Mary Warner, in the previous post about healthcare:
I’m one of the millions of Americans already benefitting from Socialised medicine. I’ve been on Medicaid since last Summer. Before that, I’d gone a few years with no insurance at all, which was very difficult as I have pre-existing conditions and some expensive prescriptions. But even so, I’d much rather have the US scrap all mandated insurance, and abolish the most of the regulations we currently have, and try to return to an actual Free-Market system. We have far too much Socialism in this country already, and letting the Government into everybody’s private medical concerns would just let them continue to erode our freedoms even farther, I think. This could very well hurt myself, I know, possibly severely. But what’s right for society, and what’s most beneficial to oneself, are not necessarily the same thing.
You’re all going to gang up on me over this, aren’t you?
There shall be no ganging! For I am one, and therefore I shall not gang.
Look, I get that libertarians recognize – correctly – that the United States is not a classical free market when it comes to healthcare. But as many a writer has pointed out better than I could before: a perfect free market in healthcare cannot exist, because in order for a free market to operate properly, consumers and sellers need a perfect amount of information, or at least something close to it.
You can’t get that in healthcare, mostly because medicine is so complex that doctors actually have to specialize in sub-areas of it to have a realistic shot at doing their jobs properly – forget about you, the non-doctoring schmuck, being able to accurately determine which treatment is best for you, even if you spend whole days on the internet. You can’t do it; even doctors mostly have to make educated guesses for the serious stuff. And that’s before you get into the idea of effective cost. Do you feel confident taking the $1000 surgery over the $1500 surgery? Christ, I wouldn’t – but that’s not a rational decision based on the relative skill of the surgeons, it’s just the root assumption that the more expensive surgeon is the better one, which isn’t necessarily true and how could I tell?
(I’ve had people seriously inform me that they know how good hospitals are based on the politeness of the staff. I mean, polite staff are nice and all, but I will pick “staff more likely to save my ass” over “staff more likely to ask me if my pillow is fluffy” ten times out of ten.)
On top of that, it’s not a free market because for the majority of serious treatments, you don’t have the opportunity to refuse. If you need chemotherapy and it’s two thousand bucks, you are not going to sit back and say “well, I’m gonna wait for the spring sale.” You spend the money. And you spend it right away. Because you’re a captive to the necessity of care, and therefore you are not a rational, discerning consumer.
And on top of that, you need some form of regulation because, hey whoops, healthcare is really expensive. There are exactly two ways to lower this cost and neither one of them is “competition.” The first way is for government to mandate how much healthcare costs, typically by employing all the doctors, or alternately by telling doctors what they can charge. The UK goes the employment route; Japan, Canada, and most of Europe goes the dictating-prices route.
The second way is through massive risk-pooling. The concept of insurance is simple: everybody pays a little into a collective fund against the risk that something bad happens to them. If something bad happens to you, the people who did not have something bad happen to them’s money goes toward fixing your something bad. This way, everybody pays a little, rather than somebody going bankrupt because of the bad thing (and since that bankruptcy can have ripple effects, in the long run it’s better to help them anyway, so it’s basically win-win).
But that concept doesn’t work for health insurance, because unless everybody dies a tragic instantaneous death or is healthy as a horse till the age of 98 and then dies peacefully in their sleep, what happens is that eventually everybody will get old and need to access health insurance – and the old people who use health insurance the most are also the biggest drains on the system. Thus, the only way health insurance works is if the healthy, young majority subsidizes the old, sick minority, on the theory that eventually they too will be old and possibly sick and will want the young people of tomorrow paying their way. And so on, and so forth. But this only works if the young people pay into the health insurance system – which (beyond maybe catastrophic health risk insurance for those inevitable bus crashes) they have absolutely no selfish incentive to do, because they are young and healthy and don’t really need health insurance to cover their yearly physical.
Thus, the concept of mandated insurance and/or universal participation. This is the other way that every country in the world with a decent healthcare system lowers costs. It works, and so the right-wing in America is predictably shitting a brick over the idea that it be proposed.
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Personally I don’t think you can aply the label of socialism to every European health-care system: certainly when you consider the negative annotations it has in the eyes of US-citizens.
I live in the Netherlands myself and I think you could classify the healthcare system as a regulated market system, which is something different. For the reasons mentioned in your post everyone is indeed obliged to take health-insurance.
However, the health-insurance sector itself is basically a free market: although the government mandates a ‘base-package’ of certain treatments that have to be supplied, the insurance companies decide prices and extra packages themselves.
This is not a socialist system: some parties (social-democrats and socialists) wanted to introduce a socialist system, but the right-wing government at the time did not like the idea: it would be overly expensive in the long run.
(just to clarify: a socialist system would consist of one mandatory healthcare insurance company for everyone, in which you would pay more money if you’re income is higher. That’s socialism.)
I don’t see the point in engaging with conservatives anymore–sensible and reasonable replies don’t draw them away from the knee-jerk opposition to anything that smacks of socialism (read: anything proposed by anything other than their own party).
The only rational thing to do with conservatives is crush them. Let them find some rational basis to object to public health care even as they benefit from it. Mary doesn’t like it, but “socialism” keeps her alive and solvent. If she’d prefer to drop dead, it’s her privilege.
This lady’s post starts off intelligent enough, but by the end it’s degenerated into right-wing buzzwords instead of an argument.
Mary, if you’re around, I’d appreciate an argument as to WHY Socialism “erodes your freedoms”, bearing in mind that Christopher and I and presumably others who post here all live in a country that’s had socialized medicine for a long time and has somehow resisted becoming a totalitarian state.
Three replies in, and yes Mary, they are ganging up on you.
I don’t get why people have a problem with “socialized” medicine yet have no problem with “socialized” police, fire departments, infrastructure, etc.
Further, the US already has a “socialized” medical structure. That is, anyone who wants health care will not be refused, because on some level, we’ve agreed it’s a right, and eventually, we all share the costs… usually through bankruptcy, higher premiums, and higher medical bills. The delivery and payment system is horribly inefficient, the profit motive drives the denial of care, marketing and bad medical dramas have turned many patients into armchair quarterbacks who demand the most expensive treatment even when its unneeded, and the skyrocketing costs of a medical degree mean that anyone who wants to be a GP can’t afford to pay back their loans.
There’s a bajillion things wrong with our medical system, and none of the things I’ve seen “conservatives” suggest solves any of them. They just want to get re-elected by chanting “socialism,” “death panels,” and “Hitler,” hoping people will stop asking inconvenient questions. I’m truly amazed they’ve convinced as many people as they have that going bankrupt when you get sick is better than having even the smallest hint of a safety net that could get you back to being a productive citizen.
Libertarians just need to face reality. Libertarianism fails in every practical application of every idealistic notion it has.
Libertarianism is the political equivalent of the 2nd ed. AD&D Psionics Handbook – lots of really interesting ideas, but absolutely not manner to bring any of them into practical application, and it falls apart with every single attempt.
Oh good show, sir! Highly nerdy analogy!
I don’t get why people have a problem with “socialized” medicine yet have no problem with “socialized” police, fire departments, infrastructure, etc.
Because their favorite political party failed to get elected last year.
I don’t think of it as “ganging up”. I think of it as an intervention.
Mary. You are telling everyone, “I believe in voting against my own best interests, possibly dangerously or even fatally so given my medical conditions, in order to uphold an abstract point of political principle which I don’t fully understand.” What part of this sounds like a good idea to you?
Some good points, but doctor charges are only a small part of the reason hospital charges are so high. Cost of drugs, other staff, lab work (with all the machines and reagents involved, probably the single greatest cost, actually), and just keeping the lights on in the hospital all add up really fast. If anyone was serious about healthcare reform in this country, they wouldn’t be talking about insurance – they’d be figuring out ways all around the board to cut costs and pass that on to consumers. But doing things right would be really hard and time-consuming, so nobody wants to do that.
I like the way that we’ve kept the cost of medicine down in sweden, the goverment only subsidizes the cheapest variant of the drug in question. if people want a different brand, they pay the difference between the subsidized brand, and the one they want out of their own pocket. That way the companies keep lowering their prices, competing to be the cheapest one, and people still have a choice of what to actually get.
We pay a LOT less for the same medicines than they do in the US.
Rattsu: Generally, insurance companies and social programs (welfare & the elderly) in Canada follow the the same plan. There is however, a cost to that in that the companies who make the cheaper variants (novopharm, apotex) do not do any research.
This isn’t a problem right now, as the US drug companies are still doing the research, but if the US did the same thing, it could kill innovation.
The obvious solution to the problem is that Governments should fund research (not just drugs, but more funding for science altogether.) But, all that does is transfer the cost from the health care system to the research councils. And of course, that would be socialism.
BTW, Insurance is fundamentally socialist.
This may sound rude, but I have some pretty serious doubts about Mary’s story. Not just the fact that she admits she’s dependent on Medicaid but thinks we should go to a pure market-based system–why, what a perfect libertarian test-case! Nor all the time-tested buzzwords and canned arguments about socialism, malpractice suits, the perfection of the free market, etc.
No, what sets my alarm bells ringing is that I have never, ever, seen an American use the “socialised” spelling. (Or “malpractise,” also buried in her comment.)
Maybe I’m wrong, maybe they’re just spelling errors, and if so I apologize. But if this is a British or Canadian sock puppet pretending to be a noble, suffering American… look, I’m sure it’s very lonely being a libertarian up/over there, but we’ve got enough of our own, okay?
“(I’ve had people seriously inform me that they know how good hospitals are based on the politeness of the staff.”
C’mon, that’s ridiculous- have you never watched HOUSE? (Hot) cranky genius FTW.
I will pick “staff more likely to save my ass” over “staff more likely to ask me if my pillow is fluffy” ten times out of ten.
This is sort of how I pick, but instead of “to save my ass” I usually go with “to remind me of the cast of Scrubs.
Important point to make: All those runaway costs? That money doesn’t vanish into the ether. That’s all profit for someone.
When doctors and hospitals “cut waste” they’re often cutting profit-making procedures and tests–stripping regulation won’t lower those costs, it’ll just make it easier for the experts (doctors) to recommend extra spending er, I mean tests.
Maryland sets rates at the state level. Minnesota has non-profit insurers only. It’s not like there’s no precedent for sensible reform in this country.
Like most Canadians, I cannot for the life of me figure out what the hell these people are complaining about.
I have a theory that the high price of health care in the U.S. is indirectly subsidizing health care in other countries. For instance, drug companies can afford to go along with price fixing in Europe because they’ll make their profit off the stupidly high prices in the U.S.
(No, this is not an informed, researched opinion. It’s a random off-the-cuff comment to a blog post. Lay off.)
If I’m right, then if we get in the U.S. get our nat’l health care, and it becomes powerful enough to control costs, then the rest of you furenners should start seeing your costs go up. Ha, that’ll teach you.
Everyone is ganging up on Mary. It’s like in grade school when the kid who was totally not me was made fun of for not showering often enough. It was mean, but there was a point to the cruelty.
Look: everywhere in the world but America, there is “socialised healthcare.” And also, freedom. And conservative parties. And the conservatives in Germany and France and Canada (well, University of Calgary apart) aren’t campaigning for an American style health care “system.”
Because “socialised” healthcare is like “socialised” roads. It is an unalloyed social good, and in no way a dangerous modern innovation. (On the contrary, “private sector” health care is a brief-lived modern aberration.)
(I’ve had people seriously inform me that they know how good hospitals are based on the politeness of the staff. I mean, polite staff are nice and all, but I will pick “staff more likely to save my ass” over “staff more likely to ask me if my pillow is fluffy” ten times out of ten.)
I’ve spent the past 3 months dealing with multiple stays at various hospitals for one of my parents. I can say with absolute certainty that politeness matters. Across the board, the places where hospital employees see the patient as an individual who they, yes, need to be polite to, have given better care. It’s not about being nice, it’s about perceiving patients as human beings rather than a chore or an inconvenience.
“Everyone is ganging up on Mary. It’s like in grade school when the kid who was totally not me was made fun of for not showering often enough. It was mean, but there was a point to the cruelty.”
Only in the post-Bush and Palin era is a request for a clarification on your position considered “ganging up.” Several people have asked her questions which, indeed, challenge her position. But that’s kind of the point of a public forum and debate.
I’m not going to gang up on Mary, I’ll leave that to the Death Panels.
I don’t understand how having my life dependent on someone else’s profit motive protects my freedoms.
If someone can explain it to me simply, I would appreciate that.
I think we should have some cancer patients who were denied care start immolating themselves on the steps of the Capital just like those monks in Saigon. A few of those would change the debate right quick.
I’m like 95% sure Mary is trolling.
But the fact that there remain significant numbers of people in this country who are apparently sincere in their belief that people need the “freedom” to die in poverty of preventable or treatable diseases is pretty ghastly all the same.
In Canada, anyway, there’s actually a period of time where the company that develops any given drug is the only one who gets to make it for X years. I think it’s around 10, but maybe more.
So, you know, it’s not like Pfeizer can come out with a Panacea, and the next day you can get Apo-Cureitall.
And seriously, you know what? Don’t feel bad for these guys. TWhen C.E.S. was discontinued except in 0.625mg, Wyeth, the makers of Premarin, the only equivalent drug for those strengths discontinued, increased in cost by an exorbitant amount.
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090603/premarin_090603/20090603/
Seriously. Wyeth says that an “800 percent” price increase is “fair and reasonable.”
I love the whole implication that unless everyone who has a problem with what Mary said basically just shuts the hell up, then they’re “ganging up.”
Well, it’s a little difficult for me to respond now. It does feel a little like you’re all ganging up on me (this isn’t a criticism; just an observation). I didn’t realise you were going to devote an entire article to what I said. I thought I’d just be one commentor amoung many, and that people would be responding to each other as much as to me.
I’m kind of shy in real life, so please understand that it’s hard for me to speak freely in a situation like this.
First of all, I guess I should say that I wrote what I did in a hurry, just a spur of the moment thing, so I probably didn’t explain my views as well as perhaps I should have.
I don’t want to give the impression that I have a well-thought-out plan for private, free-market medical care. I don’t. I have thought about the issue many times, but there is a lot I don’t know, and it is very complicated, so I can’t guarantee that a free-market system would necessarily work well. It’s just that I feel that the idea needs to be examined, rather than simply rushing into a huge, expensive, convoluted Government-run system.
I am fully aware that the various Socialist plans found in most countries do work reasonably well. It wouldn’t necessarily be a disaster if it were tried here. (Although it could be disastrous if it’s done wrong, and I really don’t have trust the competency of the Federal Government.) And I know that not all of these other countries have a fully government run system of medical care. I know there are private-state versions that do allow market principles to work. (I’ve heard good things about the Australian system, but I don’t know a lot about it.)
I do think that if we have to use some kind of government-funded and -run programme, it should be done by the states, not by the federal government. It’s a better fit for American political culture, the beauracracies would not be as huge, and once the programmes have been going for a while, it would be much easier to know what’s working and what isn’t. I really fear a national version could ruin everything and be difficult to change.
But that’s only if some government programme has to be done. I still haven’t given up on a purely free-market version.
To respond to a few specific criticisms… A free market doesn’t actually require perfect information, like MGK said. It only requires that most of the important information is known to the people involved. Nobody has perfect information, that’s why we get bubble-markets. But despite what people like Michael Moore might claim, the existence of market crashes such as the recent one does not invalidate the whole system. The gradual stagnation and increasing inefficiencies found in non-capitalist economies tends to do more damage over time. The lack of information would cause a lot of problems in a free market for medical care, but as far as I can tell, the lack of information causes a lot of problems for the various Socialist systems as well. I’m not sure why it would be any worse.
Marc, I really am American. I’ve lived my entire life in Oklahoma, and I’ve never been farther away than Corpus Christi. But I do use British spellings and punctuation most of the time. I’ve been doing that since I was a teenager. I just never liked the idea of having different spelling conventions in different countries. We have enough dialect differences already; we don’t want to make communication any more difficult. And since British spellings tend to be the international standard, that’s what I use. Also, and this is probably an even bigger reason, from an American perspective, UK spellings look cool.
Sombody else said that I’m ‘trolling’. I’m still pretty new to the internet and I don’t know what that means. I know it’s a common insult on here, but I can’t respond without knowing more.
I had planned to respond to several other comments on here, but I’ve been writing for more than an hour and I’m tired.
I might say more later- I’m not sure.
Thank you all for disagreeing nicely. (Most of you.)
I’m going to go ahead and reply to Ed (Jack Norris), since his comment wasn’t there when I started writing the last thing, and I don’t think it should go unanswered.
I never meant to imply that people had to agree with me or shut up, or that if they did disagree, that that would constitute ‘ganging up’. It was mostly just an off-hand remark, meant to be a little funny, because I knew that I would be getting criticised. But I guess what makes it ‘ganging up’ is the fact that EVERYBODY is in opposition, many of you quite strongly, and that is always intimidating, even on the internet. This is why most people, when they hold an unpopular opinion about something, are reticent to speak up about it, particularly when nobody else is around who might agree.
But please don’t think that I am against other people voicing their own opinions, under any cirumstances. I am a free-speach fanatic, even when it’s something I really don’t want to hear.
@ Mary:
1. You’re on Medicare
2. You’re alive
So you DO trust the federal government to run a medical program, even if you don’t realize it.
Having the many states run public insurance programs is the worst solution imaginable. 57 different programs, when you count DC and territories? How is that possibly a better, less complicated system? What happens when you get hurt on vacation? This is leaving aside the fact that states, by and large, don’t have the budget to run a health care system that’s not a mandate like medicare/medicaid. I live and work in North Carolina and we actually do have a last-resort reinsurance pool and it covers all of .02% of the population. Just the people who could not get insurance (even the Blue Cross junk rate) any other way. And, you know the state had to cut 20% out of the budget in the last fiscal year. So how’s that going to work? There’s a reason why in the ARRA (the Recovery Bill Obama signed in February) counted the FMAP (Federal Medical Assistance Percentage) increase as a state budget stabilization measure, because it allowed states to use all those funds that go to medicare (which are increasing as people lose jobs, and therefore coverage and get sick) to move to, say, payroll. Because states have to have balanced budgets.
Look, I assume that you’ve read this blog for a while and are award of the somewhat varied breadth of knowledge that gets thrown around here. Frankly, you shot from the him in a subject that people know a lot about from a purely ideological perspective and got called to the carpet for it. There are worse things than being forced to defend your beliefs.
There is no rushing going on. People in the US have been trying to reform the system for many, many decades. The current reforms are even a watered down version of what people have tried to implement. There have been armies of people examining and thinking about this. There are dozens of countries that can be examined as a guide of what to do, and what the likely consequences are. And even the current reforms won’t take effect for several years.
The impression that things are being rushed is either because you are personally new to the topic, or because you have picked on the right-wing talking point that things are being rushed.
“picked up on” not “picked on”
Isn’t Canadian health care run by the provinces? I read somewhere that that is the case, but I don’t know for sure. So it does seem that it should be possible for US states to do it. And if the Federal budget is shrunk significantly, federal taxes could be reduced and state taxes raised to cover the medical programmes without a significant increase in overall taxation. (At least no more than what would probably be needed for a national medical programme.)
Getting back to something somebody said earlier, I’m not one of those fanatical libertarians who wants private roads and police departments. I do want much less government in general, but I do want to keep the most essential parts. That does include schools, and the military (although I would like to shrink it quite a bit), and I’m willing to accept some government funding of emergency medical care (which I think is the part most likely to suffer in the free market). But too much government funding would result in government control, and that’s the part that scares me.
I guess I have trouble trusting any institution which so much power. I much prefer seeing power distributed widely, so that nobody has very much of it. The Government does so much already that really turns my stomach (war in Iraq, drug laws, ‘Homeland Security’, immigration restrictions– there’s a lot more, but these are some of the worst offenses), that I just don’t trust the idea of letting them do anything more. And once the Government (any government) gets its hands into something, it becomes almost impossible to ever get it to stop. Look at some of the ‘temporary’ measures from World War II that are still around, or even World War I. (Daylight Savings Time began as a temporary measure for World War I. So did passports.)
Mary,
to troll, in the context of posting on a website with other commentators, means that you are writing in order to inspire an angry response from the other commentators. Don’t ask me why.
I’ve seen two different derivations of the internet verb ‘to troll’. One claims that it comes from the fisherman’s term ‘trolling’, which means to drag a net over the bottom of the sea, to dredge up all the mud-dwelling creatures and fish. The other derivation is from the mythological ‘trolls’ of Scandinavia. Big, ugly meanies who lived in the woods, collected gold, exchanged their own babies for human babies, and generally made people’s life miserable. Both these possible origins of the word seem rather probable to me.
In fishing, trolling is to toss a hook in the water with no bait or lures, then drive the boat back and forth until it snags on something. Fishing with none of the usual thought, effort, or sport.
On the internet, Trolls drop inflammatory statements on forums until someone is silly enough to take one of them seriously and try to respond seriously. They then spend the evening fanning the flames for their amusement. A Troll doesn’t usually believe what he says. He’s just trying to provoke you.
I’m not entirely convinced that it’s useful to talk about “health care” like it’s one thing. The beast that we call “health care” is a multi-trillion dollar per year sector of the economy: it just seems prima facia unlikely that anything that large can really have too many characteristics that apply all across it.
Specifically, check out the differences between:
1. Routine care for a basically healthy person.
2. Emergency one-time costs resulting from a disaster (like, say, a car accident)
3. Chronic-long term care.
Of those three, it seems to me like only the third is particularly problematic.
Routine care for a basically healthy person can probably be handled with a purely market-based system (no insurance or anything, just pay for it like you pay for anything else). Information problems like “I don’t know how to qualify a good doctor” can be handled through any of the existing well-understood ways we have to deal with that, like accreditation, and anyway the downside of choosing a less-than-optimal routine care physician are not all that severe.
Short-term disaster medical care, like “I broke my arm,” or “I got appendicitis,” could be well-handled by traditional insurance, very much like auto-insurance. It doesn’t have inevitability problems (lots of people go through their lives without ever breaking limbs or having curable short-term acute diseases), and it doesn’t have the unbounded upper ceiling on costs that chronic long-term care does. And, definitionally, there’s no such thing as a pre-existing condition for a disaster.
So, finally, you have the most problematic form of health care: people whose health care costs can literally run millions of dollars over decades. Usually, people with a particularly bad illness, or people late in life whose health is just generally fragile enough that they get lots of minor illnesses. This is certainly the toughest case to address with traditional (ie, non-socialized) healthcare models, and, accordingly, it’s where the strongest arguments for socialized healthcare rest.
I think it’d be interesting to see whether breaking healthcare down from the current monstrous sector to some kind of subdivided concept — whether it’s the one I sketched out above or some other division — and targeting government intervention to the portions that it fits the best, would change the debate at all.
Michael Sullivan brings up some good points. Restricting Government funding to just the severe chronic illness, or maybe the more extreme emergencies, while leaving routine service to the free market is probably a good compromise.
I just wanted to say again that it is really hard for me sometimes to state my opinions clearly amoung people who strongly disagree. I have a strong instinct to be nice and agreeable, and I tend to get terrified at the possibility that people might hate me. It’s not much of a problem when I’m just one person leaving a comment amoung many others, but being the centre of the discussion like this is very difficult. I’ve been a nervous wreck all night while reading these comments.
So I want to thank everyone again for being so nice. I know there are a lot of places on the internet where people constantly insult each other for no apparent reason, or where any dissenting opinion is subjected to strenuous abuse. But that hasn’t happened here. You have all objected to my ideas (which I admit were not well organised), but you have done so with reasoned arguments in most cases, and the criticism has all been directed towards my views, and not against myself. I do appreciate that.
I hope I’m not too afraid to comment on future posts after this.
“(Daylight Savings Time began as a temporary measure for World War I. So did passports.)”
So? It is possible that temporary measures may be retained if they fulfil a need that extends well beyond the original circumstances that spawned it.
Re: the Canadian system, health-care is managed and delivered at the provincial level, but federal regulations ensure that certain basic levels of service are mandated across the board, which also is a requirement if the province wishes to receive federal funding. This website is helpful:
http://www.hc-sc.gc.ca/hcs-sss/index-eng.php
If you’re vacationing for a short period in another province, you can just show your provincial health card and they will bill your home province directly.
Mary, I totally understand you worrying about the government’s level of competence, but it seems strange to complain about it in this particular instance, because I can’t see how a shift to government health care could possibly be WORSE than what you have now. People who can afford it will always be able to get superior care; people who can’t will get government-sponsored health care, and no matter how terrible that may be, it’s got to be an improvement on absolutely no care whatsoever, right?
A distrust of authority is healthy and American (well, I assume, being Canadian myself, but it sure seems that way). But the thing to bear in mind is that this isn’t an issue about authority vs. freedom; it’s a choice between two authorities. The authority of the government vs. the authority of a large corporation. Of those two, one is arguably less efficient (though Lord knows giant corporations can be bureaucratic too) but it’s answerable to you. That’s the thing: it’d be one thing talking about the sins of the government if we lived in a monarchy, but in a democracy, the government is YOU. I feel like people who spread distrust of the government are frequently undermining democracy rather than promoting it, because in their headlong rush away from the government they help put power into non-governmental authorities that are NOT answerable to the people.
It’d be far better to take that skepticism and apply it to helping make the system work better, rather than trying to dismantle it.
Mary, I just wanted to say I probably wouldn’t have mentioned the ganging-up thing if it hadn’t been kind of taken up and built into its own thing in the comments.
I’ll admit that a few things you said did bother me, but I do get the impression that you are a nice, well-meaning person, so I suppressed the urge to pounce that some of the buzz-words you used might otherwise have inspired.
As a Recovered Libertarian, I have some sympathy for the things you place importance on; I actually totally agree with the sentiment “I much prefer seeing power distributed widely, so that nobody has very much of it” but over the years my belief in the same ideal has caused me to abandon the libertarianism of my youth and move significantly leftward as I’ve come to see that the most dangerous concentrations of power are in multinationals and high-end wealth, and the balance of power is clearly, blatantly out-of-whack in their favour, and what is usually lumped together as the “left” offers the only way of bringing them to heel and loosening their grip on the institutions that are supposed to answer to everyone.
Plus, the whole “socialized medicine threatens freedom” is just plain nuttiness. It threatens nobody but health insurance companies, who, considering their record of denying service and controlling treatment are no small threats to an individual’s freedoms themselves.
“Restricting Government funding to just the severe chronic illness, or maybe the more extreme emergencies, while leaving routine service to the free market is probably a good compromise.”
I disagree. If the routine stuff, including wellness visits, were covered, you’d have fewer chronic conditions. Further, you’re more likely to need routine visits, if by routine you mean sudden injury, infections, etc. Having had what was one of the top rated plans for small businesses once, I wound up paying 500 bucks a month for a policy that charged me three grand out of pocket for the removal of an injured toenail. Scissors, pliers, and three shots of local anesthetic shouldn’t cost as much as a used car no matter where you live.
“I disagree. If the routine stuff, including wellness visits, were covered, you’d have fewer chronic conditions.”
I’m pretty dubious about this. A lot of preventative medicine has been shown to be pretty ineffective at bettering healthcare outcomes. (Check out this New England Journal of Medicine article on mammograms, for example: http://content.nejm.org/cgi/content/abstract/351/5/427). Presently, I think that a lot of the stuff that happens at routine care is profit-driven, and that kind of detail-oriented little bits-and-pieces stuff is what the free market is particularly good at controlling. (A bureaucratic approach tends to fail in detail, as there are just too many cases and too many variations to codify into rules).
Note that the present system isn’t what I’m talking about: straight up paying out of pocket is. The present system makes the bureaucrats the insurance companies.
You’re right that scissors, pliers, and three shots of local shouldn’t cost thousands of dollars, and they don’t. Health care providers game the system and look for places that they can charge tons of money. A place like India, which has mostly out-of-pocket healthcare, has very reasonably priced routine care. And while I wouldn’t want to have India’s healthcare system for chronic or acute care, they’re just as competent with scissors, pliers, and three shots of local as were the doctors who charged you three grand.
Odd, the Onion posted something very similar to our topic here…
http://www.theonion.com/content/opinion/like_hell_im_going_to_let_some
A little late to the party here, but I’d like to add that Mary’s story smacks of sock puppetry to me as well. In fact, I’d go so far as to say it’s a sock filled with a bull’s fecal waste, animated with a stick, while a perfectly healthy libertarian dude holds his nose shut and talks about the sock’s health problems and free market political idealism.