treated by an MD with antibiotics, a pain killer and an anti-venom. We were given a small box of medication to take with us, covering another 6 days of treatment. When I went to pay, the administrator looked at me as if I had taken leave of my senses, and said with a shrug of her shoulders, "E libro," "It's free." Then she asked if this was not so in the United States and I said generally only for the poor or those without insurance. "How can ANYONE not have insurance?" she asked. "Don't ask," I said and left, having thanked her profusely. Here we were, strangers in a country, treated for free, promptly and efficiently. Just imagine what that would have cost in time and money in America! There are many ways to define progress.
Isn't France full of rampaging religious fanatics who regularly riot, set hundreds of cars on fire, take potshots at ambulances venturing into their turf, and generate huge levels of violent crime? How does that factor into it?
--- Ummm the U.S ranks about 25th for most murders per capita, France ranks about 40th, UK, Italy, Spain and Germany rank 46, 47, 48 and 49, Japan ranks about 60th. The U.S. murder rate is about double that of France.
JonF,
"Maybe, but it's odd the overall mortality figures don't reflect it."
It's actually not that odd, and Gratzer partly addressed that in another part of the piece I linked to above:
Gratzer didn't mention the effect of demographics on life expectancy either, but that's another difference. Different ethnic groups tend to have different life expectancies, and when we compare the U.S. to more ethnically homogeneous countries, we need to bear that in mind. For example, Asian American women in my county have the highest life expectancy of anyone in America: 91 years. There are Native American men in the Dakotas with life expectancies almost 40 years shorter.
"You can currently buy a policy from a company headquartered in another state. However that policy must conform to the laws of your state of residence. Why should it be otherwise for insurance companies when the rest of us have to obey the state law of whatever state we find ourselves in, even as temporary vistors? If you live in Montana, you will not get out of a speeding ticket in Maryland claiming that where you live you can legally drive 75mph."
It's an accident of history that insurance is regulated at the state level. I suspect health insurance rates would be lower if that weren't the case, and I'll tell you why I think that. Compare the fees in the investment product that's regulated mostly at the state level, variable annuities, with the fees associated with mutual funds*: mutual fund fees tend to be much lower.
"No it won't. Cost is not the only thing goods and services compete on. Public schools are 100% free but they have not driven private schools out of existence."
You could be right: under a single-payer system, unless the government bans it outright, there may be a few private alternatives. But what this will likely mean is that the wealthy will get the best treatment, and the middle class will get worse treatment than it does now. For example: a family member of mine was treated at one of the two top cancer centers in America (which means one of the best centers in the world). He wasn't rich -- just had regular health insurance. On the top floor of the hospital were wood-paneled suites where some of the wealthiest cancer patients in the world got treated -- but they got the same treatment my family member did, including expensive (thousands of dollars per treatment), cutting-edge drugs. In a single payer system, it's likely that that whole cancer center would be the province of the wealthy with their private insurance, and wouldn't be available to middle class folks.
*This is a simplification for our purposes. Federal and state regulations apply in both cases, but the salient point is that, for all intents and purposes, states have much more authority in regulating variable annuities than in regulating mutual funds.
"If the AMA didn't carefully manage how many people enter and graduate med school each year and allowed a true open market for medical talent to exist (as it does in law), then I might have some sympathy. Instead, the supply of doctors is artificially fixed, meaning they get much higher compensation than might otherwise exist. Additionally, the AMA fights tooth and nail against out-patient clinics in pharmacies and department stores because it cuts into general practitioner business."
I actually agree with all of that, but unless the Universal Health care Plan includes dismantling the AMA (which I would support), the only two possible outcomes of doctor salary caps are A)are more severe doctor shortages or B)lower standards for doctors.
"I want to live in a country where kids don't feel guilty when they go with their parents to see a doctor."
At least they get to see a doctor. I want to live in a world where it rains candy, broccoli tastes like ice cream, and all my neighbors look like Scarlet Johansson. We don't always get what we want. If you really care about the children, you wouldn't be spending their inheritance on another big government bureaucracy that will push us even closer toward fiscal ruin.
Re: It's an accident of history that insurance is regulated at the state level.
Well, yes, it's an accident of history that we have state governments at all, and that states are responsible for stuff like marriage and inheritance laws, traffic laws, education and the like. And given that the alternative to states regulating insurance companies is to have a one-size-fits-all set of regulations at the federal level, I would think anyone right of center would prefer keeping that power at the state level.
Re: There are Native American men in the Dakotas with life expectancies almost 40 years shorter.
Given the roll that extreme poverty and alcohol play in Native American life, that's hardly surpising.
Re: In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.
That's apples to oranges unless the "other country: rates also exclude accidental and violent deaths (homocides may be lower abroad, in some cases, but suicides rates in some cases are higher)
Re: You could be right: under a single-payer system, unless the government bans it outright, there may be a few private alternatives.
It would depend very much on the details. If the public plan is of good (or a least acceptable) quality and is either free or of very minimal cost, then the public plan will predominate (the public school model). But if the public plan is of Medicaid-level crappiness, and yet also requires a significant copay from the individual, then most people will stick with private plans and employers will perforce have to offer them in order to attract workers (this would be the public transportation model). In any event, under no circumstance involving free choice and not outright coercion do I see private healthcare vanishing no matter how long you run out the projections. As I said, I expect it to fall somewhere in between, with most middle class people sticking with their workplace plans, while working class (except union labor) and the self-employed would often end up in the public plan, at least for long stretches during lean periods.
Setting aside the irony of liberals trying to defend the Obama admisitration against charges that it is socialist after years of frantically whining that big-government-massive-deficit-spending-nation-building-federal-education-expanding-amnesty-for-illegal-alien George Bush was an "extreme conservative", Farrell mounts a typically pedantic liberal argument. No you silly conservatives, the US won't be like France, it will merely become more France-like within the context of American social and political norms.
Wow, that makes me feel much better. Not. See, not only do I not want to become like France, I don't even want to become more France-like. No one is arguing that the US will become France, they are afraid that we are hurtling down the path of over-leveraged-government-ponzi-scheme armegeddon and that we may be at a tipping point from which we cannot recover.
The simple truth is that you cannot consume more than you produce over the medium to long term. In the short run, individuals and countries can borrow money to finance over-consumption but at some point the available credit dries up and you are SOL. Megan has made this point incessantly. Since WWII, France and the rest of Europe have been free riders on US military spending. For at least 15-20 years they have been free riders on the medical innovation funded by the American economy. They have also benefitted from having the world's largest economy as a trading partner. In sum, Europe would be a different place without the US and I am not so sure that you can say the converse. Would the welfare states of Western Europe have imploded by now if they had been forced to fund their own defense; would they be part of the Soviet Union; would they have statins or MRI's; would they have the wonderful health care system that liberals so badly want to immitate? Maybe, maybe not. However, the United States has already borrowed and spent its way to the worst recession since the 1930's and now we have the re-birth of liberalism ready to put its foot on the proverbial gas pedal with more borrowing and spending by several orders of magnitude. Europe's nanny states are starting to implode and Obama's proposals would be unsustainable even without the impending medicare/social security demographic time bomb.
Farrell may be right. We won't actually become France. So what? We were already headed in the wrong direction and now we are picking up speed on that same track. God help us.
JonF said: "That's apples to oranges unless the "other country: rates also exclude accidental and violent deaths (homocides may be lower abroad, in some cases, but suicides rates in some cases are higher)"
Dude, are you a retard? Ohsfeldt and Schneider factored out homicides and accidental deaths from all of the health statistics from all of the countries in their survey. It wasn't apples to oranges. They controlled for those factors across the board. Face it, American health care is the best in the world at treating and curing the sick. It is more expensive because there is more of it to buy, we don't have government rationing and there are major distortions of the free market.
Re: Dude, are you a retard?
Dude, are you an uncivil boor?
Re: American health care is the best in the world
Yes, and that's why we want to make it available to all Americans.
I have to chime in on an element of this debate that has just started to pop up in the later part of this thread. The assumptions about the "advantages" of the health care systems of other countries. Others have - wisely - pointed out that many of the costs of US healthcare are multiplied by our greater propensity for violent and/or accidental death. However, there are several other significant factors that argue against these assumptions.
1) Compared to most of the "successful" universal healthcare systems, the US system is treating a body of people who are significantly more overweight, less active, more inclined to smoke and binge drink, use illegal drugs, and get pregnant as a teenager (among other things). Before anyone goes there, yes, we actually do smoke more than the French and teenage pregnancy contributes disproportionately to healthcare costs because of increases in multiple risk factors, not the least of which is premature birth which leads us to point number 2
2) Inadequately comparable health care statistics from country to country (and misunderstanding of those statistics that are available). Periodically, someone will publish an article or op-ed, essentially saying that the infant mortality and life expectancy statistics for the US demonstrate the inferiority of our healthcare system. Not only do they ignore the accidental/violent death factor but they do not know or ignore the huge differences in the recordkeeping standards of the countries in question.
The attached article (http://health.usnews.com/usnews/health/articles/060924/2healy.htm) explains how other countries simply do not count many live births, dramatically altering their results. This not only affects the infant mortality rate but that rate influences the models used to estimate overall life expectancy.
Life expectancy numbers have other problems as well - the UN agency that compiles this data also rates the recordkeeping systems of the nations providing the data and you will find that it is not just the third world countries that have problems - they consider most of the western european records inferior to those of the US.
So, the universal healthcare statistics are probably wrong and overstated, yet there is also a flaw in the public understanding of these numbers. Life expectancy numbers are a statistical estimate subject to a margin of error (based on the limitations of the estimation process, not the probable errors in the base data in this case). When we say France has an estimated life expectancy of 76.6 years and the US is at 75.3, you need to recognize that this includes the possiblity that the actual numbers are US 77.6 and France 74.3.
In other words, our country may be considering changing from an admittedly flawed system to models that are probably not providing equal results, while facing far fewer challenges.
As I understand the numbers, there are around 47 million people without insurance in this country but that a quarter to a third are not in this country legally (in which case we either need to kick them out or make them citizens, not change the healthcare system)and a similar number are people with the means to afford insurance but who are making an active decision to spend their money on other things. It just seems to me there are simpler solutions to cover the remaining 20 mllion or so than changing the whole system.
If we focus on making the whole system less costly (less defensive medicine, more emphasis on prevention, carrot and stick options to lead people to address their smoking, obesity, sloth problems, etc, etc, etc) we will have a lot of better options.
Jon F asks: "Dude, are you an uncivil boor?"
No I'm not. I'm just sick of people who know what they know despite the facts that contradict what they know. Whether or not you are a liberal, in your earlier comment you did exactly what liberals always do. You made a false assumption to support your position despite the fact you had just been given information that showed your assumption to be false. You did so in order to cling to your predetermined and rigidly held belief that our health care system isn't as good as socialized systems around the world. Liberal proponents of socialized medicine are liars. They misuse life expectancy statistics to support their religious belief in government run health care.
Despite your bias and inability to understand basic facts, the American system dispenses the highest quality care in the world. Our cure rates for major diseases are higher than anywhere else. Read the Gratzer column. While there are serious inefficiencies in our system, almost all of them are caused by the government distorting the market. As usual, liberals want to address problems caused by government intervention with more government intervention.
The most disgusting thing is that a government run system will address only one item on the list of failings liberals cite in support of their desire to socialize the system. We will spend less on a macro level because bureaucrats in Washington will ration care. There will be less preventative care, people will be deprived of expensive treatments and bureaucrats will make the cost benefit analysis in determining what care gets dispensed to each person. It won't be better, it will be worse than what we have now.
RRD, you are right on. Good post. I have long argued, let's take care of the 15-20 million of working poor who can't afford insurance rather than throw the baby out with the bath water and make it worse for everyone.
jt007
Thanks for the compliment - your comments to Jon F resonate with me as well. I don't think you have to be misinformed or lack critical thinking skills to be a liberal but it sure seems to be a common thread among them.
There are legitimate liberal arguments on key issues and sensible proponents of those positions but so often, I find that many others who support those positions do so with a lack of basic information or the ability (or, perhaps, the will) to process that information.
There are so many problems with our "information systems" (by that I mean our schools and our media) that I see fixing those as the great challenge of our time. Healthcare is going to be simple compared to that.
RRD
Re: I'm just sick of people who know what they know despite the facts that contradict what they know.
You have a right to your opinion-- but not to your own facts.
The rightwing is delsuional, as usual.
And you are an uncivil boor.
JonF,
"if the public plan is of Medicaid-level crappiness..."
You are apparently unfamiliar with Medicaid. I know RNs who treat Medicaid patients -- those patients get first class care and don't pay a cent for it.
Davein Hackensack
You have a point and yet you do not. You are correct in that when a Medicaid patient recieves care, they recieve it from qualified and caring personnel, in good facilities - generally the same personnel and facilities as many people with private insurance. HOWEVER,...
Medicaid demonstrates some of the charac teristics opponents of government run healthcare fear - rationing and or unsatisfactory standards of care. The classic example right now is Medicaid payment for HIV positive patients. Certain treatments - recommended by the AMA for patients with a t-cell count below 350 - are only available through Medicaid when the count is down to 200. Not good for the patients, obviously, but some argue that earlier treatment would also reduce costs by reducing the frequency and extent of infections and complications (which can require medication, hospitalization, and other care that is charged to Medicaid, public aid, etc.
So, I offer my great respect to your friends in healthcare (around 20 years ago, I provided some consulting services to Hackensack Medical Center, so there is a remote chance I've met them too) but I suspect that if you ask them, they can tell you more shortcomings of the program (and, yes, they are probably grateful that it exists, as am I. We just want to get to a better solution).
RRD
Whether or not med student/doctor concerns about salary is whining is on open question. However the assertion that doctor salary is a driver of increasing health care costs is not. It simply makes no logical sense to say that it is. So while the stereotype of rich doctors driving around in BMWs while people go without health care may be good for stirring up outrage it is pure distraction from the real financial questions in our health care system...