Wednesday, May 20, 2009

Post No. 119a: Reposting of Post No. 69: A Country Has to Know Its Limitations


© 2008, the Institute for Applied Common Sense

On November 30, 2008, shortly after Sen. Obama’s election, we asked our readers whether any governmental entity should have the responsibility to provide healthcare for its citizens.

We invited our readers to provide their views on the subject, prior to our putting forth an argument as to why no government entity should have that responsibility, except perhaps in the case of veterans, or those injured during the course of service for the nation. (Since that time, we have also considered the inclusion of children below a certain age, since they have very little role in making decisions about their health until they are much closer to adulthood.)

It led to a very lively and stimulating exchange. Even a cursory examination of the comments in connection with Post No. 68d (http://theviewfromoutsidemytinywindow.blogspot.com/2008/11/post-no-68d-argument-why-no-government.html) reveals the diversity and passion of opinion regarding this subject.

Is it really the government's responsibility to ensure the good health of, and the provision of health care facilities and treatment to, its citizens? Why do so many citizens feel that it is something which the government, at some level, should provide?

Is there a reasonable expectation on the part of the taxpayers that health care is a "service" due them by virtue of their current level of tax contribution?

What responsibility should be placed on the citizens themselves to make the "best efforts" to maintain their health, and utilize the very latest in scientific knowledge about health risks, particularly nutrition, and the detrimental consequences associated with certain behaviors? Should citizens be required to show that they engaged, or failed to engage, in certain behaviors, prior to being extended heath care benefits by the government?


We indicated that we would generate some thoughts after entertaining those of others. Here are five arguments which can be advanced to support the notion that we should not have a national healthcare system, or perhaps that America is not ready to have such a system.

1. All relationships are about expectations. An argument can be made that the American public has an unreasonable expectation about what it takes to manage and operate a large organization and its accompanying bureaucracy. Most interestingly, those who have never run a large organization seem to think that they have all the answers. The criticism of the various executives, associated with the Big Three American Automakers, suggests to us that we as a nation do not fully comprehend the complexities and difficulties associated with management of a large organization in an everchanging, global environment. We are apparently “qualified” to criticize others who do not achieve the results that we expect.

2. In contemplating a national healthcare system, it appears that most proponents suggest that it provide benefits to all of our nation’s citizens, namely 300 million people. We do not have the capability to manage anything involving 300 million people. We don’t do it with respect to the other “essentials” of civilized life, food, housing, clothing, or education, which are arguably more simplistic in nature, and which at least have components around which we can wrap our arms. What makes us think that we can do it with respect to arguably the most complex of issues, namely human health? To borrow a phrase from Dirty Harry, “A country has to know its limitations.”

3. We do not have anyone, or any board or committee for that matter, with the capabilities, sophistication, and experience to manage a 300 million recipient organization. Furthermore, as noted earlier, as an organization grows in size, its sense of “reality” changes to ensure the advancement of its interests and its continued survival. We’re setting ourselves up for failure and unnecessary criticism.

4. Any system delivering services to 300 million people will undoubtedly parcel out its services in unfair and inequitable ways during the course of the execution of its policies. It’s not like an engine with simple, mechanical, moving parts. Humans do not function in accordance with the rules of physics. They’re emotional, and they have minds of their own. No one has yet discovered how to manage emotion. At least in the military, they understand what needs to be done to craft humans into fungible, interchangeable units, for management purposes, and even they have difficulties.

5. What makes us think that we can devise a system to provide benefits or services to recipients who essentially do whatever they want or desire to do, from a health perspective, and then have an expectation that the system should address the negative ramifications flowing therefrom? It doesn’t make sense. What makes us believe that we can “herd cats,” each with their own goals, motivations, and selfish interests, and deliver some nebulous, unspecified level of service resulting in what we refer to as “good health?”

As a general proposition, Americans are not “sufficiently motivated” to maintain a state of good health. We don’t want it badly enough. The only proven way to get humans to adhere to a policy or approach is to force/ prod them, or have them buy into it voluntarily.

Although some ambitious and very thoughtful suggestions were put forth in your comments, no one, who responded to our challenge about reforming the health care system, really explained how they planned to address the uncertainties and complexities associated with the human side of the equation, and each individual’s responsibility to the system.

As a practical matter, it can’t be done in America, at least not under our current political philosophy. Any attempt in that regard will be regarded as socialist, or even worse, communist, in nature. As we all saw during the most recent election, we can’t have that.


This is a country built on social Darwinism or survival of the fittest. If you happen to be one of the fittest and you survive, kudos to you. If you are one of the not so fit, we leave it you to fend on your own, perhaps with the gratuitous assistance of non-profits, the religious community, and the kindness of others. Many in our country feel that if we assist the not so fit, or guarantee certain things to the masses, we play into their weaknesses and thus become enabling agents.

This is neither a culture nor governance model which has as its goal the equal treatment of its citizens or the equality of the services or opportunities available to them. It is a culture that simply guarantees that each individual citizen has a chance to pursue whatever they might so desire. That has nothing to do with results.

We don’t guarantee results in America.

Simply put, a national healthcare system does not fit within our governance model, nor does it fit within our cultural philosophy. This is not to suggest that it should not, just that it does not. It’s just that it would require a significant paradigm shift in our way of thinking about our role as citizens.

Don’t you think?

© 2008, the Institute for Applied Common Sense

59 comments:

  1. I think that America can do what every other economically advanced nation in the world is already doing.

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  2. Look, the bottom line is that while our health care technology is world-class, our health care delivery system--for all but the most well-to-do--sucks.
    Our health care system is based on the theory that investors should be able reap huge profits from the miseries of their fellow citizens. To my mind, this is despicable.
    America, with its superior technology, should lead the world in infant mortality rates, for instance. America does not.
    America should provide the poor with a better place to go for health care than emergency rooms. America does not.
    I could go on. I will not.

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  3. Just the other day, I saw this:

    "Forty-two percent (42%) of Americans say everyone in the United States should havefree health care.

    The latest Rasmussen Reports national telephone survey finds that 44% disagree.

    However, by a two-to-one margin (60% to 27%), Americans reject free health care for all if it means changing their own coverage and joining a program asministered by the government."

    See...
    www.rasmussenreports.com/public_content/business/health/

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  4. Interesting post. I think that we should provide a minumum level of healthcare to all. Not so much because it is the governments duty, but more so that we all share the burden of cost(our medical professionals and hospitals are suffering atm). I agree with Dougs statistics that most of us dont want to change their healthcare situation... so why not just have a welfare of sorts for healthcare and allow everyone access to low cost, adequate healthcare insurance through the government? Like a big group plan...

    On the flip side, 'where there is a will there is a way'. I know there are plenty of uninsured people out there, but hospitals cant turn people down, many have free mamogram and other screening services, and most doctors will work with you on costs. My brothers gf has late stage breast cancer and no insurance. Her docs forgave almost all of the bills, the hospital costs were covered by a grant of sorts and she is able to pay a monthly fee (perhaps for the next 30 years, but its reasonable) for the remainder. Its not great, but its working. It wasnt lack of insurance, by the way, that kept her from doing anything about the lump she found in her breast a year ago, it was lack of motivation... denial really. Its a very sad story and I am not sure what the outcome will be.

    happy wednesday!

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  5. I have written so much about the American Health care system that I cringe anymore every time I see the topic mentioned. But, I have to weigh in regardless.

    Government involvement with the institution of Medicare in 1965 was, I believe, the largest contributor of the "broke" system that we now have. By "broke" I believe we are all talking about unaffordable. Since Medicare became a government entitlement medical cost has grown by double digits yearly! Therein lies your culprit: costs. And, there is no way to put the genie back in the bottle now and reduce these costs. To try to publicly finance medical care for the entire population at today's costs (in the United States) is simply impossible.

    When the government gets into anything the costs escalate irrationally. We see this in education since the subsidized student loans (government pays the interest on the loans until 6 months after the students graduate)college cost have sky rocketed. My own alma mater is a good example. My entire four years at a small college tuition, books, room and board was $3,600. Ten years later and after student loans came into vogue the same things cost $8,000 a year!

    We see this in government subsidized housing with the government paying rent for dumps that could not exist on the open market because no one would pay to rent such places.

    When the free market and competition for customers, which means customer willingness to pay out their own hard earned cash for the product is removed from the equation you get abuse--serious abuse from both the provider and the user.

    Back to medicine: both Medicare and Medicaid are over used and abused because the patient has no monetary stake in the care given. Even a sufficiently large co-pay would eliminate the over-use and abuse of the system and cause people to decide for themselves just how badly they need to see a doctor. It would also cause people to consider how badly they need that piece of cake to some extent. So there we come back to costs!

    The most efficient and cost effective medical system is the one in which the patient has a monetary stake. Anything else will be abused by both the patient and the providers as we have already seen with Medicare. Perhaps this latest mandated health care insurance coverage by all citizens can be made to work. People will be made to purchase their own insurance so they will, naturally look for the best coverage for the money they have, or want, to spend. This should lead to competition among the carriers.

    The amount of competition of course will depend on the degree to which the government stays out of the business of subsidizing the costs. The current Senate plan is considering susidizing the costs of insurance on a sliding scale beginning at incomes 4 times the poverty rate for a family of 4. That would mean a family income of $88,000 a year would get some amount of subsidized insurance. That to my mind is pure and simple stupidity! Any family of four with a yearly income of $88,000 can surely afford health insurance even at the current rate of approximately $12,000 a year! It will only benefit the insurance companies if the government sets the subsidization rate too high because that will give the incentive to just raise the rates and forgo competition. (It is also at this level of income that people are more educated and better able and willing to force competition by shopping for the best value. Less educated individuals tend to accept the costs without question.)

    I would set the top tier for subsidiized insurance at 1 1/2 times the poverty levely for a family of 4 and then make the sliding scale more lenient.

    I have blogged on this Senate bill and will be keeping a close watch on what happens with this issue in the future. BB

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  6. Rev 1:3 Blessed is he that reads, and they that hear the words of this prophecy, and keep those things which are written therein: for the time is at hand.

    Please, visit to:
    http://thewordofgodistheswordofthespirit.blogspot.com/

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  7. Why should the government bail someone out for poor health decisions? Where is the personal responsibility?

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  8. Some might say we have the responsibility to take care of those who cannot take care of themselves. I don't know if that's a responsibility so much as a human kindness. But, as you say, what about personal responsibility on the part of those who do not make the right choices about their health? Let's add genetics and upbringing into the equation. Some people (maybe many of the obese) can point to their genetic makeup as a root cause. Would these people qualify as those who cannot help themselves?

    But how do we determine who deserves the help and who doesn't? How do we pay for the bureaucracy needed to make those determinations and to ensure, though oversight boards, that these are done equitably?

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  9. I couldn't disagree with you more. In response to each of your 5 points:

    1. Government already manages large organizations where the American public has high expectations (Military, NASA, etc.). Why would expectations of success make you want to avoid trying?

    2. Know your limitations? It's too hard, so let's not try? The great thing about people is when we put our minds to it we can accomplish anything. The same argument you make here was made against trying to go to the moon.

    3. We don't have an administrative board to do this? Easy fix: make one. This will also mean we've created some jobs.

    4. Nothing is perfect. Even engines are not all made perfectly. That shouldn't stop us from trying. When it comes to healthcare, it is inherently unfair. While we all hope to live healthy lives free from any disease, it's possible that something happens. We pool our money so we can work through the bad times if something horrible happens to one of us. Those of us lucky enough to remain healthy shouldered more "unfair" burden, and that is the way it is.

    5. I believe most people don't desire to go to a hospital. Most people want to be healthy, and I believe we can provide for them. There are people out there that may try to abuse the system. This occurs in our current privitized system as well. I'm sure we'll have policies and procedures to mitigate the problem areas.

    Also, the healthcare plan being proposed will most likely be implemented in baby steps and will not be as dramatic as you seem to think. Obama has said many times that this will really just be a supplemental plan and that those with health plans can keep theirs. This isn't mandatory health care. This will likely be an additional optional public healthcare plan.

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  10. Anonymous and rodak, you might consider that the military and NASA screw up from time to time and people die... horribly. What recourse might you have if your loved one has the wrong foot amputated? Sue the government? Who actually pays for the mistakes? Not the responsible parties.

    People game the system. They game welfare, they game unemployment, they game Medicare and Medicaid, they game just about every government program available.

    I have to agree with Brenda, the cost of medical care rose exponentially with the advent and growth of Medicare. A national health care system will not reduce costs but merely move the even faster increasing costs onto the already overburdened taxpayer.

    I don't know if any of you have family members on Medicare (or Medicaid) but, if you do, examine the billing closely sometime. You may change your mind about a national health care system.

    My desire is to see a national catastrophic health care system. That is, a sharing of the cost of catastrophic care. Not the day to day stuff but the truly savings depleting, budget destroying, bankruptcy causing illnesses. That makes sense to me. But the the normal mundane health care? Nope, leave that up to the individual.

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  11. My desire is to see a national catastrophic health care system.That argument has merit for those who already have some kind of affordable coverage.
    But what would you do about the working poor?
    And, btw, the insinuation by some on this thread that everybody gets to choose whatever doctor they want as things are now just doesn't jibe with the facts. I, forinstance, don't get full coverage for my family's dentist; he isn't on the insurance carrier's "list." I can go to him, but I have to pay extra out-of-pocket to do so. Why? Because he is more highly skilled, and able to perform more and better services (which, of course, cost more) than is the "average" dentist in my health care service area.
    With national health insurance we would be trading a corporate insurance bureaucrat who decides what doctor I can go to and what procedures I can be covered for, for a government bureaucrat doing the same thing. The difference would be that the corporate bureaucrat is charged with making a profit at the end of the day; the government bureaucrat only has to stay within a budget. (As if gov't budgets were ever adhered to!) I'll take my chances with the gov't guy.

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  12. Rodak, the "working poor" are a small minority. Most are not older, not in poor health. But my sister-in-law would qualify. She has limited health insurance through her low wage job. She has health problems that are ongoing (diabetes and the advancement of age). If her condition causes her to have to leave work, she can apply for Medicaid or perhaps Medicare and SS disability. But I was once one of those "working poor", supporting a wife and young son on a job that barely paid above minimum wage. Somehow, I managed. By watching my budget, by relying on family when I could, by staying as healthy as I could, and by using those facilities run as charities (they were called "free clinics"), we managed. We were not alone, there were other families that we knew who were in similar situations. We all survived. Would it have been a little easier if we had an affordable alternative? Maybe but we still still made it and we had a viable reason to. We had incentive to find jobs that had health coverage, we had incentive to earn more, we had good reason to better ourselves.

    I understand your comment about the dentist not being on the list. But you still have a choice. You can go to the dentist you want and pay it out of pocket or you can choose one of the ones atht are on your carrier's list. Believe me, I know about this. My insurer changes the doctors on the list each year. It is up to me to make sure my physician of choice is still there.

    Having been at the mercy of government run health care while in the Navy, I would rather not take my chances with the government.

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  13. Douglas--
    Yes, you describe the level of health care delivery available in this country quite accurately.
    So, that's really the best that you think the richest nation on earth can do?

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  14. Rodak, yes, I think it is... so far. We have made more advancements in medicine and medical procedures and technology than almost anywhere else on earth. And we did this through something called the Profit Motive. We have people from all over the world, including those countries with national health care, coming for medical treatment that is difficult or impossible to get at home. We really do have the best medical care in the world. Our citizens are not unhealthy because they can't get adequate medical care, they are unhealthy because they eat too much, exercise too little, and make other poor choices.

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  15. What is this "richest nation on earth" hypocrisy? Have you been reading the papers or listening to any thing other than the Obama worshiping Main Stream Media? Try my blog and maybe you will see that we are certainly NOT the richest nation on earth. We are the MOST INDEBTED nation on earth. And becoming more indebted every time the Congress passes a new spending bill which seems to be on a weekly basis.

    I am not the best source of news, but I do reference everything I say. If you get over to my site you may check out some of my blogroll sites. The ones with ** before the name are the political sites. They are some of the best.

    We Americans are in deep stuff here and getting deeper with every day that passes while most of us go on our way still believing that nothing has changed and we are still walking tall. My blog on the interactive map showing unemployment across the country (search: interactive map) might be informative. And you better believe it is just beginning because Obama's restrictions on business is closing the small ones and sending the large ones overseas taking all those riches with them. BB

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  16. What is this "richest nation on earth" hypocrisy? Have you been reading the papers or listening to any thing other than the Obama worshiping Main Stream Media?Brenda--
    Were you born the day after Obama was elected, or what? I've held my opinions on health care since Obama was a teenager. And, btw, I've spent much of that time working in the health care industry. And my wife, who is a nurse, has spent all of that time there. Who are you listening to? Rush Limbaugh, maybe? Sean Hannity? Glenn Whatizname?...

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  17. How do we determine who made poor financial decisions with respect to their mortgages? How do we determine who made poor educational decisions? How do we determine who made poor decisions about sex? About marriage? About having children? About any human choices?

    If we can make any of those determinations, arguably we can craft a mechanism to determine who made poor health or lifestyle decisions affecting health also?

    Where are the free market, let the private sector and capitalism operate adherents? Isnt' everything about personal responsibility? Why should we permit leniency, or not tolerate poor decisions in some areas, and not others?

    Just provide a consistent construct, or tell us why exceptions should apply to whichever rule you contend should apply to the governance model. Or tell us that it should be determined on a case-by-case basis.

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  18. Anonymous, the debate is about who should make those determinations. The State or the Individual? This country was not founded on the rights of the State to make such determinations. It is human nature to want an entity to care for one's needs. It is also human nature to want privacy and non-interference (we might call that "liberty"). The struggle is always between these two human desires. When Franklin said that one should not give up liberty for security, he wasn't talking about just security from an external threat. He could have just as easily been talking about security from life's woes.

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  19. We do not doubt that we, as a nation, could dramatically improve our health and create a system which would be the envy of the world. However, that also applies to many other countries which happen to fortuitously have the the appropriate resources.

    The issue is whether we can, but rather whether we have the "will," whether political or otherwise. Are we sufficiently motivated to achieve that goal? Obviously not. We have been arguing about it for years, and the fact that we have been arguing about it for so long suggests that we have not reached a national consensus.

    Think about how long this country argued and debated the institution of slavery, which had to do with one's basic, fundamental, human existence. Think further about how desegregation came about.

    It's not going to be easy. If that movement took as long as it did to come to fruition, arguably the issue of public health is not as pressing a basic human issue.

    Assuming that we posed the following question to humans in any country, how do you think that vast majority of humans would respond?

    Given the choice between emancipation from slavery, and the right to have health care funded by your government, which one would you prefer, assuming that you can not have both?

    We highly suspect that the nation is not "sufficiently motivated."

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  20. Thanks to all who shared comments responsive to this article. We are trying a new method of dealing with comments. Instead of responding to each, individual comment, we hope that you will engage others in analyzing the issues, and we'll just pose additional questions along the line.

    We welcome all points of views, and value them. Thanks for visiting.

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  21. Here's something to consider. Those large urban centers which developed mass transit prior to, let's say 1940, have that infrastructure in place. When cities like The Bay Area of Northern California, Atlanta, and Los Angeles started their systems much later in the game, the costs and logistical issues were far more complex. Isn't this also a factor to be considered in connection with the health care system?

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  22. This last question is one I have posed (in my meager little mind) in regard to many issues and problems. When Ike began the interstate highway system, he envisioned an American Autobahn (where he got the idea). What if he had considered the aquaducts of ancient Rome at the same time? So that in building the interstate highways, they also installed a huge interconnecting pipeline alongside which would channel water from flooded areas into drought stricken ones. Think what that could do for us when Floods hit some places in the Spring while other regions are parched. The issue remains today but imagine the huge costs to implement a solution. A different, cost effective, solution may be out there but we first have to see it as a universal problem, not simply one that adversely impacts a portion of the population.
    In other words, we do not yet have a consensus that health care is a problem beyond being expensive. And it won't get any cheaper by nationalizing it.

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  23. And it won't get any cheaper by nationalizing it.That just isn't true. We spend more per capita for health care in this country than do the nations with national plans. Stop just listening to the corporate shills and look it up for yourself.

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  24. Yes, we do spend more... per capita. And we have better health care because of that. We do not have to wait 6 months for a simple procedure. We do not have some bureaucrat deciding what we can, or cannot, have. What is that worth? I don't listen to corporate shills anymore than I listen to socialist ones.

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  25. "You think health care is expensive now, wait until you see what it costs when its free."
    -- P.J O'Rourke.

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  26. With the exception of Douglas, virtually everyone has ignored our inquiry into the personal responsibility component. Why should people who are not sufficiently motivated to care for their bodies, health, and avoid certain behaviors on the front end, have an expectation that someone or some institution or entity will provide them with health care on the back end, if a link can be established between the front end conduct and the resulting poor health?

    Why, if I do not put any money, or a very small amount of money into my account, should I have an expectation of being able to withdraw a substantially larger amount (not including interest) in the future? Why, if I made poor financial decisions involving a mortgage, should I expect some institution or entity to bail me out?

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  27. See Medicare. You've paid into it with every paycheck. It's in deep trouble because of poor management and oversight along with rapidly rising costs of medical care and the ever increasing life expectancy. I went past a billboard today advertising cosmetic surgery, eyelid "lifts", and that they were "covered under Medicare". As is Viagra and other ED medications.

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  28. **And we have better health care because of that.**
    No we don't. Study the stats.
    **We do not have some bureaucrat deciding what we can, or cannot, have.**
    Yes, we do. He works for an insurance company.
    **What is that worth? I don't listen to corporate shills anymore than I listen to socialist ones.**
    Try listening to doctors and nurses. Listen to corporate CFOs.

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  29. **Why should people who are not sufficiently motivated to care for their bodies, health, and avoid certain behaviors on the front end, have an expectation that someone or some institution or entity will provide them with health care**

    If we let them die on the street when the stuff hits the fan, you'd have a point. But we don't. They end up in ER's and we pay much more for them than we would if they had routine health care. Many more people than go now would see physicians routinely, if they didn't have to worry about what it will cost them. Those who wouldn't, and end up in the ER as is the case now, would still be cheaper to care for with a national health plan.

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  30. Ah hah! Rodak wrote:

    "If we let them die on the street when the stuff hits the fan, you'd have a point. But we don't. They end up in ER's and we pay much more for them than we would if they had routine health care. Many more people than go now would see physicians routinely, if they didn't have to worry about what it will cost them. Those who wouldn't, and end up in the ER as is the case now, would still be cheaper to care for with a national health plan."

    Now this is an interesting argument around which we can wrap our arms from a systemic perspective. IT'S MORE COST EFFECTIVE. Most of the traditional arguments are not humanistic in nature, they are financial. This is a financial argument, since theoretically tax dollars are used to support the proposed system.

    Should we live them in the streets to die? Anyone out there support that?

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  31. At the core of this debate on national health care are the same forces which operate in the quest of humans to get to heaven: Emotion and Competition. Those who think that there is a selection process to gain entry into heaven, and that there are limited open slots, are concerned that others, less desirable or less worthy, may gain entry at their expense, so there is a motivation to demonize and belittle others to ensure their competitive advantage.

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  32. Should we [leave] them in the streets to die? Anyone out there support that?Of course no one supports that. It's the old strawman again. The question is: Is it cost effective? The answer is there are no definitive studies to prove one way or the other. It all depends upon who does the study and what they decided the answer would be. Like telling me to "study the stats" about whether we have better health care. It depends upon how you measure it. It depends upon how you define "better."

    Or how you define "bureaucrat", perhaps. If your health insurance disagrees with you about what they will pay for, you can choose to pay for it yourself. But what happens when the government runs it all? Where can you go? You won't be able to do what Canadians can do, head for another country nearby. Unless you want to go to Mexico. Which may benefit from our nationalization of health care.

    I then wonder why a corporate CFO is not a "corporate shill?" Maybe that CFO just wants to dump the medical benefits off onto someone else?

    But there are doctors and nurses who don't want nationalization. Can I listen to them? The AMA argued against Medicare at one time. We didn't listen.

    Who do we listen to? How do we verify the data?

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  33. But what happens when the government runs it all? Where can you go? Since you assume a universal ability to "choose to pay for it yourself"--then, when the gov't run it all and won't cover it, you simply "choose to pay for it yourself."
    Do you ever stop to read the stuff you post before you hit the button?

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  34. We'd ask that those individuals who are privy to inside information and already know the form and details of health care coverage, which will ultimately result from this potential legislative effort, to please share that information with the rest of us.

    There are so many discussions with so much specificity that some are apparently privy to information which others are not.

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  35. Douglas: We disagree with you, to some extent, about whether some in our society feel that people needing health care should be left to die in the streets.

    We suspect that there is a very substantial segment of our population which would not have a problem with letting people die in the streets, as long as it was not on their street, and any diseases potentially flowing therefrom did not pose a risk to them or their loved ones.

    It is the politicians (a very small segment of society), who desire re-election and who depend on being viewed in a positive light, who would not allow it to happen, although some might privately support it.

    The reality in the world of governance is that you can not help everyone who needs help, including many of those who are trying their best. No system is perfect.

    In fact, we strongly suspect that some of the demonization and characterization of many poverty stricken individuals as scofflaws or cheats is actually a construct that allows those critics to rationalize their position that their hard earned tax dollars not be used on "those who have not tried to help themselves."

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  36. To their credit, at this particular moment as we type this, Christina Applegate of "Married with Children" fame is on Oprah discussing her bout with breast cancer. Her doctor is about to come on after the commercial break to discuss the disease.

    We'd be curious to know how many women, who are uninformed about the disease, will pass by this program, and opt to go to another more entertaining show.

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  37. Yes, rodak, I do read what I write. On the other hand, you do not understand it. You might want to work on your comprehension And on your contradictory writings. Corporate shills are not to be listened to unless, perhaps, they agree with you (those CFO's you mentioned)?

    When govt runs it all, you will have no place to go to choose to pay for it yourself. Or did you not understand "runs it all"?


    Inspector - You may be correct. Though we might disagree about who those uncharitable ones are. I do not think the majority are that callous. If they were, there would have been a short life to the Civil Rights Movement. If they were, charities would be a rarity.

    But I did use an absolute, saying "no one." I might better have said "no one would admit to that."

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  38. Douglas: When all is said and done, we're probably in the same camp with respect to the compassionate quality in the vast majority of humans. We see it all the time in the public's responses to disasters.

    What is more complicated is the rationalization process employed by many when we need to move on and deal with our own personal crap. We develop a certain detachment to focus on our own "survival."

    As for the speed with which the Civil Rights Movement proceeded, we must admit that we still, to this day, are surprised at the pace. We do think that some of our nation's continuing confusion about race is due to the pace with which the change took place, and the fact that it was "imposed" involuntarily on the populace through judicial activism. The legislative branch was obviously not ready to carry the baton forward, since the elected representatives did not feel that their constituents were interested in going there. (We are reminded of Mikhail Gorbachev's desire to proceed slowly and Boris Yeltsin's insistence on speed, and the ramifications flowing therefrom.)

    What is of perhaps more interest to us is how long it took for our nation to abolish slavery. That lengthy period of time was pretty amazing, when you consider the human dignity issue involved. (But it also reflects something about the fabric of our society.)

    Alexis de Tocqueville, in the mid-1800s and prior to the Emancipation Proclamation, anticipated the long-range problems associated with maintenance of the institution of slavery. That we appear to be surprised today, or contend that the ramifications should have disappeared by now, is also reflective of who we are as a people.

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  39. There were economic ramifications to the abolition of slavery. Tied in with a strong racism which was reinforced throughout our history. I am one who believes that much of the reason for the slow progress in race relations within the US after the Civil War has to do with the lack of a slave revolt. This has also much to do with a lack of power of a minority population. It's way too complex to go into in a few comments and I would love to sit with you sometime and discuss my opinions about this subject at length. We could easily spend hours doing this.

    Have you ever read Freedom by Orlando Patterson?

    http://www.amazon.com/Freedom-Vol-Making-Western-Culture/dp/0465025323

    To be honest, I still have not finished it but it has had a great influence on my thinking.

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  40. When govt runs it all, you will have no place to go to choose to pay for it yourself. Or did you not understand "runs it all"?You are envisioning what? A fascist state organized around its health care system?
    Do you imagine for one moment that persons of means in European nations with nationalized health care systems wait in line with their servants for health care?
    A single-payer health care system would not preclude persons with the means to do so from purchasing supplemental insurance (as Medicaire recipients can do now); nor would it preclude groups from establishing private clinics and hospitals. So what do you mean by "runs it all?"

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  41. Douglas and Rodak:

    We apologize for not focusing on this "when government runs it all" hypothetical earlier, and enter the discussion. We refer to it as a hypothetical, since that is what it appears to us.

    1. We'd be the first to acknowledge that we have a tendency to sometimes pose questions in an either /or manner; however, we simply do that to stimulate thought and develop different ways of looking at the issue, not because we view that as the reality;

    2. One of our major concerns about the "re-vamping" of the health care system is that it would add MORE complexity because it would theoretically be even more of a patchwork of multiple systems. It does not appear that anyone is suggesting that we should scrap or wipe out everything which currently exists, and start afresh;

    3. We suspect that no one is suggesting that we employ a Soviet / Communist system of health care, and even there, we doubt that everyone truly was limited to that proscribed system. We've spoken to numerous former Soviets emigres over the years, and the dealing in special treatment and favors ran rampant, depending on your financial resources; and

    4. We have quite a bit of experience with the British and Canadian versions of socialized medicine, and they are not all one way or the other, but a different type of patchwork.

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  42. The issues are: 1) to get full-range, quality coverage for people who currently don't have access to it; 2) to eliminate the risk of financial ruin due to catastrophic costs for the middle-class; and 3) to remove the burden of paying for employee health insurance from businesses (especially small ones.) Any system--regardless of how it's funded--that would accomplish these three things in an affordable way would go along way toward satisfying me on the issue.
    As for complexity, single-payer would remove all non-elective complexity from the picture. If you want to keep it simple, you elect to be in the single-payer system, and that's that. If you want to make it complex for yourself, you start shopping around for supplements and/or alternatives. Simplicity is one of the main features of single-payer.

    ReplyDelete
  43. Good post... I do have to disagree with this:

    "This is a country built on social Darwinism or survival of the fittest."

    Most hard working Americans have a lot of sympathy for the less well and less well off... but we do have a problem with the able bodied who abuse the system. You can not tell me that our system does not foster abuse and dependence. I have watched it happen time and time again.

    Our current system fosters and enables generations of families who never try another path because of the dependence it creates. The draw of the familiar and the path of least resistance is a human weakness.

    Our Government gives huge tax breaks to the non-profits, and that is an in-kind contribution that many of them could not exist without. As a social worker I will say that a community based non-profit will serve more people, and do it more effectively and more efficiently than any government program out there. The government is wasteful and it is often run by social elites who have no clue as to what the poor really need.

    One thing we see time and time again with Gov. policy concerning the poor in this Country are the "unintended consequences." that happen when the wealthy dictate public policy for helping the poor. They don't understand day to day things that prevent people from availing themselves of help...Leave it to a politician to build a beautiful and expensive clinic in a rural neighborhood and then scratch his head wondering why the poor people aren't coming. I mean don't all poor people have cars? Bus fare? WHAT? You mean we have counties so poor their are no buses?

    Another example of this happened recently in this Country. The Feds. passed a law banning the resale of children's goods. They seemed to think that families like mine resell and buy used children's clothing, furniture, toys and books for the sport of it. No, my family and millions like us, consign such items to make it affordable. Items are recycled, others can buy them cheaply and I can earn money back to buy what's next on my daughter's needs list. That stupid piece of legislation was literally a day or two away from shutting down consignment stores every where. They had to pass emergency legislation due to this "unintended consequence" -- don't even get me started on the agriculture bills that could shut down small local farmers. Seems we would be better off if the Feds would get their own life and leave ours alone!

    Anyway, I do think that one benefit of a free system is that we are a generous people in this great Country. Many generous people and giving people.

    I worked in rural Appalchian Culture in mental health for years with violent and assaultive youth. My clients always had needs, but it was the churches, the clubs, the locals who reached out. All they needed was a facilitator to say "Here's what the need is, can someone help?" There were always creative answers... and the best part of all? Those connections last becasue they are organic and naturally occuring resources. They are not dictated by the government.

    What we need in this Country more than another social program is a good reminder of how to be a neighbor to one another.

    I recently got to write some grants for local clinics that offer services for uninsured and under-insured patients. Not one person in this town has to go without care. They turn no one away and they catch the ones that fall through the government crack. All they needed was a good facilitator to talk with area physicians. You would be amazed to see how the doctors here have reached out to be a good neighbor to those in need.

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  44. Claire: Welcome to our forum, and thanks for providing a comment reflecting much thought and consideration on your part.

    You took issue with the following statement in our original post: "This is a country built on social Darwinism or survival of the fittest."

    The reason that we mentioned this is that we consider this country to be one where the citizens compete against one another for resources and benefits. However, not every one can win; not every one can be in the top 10% of any category: money, talent, property, etc. The competitive process necessarily leaves some battered casualties along the way.

    Some cheat the system. Some get discouraged. Some are slicksters. Some are not particularly talented. Some are not interested in competing.

    At any rate, most people figure out a means by which to survive which suits their goals and purposes.

    You make some very valid points about neighbors reaching out to other neighbors. However, we suspect that the dynamic changes from region to region, city to city, depending on a number of factors.

    Thanks again for participating in the discussion.

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  45. Yes, there are some problems on our healthcare system, but by far, the biggest problem is that we, as healthcare providers are not permitted to determine treatment modalities. The government, along with attorneys and insurance bean-counters are practicing medicine without a license and dictating to us what we can and cannot do. And as any student of economics knows, rationing creates scarcity which creates higher prices.
    The best solution to our healthcare "crisis" is to leave healthcare to those who are trained to provide healthcare. If we remove government and attorneys from healthcare and leave it to licensed physicians, dentists and others, the picture will improve greatly. We do not need more bureaucracy cluttering up American healthcare.
    Turning healthcare over to the people who cannot deliver our mail on time, who cannot balance a budget, who invite corruption and cronyism, and who are only looking out for their own best interest will set us back 50 years.
    And what is their actual goal? I believe their is some jealousy of those who sacrificed so much of their young years to obtain the training that helps us to stay healthy. These individuals deserve to be rewarded for that sacrifice.
    We are headed for a precipice, and our President wants to push us over the edge. We can't let that happen.

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  46. Thank you much Robert Stevenson, DDDS for your comments, based on practical experience as a medical professional. We can not quarrel with much of what you have outlined. However, it is not the nature of the private sector in the United States to leave health care decisions to trained health care professionals. We as a society function on a profit/bottom line reduction economic model. That's who we are. That's why refer to the need to recognize the limitations of a chosen model. No model can be all things to all people, and advance all interests.

    AT THIS POINT IN OUR COUNTRY'S EVOLUTION, the drive for profit, not the health of its citizens, reigns supreme. To transition to the model which you suggests would require a significance change in the country's mindset.

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  47. Why is it that people feel that they should be entitled to something for which they did not work? Just a few minutes ago, CNN did a piece on the Cleveland Clinic, and the top quality health care that it delivers at a relatively low price.

    The administrator focused on preventive care, and stated that chronic diseases in the US are primarily due to lack of exercise, obesity, and smoking. Why should health care, at government/taxpayer expense, be provided to people who do not take preventive measures?

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  48. We were just listening to C-Span's Washington Journal where callers are allowed to express their views on various subjects. One caller just said something that we had not previously considered. He said that "healthcare should not be about profit. Healthcare should be about people helping one another during a time of need."

    We had not considered the possibility that the profit motive be removed from the equation.

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  49. Although we have stated the reasons supporting our belief that the United States in not ready for nationalized health care, in the July 27, 2009 hard copy edition of "USA Today" appears an article entitled, "Would God Back Universal Health Care." It is an interesting read.

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  50. At this point, although the debate and spin continue, this bill is essentially dead from an emotional and mandate perspective, even if some version gets passed. Whether it ultimately proves to be of any benefit to society, or a detriment, will take years, if not decades, to appreciate.

    This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal.

    There's been too much arguing about the details. People can not describe in 2 or 3 sentences the conceptual parameters of the effort and what it is supposed to accomplish. Unfortunately, people can describe how they feel about it in 1 or 2 words, and that's not good.

    If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there's a big problem.

    Even more so than how something is done, people are interested in results, not the details. And once again, as is frequently the case with much of human processing, the facts don't really matter. How people view the world, what they value, and what they want, matters.

    And there is nothing collaborative in nature about that. Factor in the strong individualistic American DNA, and this effort is emotionally toast. A country needs to know its limitations.

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  51. As we type this, Brian Lamb of CSpan is interviewing former Washington Post reporter T.R. Reid, regarding his book examining health care around the world, and how the United States system stacks up. Click here for a description of the program.

    ReplyDelete
  52. Yes, there are some problems on our healthcare system, but by far, the biggest problem is that we, as healthcare providers are not permitted to determine treatment modalities. The government, along with attorneys and insurance bean-counters are practicing medicine without a license and dictating to us what we can and cannot do. And as any student of economics knows, rationing creates scarcity which creates higher prices.
    The best solution to our healthcare "crisis" is to leave healthcare to those who are trained to provide healthcare. If we remove government and attorneys from healthcare and leave it to licensed physicians, dentists and others, the picture will improve greatly. We do not need more bureaucracy cluttering up American healthcare.
    Turning healthcare over to the people who cannot deliver our mail on time, who cannot balance a budget, who invite corruption and cronyism, and who are only looking out for their own best interest will set us back 50 years.
    And what is their actual goal? I believe their is some jealousy of those who sacrificed so much of their young years to obtain the training that helps us to stay healthy. These individuals deserve to be rewarded for that sacrifice.
    We are headed for a precipice, and our President wants to push us over the edge. We can't let that happen.

    ReplyDelete
  53. What is this "richest nation on earth" hypocrisy? Have you been reading the papers or listening to any thing other than the Obama worshiping Main Stream Media? Try my blog and maybe you will see that we are certainly NOT the richest nation on earth. We are the MOST INDEBTED nation on earth. And becoming more indebted every time the Congress passes a new spending bill which seems to be on a weekly basis.

    I am not the best source of news, but I do reference everything I say. If you get over to my site you may check out some of my blogroll sites. The ones with ** before the name are the political sites. They are some of the best.

    We Americans are in deep stuff here and getting deeper with every day that passes while most of us go on our way still believing that nothing has changed and we are still walking tall. My blog on the interactive map showing unemployment across the country (search: interactive map) might be informative. And you better believe it is just beginning because Obama's restrictions on business is closing the small ones and sending the large ones overseas taking all those riches with them. BB

    ReplyDelete
  54. The issues are: 1) to get full-range, quality coverage for people who currently don't have access to it; 2) to eliminate the risk of financial ruin due to catastrophic costs for the middle-class; and 3) to remove the burden of paying for employee health insurance from businesses (especially small ones.) Any system--regardless of how it's funded--that would accomplish these three things in an affordable way would go along way toward satisfying me on the issue.
    As for complexity, single-payer would remove all non-elective complexity from the picture. If you want to keep it simple, you elect to be in the single-payer system, and that's that. If you want to make it complex for yourself, you start shopping around for supplements and/or alternatives. Simplicity is one of the main features of single-payer.

    ReplyDelete
  55. We'd ask that those individuals who are privy to inside information and already know the form and details of health care coverage, which will ultimately result from this potential legislative effort, to please share that information with the rest of us.

    There are so many discussions with so much specificity that some are apparently privy to information which others are not.

    ReplyDelete

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