« Quick Administrative Note | Main | My Marriage Proposal »

June 14, 2007

The Sad, Sad Truth Regarding American Health Care

"With universal [health care], you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches. But for millions of people, that would be a big upgrade."

-- "Dr. Virus" from "What's Up Doc?," an article in New York magazine in which five anonymized doctors discuss what really goes on with doctors, health care and patients. Good if mildly depressing reading.

Posted by john at June 14, 2007 05:04 PM

Trackback Pings

TrackBack URL for this entry:
http://www.scalzi.com/mt2/mt-tb.cgi/4774

Comments

CJ | June 14, 2007 05:42 PM

I've been in countries with socialized medecine, and seen doctors in England, France and Italy. Some of the care I received there was better than I have received in the US, even with good insurance.

I'm a fan of the two-tier system, public and private coexisting. Basic care should be easily obtainable for all citizens.

Janiece | June 14, 2007 05:51 PM

VERY depressing...

But interesting, nonetheless.

will shetterly | June 14, 2007 06:26 PM

I was a Canadian landed immigrant decades ago. I let that lapse and stayed an American. I regret it whenever I have to deal with US health care. Canadian health care was great then. Canadian conservatives have been chipping away at it, but it's still mighty good. My parents and sister became Canadians. They would not swap their system for ours in a second.

Laurie Mann | June 14, 2007 06:55 PM

Interesting article and more than mildly depressing.

I was diagnosed with a minor but annoying condition in March (I started having symptoms in early January). I thought I was going to be told today that I could schedule corrective surgery, but am stuck with three more months of "wait and see." Gack. I had this same thing once before and I know it doesn't just go away in my case. Surgery cleared it right up before (for 30 years!). I'm still not sure why my doctor is so reluctant to schedule me for it this time!!

Espana Sheriff | June 14, 2007 08:20 PM

No surprises.

But yeah, crap coverage is still be better than no coverage (what I have now) ... thank god for Planned Parenthood at least.

Schloi | June 14, 2007 09:37 PM

nothing quite as bleak as trying to save lives I guess, except puppies, that would make puppies pretty bleak
then it would be more along the lines of:
"if everyone had a puppy, they would be lousy and stubborn and ugly, but it would still be better if everyone had a puppy"

Smith | June 14, 2007 11:36 PM

I thought it was interesting that every doc on the list was a specialist, most of whom make their money on a procedure-by-procedure basis. Where was the internist, Dr. Diagnosis? Now THERE'S a guy who could talk about the economics of medicine.

Doc (not a doctor) | June 15, 2007 12:21 AM

"For millions it would be a big upgrade."

What would it be for everyone else? Would it be a big step down for millions? Tens of millions? Is shitty coverage for everyone better than no coverage for some with good coverage for most?

StephanieG | June 15, 2007 12:25 AM

I am a physician myself, of the family practice variety. I don't have any factual quarrel with the interview, but the tone sort of turned me off. Nobody seems to be very happy. I understand that it is meant to be an expose of the dark underside of medicine. But still.

It's true that my experience is as a primary care physician in a small town, working in a hospital that does not have residents. My biases will not surprisingly be different than theirs in many important aspects. Sorry not to be able to put a better finger on what disturbs me about this.

BTW Scalzi, I enjoyed meeting you at your reading in Columbus.

StephanieG | June 15, 2007 12:28 AM

I am a physician myself, of the family practice variety. I don't have any factual quarrel with the interview, but the tone sort of turned me off. Nobody seems to be very happy. I understand that it is meant to be an expose of the dark underside of medicine. But still.

It's true that my experience is as a primary care physician in a small town, working in a hospital that does not have residents. My biases will not surprisingly be different than theirs in many important aspects. Sorry not to be able to put a better finger on what disturbs me about this.

BTW Scalzi, I enjoyed meeting you at your reading in Columbus.

MWT | June 15, 2007 01:30 AM

Doc (not a doctor): What would it be for everyone else? Would it be a big step down for millions?

Why does it have to be a step down for anyone? Why can't we have both? People who have health care plans through their employers or whatnot can just continue doing what they're doing if they want. People who don't want those or can't have them can have access to the Universal rather than having nothing at all.

KL | June 15, 2007 03:34 AM

"What would it be for everyone else? Would it be a big step down for millions? Tens of millions? Is shitty coverage for everyone better than no coverage for some with good coverage for most?"

This is inane. Universal is not some abstract theoretical concept, it's something that is currently in existence in scores of countries around the world. To wit, you can actually go out and see what the results are, and if you're actually serious about implementation, determine which implementation works BEST and copy that (France, by the way. Ironically, given our "love" of France in the US)

All evidence is that, unless you are incredibly wealthy or suffering from some bizarre and obscure chronic condition or require some one-in-a-billion surgery, what the US offers is already mediocre shittiness. Everything in those interviews does nothing but confirm that.

So the calculation is not "will my healthcare get worse", because unless you're a statistical anomaly, it's already pretty shitty in the US of A. The calculation is, "can I get it cheaper" (1/2 the cost for the same mediocrity, everywhere that has Universal), and if you actually care about your fellow citizens, "can everyone get covered" (yes, under Universal).

For example: Canada's current HAMSTRUNG system offers mediocrity comparable to the US, for less cost, much less hassle, and offers it to EVERYONE. And Canada's system is at the *low* end of what countries with Universal can do.

ucfengr | June 15, 2007 06:47 AM

Healthcare in this country is great; health insurance is crappy. Much of the reason it is crappy is because of government (federal and state) controls and mandates. The answer to fixing health insurance is getting government less involved, not more.

Doc (not a doctor) | June 15, 2007 07:12 AM

If you think everyone has mediocre health care, unless they have none, I'm sure it seems inane - but I wouldn't describe health care in America as mediocre, and I'd wager the doctor in question wouldn't either; "you'd get the same kind of mediocre shittiness" implies a change from what we have. That change would be an upgrade for millions. What would it be for everyone else?

For me, the calculation IS "will my care get worse" - or rather, will my family members get worse care, since I'm pretty healthy. I'm pretty sure I'd be out of grandparents under another system, and shy one mother.

I like American health care. I don't think it's broken. I pay for my own (group) insurance, and it isn't outrageously expensive. My uninsured experiences weren't traumatic, a few hundred bucks at urgent care facilities.

The only thing I have to compare it to is the Chinese health care system. It's cheap, with long lines, and isn't as good as I'd expect in the US. Of course, I'm in South China, so this may not be representative. Also, you can shell out for VIP service, or so I hear. I still schedule my doctor visits during my limited time in the US.

Lugo | June 15, 2007 08:11 AM

Based on what I hear from my relatives in England, I sure wouldn't trade our system for theirs.

Matt McIrvin | June 15, 2007 08:19 AM

"Being poor is hoping the toothache goes away." If we could just fix that we'd be way, way ahead. How about universal dental care as a first step?

Buck | June 15, 2007 08:37 AM

Funny, I was just visiting friends in Australia last December, and everyone was politely damning of the US, especially for our disastrous foreign policy and lack of universal health care.

That being said, Australia covers medical but not dental. A friend with congenitally poor teeth spent something like $15,000 getting her teeth fixed over a several year period.

As a lawyer, I thought the comments on competence, arrogance, training, mistakes, etc. were interesting and in parallel to my profession. In the legal field, you have all this training (unfortunately in the US without mandatory internship) and then basically get sent out into the wide world without a clue on how to actually practice law.

Wakboth | June 15, 2007 08:38 AM

The really weird thing with the US lack of universal health care is how *expensive* it is to everyone involved.

In the long term, preventive and/or early-intervention care is massively cheaper, and you get a healthier, happier population that is able to work better to boot.

Sam | June 15, 2007 08:56 AM

You know its bad when major Health insurance companies are paying for patients to get their operations over seas.

Jeremiah | June 15, 2007 09:32 AM

Hi ucfengr! We meet again. How's life? What laws specifically are you talking about?

General comment: I find it annoying that many people think we have to have it one way or the other. All universal or no universal. I want both ways. Universal health care in the US could cover all children under 13. On a voluntary basis. That's not bad, right? And then we could go from there.

It's just like the fuel arguments (I know this is off topic. Bear with me). People say ethanol will not work for everyone. That is true! But if we put 10% of the US on ethanol, 10% on biodiesel, that's a fifth of the people now not using fossil fuels.

Why can't we all just get along and find mixed solutions? :)

ucfengr | June 15, 2007 09:35 AM

What the doctor's say in the article is not all that surprising. My wife is a nurse and I was a Army pharmacy tech, so I do have some direct experience from the provider side as well as consumer side. I have never experienced medicine outside the US, but I would be surprised if the situation was any better, I suspect it is worse.

Just as an aside, having worked in socialized medicine (the Army) I can tell you, I prefer private. All the jokes you hear about military doctors, they are true. Not to say all military medicine is bad; if you get shot or severely burned, you will have a hard time finding better treatment, but the Army is just not geared towards providing pediatric care or elder care, etc. Military medicine largely exists to keep the soldier healthy and able to perform his mission. Providing other services is just not a priority.

ucfengr | June 15, 2007 09:51 AM

Hi ucfengr! We meet again. How's life? What laws specifically are you talking about?

All states mandate certain coverages, some more than others. For example in my state, Maryland, they mandate coverage for autism. Now for me this is good; I have an autistic son, but if I had no children I wouldn't pay additional for this coverage. Many states also mandate that you can't buy coverage from out of state providers. So if I lived in Texas, where they don't mandate autism coverage, it might be helpful for me to buy a policy from a insurer in Maryland or vice versa if Texas mandates certain coverages that I might want. All these mandates serve to limit choice and in most cases to drive up costs.

General comment: I find it annoying that many people think we have to have it one way or the other. All universal or no universal. I want both ways. Universal health care in the US could cover all children under 13. On a voluntary basis. That's not bad, right? And then we could go from there.

Doesn't Medicaid cover low income children? In the US we do have a public/private system. We have Medicare to cover seniors and Medicaid to cover low income people. Those programs account for something like 40% of all health care spending in the US.

ucfengr | June 15, 2007 09:55 AM

Granted we have no government program to fund health insurance for the middle and upper classes, but do we really need one.

Matt Jarpe | June 15, 2007 09:57 AM

Before we figure out the universal health care thing we're going to have to have a series of very difficult conversations. Talking about health and economics in the same sentence can make people cringe.

There is an amount of suffering and death that is inevitable, no amount of medical care can make it go away. There is another amount of suffering and death that is, let's call it natural. It's what you get without medicine. Somewhere in between those two extremes is an amount of suffering and death that is acceptable. You set the acceptable bar where you want it and you look at the price tag.

And if it's the government looking at the price tag and setting the bar, the position of the bar becomes a political matter. It's going to change with the changing political tides, and with the country evenly divided you will be in the minority on some health care issue that you care deeply about. And I don't know anything that affects us on a more personal level than suffering and death.

I don't want to see the questions of suffering and death fall under the current political asshattery we've got happening now, but if it does I'd rather we all walk into it with eyes open.

Jeremiah | June 15, 2007 10:07 AM

Thanks for the reply.

I honestly don't know much of anything about Medicare or Medicaid. So I can't say much of anything definitively. I will admit that openly.

I do know two things. 1) one of the primary debates talked about taking away state boundary laws for coverages. Like usfengr was saying. I totally agree with that. Let the state insurance companies compete with other state's insurance companies. awesome!

2) Here in Pennsylvania they just passed laws to create healthcare for all children under some age. So now all children are covered. I think it's a good thing from what I know. But, again, I don't know much.

Anonymous | June 15, 2007 10:21 AM

And if it's the government looking at the price tag and setting the bar, the position of the bar becomes a political matter.

This is an excellent point. For example, the current level of Medicare spending is certainly justified by political criteria, because seniors vote, but does it make sense using medical criteria. What happens when the current baby-boomers starting getting health care under Medicare? Suddenly the voting block for people dependent on Medicare gets even more powerful. Would that be a good thing?

Stan | June 15, 2007 10:21 AM

Doc: "'you'd get the same kind of mediocre shittiness' implies a change from what we have."

How does the word "same" imply a change? One of us made reading comprehension failure.

You seem to be looking at it as a sum-zero situation, that better for some means worse for others. That may not be the case. Increases in efficiency might mean slightly better care for most and much better care for some.

It's pointless to discuss the issue as if it were a binary situation. There is a spectrum of ways that things could be privatized/socialized. For example, we could have the same hospital structure but have the government be the insurer for everyone, or just for those who can't find better coverage. Obviously, Insurance companies are against anything that would take away their biggest earner so you can expect them to preach the evils of socialized medicine.

Actually, the U.S. is only partially private now. A huge chunk of care is funded by Medicaid/Medicare/Veteran's. Plus, due to levels of guaranteed care, hospitals treat people they know will never pay and lump it. The question isn't whether to socialize, it's whether to streamline our already semi-socialized hodge podge system.

ucfengr | June 15, 2007 10:23 AM

And if it's the government looking at the price tag and setting the bar, the position of the bar becomes a political matter.

This is an excellent point. For example, the current level of Medicare spending is certainly justified by political criteria, because seniors vote, but does it make sense using medical criteria? What happens when the current baby-boomers starting getting health care under Medicare? Suddenly the voting block for people dependent on Medicare gets even more powerful. Would that be a good thing?

ucfengr | June 15, 2007 10:26 AM

John, the Anonymous post was me. I re-posted under my "handle", so please delete the original if you feel the need.

braxis | June 15, 2007 10:31 AM

Lugo: What have your relatives in the UK told you?

The UK system is excellent for the basics; free consultations with a General Practitioner within 48 hrs. for everyone; A&E treatment for all, that costs only your time in the waiting room; free dental and eye care for the vulnerable (children, the poor, elderly, etc.) and subsidised for the rest of us.

Where it 'falls down' is in the system chosen to ration access to expensive and/or time consuming courses of treatment. The UK does this (mostly) via the waiting list - the US (mostly?) via economic means.

In the UK, nobody has to ask themselves the question 'Should I eat, or see the doctor?' and everybody, eventually, gets access to the fancy stuff too. Personally I think this is worth every penny we pay for it.

Doc (not a doctor) | June 15, 2007 10:55 AM

My bad. I should have included the rest of that sentence: "you’d get the same kind of mediocre shittiness that you’d get in all other kinds of standardized approaches." Same here is the same as with other kinds of standardized approaches.

Perhaps he's saying that we have one of those other standardized approaches, but I don't get the feeling that we do.

It isn't necessarily zero-sum, and I wasn't trying to say that it was (not that I'd look to government involvement for 'efficiencies'). Perhaps I should have, though - health care is a finite resource. We can add more doctors and nurses over time, but it will remain limited. A doctor can only see so many patients.

Jeremiah | June 15, 2007 11:09 AM

political criteria/seniors voting...

This is gonna sound pessimistic, but we already cater to the wants and whims of big business. and many people see that as "normal". And the outcome of that is more money for them. So why not setup a system that also caters to the wants and whims of individuals, as far as health care? The outcome of that will be people will be more healthy.

I'd rather have laws that let people decide how much care they get, instead of laws that let corporations decide how much money they get.

ucfengr | June 15, 2007 11:28 AM

This is gonna sound pessimistic, but we already cater to the wants and whims of big business.

I am really not sure what you mean by this. Do some industries benefit from their political clout? Of course, but it is not as widespread as you think, and a lot of businesses are hurt by government action.

Let's look at universal health care as an example; who would benefit most from a Canadian style plan? If your answer is "big business" you get a gold star. The big automakers and airlines would love for someone else to pick up the tab for the commitments they have made for employee and retiree health care. Of course it would not be such a good deal for the employees, because their benefits would likely be reduced.

PixelFish | June 15, 2007 12:30 PM

Health care in this country, if you have reasonably decent insurance, is okay. I got about the equivilant in Canada for 500 CDN a year as a tax-paying working US citizen on a visa. This is cheaper than whatever comes out of my paycheck. I had a minor surgery conducted while I was in Canada, and the exact same surgery conducted a year and a half later in the US, and there was NO noticeable difference in my care, except that I paid more in the US. Also, hospital stays in Canada often go until the patient is successfully treated, not until their insurance company kicks them out. Such was the case with my ex-fiance's uncle who suffered a stroke. They didn't let him out of the hospital til they were sure he could function in his home.

While I have excellent care, and would certainly want to maintain the quality of that care, it's an illusion that I am at all secure. Certainly I am covered....but I just moved and am jobless. If it weren't for my boyfriend and me being covered under Massachusetts domestic partner laws, I wouldn't have insurance at all. In fact, the last time I moved, I had a year's gap in my coverage. The entire time I was stressed about it....any accident or medical need that might come up would easily eat through my savings.

And while I'm covered, most of my family...isn't. Or they are covered under medical plans offering the bare minimum of coverage, because the employers in their state are notoriously cheap. My parents may or may not be covered. I haven't found out if my mother's new job gives her benefits. I hope so, because both she and my father have ongoing health issues that could easily spiral out of control.

Any way you slice it, for the average lower- and middle-class American, it's all too easy to lose coverage or be denied coverage. Self employed? Oh, try getting coverage then....that's a laugh riot.

Another example: The Blurbodoocery folks were denied health care coverage as well, for being successfully treated for past maladies. To quote Jon: We’ve been refused health insurance from the monopoly health care provider in our state. All three of us were refused. Irony 1: This same company who covered my successful cornea transplant in 1998 used this against me and declined coverage. Irony 2: Heather’s post-partum depression being successfully treated was used against her and she was denied. Irony 3: Leta’s two MRIs, which proved she was healthy have been used against her. Denied.

That tells me there's something incredibly screwy with our system. And while I feel reasonably good about MY health care, I don't feel good about the chances that I'll always be covered. Or that some medical emergency won't tear into my savings. Furthermore, the current system ensures that we'll have an ever-spiralling cost. Maintenance care is always cheaper in the long run than emergency care. And I end up paying indirectly through rising premiums.

PixelFish | June 15, 2007 12:50 PM

ucfengr said: Of course it would not be such a good deal for the employees, because their benefits would likely be reduced.

Not necessarily true. Some companies severely skimp on health care coverage, and many don't even consider dental or eyecare to be vital. When I was in North Carolina, the company I worked for got to announce that they had "competitive top notch benefits" because they offered dental coverage that covered a whopping 50% of your dental care. I got no eyecare, no long term disability, and only received my benefits after I had worked there for three months. Mental health and therapy? Chiropracty? Physical therapy? Forget about it. I did the heavy lifting there. Contrast that with my California job where I got healthcare from day one, and EVERYTHING was covered and even my prescriptions dropped to almost half of what I was paying in NC. (And which company was in better overall financial health? I'd say the one that provided optimal health care....they had less workers losing time to being sick, better overall productivity, better morale. Sure big business will benefit by universal coverage, but so will employees.)

Furthermore, when companies don't have the rising costs of health care to deal with directly (indirectly, their overall taxes still rise a little to cover government subsidy programs for health care) the unions they work with have increased bargaining powers for other programs.

ucfengr | June 15, 2007 01:24 PM

Pixelfish, with respect to the examples (automakers and airlines) I used it would almost certainly be true.

When I was in North Carolina, the company I worked for got to announce that they had "competitive top notch benefits" because they offered dental coverage that covered a whopping 50% of your dental care. I got no eyecare, no long term disability, and only received my benefits after I had worked there for three months. Mental health and therapy? Chiropracty? Physical therapy?

I bet they didn't offer aromatherapy, acupuncture, or reflexology either, but what's your point? Do you think some sort of Canadian-style single payer system is going to offer all that crap either? Regarding long-term disability, that is generally covered under a long term care policy that is not a part of your health plan.

ucfengr | June 15, 2007 01:29 PM

You know Pix, the best way to resolve your complaint would be to separate health insurance from employment. Then you could buy a health insurance policy that would cover everything you want plus your vitamins and gym visits too. Of course it would be incredibly expensive, but your policy in California was incredibly expensive too. You may not have seen the cost, but your employer did and it was reflected in your compensation package.

John Scalzi | June 15, 2007 01:32 PM

Ucfengr (and everyone else, actually) do me a favor and if you're responding to more than one person, try to put them in one post rather than a series of posts. Multiple sequential posts from the same person has always been an obsessive-compulsive bugaboo of mine.

ucfengr | June 15, 2007 01:35 PM

No

ucfengr | June 15, 2007 01:36 PM

Problem;).

John Scalzi | June 15, 2007 01:39 PM

[Adds Ucfengr to "Enemies" list]

braxis | June 15, 2007 01:41 PM

My wife is currently receiving acupuncture treatment from her GP, for the relief of chronic sinus pain. She's also booked in for physical therapy sessions starting next month, to help her recover from a broken ankle. My brother-in-law, a paranoid schizophrenic, has had almost twenty years of treatment for his mental condition.

All of this under the UK's National Health System.

F-L | June 15, 2007 01:51 PM

The article bothers me more for tone than content. There are real issues and real problems in medical care in this country. Some of the doctors they were interviewing clearly had personal issues and attitudes that definitely do not reflect a large number of people I very much respect in the profession. Unfortunately, a lot of people are going to read that article and think it's representative of everyone. There are good people out there who deserve to be better represented.

Steve Buchheit | June 15, 2007 01:53 PM

Scalzi, I always imagined those lists like Colbert's "On Notice" and "Dead to Me."

ucfengr | June 15, 2007 01:58 PM

My wife is currently receiving acupuncture treatment from her GP, for the relief of chronic sinus pain. She's also booked in for physical therapy sessions starting next month, to help her recover from a broken ankle.

That's all well and good, but all that service is very expensive, even if your sister never sees a bill. Somebody is paying for it. How much does is cost, better yet, does the NHS provide this level of service universally? How much would it cost to provide this level of service universally? What are the trade-offs?

PixelFish | June 15, 2007 02:00 PM

Scalzi, sorry about my multiple post....its just that I responded first to the primary post with links and whatnot, and only after I'd hit submit did I see a point that ucfengr had made that I wanted to respond to.

ucfengr: My other post is still waiting in the queue, so you don't happen to know that I've had experience with the Canadian health care system as well and even had the opportunity to compare it side-by-side with two operations a year and a half apart in two different countries. The Canadian health care I received was roughly comparable to my California health care, not my NC. Also, I point out that while there were costs to my employer, there were clearly benefits to the work enviroment they had created.

Rhiannon_S | June 15, 2007 02:35 PM

ucfengr
Your question about trade offs does not make sense. You are trying to measure social health in bean counting terms as to how it financially affects an individual in terms of income and expenditure only. Social health does not work like that. The benefits are spread out far beyond the individual who receives treatment and are not always measurable in purely fiscal transactions.

We get a more secure population from NHS confident in the knowledge that pretty much any illness we suffer from will be treated (there are exceptions) that creates a feeling of security in just about everyone for a start. It's one less thing to worry about. Virtually everyone in the population will at some point need treatment from the NHS, usually at the point where we can least afford it from a private source. Via national insurance everyone contributes throughout their working life (and via VAT and other taxes too) so what we get out we will pay back in some manner. By having the NHS it means that people will (mostly again) be able to return to work and further their career and put more money into the treasury and personal pot.

The stark differnce (which is still within living memory of a lot of the UK's population) between the time before the NHS started in the late forties/early fifties and now is illustrative of it serving a greater social good than any ledger book can show.

FWIW my own experiences of the NHS have been great when it serves its original mission and poor when it's tried to follow the US/Thatcherite internal market system. It's the latter that generates layer upon layer of management, waste and poor treatment. To me that says it all.

braxis | June 15, 2007 02:42 PM

[i]That's all well and good, but all that service is very expensive, even if your sister never sees a bill. Somebody is paying for it. How much does is cost, better yet, does the NHS provide this level of service universally? How much would it cost to provide this level of service universally? What are the trade-offs?[/i]

Yes, someone is paying for it - every single tax-payer in the UK.

This level of basic care is universally available - except maybe the acupuncture, which is due to having an openminded GP who is willing to try alternative therapies. If you're with a more conventional GP, you'll be offered more conventional treatment.

I don't know how much it costs and I'm not sure where I would find reliable (i.e. non-politicised) figures, but it's x% of the UK tax revenue.

The trade-offs:

Pro's:

Every single person, regardless of their means, recieves the same level of treatment. If you're poor this is good.

If you are diagnosed with an illness and prescribed a course of treatment, you will be able to afford it. Prescriptions are 'sold' at a fixed price (~$10) or are free. Again, no-one has to decide between food and medicine.

Economies of scale. It's as if the UK government negotiated health insurance for the whole population of the UK.

There's never a reason not to go to see your GP. This makes the prevention of disease easier and also makes control of contagious diseases more likely.


Con's:

Every single person, regardless of their means, recieves the same level of treatment. If you're rich this is bad. You can always 'top-up' with private insurance though.

Politicisation of the health system. As the system is ultimately controlled by the government it can become a political football.

Expensive treatments are rationed. They may not be available at all. If they are available you may have to wait a long time to access them. You may die before it's your turn.


Pro/Con depending on your philosophical leanings:

The higher tax payers subsidise the lower/non tax payers.

Chris | June 15, 2007 03:09 PM

To answer the question about how much the NHS costs, in 2004 UK health spending was $2546 per capita, compared to $6102 per capita in the USA (according to the OECD).

I'd be interested to see how the average survival rates for cancer, stroke, etc. compare between the countries. I know life expectancy is roughly the same.

PixelFish | June 15, 2007 03:21 PM

Chris said: I'd be interested to see how the average survival rates for cancer, stroke, etc. compare between the countries. I know life expectancy is roughly the same.

Don't forget we have the second highest infant mortality rate of the first world countries. (I think the highest belonged to a former Russian republic.)

(Alternately, I read that it was ranked 28th in the world. Whether that equates to being second highest among industrialised nations is math I haven't done yet.)

Of course, there are multiple causes for this, but as you might expect, it seems the mortality rate is highest among the uninsured.

Harry | June 15, 2007 04:36 PM

Ezra Kline, Health of Nations compares the costs, effectiveness and structure of several national health care systems. Interesting reading.

I work in primary care, answering phones and making appts for people (in the U.S.). My health insurance is crappy; apparently, insurers don't like to cover health care workers because they tend to go to the doctor when they need to.

Paul Barnes | June 15, 2007 05:22 PM

As a Canadian and a political science student, I would like to comment on the funding of our health care system. Constitutionally, the two most expensive programs are funded by the provinces, which are education and health care. The federal government receives most the tax revenue and then gives it back to the provinces through equalization payments.

In Ontario, we regularly give billions more to the federal government than we receive back. Not only that, but the power of taxation is limited for the provinces, so that many experience deficients (I believe that only Ontario and Alberta are "have provinces")

On October 10 of this year, Ontario is having a provincial election. The Progressive Conservative candidate, John Tory has promised 8.5 billion increase in health care funding over the next five years. It is the first thing that is discussed in his new policy platform. In other words, this is a very important social and political issue.

So what does all this mean? Well, the reason why we need this increased funding is because we do not have enough doctors, MRI machines, or hospital beds. We are overcrowded and understaffed. Coincidently, less things (dental and eye) are covered than they were 10 years ago, while we are paying more. For example, the current Premier of Ontario, Dalton McGuinty, substantially increased taxes to explicitly cover health care costs. For less coverage.

Essentially, I am unsure how long our system can last.

Paul Barnes | June 15, 2007 05:24 PM

Also, I have noticed some poor grammar on my part. Please forgive me for my haste.

Anonymous | June 15, 2007 06:08 PM

There is even a third option, which no-one has mentioned. In Japan, insurance is offered by the government. The cost is scaled, with wealthier participants paying more. There are some problems with the system - the wait times in hospital out patient clinics can be even worse than ours. But Japan has excellent health statistics.

I will throw a little fuel on the fire and suggest that our problem includes three profit making groups: insurance companies, hospitals, and doctors. Each of these groups is making nice profits. We pay for that as well as for the health care.

ucfengr | June 15, 2007 06:32 PM

Don't forget we have the second highest infant mortality rate of the first world countries.

This is one of those statistics that gets tossed around a lot but it is more than a little misleading. From a CBO study (http://www.cbo.gov/ftpdoc.cfm?index=6219&type=0), "Problems of definition and measurement, however, hamper cross-national comparisons of health statistics. Alternative measures of infant mortality may provide better information but cannot completely compensate for differences among countries in the overall rates of reporting of adverse pregnancy outcomes. For example, very premature births are more likely to be included in birth and mortality statistics in the United States than in several other industrialized countries that have lower infant mortality rates" and Variations in infant mortality rates among the states and between different racial and ethnic groups in this country are greater than the differences between the United States and many other countries. Black infant mortality rates, in particular, are exceptionally high, and the relative gap between black and white infant mortality rates has been increasing over time."

Euan | June 15, 2007 07:35 PM

Following on from Chris' post above about costs of health care per capita in the OECD:

http://www.kff.org/insurance/snapshot/chcm010307oth.cfm

Not only does the US spend nearly twice the OECD average (an eyeball mean, not a calculated one), but the cost of treatment is also rising there faster than in the rest of the OECD.

However, "Despite this relatively high level of spending, the U.S. does not appear to provide substantially greater health resources to its citizens".

Seems like something's broken to me.

PixelFish | June 15, 2007 09:46 PM

Ucfengr: I can kind of see what the differences in standards for reporting premature births might make, but why is the fact that there is a disparity between different racial and ethnic groups with the mortality rate an example of this statistic being misleading? The fact is some of our citizens are not getting the care they need. The fact is those babies are dying. Why? Could any part of this be alleviated by universal health care? I'll just bet. I also bet that A reason our statistics are skewed is because the infant mortality rate is high among the poor and the folks that lack appropriate neo-natal care. It's not the only reason, but pretending that it doesn't factor in at all seems silly to me.

mythago | June 15, 2007 10:59 PM

F-L, I think most people who have negative attitudes about doctors will have had those attitudes well before they saw that article. And it will be from their own experiences with doctors.

ucfengr | June 16, 2007 03:24 PM

Pixel, the disparity in health between the different racial and ethnic groups has less to do with accessibility of health care and more to do with the disparity in wealth. The reality is that Hispanics and blacks are more likely to be poor than whites and Asians. Then you have to ask yourself why poor people are poor. Are poor people poor because some guy named Rockefeller, Kennedy, or Forbes got in line first in the great global money trough and took more than their fair share? Or is it because by and large the things that are important to poor people are not things that are conducive to leading a healthy and productive life? Poor people have access to free education through the public schools, but very few take advantage of it (not that they don't go, but they don't take advantage of it); they also have access to free health care through Medicaid. What makes you think they are more likely to make full use of free health care than they are to make full use of free education?

Your question about trade offs does not make sense. You are trying to measure social health in bean counting terms as to how it financially affects an individual in terms of income and expenditure only. Social health does not work like that. The benefits are spread out far beyond the individual who receives treatment and are not always measurable in purely fiscal transactions.

Rhiannon. what I am saying it is going to take more than an anecdote or two to convince me that the British NHS can provide a level of health insurance that would make union auto worker jealous to every British citizen and make it affordable. There is something missing. Doctors may make less in Britain than in the US, but it can't be that much. I make roughly $90k/year as an engineer with 5 years experience and a 4 year degree. If I completed 4 years of college + 3 of medical school + an internship I would expect to earn considerably more than I do as an engineer. I expect it is similar with most other medical specialties. Otherwise many of the really good doctors would come over here. Same with nurses. And I am sure economy of scale has some impact, but an MRI machine, or an EKG machine is still going to be very expensive.

Steve Buchheit | June 16, 2007 09:11 PM

ucfengr, you must be new here. I suggest that before spouting off about poor people, you read one of John's most linked to posts, "Being Poor"
http://www.scalzi.com/whatever/003704.html

Or to his "Being Poor is Hoping the Toothache Goes Away" (since you like to tout medicare coverage)
http://www.scalzi.com/whatever/004910.html

Having worked in the Admissions Office for my University (one of several jobs I held to work my way through school), I got to witness first-hand the admissions process and interviews for NEOUCOM (NE Ohio Universities and Colleges of Medicine). I thought during my freshman year when my classics prof came into class one Monday morning and spent the first 15 minutes ranting about the motivation of incoming NEOUCOM students (he was a part of the interview process) I thought he was just disgruntled. After seeing it first hand for three-years, I share his disgust. I only met four potential students that wanted to "give service" as doctors (of about two-hundred I personally helped through the system). All the rest wanted the money and status.

Oh, and as a Union Member (GCIU, affiliate of the Teamsters) I would kill to have medical access equal to the British System.

braxis | June 17, 2007 10:33 AM

ucfengr:

Firstly, the factual stuff: Doctor's Salaries

So a GP earns $100,000 - $240,000 depending on experience and range of duties.

Secondly, I think you are missing Rhiannon's point. In a social health service you don't expect the best that money can buy - you expect a good service, available to all regardless of their circumstances at the time of need. You accept that you may have to wait for treatment if that treatment involves expensive machines or drugs, as an exchange for the knowledge that no child will die of tooth decay because they cannot afford to see a dentist.

If, as you seem to imply in your previous post, you think that the poor deserve their poverty and the rich their riches, this may seem an abomination. Why should the middle and upper classes subsidise the poor? If you believe that poverty is a random fact of life and that privilige does tend to perpetuate itself, then it is a price worth paying for a little fairness for all

James Nicoll | June 17, 2007 02:19 PM

"In Ontario, we regularly give billions more to the federal government than we receive back. Not only that, but the power of taxation is limited for the provinces, so that many experience deficients (I believe that only Ontario and Alberta are "have provinces")"

Ontario and Alberta do not get transfer payments but that does not mean they are the only ones making a net contribution to the system. As I recall, the only provinces that do not have a positive figure for [Federal taxes paid] - [Federal Benefits Received] are the Atlantic Provinces, Quebec and Manitoba. In that group, Quebec gets the least amount per capita but the largest amound in total.

There are couple of analyses here:

http://bouquetsofgray.blogspot.com/2005_07_01_archive.html

ucfengr | June 17, 2007 09:49 PM

ucfengr, you must be new here. I suggest that before spouting off about poor people, you read one of John's most linked to posts, "Being Poor"
http://www.scalzi.com/whatever/003704.html

Being poor sucks. I have been poor and I have been "not-poor". The difference between "poor me" and "not poor me" was in the decisions I made and the things I prioritized. That is not to say that "poor me" was bad and "not poor me" was good, it just is to say that they are different. I have also worked with poor people and my observation is that poor people are largely the same as "not poor people" except in the decisions they make and the things the prioritize. Among the things they don't prioritize is long term health.

Oh, and as a Union Member (GCIU, affiliate of the Teamsters) I would kill to have medical access equal to the British System.

Or you could just emigrate to Great Britain. Killing someone seems a bit drastic.

In a social health service you don't expect the best that money can buy - you expect a good service, available to all regardless of their circumstances at the time of need. You accept that you may have to wait for treatment if that treatment involves expensive machines or drugs, as an exchange for the knowledge that no child will die of tooth decay because they cannot afford to see a dentist.

I am not really up on the statistics, but is tooth decay are primary cause of death among American children? I would think I would have heard about it if it was. But which is it? Does the NHS provide a basic level of health care? If it does, it really isn't all the different from the US system (getting a basic level isn't all that hard ), except in the method of payment. Or does the NHS provide acupuncture and other exotic and expensive form of heath care, regardless of ability to pay. If the former, yawn; if the latter, wow, I gotta get me some of that.

braxis | June 18, 2007 06:16 AM

Here's the story, from earlier this year, that prompted the tooth decay comment. When I read this, I was horrified that it could happen in the richest nation on Earth.

Here's some of the treatment my family have received over the years:

I was diagnosed with Asthma at the age of 5 and have recieved 35 years worth of prescription medicines, of increasing effectiveness, to treat this condition. This was free up to the age of eighteen and subsidised since then.

I was hospitalised at seven, with a combination of asthma/lung infection. I spent around a week in hospital.

As a child, before I learnt how to care for my teeth, I had three fillings. I also has four adult molars extracted as my mouth was to small for all my teeth. As I was under eighteen at the time all of this was free.

I'm short sited. As a child I had several pairs of free glasses. I still receive subsidised eye exams by a qualified optician.

My daughter also has asthma and will, if necessary, receive treatment for the rest of her life at no/low cost.

My daughter suffers from double teeth. Her baby teeth are failing to fall out when her adult teeth erupt. Over the next few years she will have these extra teeth removed and receive orthodontic treatment to straighten the misaligned teeth. This will be free.

My wife has had more problems than most! Here's a sample of the treatment she has received:

Asthma medicines
Acupuncture for chronic sinus pain.
A Tonsilectemy (with a three day hospital stay).
An operation to remove polyps from her nose.
Physio therapy after breaking her ankle.
Two goes in an MRI machine whilst investigating the cause of a lower back pain.
Giving birth to two childeren with just over a week in hospital for both of them.

My wife's brother was diagnosed Schizophrenic at the age of twenty. He's been on various drug treaments since then and receives regular visits from a psychiatric nurse. He's also had several stays (one involuntry) in a psychiatric hospital.

Inumerable visits to the GP and A&E for minor ailments, cuts and sprains.

My father is one of the 'losers' in this system as he doesn't 'believe' in being ill. Although even he has succumbed to spectacles recently!

Is this better than basic US care? It's hard for me to know. My only recent 'experience' of the US system comes from 'House' and 'Ugly Betty'. In one, you get instant access to everything, so long as you have an interesting problem. In the other you have to choose between food and heart medicine, and spend hours on the phone to Medicaid.

Steve Buchheit | June 18, 2007 07:33 AM

ucfengr, "Or you could just emigrate to Great Britain."

It's easier to educate people like you so you all don't freak out when we change the system.

ucfengr | June 18, 2007 08:12 AM

It's easier to educate people like you so you all don't freak out when we change the system.

Perhaps you can start by explaining how the government have access to your library records is bad, but having total control over your health records and even your access to health care is good.

Steve Buchheit | June 18, 2007 08:33 AM

One is surveillance of activities with little return to the user (and little oversite from other branches of government and retricted avenues of redress when it's abused), the other provides a service with a great return to the user and can be done in the open, with oversite and redress.

Also, there are already private databases which collect this information (your health information, including diagnoses, precriptions, and long-term care issues, which HIPA was supposed to help with, but which has industry written loopholes) which have no oversite or controls placed on them. With government systems, we can place the proper controls on them.

Like how illegal immigrants can file with the IRS without having ICE have access to that information.

braxis | June 18, 2007 09:45 AM

[em]Perhaps you can start by explaining how the government have access to your library records is bad, but having total control over your health records and even your access to health care is good.[/em]

In the UK, for now at least, the government has no control of your health records.

The data owner of your general health record is your current GP and they are severly restricted in what they can do with those records. Basically, unless they have the patient's permission, or a police warrant, they are secret, and do not leave the surgery.

Again, the main point of universal health care is that it's universal, so I don't understand how anyone can claim control over access?

ucfengr | June 18, 2007 10:08 AM

Here's the story, from earlier this year, that prompted the tooth decay comment. When I read this, I was horrified that it could happen in the richest nation on Earth.

This is a good example of my comments about the differences between the poor and "not poor". I hate using personal examples, because I like to keep my private life private, but this one illustrates the point pretty well. My son was recently diagnosed with autism. After my wife and I got over the shock, we started doing research. What we found is that autism can be treated, but it isn't cheap, our insurance doesn't cover it, and the school systems are reluctant to fund it. This therapy can last several years at a cost of $20k-40k/year. Now I may not be poor, but their isn't $40k of wiggle room in my budget. We decided cost didn't matter, we were going to get our son treated and give him a chance at a normal life even if we had to spend every dime we had saved over 10 years of marriage and every dime we could beg or borrow. We attacked the problem from 2 directions, first we started studying the law to try to determine how we could get the school system (the controlling agency) to fund at least a portion of it and then started looking at our financial picture to determine how long we could fund it with our current income and assets. In the meantime, we made preparations to start the therapy out of our own pocket; we weren't going to wait for government to get involved. We were pursuing that avenue, but whether we got it or not, we weren't waiting (research shows that early intervention significantly improves the chance for success). We were fortunate; through our research of the legal issues and the case law, we were able to convince the school system that they were obligated to fund a significant portion of it, but the point is we weren't going to wait for government to come bail us out, like the unfortunate woman in the story. Looking at her example, if one of my kids had a tooth ache, I am going to find a way to get him into the dentist; I am not going to wait for some government agency to give me permission.

Let's look at Medicaid for a second. In 2005, Medicaid spent $305B providing health care to 57M people. This adds up to roughly $5.3k per person per year and they can't even provide basic dental care. This is who you want to turn your health care over to? I wouldn't let these people provide health care/insurance to Steve Buchheit, let alone someone I actually care for.

One is surveillance of activities with little return to the user (and little oversite from other branches of government and retricted avenues of redress when it's abused), the other provides a service with a great return to the user and can be done in the open, with oversite and redress.

Free books and internet access isn't a significant benefit to the user? And no one is compelled to use the public library, unlike many of the single payer health plans you folks advocate. Looks like you need a better grasp of the issues yourself before you can begin to educate me, Bubba.

Steve Buchheit | June 18, 2007 10:35 AM

ucfengr, gee, I didn't know the DHS and FBI were providing libraries with books and internet access? You know, the people who enforce the security letters to get the information from your library. Or do you not understand the difference in what I'm arguing here, the part of government (local) that provides library services and the federal police services and are you being intentionally obtuse?

Looks like you need to get a better basic education before I can help you.

braxis | June 18, 2007 10:50 AM

Let's look at Medicaid for a second. In 2005, Medicaid spent $305B providing health care to 57M people. This adds up to roughly $5.3k per person per year and they can't even provide basic dental care. This is who you want to turn your health care over to? I wouldn't let these people provide health care/insurance to Steve Buchheit, let alone someone I actually care for.

Newspaper reports put last years NHS budget at around 80 billion pounds - this equates to 120-160 billion dollars. The UK population is somewhere in the region of 60 million which matches nicely with the medicaid population. So the NHS, which is not noted for it's efficiency, can supply a much higher level of service for half the cost.

Scale it up and you could cover the whole population of the US for 800 billion dollars. Just over twice the price you're already paying, to gain a good level of care for every citizen.

ucfengr | June 18, 2007 12:19 PM

ucfengr, gee, I didn't know the DHS and FBI were providing libraries with books and internet access? Or do you not understand the difference in what I'm arguing here, the part of government (local) that provides library services and the federal police services and are you being intentionally obtuse?

Let's see, in FY07 the federal government provided almost $300M in direct funding to local libraries. The Department of Education also provide $12B in Title 1 grants to local education agencies, including public libraries, and that doesn't include indirect funding, so the feds are pretty heavily involved in funding public libraries, but you already knew that, didn't you professor,? A little insight into library operations to make sure that bad guys aren't exploiting the system doesn't seem out of line in exchange for the funding. I guess you could argue that libraries aren't directly funded through the FBI, but that's kind of silly. You would have the same objection if the DOE set up an anti-terrorism task force to focus on terrorist use of libraries.

Scale it up and you could cover the whole population of the US for 800 billion dollars. Just over twice the price you're already paying, to gain a good level of care for every citizen.

Number one, I don't accept your assessment of the NHS as all wine and roses. Number two, I don't accept your assumption that the same federal government that can't provide basic health care for half of what you purport to spend is suddenly going to be able to provide it for everybody while cutting their costs in half.

Steve Buchheit | June 18, 2007 12:36 PM

ucfengr," You would have the same objection if the DOE set up an anti-terrorism task force to focus on terrorist use of libraries."

Actually, I wouldn't mind seeing the FBI and DHS form such a task force and use court approved search warrants to access the data for real investigations inline with the recomendations of that task force. You know, instead of the fishing expeditions they use it for now.

Oh, and since those funds didn't come from the agency that would be performing the search and collection of the records, you only proved my point farther. Thanks. Or do you also view the "whole gubberment" as one big entity. You know, the Feds, those jack-booted, black helicopter flying dudes.

I'm going with intentionally obtuse at this point.

ucfengr | June 18, 2007 01:12 PM

I'm going with intentionally obtuse at this point.

Doesn't take you long to devolve to name calling. does it, Bubba? I guess if my argument quiver was as empty as yours, I'd be reaching for that last, bent-up, old arrow too.

Back to the glorious NHS, it took about 15 minutes of research to find out how the vaunted NHS promises such high quality service at such a low price, waiting lists. From "The Times" (http://www.timesonline.co.uk/tol/news/uk/article745245.ece):

"Harrow Primary Care Trust, which is facing a deficit of £8-£12 million, has asked the hospitals treating its patients to do “the minimum required” to meet national targets. In the leaked letter, Ken Walton, chairman of the trust’s professional executive committee, tells GPs: “This means patients sent for outpatient appointments will only be seen at 10-13 weeks (national target 13 weeks) and elective surgery will be delayed until the sixth month (national target six months)....It means that the maximum wait of six months promised by the Department of Health will become the minimum. However, the delays will enable the trust to postpone paying for operations, saving it money this financial year.”

It doesn't look like the NHS would have helped the young lad in the Washington Post article, does it?

It always amuses me when folks like Steve call me a coward for having the opinion that in wartime it is appropriate to be willing to temporarily sacrifice a little freedom and privacy in the interest victory, but they are willing to give up big gobs of freedom permanently for a pitiful little health care security.

braxis | June 18, 2007 01:22 PM

Number one, I don't accept your assessment of the NHS as all wine and roses.

I never said it was - I've listed some of the downsides in previous posts. If you'd like another example of the cons, my wife had to wait six months for her appointment with the MRI machine.

Number two, I don't accept your assumption that the same federal government that can't provide basic health care for half of what you purport to spend is suddenly going to be able to provide it for everybody while cutting their costs in half.

I wasn't making assumptions - I was comparing the factual costs of the two systems.

If your system can't do at least as well as the burocracy riddled NHS, then it is doing something very wrong. Maybe it needs to be scrapped and rebuilt?

Steve Buchheit | June 18, 2007 01:27 PM

ucfengr, "Doesn't take you long to devolve to name calling. does it, Bubba?"

I'll remind you that you reached for "Bubba" first. As for my argument quiver, I haven't even broken a sweat, yet.

And yes, givng up freedoms because you're scared kind of leads me to that conclusion.

And how is having a National Health Care single-payer system giving up freedoms. See, freedom of market isn't real freedom of real persons, but your politics blinds you to this point.

And, BTW, you're confusing several people giving you counter argument here with me.

braxis | June 18, 2007 01:44 PM

As I 'admitted' in my first post:

Where it 'falls down' is in the system chosen to ration access to expensive and/or time consuming courses of treatment. The UK does this (mostly) via the waiting list - the US (mostly?) via economic means.

And yes, our system would have helped the Washington Post boy as he would have:

Registered with a dentist at around one year of age.

Had regular (six monthly) free visits to that dentist.

Been able to book an extra, free, appointment with the dentist if he had a problem.

Received free treatment until he left full time education and began working.

So, the problem would have either been prevented by the regular visits, or treated whilst it was still a dental problem - rather than a brain infection.

ucfengr | June 18, 2007 02:42 PM

If your system can't do at least as well as the burocracy riddled NHS, then it is doing something very wrong. Maybe it needs to be scrapped and rebuilt?

Well, you are half right anyway, brax.

I'll remind you that you reached for "Bubba" first

Where I come from, "Bubba" is a term of endearment, no where is "coward" one.

And yes, givng up freedoms because you're scared kind of leads me to that conclusion.

If I was a psychologist, I might suspect you are engaged in a little projection. You're in a dark little corner of your bedroom wetting your pants over some imagined losses of freedom while calling me a coward because I recognize a real threat and am willing make sacrifices to address it.

And how is having a National Health Care single-payer system giving up freedoms. See, freedom of market isn't real freedom of real persons, but your politics blinds you to this point..

The reason these single payer systems can exist is because they mandate membership. In other words, the government forces you to join. I understand I may be talking about things that are beyond your comprehension but "mandate" and "force" are not synonyms for "freedom"

And, BTW, you're confusing several people giving you counter argument here with me.

No, I'm not. I generally reference the comments I am responding to and where I don't I address the person I am responding to by name. I understand how you might be confused, though. You all seem to be using roughly the same arguments so I could be responding to anybody.

Steve Buchheit | June 18, 2007 02:54 PM

ucfengr, "Where I come from, 'Bubba' is a term of endearment"

Yeah. I'm sure you meant it in the most positive way. Like when you called President Clinton, Bubba.

So you're saying that Social Security, Taxes, Drivers Licsenses, resigistering for Selective Service, all those nasty things the government "forces" you to get take away your freedoms?

And again, freedoms of market are not personal freedoms.

Well, there's a group of Constitutionalists here in Ohio you can join.

Steve Buchheit | June 18, 2007 02:57 PM

Sorry, ucfengr, I meant to say "when your primary news source, Fox, called President Clinton, 'Bubba.'"

I've been reading you're argument habits so closely, I'm starting to adapt them.

ucfengr | June 18, 2007 03:40 PM

Like when you called President Clinton, Bubba.

I don't recall referring to former President Clinton as Bubba, though he probably met the criteria (good old boy from the South, into fried foods and pick up trucks, not opposed to women of questionable virtue) and I probably won't refer to any future President Clintons as Bubba either.

So you're saying that Social Security, Taxes, Drivers Licsenses, resigistering for Selective Service, all those nasty things the government "forces" you to get take away your freedoms?

Are you saying they don't? You seem to have a very funny definition of freedom; when the government forces me to do something I don't want to do, but you want me to do, you consider that freedom. I guess the old cliche' is true (at least in your case), "scratch a liberal, you'll find a fascist."

when your primary news source, Fox, called President Clinton, 'Bubba.'

My primary news source is the internet, my primary television news source is my local NBC affiliate. I will occasionally watch the Fox News business shows during my morning exercise routine (they re-run them until 6AM)., though I am just as likely to have some music on.

So far as I can tell, I have never met you, yet you assume to know a lot about me, most of which appears to be wrong. If I made the assumption that all members of a minority group are alike, I would be rightly caused a racist. What does that make you when you assume that all people who disagree with your are alike?

Steve Buchheit | June 18, 2007 03:47 PM

ucfengr, "So far as I can tell, I have never met you, yet you assume to know a lot about me, most of which appears to be wrong. "

Hey look, we must have something in common. You think this about me an I think this about you.

ucfengr | June 18, 2007 03:57 PM

Hey look, we must have something in common. You think this about me an I think this about you.

What personal assumptions have I made about you?

Steve Buchheit | June 18, 2007 04:38 PM

June 18, 2007 12:19 PM "You would have the same objection if the DOE set up an anti-terrorism task force to focus on terrorist use of libraries."

And I showed you wrong in my next post to you.

June 18, 2007 02:42 PM "If I was a psychologist, I might suspect you are engaged in a little projection… because I recognize a real threat and am willing make sacrifices to address it."

Like I haven't recognized a real threat and made sacrifices to address it. Oh, yes, yours is the first generation to face a "real threat." The rest of your argument I could go apply it back toward you but it would become recursive.

June 18, 2007 03:40 PM "I guess the old cliche' is true (at least in your case), 'scratch a liberal, you'll find a fascist.'"

June 18, 2007 01:12 PM "It always amuses me when folks like Steve call me a coward for having the opinion that in wartime it is appropriate to be willing to temporarily sacrifice a little freedom and privacy in the interest victory, but they are willing to give up big gobs of freedom permanently for a pitiful little health care security."

Hmm, I don’t' remember having the government controlling big databases to provide needed service as being a big freedom swap. Also, "Folks like Steve." There's folks like me here? Reminds me of the Monty Python and the Holy Grail Skit. "You're all different!" (and in the back someone shouts, "I'm not.")

And since you brought that argument over here.

June 12, 2007 01:44 PM "Maybe the courts could award them Social Security and Medicare benefits; then you could break out the champagne."

Funny, I don't have any champagne. And SS and Medicare wasn’t a part of my argument anyway.

June 12, 2007 08:15 PM "Also a lot of folks seem to be having problems separating their hatred for Bush from this discussion. It's not hard to imagine them being quite a bit more sanguine under a President Clinton or Obama."

I don't remember hating President Bush. Sad, disappointed, looking forward to when he's no longer President. But I don't remember hate.

ucfengr | June 18, 2007 04:47 PM

Note I said personal assumptions, like this one here,

Oh, yes, yours is the first generation to face a "real threat."

What generation am I?

Not policy ones. I am about to make a personal assumption about your reading comprehension, but it will be based on your posts, not just on the fact that we largely disagree.

ucfengr | June 18, 2007 05:01 PM

June 18, 2007 03:40 PM "I guess the old cliche' is true (at least in your case), 'scratch a liberal, you'll find a fascist.'"

Using out of context quotes to support your argument? Come on, Steve, this is just sad.

Funny, I don't have any champagne. And SS and Medicare wasn’t a part of my argument anyway.

Wow, it's like arguing with a three year old. When someone says "I'll do "x", when pigs fly" you aren't meant to take it literally. I don't have any insight into the contents of your refrigerator and I think you quite stupid to assume that I really thought I did.

Steve Buchheit | June 18, 2007 05:05 PM

ucfengr, but we were so close.

And I'm sure you also meant to call me a "fascist" using it in it's most positive sense. Like, "What lovely fascists we have down the street. We should have them over for dinner soon."

John Scalzi | June 18, 2007 05:10 PM

Steve, Ucfengr, don't make me turn this blog around.

Steve Buchheit | June 18, 2007 05:20 PM

Sorry, John. I'll make nice. And I apologize to the other commentors for participating in hijacking this thread.

ucfengr | June 18, 2007 05:39 PM

Steve, Ucfengr, don't make me turn this blog around.

But..but..but, he started it. (Sulks) Man this family sucks. BTW--Sorry for the multiple consecutive posts, I know it offends your aesthetic sense.

And I'm sure you also meant to call me a "fascist" using it in it's most positive sense.

Nope, Steve; I meant in sense of someone who thinks he should be able to force people to make personal decisions that he approves of, but that they wouldn't volunteer to do. Like say health care; you approve the British NHS, a system that exists because it is able to force people to participate. Contrary to some of its advocates, very few people would volunteer to accept such a crappy system when much better private alternatives exist.

John Scalzi | June 18, 2007 05:44 PM

Ucfengr:

"But..but..but, he started it."

Yes, well, I'm ending it.

More to the point, it's clear the two of you push each other's buttons a bit. Best if you guys attempt only to address the policy aspects of your arguments, without speculation as toward the political/personal habits of one another. Simple.

braxis | June 18, 2007 05:54 PM

ucfengr:

you approve the British NHS, a system that exists because it is able to force people to participate. Contrary to some of its advocates, very few people would volunteer to accept such a crappy system when much better private alternatives exist.

I couldn't let this one go.

At least 50% of the British voting population disagree with you. How do I know this? From the fact that not even the most right wing of our governments in the last 60 years have even dared hint at getting rid of it.

The steel industry, mining, the Post Office, even the transport system have passed back into private hands in the past 25 years; but even Maggie Thatcher, at the height of her power, knew that threatening the NHS was political suicide.

ucfengr | June 19, 2007 08:29 AM

At least 50% of the British voting population disagree with you. How do I know this? From the fact that not even the most right wing of our governments in the last 60 years have even dared hint at getting rid

The same could be said for the Social Security system in our country. People will fight tooth and nail to protect it, but how many would volunteer to join a system that forced you to contribute 12% of your income throughout you working life to a system that only promised a 1% return on investment, and even that 1% is subject to the whims of the political class.

Anonymous | June 19, 2007 11:48 AM

Presumably those people who 'will fight tooth and nail to protect it' count as volunteers to this system?

The ROI is irrelevant. I can't think of a single insurance product, government or commercial, where I'd want to be on the 'winning' side.

braxis | June 19, 2007 12:25 PM

...except for pensions!

ucfengr | June 20, 2007 09:08 AM

Presumably those people who 'will fight tooth and nail to protect it' count as volunteers to this system?

I probably should have been more clear. I think the current beneficiaries of the system are fighting tooth and nail to protect it. For them it makes sense, they have already paid into the system (a lot less than future beneficiaries will have to pay). Their ROI is quite good. For people on the other side of equation, those paying into the system the deal is not quite so good; in fact it is quite bad. Very few people my age (30-40's) are counting on Social Security at all; I kow I am not. If it is there, I will take the check, but given a choice I would much rather forgo the check and put my money in a private retirement system. I think it is quite reasonable to assume that very few people would volunteer to join the Social Security system. The problem is that the people that benefit from the system vote in much greater numbers than those the pay into the system, and as the baby boom generation starts retiring that discrepancy will increase.

The ROI is irrelevant. I can't think of a single insurance product, government or commercial, where I'd want to be on the 'winning' side.

Social Security is a retirement product as well as an insurance product. Every body plans on being on the "winning side" of the retirement part, but very few would like to be on the "winning side" of the disability part. Even at that, the fact is that their are private products that are a much better deal than either the SS retirement plan or the disability plan.

Post a comment.

Comments are moderated to stop spam; if your comment goes into moderation, it may take a couple of hours to be released. Please read this for my comment moderation policies.
Preview will not show paragraph breaks. Trust me, they're there.
The proprietor generally responds to commenters in kind. If you're polite, he'll be polite. If you're a jackass, he'll be a jackass. If you are ignorant, he may correct you.
When in doubt, read the comment thread rules.




Remember Me?

(you may use HTML tags for style)