Summary: With Carter America returned to our 19th century tradition of electing cardboard cutouts as President. “Tippecanoe and Tyler too”! Obama stands tall as a proud addition to this roster. While his fidelity to his master might mean electoral defeat in 2012, they’ll easily find another man (or women) from which to manufacture a stirring (if fake) narrative.
On second thought, the summary said it all. So let’s discuss health care reform, in another 100% opinion post (with little supporting evidence). The basics are simple.
- It’s going to bankrupt us if not changed. Only with the Blue Fairy can fulfill the absurd promises made by the government.
- The operation of our system would be considered irrational and foolish by a colony of cherrystone clams.
- Our system costs roughly 2x (or more) than those of other developed nations, and produces inferior results (for those who fall between what we lightly call “the cracks”). We could throw darts at a map of the EU, adopting the system of the nation hit, with a massive improvement. After a generations of trial and error, designing an efficient (if not perfect) health care system is no long rocket science.
- This may have been our last opportunity for reform before a crisis. Medicare went cash-flow negative in 2004, and the deficit will grow inexorably each year.
With this backdrop, your local Boy Scouts could have devised a winning strategy. Focus on the uninsured. Make the hated insurance and drug companies, far more profitable than their foreign equivalents, pay. Center the program on an expansion of Medicare, deeply beloved by its “clients.” You have good coverage; why shouldn’t this sick little girl have medical care as good as yours?
Despite all these things, Obama’s project has been an almost total failure.
Step one was striking deals with the insurance and pharmaceutical industries, so that “reform” would increase their profits. And guarantee that other powerful special interests (e.g., doctors) would not suffer a loss of income.
Step two was passivity in the face of nutty right-wing propaganda. Esp crazy were the horror stories from England and Canada. As if US healthcare does not generate thousand of equally awful stories. As if sane analysis does not show far superior results from the various proven superior systems.
Step three was defeat. The resulting bill, whatever it is, will be an ineffectual monstrosity. But hundreds or thousands of contributors to Presidential and Congressional campaigns will rejoice in their money well-spent.
Democracy (American-style) in action. Let’s hope that the next system, probably imposed on us, will work better.
Here’s some articles about this situation, which would have been rejected as too bizarre by the writers of Monty Python.
- “Why I Prefer French Health Care — The U.S. system’s deep flaws make socialism more tempting“, Matt Welch, Reason magazine, January 2010.
- “Gimme an Rx! Cheerleaders Pep Up Drug Sales“, New York Times, 28 November 2009
- “Promotional Spending for Prescription Drugs“, Congressional Budget Office, 3 December 2009
(4) Esp this: “White House as helpless victim on healthcare“, Glenn Greenwald, Salon, 16 December 2009:
Of all the posts I wrote this year, the one that produced the most vociferous email backlash — easily — was this one from August, which examined substantial evidence showing that, contrary to Obama’s occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it.
From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House — hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama’s campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN). Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn’t pass it. The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party — rather than the GOP — will continue to be the prime recipient of industry largesse.
As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this — the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional “centrists.” Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start — the one that is a huge boon to the health insurance and pharmaceutical industry.
(5) “The Best We Can Do“, by digby, Hullabaloo, 115 December 2009 — Excerpt:
And Obama can say that you’re getting a lot, but also saying that it “covers everyone,” as if there’s a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don’t get it from their employer. I guess you can call that progressive, but that doesn’t make it so. In fact, mandating that all people pay money to a private interest isn’t even conservative, free market or otherwise. It’s some kind of weird corporatism that’s very hard to square with the common good philosophy that Democrats supposedly espouse.
Nobody’s “getting covered” here. After all, people are already “free” to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won’t make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn’t or didn’t want to write. Indeed, it actually looks like the worst caricature of liberals: taking people’s money against their will, saying it’s for their own good. — and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don’t miss the money as much when they never see it.
And as for the idea that insurance reforms are a huge progressive victory that can only be accomplished once in a generation, well that’s a pretty sad comment on our country — and progressivism.
What this huge electoral mandate and congressional majority have gotten us, then, is basically a deal with the insurance industry to accept 30 million coerced customers in exchange for ending their practice of failing to cover their customers when they get sick — unless they go beyond a “reasonable cap,” of course. (And profits go up!) If that’s the best we can expect of progressivism for the next generation then I’m afraid we are in deep trouble.
For more information from the FM site
To read other articles about these things, see the following:
- About Obama, his administration and policies
- Politics of the FM site: radical leftist reformer or right-wing iconoclast?
Reference pages about other topics appear on the right side menu bar, including About the FM website page.
Other posts about health care on the FM site:
- The perfidy of ABC News (tentative conclusion on a breaking story), 18 June 2009
- Beginning of the end of the Republic’s solvency. Soon come the first steps to a reformed regime – or a new regime., 14 August 2009
- Media madness #2 – their lies and ignorance make us stupid, 4 December 2009
Afterword
Please share your comments by posting below. Per the FM site’s Comment Policy, please make them brief (250 word max), civil and relevant to this post. Or email me at fabmaximus at hotmail dot com (note the spam-protected spelling).
Nobody seems to get it, so here’s the short explanation:
Only 4 profitable industries remain in America after we outsourced all our high-paying blue-collar jobs overeas in the 80s and then outsourced our remaining high-paying white-collar high-skilled jobs overseas in the late 90s and early 2000s to Chinese PhDs eager to work for $5 an hour. Those 4 profitable industries are FIRE + military-industrial complex. Meaning, finance, insurance, real estate and Pentagon procurements.
Finance is flat on its back courtesy of the global financial meltdown, real estate is dead in the water because of the subprime crisis, and that leaves only the military-industrial complex and insurance (the cash cow of which remains health insurance) to prop up America’s GDP. The rest of the U.S. economy is nothing but junk jobs, dog groomers and xerox clerks and Wal*Mart greeters and waitresses and bicycle couriers.
Now the insurance industry discovered that all that outsourcing had wrecked the American middle class, leaving ’em unable to pay thoes huge cash infusions required to keep the health insurance industry profitable. What do do?
Aha! A light bulb goes on over the heads of the insurance industry execs’ heads. They’ll lobby congress and the president to legally force all Americans to buy expensive overpriced private insurance, with no meaningful cost controls, and an insurane exchange where the insurance companies can conveniently dump the problem insured (people dying of cancer, etc.) until the states that fund the exchanges go broke and the government has to chip in and bail ’em out. Hot diggity! The insurance execs are high-fiving each other right now, shouting “Bugatti Veyron, baby! Rolex Presidential! Cayman islands vacations every weekend!”
As Russ Feingold pointed out, this is not incompetence or inexperience on Obama’s part, contrary to your claims. All the evidence shows that this is the bill Obama originally wanted for health care reform.
Obama’s white house is perfectly capable of playing hardball politics when it really wants to enforce party discipline among Democrats. Just look at the way Obama’s white house threatened and bullied the democrats who made noises about not voting for the appropriation to pay for the Afghanistan escalation. Obama could easily have done the same thing to force single-payer into the health care reform bill — he just didn’t want to.
Moreover, Obama campaigned on a promise to escalate the doomed and futile pointless war in Afghanistan. How can you possibly say Obama is “weak” and “got rolled by the generals” when his repeated public statements during the presidential campaign show that Obama promised many times to do exactly what he is doing now — double-down on an insane lost war in Afghanistan.
Health care reform and the Afghanistan quagmire are disasters, but they didn’t come about from weakness or indecisiveness on Obama’s part. They came about because Obama genuinely thinks these insane policies are absolutely wonderful. Like Tom Friedman (whose latest idiotic book Obama is eagerly reading and taking notes on), Obama has drunk the beltway Kool Aid. He no longer has any contact with reality and thinks the U.S. military is just wonderful and no improvement needed, and he thinks America currently has the world’s greatest health care system and only needs a little fine-tuning around the edges. Obama has thought that way for some time, moreover. The logic behind his support of the disastrous TARP bailout is that one of the only 4 profitable major industries in America is going under, and we need to preserve it at all costs. Likewise, the reasoning behind Obama’s support of this godawful mess of a health care “reform” is that another of the only 4 profitable major industries in America, the insurance industry, is going under, so we need to preserve it too at all costs, whatever it takes, no matter how degraded or debased the means required to preserve it. Obama, in short, knows that America is fast becoming a third world banana republic and only the finance and health insurance and real estate and military-industrial comonents of our economy now differentiate us from Guatamala or Honduras.
Claims that these disasters are due to Obama’s “inexperience” or “lack of political skill” just won’t fly. Obama campaigned on an Afghanistan escalation and even before he ran for president, he supported widening the Afghanistan quagmire. Right at the outset of health care reform, Obama repeatedly announced that “single-payer is off the table.”
That’s not inexperience or lack of political skill, Obama is doing what he promised to do, both in Afghanistan and with health care reform.
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FM reply: There are more than “4” profitable industries remaining in America. These are industries not exposed to foreign competition or outsourcing. Amont the major ones are —
* Professions protected by guild-like licensing barriers: health care, law, accounting, etc.
* Government and education.
You are of course right about Obama’s willingness to expand the Afghanistan War (as I have stated many times). Still, he was humiliated and rolled by the generals. His conduct of the health care initiative has made him look weak, and burned much of his political support. Whatever Obama’s goals, and we can only guess about such things, these things are signs of inexperience.
Nobody goes from IL community organizer to President in 12 years unless backed by powerful interests, for whom one renders faithful service. America is what it is because politicos give value for the money they’re paid.
Comment #1: * Professions protected by guild-like licensing barriers: health care, law, accounting, etc.
* Government and education.
I’m sorry, but my definition of a pro-Obama Democrat ( as of today and not necessarily someone who voted for him last fall ) is someone who talked about civil rights while at law school and then went on to become a corporate lawyer. And believe me, that ain’t no compliment.
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FM reply: I don’t understand your comment. The sectors you quote above are those protected from foreign competition, nothing to do with their political allignment. Also, your definition of a “pro-Obama democrat” is absurdly narrow — considering that he’s still supported by tens of millions of voters.
FM: “Our system costs roughly 2x (or more) than those of other developed nations”
And this is a problem because? Are you going to complain that petrol in Europe is twice as expensive as in the USA? Are you going to complain stadium tickets are too expensive?
“and produces inferior results (for those who fall between what we lightly call “the cracks”).”
Evidence? Names, dates, places, specific details of inferior results. FWIW, I always ask for this from friends. They never provide it. Urban Legend perhaps?
“We could throw darts at a map of the EU, adopting the system of the nation hit, with a massive improvement.”
Finland? http://blogs.dailymail.com/donsurber/archives/5536
England? http://www.dailymail.co.uk/health/article-1235921/Midwives-meltdown-A-NHS-worker-reveals-understaffed-maternity-wards-sinking-chaos.html
France? Yep I read the Reason Magazine article. With no supporting data (grin), betcha French Health Care Costs are equal to or greater than USA with worse outcomes. Add those out-of-pocket payments mentioned in the Reason Magazine article to the government tax rate. In other words, ‘hide’ health care costs behind other fungible (sic?) pathways for the money to reach health care.
You missed Japan!!! Care for some Japanese Emergency Room care denial stories? Didn’t think so.
While you are responding please research French Malpractice Law Suits or lack thereof. Interesting it will be.
“After a generations of trial and error, designing an efficient (if not perfect) health care system is no long rocket science.”
Hayek disagrees … http://www.econlib.org/library/Essays/hykKnw1.html
> Esp crazy were the horror stories from England and Canada.
So many ‘crazy stories’ from England & Canada and not one USA ‘horror story’ that stood up to investigation:
(1) Patient too lazy to visit doctor (Oregon)
(2) Patient too cheap to sell house to finance elective operation (San Diego)
(3) Senators/Representatives/President unwilling to forgo their gold-plated triple-diamond platinum icing medical care (DC)
(4) Patient’s parents are cheap but wealthy ‘trust-fund’ artists living in high-end of town (Baltimore)
(5) Patient dumping in Los Angeles by Los Angeles’ publicly funded hospital. LA has a Democrat Mayor.
(6) Patient dumping in Chicago from Univ of Chicago Hospital to City of Chicago Hospital. Mrs Obama sat on the University of Chicago Hospital Board of Directors.
(7) the list goes on
There is a problem alright. Wish those complaining about it would look in the mirror before blaming me and making me pay for their own lack of Personal/Christian/Confucian/Islamic/etc charity.
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FM reply: Perhaps your friends just roll their eyes, as you ask about things that have been extensively studied for decades — and well-known to anyone even slightly familar with health care issues. For a few links see section 4 of Update on our government’s deteriorating solvency (esp to the OECD’s extensive cross-national studies). Or see the studies at the World Health Organization or the Commonwealth Fund. Or the many academic studies. Your grab-bag of annecdotes and blog posts means nothing. Only systematic study can produce meaningful comparisons.
BTW: While we discuss the travails of little Barak Obama, a development with vastly greater implications has occured, Mexican drug lord Arturo Beltran Leyva has been shot.
Enquiring minds would like to know how this may affect archrival Shorty Guzman. ( Was he involved? ) Will the Zetas move in?
Let’s not loose our heads over this one. This involves serious business with serious people who actually can do things that might affect our lives.
“Oh and “thanks” for the RANT from the Grand Moofti. Helped him in some way I hope.”
Anyway. One might surmise that Obama and most of our Representatives really would rather NOT solve any major problem.
Why? They simply never seem to find time to gain consensus on a clear definition of the Problem before they head off into Solution Land.
Greg
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FM reply: I agree, this is a serious problem. These fools run off half-cocked, writing solutions when they don’t understand the problems — let alone the costs/benefits/risks of alternative actions.
@Frisker
What’s about using serious sources, I bet the OECD reports are available in English. If you read/understand German there are plenty good German, Swiss and Austrian sources in the internet, which clearly contradict your statements.
Greetings from Graz!
Are debt slaves allowed to die without permission?
You load sixteen tons, and what do you get?
Another day older and deeper in debt.
Saint Peter, don’t you call me, ’cause I can’t go;
I owe my soul to the company store…
@ Ulenspiegel
Extremely familiar with OECD reports _and_ selection bias inherent in english-only “horror stories from England and Canada”
You did read the “horror story” from Finland?
If more American journalists spoke/read other than English, I know there would be more “horror stories” (true stories? representative stories? reality stories?) from non-English speaking countries. Damn bought & paid editors [censors!!!] are another issue.
Babblefish and its successor seem unknown to my [unemployed] journalist colleagues ;-);-);-)
“So let’s discuss health care reform, in another 100% opinion post (with little supporting evidence).”
Fabius knows that occasionally satire has its uses ;-);-);-)
@Moofti: It’s all YOUR fault! I demand that You pay for my friends sex change surgery! Ge gegegege!
Hah. I love that “throw a dart” comment. You can add Japan, Singapore, Australia, New Zealand (and a few other) to the mix .. and of course CUBA, the one with the most cost efficient health system in the World.
In some stats Cuba actually beats the US and/or is equal or just slightly under it. E.g. male infant mortality is actually worse in the US compered to Cuba. Its average life expectancy is only 0.2 years less than the US (of course I sit smugly here in Oz which is up with the big boys of Japan, Monaco, San Marino and Switzerland).
And this is, pause to load the old s/s (must update it it only goes up to 2002, though the WHO, etc stats always lag a few years), on a spend of $3,166 a year vs the US’s $35,056 then!
Interestingly enough there is some private health (or contributions) there. Its % of health spend that is paid by the Govt is 86.5% .. same as Luxembourg and only slightly higher than the UK!
Fascinating thing health stats, used to work in the area for years and still try to keep in touch, it is the most counter intuitive area around.
E.g. more Japanese smoke than Americans, but outlive them markedly. Or another e.g., more machines that “go ping” (ref Monty Python)have only a tiny effect, getting doctors to wash their hands has a bigger effect than a CT scanner. Even having more drugs avaialable has a downside, the chances of giving the wrong one increases markedly.
The more complex the health care available the greater the number of people killed though misdiagnosment/mistreatment or just plain stuff ups. Here in Oz, which has a pretty good system (though definately not perfect) more people by “an order of magnitude” (look it up) die through misdiagnosment or mistreatment or avoidable infection in hospitals than are killed in car crashes every year.
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FM reply: I know little about it, but the Cuban system provides fascinating evidence that our intensive education for primary physicians is largely wasted. Or we could rely far more on nurse practicioners and such. Eight years of advanced education seems to do little other than inflate health care costs. Oddly enough, we’re moving in the opposite direction — as the guilds that control our health care system are pushing for more nurses to have master’s degrees (after drastically reduced the fraction of non-registered nurses.
Lets see. Should I prefer the Danish system — where it was going to take me over a week to see a doctor so I could get a prescription of a tube of Lamisil since the local pharmacies were unable to ring up a cash sale? Or how about the system in France where I will be on a plane three days before I can get in to be seen for my dislocated shoulder? How about the German system where it took almost eight months to get in to see an Orthpaedic specialist after taking an 80 foot fall of a cliff (and if I could have gotten in and seen the Ortho within the first month, surgery would have fixed my knee but after all that time it would not be able to). How about the system in Hong Kong where a sinus infection I had turned into life threatening pneumonia because I could not get seen for over a week and antibiotics — readily available over the counter in Shenzen — are considered to be “poisions” for purposes of crossing the border back into Hong Kong and therefore are banned?
And statement #3 about our health care system costing 2x what it does in Europe is absolute nonsense and all of the studies back this up. In fact, health care costs about the same in the US and in Socialist Europe on a per procedure basis. Its even worse than that as every time I have sat down and compared pay checks with my EU counterparts we find that within a few percentage points, my taxes + healthcare (including the company portion) is about the same as their tax burden.
The primary difference is that I can actually be seen by a doctor in the US and I can actually get the treatments when I need them.
This misinformation is usually based on “spend” (you can’t spend money on a service that is not available no matter how hard you try — unless of course you go to another country that does not have socialized medicine and spend your money out of pocket, but I guess that drives up the cost in the other country as more money is spent in total for the same size population) and not on “costs” so using this simple trick it appears that the system in the US is more expensive when, if you look at total cost burden, it is about the same BUT an order of magnitude more available in the US.
I guess in a nutshell having lived and experienced the health care systems in the US and in multiple EU countries and in Asia (I’ll explain the health care system in Japan if you want sometime — how it really is vs. how it is portrayed) I prefer the system in the US as it is qualitatively head and shoulders above any other system I have had to deal with.
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FM reply: You asked for studies supporting my assertions; I gave links to reports from 3 major insitutions. Let’s turn that around. Do you have any authorities supporting yours? I don’t mean a blog post talking about someone’s brother in the hospital. Real data and analysis. Otherwise we’ll conclude you are just making stuff up.
Yes, Cedric, it’s all about YOU, and what you can afford. No need to worry about health care for those other folks. Ge ge!
Start with “Comparative Effectiveness in Health Care Reform: Lessons from Abroad“, Helen Evans, Heritage Foundation, and very carefully read the bibliographic references.
One telling point — and yes it only applies to the UK — is that NICE is designed to contain costs by rationing health care. So yes of course “costs” in the UK are lower — but even a cursory examination of the totality of the facts shows that the quality of the care is much, much lower.
Other socialized systems in Europe exist that I have not called out — I lived in Amsterdam for 18 months and the combination public/private system there (very similar to the one in Germany today vs. the fomer fully public system that has left me with a bad knee to this day) worked well enough that I can not complain.
And I fail to see the “three major institutions” in your article — unless you are counting puff piece magazine articles and commentaries on the evils of marketing a product.
I will admit that my analysis is based on — as I stated — comparing paychecks with collegues of mine working in Denmark, the UK, France, Turkey, Dubai, Singapore, Hong Kong, PRC, Japan, Mexico, the Netherlands, Belgium, Germany, Sweeden, Norway, Austria, Switzerland, and Australia.
Of course I am not sure if the pay statements of those who are in the top 5% of wage earners in their respective countries can be taken as a broad enough sample. I do know that when I am done comparing those pay statements and when I exmaine the total cost burden, they are similar enough that I am not tempted (yet) to change citizenship for financial reasons.
And the financial analysis as it applies to me (and I freely admit that) has been performed by my CPA. It might not apply to others.
Now, as to the incidents I have described, they are not those of others found on a blog or apocryphal stories — they are all incidents that have happend (or in the case of the dislocated shoulder are happening) to me in my life. (And this is one reason why the article on prefering the French health care system is making me laugh right now.)
And yes Mikyo it is all about me — I see no reason to pretend otherwise. My needs had better be met by the system otherwise I will take the tax dollars I have been pumping into the US system and spend them elsewhere. I have no problem voting with my feet and I have immigration rights in multiple countries at this point. And that move will eliminate at least one full time federal drone’s income based on what I pay in personal taxes each year as well as the well paying jobs in the US that I provide.
And this is what is happening to New York today as we speak — the average income of people leaving is almost $80K and the average income of the people moving to New York is only $18K. It will soon begin to happen to the US as well if things keep going the way they are going.
So Mikyo please explain to me why I should be forced to endure low quality and potentially life threatening rationed medical care so that somebody who chooses to not be responsible can get a free ride? And I am not talking about somebody’s poor grandmother or the mentally handicapped I am talking abut the large group of people with jobs who do not take employer provided health care (for their personal financial gain) and yet saddle society with the cost of their hospital emergency room visits? Or the millions of illegals in the US? Or the twenty-somethings who feel invincible and therefore don’t need a health plan?
More importantly why should I suffer health care rationing for my children — for all of the same reasons I have listed above — when it might kill them? Yes go to the link I have provided and read the articles (#’s 5 – 9 in the bibliography) about the wonderful effects of the health care system in the UK.
And these are articles by respected institutions (in their journals) such as the Royal Medical Society and the American Medical Association. Not a newspaper that runs bigfoot stories (see http://www.nytimes.com/2008/08/15/us/15bigfoot.html?_r=1) or a magazine with UFO stories (see http://reason.com/archives/2006/12/08/saucer-scandal/print).
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FM reply: I don’t see anything in the Heritage article or the citations to support your grandiose statements. It looks like you’re just making stuff up. Please stop, this is not that kind of website.
Also, you missed the point repeatedly made here and elsewhere — the UK system is among the worst in the developed world. Nor is anybody in Congress proposing to convert the US to anything like the UK NHS. The focus on the UK a strawman for morons, just propaganda. The useful comparisons are to the mixed public-private systems used in most EU nations.
Don’t give a damn about anyone but your precious self. That’s fine. Take your tax dollars and run. Vaya con dios. Let us know how it comes out. :P
I’ve been thinking about Keith Olbermann and Howard Dean’s statement that we should simply kill the bill as it is currently constituted, just scrap the entire thing and start again from scratch (“Olbermann: ‘Not health, not care, not reform’“, The Raw Story, article by Diana Sweet, Dec. 17, 2009). It has been pointed out many times that proponents of healthcare reform have an important strategic disadvantage, which may be so obvious that it is hard to see. To wit, proponents of healthcare reform care about the nation’s healthcare. They care about the enormous cracks in the system, the misspent aggregate dollars, and the lousy aggregate outcomes. The opponents of healthcare reform, on the other hand, don’t care about these things. Either they are like Cedric in #13, with some reason to believe it will impact themselves negatively, or they are like the tea-baggers who see commies under every rock and behind every tree, or they are like Joe Lieberman, who’s just an asshole.
It seems to me that if side A cares about outcomes, and side B does not, that’s advantage for side B. And I wonder if this advantage could be nullified or at least diminished if side A showed a willingness to say, “OK, screw you and your hopey changey mess. This bill sucks. Trash it and start again. We’ve got three years left. This is important.”
Atheist — I KNOW this will impact me negatively. It is not a belief. I have seen the independent studies. I have lived/experienced the healthcare system in countries that the statists in their guise as populist liberals want to follow and I can tell you that it is a nightmare for anybody under it. I know that my tax burden — both personally and for my business — will increase. I know that my cost of providing health care benefits for my employees will go up under most of the proposals being talked about.
And then as a businessman I will sit down and run the numbers and odds are I will be relocating more and more of my operations overseas. All of the feel-good vibes in the world won’t feed my children or provide another dime of benefit for my employees.
When the outcome for the vast majority of Americans is going to be negative — from a reduction in the quality of the care they have today to an increased tax burden — it does not make rational sense to move forward.
But I guess feelings and intentions are more important to people like Mikyo and you than real measurable outcomes.
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FM reply: Let’s replay what you said in comment #11.
“Evidence? Names, dates, places, specific details of inferior results. FWIW, I always ask for this from friends. They never provide it. Urban Legend perhaps?”
Asking for evidence is SOP on this site. I’ve asked for evidence from you, and you provided a Heritage Foundation article that, while interesting, does not address your extreme assertions.
You comments remind me of dorm room bull sessions, with folks just making stuff up — with conviction. That was a long time ago, since which my dislike has grown for this behavior. Please stop, or go elsewhere. Your imagination is vivid, but this is not the place to display it. Or — best of all, cite some expert support for your views. One or the other is mandatory here.
And yes part of the “moving operations” means that some of my employees in the US will be out of a job.
“In some stats Cuba actually beats the US and/or is equal or just slightly under it. E.g. male infant mortality is actually worse in the US compered to Cuba.”
Did you ever wonder if there’s a more plausible reason for this, other than the utopia of Cuba just simply being better than us? I’ll give you a hint; find out what criteria Cuba has for officially counting an infant death, and compare that to the US criteria.
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FM reply: You raise two important points.
International comparisons of health outcomes is not easy, as nations use different reporting systems. Analysts must adjust for these things, with varying degrees of success. I believe the adjusted numbers for Cuba are better than the US (from memory).
But this results from more than just different health care regimes. The pathology of our inner cities lowers the average numbers of the US in many quality of life metrics.
And yet, you still expect to be allowed to do business in this nation. Why is that?
Mikyo, your question shows an absolute lack of understanding of how the real world operates. Either that or you are nothing more than a troll but on the off chance you are not …
Nobody grants permission to a business to operate. You merely sign up to pay taxes via local and federal level registrations.
Those countries where this medieval mentality still persists (it used to be called “grants” as in the king would “grant” you the right to fish, farm, own a tavern, etc.) are the most economically backward and corrupt in the world. Such models of economic efficiency and Bolivia and the Palestinian controlled areas.
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FM reply: No personal attacks are allowed here. Repetition will result in future comments being moderated.
“Nobody grants permission to a business to operate.”
Businesses operate in the US under an implied contract, in which they operate so long as they comply with a wide range of requirements — far beyond “signing up to pay taxes.” They vary by State, but include occupational safety, envirnomental, operational and financial reporting, providing various forms of insurance (e.g., unemployment, health), etc. Many businesses require specific licenses for their activities in order to open the doors. Collectively these provide the government’s “permission to a business to operate.”
FM: “2. The operation of our system would be considered irrational and foolish by a colony of cherrystone clams.”
You’re making me laugh today
disclosure: I’m an independent, non-partisan american citizen. I believe trans-partisan, integral politics are the future. The Constitution must be upheld, so I guess that makes me more “republican” than any other conventional category. I support Ron Paul.
Ok, so, a story about health care in Europe:
My wife’s father recently (Dec. 2009) died in Spain, under the public health system. He was a native and citizen of Spain. He had generally excellent to good health for 79-1/2 years. He grew up and worked in a small family owned manufacturing business (100 employees) until 70 years old, then managed family real estate assets (industrial properties that were converted/developed for other business purposes). Like many of his people, he had good eating habits, didn’t smoke, drank in moderation until about 70 years old, was active and extroverted, enjoyed his work and life (especially after democracy was restored in the 1970s), and was as devout as most of his generation (childhood survivors of the Spanish Civil War). He spoke four languages, but was not an intellectual, or over-educated. He was a lucky man that worked with his hands and made good money from his family business. He traveled occasionally in other countries in Europe, enjoyed mountain climbing and skiing, and like most businessmen, had small, modest, but comfortable, beach and mountain residences for long summer vacations.
Last summer, he began having cognitive problems, which the doctors said, apparently mostly based on anecdotes and guesses, were probably strokes. No tests were done. No expensive head/neck scans. Apparently the low-cost idea in public health systems is that once someone is old and gets sick, they are simply expected to die quietly unless some easy, cheap therapy is available that doesn’t require extensive hospital care.
After a couple of months, the symptoms were not tracking the diagnosis well, so the doctors finally started doing tests. Oops, come to find out, it was actually cancer, not strokes. Brain tumors, and liver cancer. He got as much pain medicine as he needed from the doctors, and was cared for at home, with no horrible tubes stuck in him to keep him alive in a extensive hospital for a few extra weeks/months. He died, at home, surrounded by loved ones. The sudden decline and passing was a shock, but in some sense it seems like a much more humane and dignified passing away than I’ve seen in the USA (for my older relatives) over the last 20 years.
I do not know if an earlier, better cancer diagnosis, or any possible earlier therapy, would have helped, or if more expensive, high-tech hospitalization would have been “better”.
Bye.
FabMax, it seems a bit smug of you to write off Obama so soon. You can only get so much thru an undemocratic Senate, particularly when all but the most rabid progressive Dems are hesitant to go nuclear with reconciliation. Apart from “moment in the sun” obstructionists like Lieberman, the Republicans have been all too successful at mobilizing not only their loony bin base, but also the baser instincts of ostensibly mainstream Americans through their unspoken slogan, “We can’t call him a ni**er but we CAN call him a socialist!” So we have the most tepid health care “reform” but we’re only at the quarter-mile point in this race, so who’s up for some “audacity of hope?”
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FM reply: Is everybody who criticizes a politico smug (Irritatingly pleased with oneself; self-satisfied)? Also, you ignored all the reasons I gave supporting my conclusions.
Prior to the last year or so, I used to state that the difference between Democrats or Republicans was that Democrats were people who distrusted business because they didn’t know howto meet a payroll while Republicans were people who distrusted government because they don’t know howto govern.
I have learned, however, that I have been wrong in two respects:
Republicans also do not know howto run a business; and
Democrats also cannot govern.
The present medical system is unsustainable; and within the intermediate future not only will Global Guerrillas tear the insurance industry apart, but they will be greeted as heros.
re: “The present medical system is unsustainable; …”
Agreed. This has been developing for at least 25 years. Dr. Andrew Weil (the natural Dr. at Univ. Arizona) stated the same on Larry King months ago. The President of Dartmouth said the same on PBS (Charlie Rose), and has a plan to change the system. Is anyone listening? Why is everything about money, not about care, compassion, altruism, community? Can’t we have a health care system that is based on healthy foods, inexpensive preventative care, natural/integrative medicine when that works? Are the greedy health corporatists and plutocrats that grow rich on other people’s sicknesses going to give up their filthy lucre without a fight?
re: “and within the intermediate future not only will Global Guerrillas tear the insurance industry apart, but they will be greeted as heros.”
Ok. Sorry, I’m a newbie here: if possible, please provide a definition of, or reference to, Global Guerrillas. Are they hiring? If so, what is the pay? :) If I retire early from the state of california, can I count on CalPERS retirement benefits, or are the Global Guerrillas going to tear CalPERS apart too? hehehe. Warmest regards.
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FM reply: I suggest ignoring speculation about global guerrillas and worry about CalPers underfunding.
* “Risky, Ill-Timed Land Deals Hit Calpers“, Wall Street Journal, 17 December 2008 — (subscription only)
* “Calpers Stays Bullish on Private Equity“, New York Times, 24 July 2009
* “CalPERS actuary: pension costs unsustainable“, CalPERS, 10 August 2009
There are many problems with the UK health service . Here are some of them :
1.The compensation culture , meaning docs have to constantly cover their backs .
2. Trial by media . Because of confidentiality , docs cannot answer back . 2.MBA managers and business consultants ,rather than doctors/nurses , as managers .
3.Nurses sitting in college rather than training OTJ .
4. Outsourced cheap cleaning .
5. Experienced docs limited to one speciality .
6. Nu Labour Targets .
(I should have made this number 1 ). This has turned an idealistic , honest service into a load of cheating mercenaries .
7. Allowing National docs to do private work .
8. Not enough unit nurses , so employing bank nurses .
9. Cannot sack rubbish staff any more .
10.Complex machines requiring out of stock spare parts from Taiwan , replacing clinical insight.
11. Lack of nursing homes , responsible families or nut-houses to discharge bed-blockers to .
12.Voluntary euthanasia not on offer .
13. Vast centralised new-buildings financed on a buy now , pay later basis by equity firms .
14. ‘ Reform ‘ every week .
None of this has anything to do with funding .
Although insurance , based on my experience with pet insurance , would just add more *^!!#$ to the system .( Workers and mployers pay here , providing health care for all citizens .
Thanks to the recession , there are fewer workers and employers .
Thanks to the wars , we now have a load of extra Afghs and Iraqis , and thanks to the EU we now provide healthcare to half Eastern Europe .
Hi fubar.
Global Guerrillas are the topic of John Robb’s blog.
Anyhow, the insurance business rests upon the assumption that, one average, things will work out a certain way and bets accordingly. When you purchase insurance, you are betting that your circumstances will not be average. The insurance industry profits because most people loose this bet. Global Guerrillas, among other things, assume that distributions instead fall into a “long tail,” which means that the insurance industry will loose many more of these bets.
FM will doubtlessly hold forth in his comments one way or the other about all this, but really you have to hang out at that blog for a while. I’m sorry, but Global Guerrillas probably aren’t good for Calpers; and California – being near the Mexican drug situation – is poorly situated.
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FM reply: The casino, insurance and investment industries make lots and lots of money from people assuming that the pros incorrectly calculate the odds.
BTW: various commentators at Firedoglake.com seem to be making an argument similar to one I have been making lately, that the left and right need to start talking to one another directly, cutting out the Inside the Beltway middleman. Eg:
What’s the Matter with Democrats
and The Left-Right Populist Wrap-Around Vs. the Beltway Insiders
Very nice articles. Yes we need a centrist alliance. I usually drink coffee, but tea is also nice, ha ha. The beltway seems to prefer booze and opium. Uh oh!
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FM reply: Ah, the great dream of an alliance of all right-thinking folks. Who will sweep away the evil extreemists. Like most dreams it leads to a dead-end, with little basis in either history or political theory. IMO political change comes not from discovery of truth, but realignment of political views. Rather than looking to extraordinary periods — like the struggle against slavery and the NAZIs — perhaps we should look to other political cycles. Like the rise and fall of the American Whig Party. Or the powerful 19th century reallignment during the Disraeli–Gladstone era.
From #28: “As Jane alludes to, we may have actually reached a point where have more in common with the teabaggers than we do with our own party (on policy, anyway).”
To me that looks like liberal naivete. It seems to come from the hopeful belief that other folks are just like you, “underneath the rhetoric”. This is combined with a refusal to understand that some political stuggles really are zero-sum. Jane Hamsher may hate the Democrats and Joe Tea-Bagger may hate the Democrats, but their reasons for hating them are vastly different.
It is possible that there is some benefit from talking with the more rational tea-baggers. I’ve got serious doubts about using it as a wider strategy, though. Here is some recent video of Glenn Beck, who is enormously popular among tea-baggers *, describing the shadowy, sinister forces of Marxism (like SEIU‘s Andy Stern, George Soros, and Obama) that are tearing the country down: (“Beck: Black Obama fans were ‘taught to be slaves,’ while progressives like Stern are ‘taking you to a place to be slaughtered’“, Orcinus blog, Nov. 5, 2009, by Dave Neiwert). Please watch the clip. It’s 11 mins long, but it’s entertaining, & quite illuminating about Beck’s, and the Tea-Bagger’s, paranoiac point of view.
Quote:
Bottom Line: Don’t try to make an alliance with folks who believe that you are a sinister, shadowy marxist cabal.
* Evidence of popularity of Glenn Beck with “Tea-Party” movement:
1. (“‘Tea party’ movement takes protest to Washington“, USA Today, Andrea Stone, Sept. 8, 2009)
Quote: Encouraged by conservative commentators such as Fox’s Glenn Beck and organized virtually on Twitter, Facebook and other social networking sites, the march will constitute “the largest gathering of fiscal conservatives ever,” says Adam Brandon of FreedomWorks.
2. (“GOP Sees Protest As an Opportunity“, Washington Post, Dave Eggen & Perry Bacon, Jr., Sept. 12, 2009)
Quote: At the event on Thursday, activists shouted “Liar!” … Protesters also shouted “No more czars!” — a reference to a line of conservative attack on administration appointments that has emerged from Beck’s show.
Indeed, many activists say in interviews that they look more to conservative commentators for leadership than they do elected politicians. Ryan Rhodes, a leader of the “tea party” movement in Iowa, noted that Beck and radio host Rush Limbaugh had come to the cause years ago. Rhodes said he had little enthusiasm for George W. Bush or for McCain, the 2008 GOP presidential candidate.
Interesting. Beck and Limbaugh have always seemed clownish. Until recently, i never would have accepted them as spokesmen for anything more than a circus tent. However, i don’t know very much about the tea partiers.
Mikyo in 31: “Until recently, i never would have accepted them as spokesmen for anything more than a circus tent.”
It’s impossible to tell if Beck, Limbaugh, et. al. really believe their own crazy statments, that the USA is being infiltrated and undermined by “fascist” groups of marxists, Islamists, “femi-nazis”, greens, & “secular humanists” who are all connected in a web of infamy (“Glenn Beck scrawls wild conspiracy theories on a chalk board“, Media Matters, Aug. 25, 2009). A less disturbing explanation, for folks like me anyhow, is to view everything they say as a clever, calculated, cynical ploy designed to gain themselves fame, followers and money, and give partisan support to their own brand of politics. Then there’s another theory, that they have huge egos &/or personality disorders, and that they act on these inner syndromes without calculation.
Honestly though, I think it is all three. I think they have a screw loose, and I think they are clever, but I think they really do believe that the USA is like a fortress that’s being attacked by Muslim armies, its walls undermined by sappers who call themselves feminists or greens, its rightful leadership compromised by Grima Wormtongue-like marxist spies. And so I find it really worrying that folks like Beck have so much real influence over politics.
Sorry if that answer is about 3x too long, Mikyo.
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FM reply: While I agree with much of this, it is looking at the nation with one eye closed. Beck and Limbaugh quote weird things said by people on the Left, writing statements much like yours. IMO this kind of analysis is useless.
atheist: Two points:
1) Fox News, Limbaugh, etc., are amongst the middlemen that need to be eliminated.
2) Working with teabaggers does not mean forming an alliance, forging a consensus, or anything of that sort. It means a willingness to consider what they may have to say and – on an ad hoc basis – work together when we might from time to time actually agree on various matters. You and I do not agree right now; that does not mean that I therefore write you off entirely forever.
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FM reply: I am sure you mean it in a benign sense, but in a political discussion to call for someone’s “elimination” evokes unpleasant echos. Statements like this are an inevitable and bad result of President Obama’s jeremiad against Fox News (see here for details).
Also, they are not “middlemen” — but rather voices with legitimate views. With large numbers of followers, who will rightly get angry at statements like yours. Did God annoint you with the task of deciding whose words get heard, and whose get silenced? this is a common trope on the left, which gives much of it a religous (even puritanical) flavor. Brad Delong (Berkely economic Professor) seldom goes a two days without decreeing that some newspaper or magazine should get closed for the sin of heterdox thought. I wonder if he sees himself as a modern Samuel or Elijah.
[youtube=http://www.youtube.com/watch?v=Zw5pmDgWMaU&hl=en_US&fs=1&]
One lump, or two?
FM: “Did God anoint you with the task of deciding whose words get heard, and whose get silenced?”
Talk about extreme language FM, consider your own. Yet I somehow manage to have survived the ordeal of having read it.
It is ludicrous to assert that I have anything like the power to determine “who gets heard,” although like anyone I have the power to decide who I will hear. No one is asking you to sign onto this or any other proposition.
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FM reply: It was a good line, but I agree it was over the top.
“ludicrous to assert that I have anything like the power to determine ‘who gets heard'”
Help me with this, please. You can advocate something without assuming any responsibility for the it? I disagree. You advocatd something that is increasingly widely advocated (in some form) on the left. Including by the President. So while you personally don’t have that power, IMO it is valid to take your statement seriously.
FM “You advocatd something that is increasingly widely advocated (in some form) on the left. Including by the President. So while you personally don’t have that power, IMO it is valid to take your statement seriously.”
To the best of my knowledge, my advocacy of direct ah hoc arrangements that transcend current political categorizations is not widely advocated nor has Obama advanced it. Such direct links would render obsolete mass communications such as Fox or Limbaugh as well as other networks and parts of the general mass scene.
Hopefully this will lay your straw men to rest.
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FM reply: Apologies; I thought my reference to your comment #33 was clear, so I did not explicitly repeat it. To explain…
“my advocacy of direct ah hoc arrangements that transcend current political categorizations is not widely advocated”
Absolutely. That is your point #2. I was referring to comment #1: “Fox News, Limbaugh, etc., are amongst the middlemen that need to be eliminated.”
@Frisker
Even with the most positive approach, i.e. using GDP/purchase power, the most expensive European system (Switzerland) is still 20% less expensive than the US system, but delivers almost 100% coverage and in most fields better quality than the US system.
Another related aspect of the dicussion is your legal system that produces – according to collegues who work in USA and Europe as dentists/ practitioner – much higher costs “There is one lawyer hidden behind each doc”
Take a personal example:
My wife falls over and over the next couple of days shows mild concussion symptoms. Goes to the GP, who basically does nothing, goes back (and with my proddiing) she then goes for a CT scan.
Radiologist comes out to her after the test (she knew she was in trouble then) and tells her she has a massive aneurysm that was close to bursting and has to see a neurologst “today”.
Got the best treatment possible (the man who invented the procedure used did it) and just a few out of pocket expenses (mainly because we have private cover as well [Australia is a mixed public/private system like many], bizarily that means you can pay more out of pocket than if you were a public patient).
If she had been a purely public patient it would have cost nothing.
Now she was warned that the time and date of her procedure could be changed if an emergency patient came in (someone who’s aneurysm has burst and is basically dying).
And that’s the way it should be, there is rationing but it is in terms of need, not money. And our private health cover meant nothing if someone’s life was at immediate risk. And her treatment would have been the same if she had been pauper.
Latest WHO health stats, 2006/07 results, hope the formating holds for the tables.
Life expectancy at birth Healthy life expectancy (HALE)
Male Female Both Male Female Both Sexes
Australia 79 84 82 72 75 74
Canada 78 83 81 71 75 73
Cuba 76 81 78 68 71 69
United Kingdom 77 82 80 71 73 72
USA 76 81 78 68 72 70
Neonatal mortality rate(per 1000 live births (2004)
MDG4 Infant mortality rate (prob of dying between birth and 1 year of age (2007)
Male Female Both
2004 2007 2007 2007
Australia 3 5 4 5
Canada 3 5 5 5
Cuba 4 5 4 5
United Kingdom 3 5 4 5
USA 4 7 6 6
Cost?
% GDP spent on health $US per Capita spent on Health
Australia* 8.7 $1,734
Canada 10 $2,080
Cuba 7.7 $183
United Kingdom 8.2 $1,782
United States of America 15.3 $4,570
* Aged care is taken out of Oz’s numbers as only a part of it relates to health, best estimates make it an additional 0.2% of GDP.
As the saying goes, a lovely set of numbers for some but the waste in the US system is amazing. Note how the much maligned UK system is actually pretty good. Plus we all, except for those good Presbeterian Canadians and the poor Cubans who obviously can’t afford to drink a lot of alcohol, drink and smoke (especially the Cubans) more than you.
No its not age, the median ages are very similar from 36 to 39 .. with the US being the youngest (because you have the highest birthrate).
That’s not a health system you guys have .. its a joke, sadly a fatal one for many Americans. And to brutally frank, if you can’t fix something as simple as health what chance your economy … or keeping and/or expanding your empire (cheeze, you can’t do a trick, look where all the Iraqi oil contracts have gone to).
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FM reply: All sad but true. And your last paragraph is perhaps the most important lesson learned from the health care reform debacle. This was the easy one among our serious problems; not a good omen for the future.
My puppy gets great health care. I pay for it out of pocket. I think the problem is that people are pussies who get hurt easily and need a cure or despair! they die.
Well that is what happens when you get brain cancer. Yeah it would be nice for a doc to fix you right up but hey, what are you going to do? ersonally, I wish no gummerment was allowed in the health care biz at all. However, fuck it, let just go full social health care. I bet it would be cheaper than Obama’s Frankenstein.
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FM reply: Here speaks nobody who has had a premature birth. Shall we let the mother and child die, Mr. Jon. Or will you be a pussie and pay the $300,000 cost? Choose swiftly…