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This is from my country, Norway.
In any case I'll assume no real offense was meant. The thing is that anything related to that time (SS, etc.) brings up a pretty strong response and the older someone is the stronger the response will be. It's probably best to avoid such references where at all possible.
In any case I am pretty liberal although you'll find that there is a surprise or two, for example gun control, but in general I try to put myself in the other persons shoes and that generally makes me side with those that are not as well off as I am.
Sorry for quoting so much of the post but as a fellow Canadian I wanted to comment on a couple of your points. Before I get started I want to point out that health care in wealthy nations unsustainable due largely to advances in medical technology. For example an MRI machine costs millions of dollars and it is not even close to being cutting edge technology. Much of the technology that makes many of the treatments we take for granted possible is apallingly expensive.
First off I do agree that our system has some major flaws. In Canada about 40 cents of every tax dollar goes to health care so using your numbers you pay around $5600 per year for health care, now if you were one of those horrible people who dares to make more money you would pay over $11,000. Now I know there are plenty of people saying well wait a minute my insurance costs me $16,000 sign me up for the $10,000 health care but it is not that simple. For one all governments here ration healthcare. It is commonplace for surgeries to be cancelled because the heath region decided to save money and not hire that extra nurse. Entire wings of hosptals sit unused as patients are shuttled from hospital to hospital in ambulances (at their own expense) as their beds are suddenly deemed 'closed' due to staff shortages caused by holidays and sickdays.
In the U.S. if you need an MRI you get wheeled to the MRI machine and get an MRI. In Canada they send you home and you hope you don't die before it's your turn. Once you are diagnosed in Canada then you typically get exceptional and relatively prompt care. In the U.S. if a hospital wants an MRI machine they go and buy an MRI machine. In Canada if a hospital wants to buy an MRI machine (or any other half assed new technology) they have to launch a massive fundraising campaign and hope that some of those dirty dirty rich people will make a donation.
The solution seems obvious just start up some private diagnostic clinics... but no wait someone might make money, and the major health care unions may be excluded... damn it seemed so promising. Let me point out that in one city in Canada we have a site (taxpayer funded) where addicts can go to 'safely' inject themselves with drugs.(I know it's off topic but I'm making a point) I believe they are provided with the drugs but I do not know that for certain and thus do not want to state that as fact. In this same city there is a group of prostitutes attempting to set up a brothel in time for the 2010 Olympics. So in Canada it is easier to start up a brothel and drug house than to start an MRI clinic. Go figure.
The point I am making is that our system like the US system has become stagnant and unweildy due to political ideology and lack of political will to change the status quo. In both cases major improvements could be made to the systems greatly improving the lives of everyday normal working people. There is a saying here that people typically get the government they deserve. As the people affected by these systems it is our responsibility to demand the nedded change and elect governments who will make the change.
As for your point about Alberta's taxes being lower because of their massive oil reserves you are only half right. The provincial government in Alberta does not spend nearly as much money meddling in people's lives as Quebec gvernments do. (ie your mandatory subsidized daycare programs.) Alberta also has no debt and they do not spend billions subsidzing inefficient companies who refuse to change their business practices. (ie Bombardier). Please do not interpret this as flaming you or your province Quebecers are clearly content with their way of doing things as Albertans are with theirs and the ability of provinces to more or less run their own affairs is part of what makes this country great.
In conclusion: we are in complete agreement... We both agree that the proverbial dart would provide us with a better system than what we have now, and we agree that there is an even better solution out there. And we agree that neither of the above will happen, at least not for a very long time.
It's kind of the blessing and the curse of the US legislative system. It forces things to move slowly. This is fortunate in many cases because problems can be discovered and prevented before they do real harm, and bad ideas can't be realized before it's too late (sometimes). Major changes require the ongoing support of the country (or maybe just the politicians..) for a prolonged period of time, which means that the ill-advised fad of the year won't swim.
The problem, though, is major reform is real damn hard, even in dire need. It's not so hard in the case of things like civil rights (women's suffrage, end of slavery and segregation et al) because despite their magnitude, they are simple changes. On the other hand, overhauling the healthcare system is... well, huge and complicated. We can't just wipe away the current system and start from a clean slate. We have to somehow migrate what we have no into something entirely different; and it has to be done piecemeal without a specific, clear target.
That's why I really do favor decision by committee. If a committee could come up with one comprehensive plan for what the system should be in 10 or 20 years, or whatever it needs to be, and if congress could agree enough to approve it, and continue to agree enough to fund it, I think that's the only way we'll end up with a half-decent healthcare system without waiting for the better part of half a century. I don't believe in taking lots and lots of little steps without even knowing exactly where we're trying to walk to - I think it'll just make things worse. And I think the only other two options are committee, and waiting so long that the nation literally starts to fall apart a the seems because of it that the government will have literally no choice but to actually take responsibility for once and do something about it (or more likely, fail to and let the country fall apart).
And as a side note: I really can't wait for the day that the politician who lets a lobbyist into his/her office is immediately stigmatized. Unfortunately I think I'll have to wait for a good dream...
The one difference is that I feel that the only possibilty for real change is for a strong leader backed by a strong congress to come out and say, we think country X's healthcare system is the best in the world and our plan is to do just what X does. Then as long as public support could be achieved and stay focused for a reasonable period of time then we could just make it happen as "the will of the people". But of course this is pie-in-the-sky and can never happen. What you've talked about would take decades and multiple administrations and congresses and an unprecedented attention span by the public. In other words it's even less likey than my pie-in-the-sky idea.
This makes *real* change pretty much impossible and we may as well be resigned to lip service which is more likely to make things worse rather than better. I live in Massachusetts and in some misguided effort to make any change there is now a state law that requires everyone to have health insurance and all companies to offer it to their employees. Failure to abide by this law results in a tax penalty that gets larger each year. This has done absolutely *nothing* to lower any costs. The health insurance companies *love* it because it forces more people into their plans and generally into individual plans as opposed to cheaper group plans. No costs have gone down in fact all insurance has gone way up this year. The insurance companies are getting richer, Massachusetts collects a few tax penalties and everyone else is business as usual.
If this is what we get at the federal level then we're all fracked.
A problem that I forsee in such an approach is that a healthcare system for one country may not fit in the system of another country. Taking the MRI scanners as an example, giving yours hospitals a fixed budget is not enough to make their price drop and could make your waiting lists grow out of control. The mechanism being used to keep these costs under control is a totally different branch of "system", in this case the European Tender legislation, which affects any purchase in the public sector.
Let's say you want to copy the system in Germany to the U.S. You then first need to study wether the system can function without the EU Tender system. Should you conclude U.S. legislation is not sufficient to make this function, you should copy the system how the public sector does it purchasing. Changing this is a huge effort by itself.
Copying a system is certainly a lot less work and faster than engineering one from scratch, but it is probably an illusion that a system copied from another country would function correctly. Some tweaking both inside and outside the healthcare system is needed, and most of this can only be done after experience in practise.
During the years that such tweaking would take place, many people opposed to change would claim "I told you that things would get worse, we feared for it, and it happened".
Plus I never assumed that if we took Germany's system as an example that we would necessarily spend *exactly* what Germany spends.
Basically I look at modelling a new system on someone else's current system an attempt at picking up the "low hanging fruit" in other words do the things that are easiest and make the biggest difference first and to me that's elimination of the health insurance industry and removing the employer as the source of most insurance. I think that's the hard part and most everything else would follow from that.
But like I said I highly doubt there will be any significant change regardless of the method used to decide how such change is to be done. Then if nothing really happens I won't really be disapointed and if some real positive change does occur I will be happy to admit I was wrong all along.
I whole heartedly agree with your point from the negative karma thread. As someone who spent considerable time in undergrad studying health care policy and various healthcare systems and is now a medical student here in the U.S., I must say that you, Mumblefratz, have some good points. But then considering how much you have written in the topic it would be hard for you not to have at least one or two good points. What is the saying about the blind squirel... Okay, not to be to rude, but I was really hoping for a substanitive converstaion, but there are a ton of errors in the information you are reporting and no way I have time to correct them all. This is clearly something you are very passionate about and you are correct no system is perfect, but some of the statements you are making a blantantly false.
I do not plan to visit this thread again, and I apologize for this rude entry into this thread. I am aware that this is more than a bit harsh, but inaccuracies and half-truthes about very important subjects really make my blood boil. Unfortunately this is not something we will solve in this thread and unfortunately this thread has a lot of misinformation. Please take your own advice copied above on this particular subject.
P.S. Thank god you and others disagreed with negative karma because after my message, I have the feeling you would be right about the possibility of its misuse. Again, please accept my apology for my rude message.
Hmmm.... You make claims of misinformation based on authority, but an undergraduate medical student that has authoritative knowledge about healthcare systems elsewhere in the world leaves a few questions. What healthcare systems did you study?
The reason I’m passionate about the topic is because I feel that other than the current economic problems that the entire world is currently facing the biggest problem that at least the US is facing is the healthcare issue. Certainly healthcare as most people talk about, but also including Medicare, which no one has really mentioned specifically, but which is also a looming disaster.
And yeah, no doubt I'm glossing over a whole bunch of detail which can clearly be part of what you’re talking about and you’re also right that it’s possible that some of things that I’ve mentioned are blatantly false. It’s tough to say because you don’t mention *which* points you think are blatantly false.
However with that said and with the same concern about causing offense that you exhibited there is also the possibility that perhaps some of the things you take to be blatantly false are simply differences in opinion.
In particular my desire to totally eliminate the entirety of the health insurance industry and my statements that in my opinion doctors make way too much money are *not* blatantly false, they are simply my honest opinion. Many may certainly disagree with this opinion but that doesn’t make my opinion false. And if other people do disagree with them I can understand their point of view. I may be a little suspicious that they might have some vested interest in holding their opinion but I do believe that reasonable people with no vested interest may disagree with me and that’s fine but that doesn’t necessarily change my opinion. If someone wants to provide evidence as to why my opinion may indeed be wrong then I will at least consider both the evidence and the source. But all I’m doing here is stating my opinion.
You’re also right about these off topic threads and what I said however many years ago was indeed correct, but my main objection to them was that they always seemed to engender nothing but flames and bad feelings. However if the flames can be avoided as they basically have seem to be in this thread then I see no overt harm.
That still doesn’t mean that anyone here should take themselves too seriously. After all, all this is, is folks writing a few paragraphs in an Off Topic forum that’s accessible from a few game sites belonging to a small independent software company. Believe me no one here is deluded into believing that this is something serious from which anything of substance can come. In the end the only thing most people are doing is expressing their opinion and perhaps doing a quick google search to locate some convenient information that supports their opinion.
So if you disagree with some of the things that I’ve said then I actually would appreciate if you specifically pointed them out and gave your reasoning as to why you feel they’re “blatantly” false. It’s possible that you may convince me that I was mistaken. It’s even possible that I may convince you that I am *not* mistaken. After all no one has said boo about the two points I mentioned in this reply and so I’ve never even stated my reasons for believing as I do. The most likely outcome is that neither of us convinces each other that they are wrong but even in this case it highlights to others that there are perhaps multiple legitimate ways to look at things.
The only thing that bothers me in these kinds of threads is when folks get down to a conflict of opinion and one side or the other simply denies that the other side’s opinion is valid. If I get to the point where I’ve heard every argument that you can make and you’ve heard every argument that I have to make and we still don’t agree then I at least will acknowledge that whatever opinion you hold is done so with honesty and without malice. Hopefully you would acknowledge the same in my case. Then we could simply agree to disagree.
It's obvious that any doctor would take offense at my opinion that they make way too much money. It's even more obvious that a medical student that is currently piling up huge loan debt with merely the hope that someday he'll be able to pay off that debt would take even more offense at this statement.
Also I can't really claim that the source of my opinion in this regard is any real studied analysis of the totality of doctor’s compensation. What my opinion comes from is from the evidence that I've seen over the course of my own life which is anecdotal evidence at best. However as I mentioned this is truly my honest opinion.
Basically I see the homes and neighborhoods that an ordinary Internist Primary Care Physician lives in and there is no doubt in my mind that each and every one of them is a millionaire a number of times over. And when you begin to consider surgeons and the specialty fields, you’re talking about some *real* money.
And how hard do these doctors work to live so high off the hog? Well again I haven’t done an exhaustive study on the subject but to take my own Primary Care Physician as an example, he takes the entire months of July *and* August off *every* year. Name me *one* other occupation where you get a deal like that.
Now I admit that the years of education and training that doctors are required to put in do indeed warrant a higher than average income. I have a PhD in Electrical Engineering which required a bit of education as well, but clearly doctors put more time into becoming doctors than I put into my doctorate and so I do believe they deserve a premium over what I earn. However my issue is that in my estimation, based on simply the lifestyle that the average doctor lives they must be earning somewhere near 3 times what I earn and it’s this level of income that I object to particularly when I factor in that yearly 2 month vacation.
In comparison I work a 60 hour week as a matter of course and am expected to put in excess of 80 hours per week during time of “crisis” and believe me there’s a “crisis” 3 or 4 times a year, every year, year after year. And I’m lucky to even get to take my two weeks of vacation that I earn a year. Most years I lose close to half of my vacation pay because I feel my job would be in jeopardy if I took all of my 2 weeks vacation.
Add to that the reality of the commercial environment where in fact your job *is* in jeopardy pretty much every day of your life. Companies these days (i.e. for the last 10-15 years anyway) are constantly downsizing, outsourcing or at the very least considering the option. Most of my 30 year career has been spent worrying about the health of my current employer and trying to figure out when it’s time to jump ship to avoid the crash.
Basically it’s a life of musical chairs and as anyone that’s unemployed now can attest, you *really* don’t want to be without a job when the music stops. I’ve had 9 different employers over my 30 year career and no job has lasted longer than 5 years, the average length of time is closer to 3 years (obviously 30/9). And I never facetiously jumped ship, I only changed jobs for more money *once*, every other time it was due to concern over the health of the company and this is born out by the fact only two of the 9 companies that I’ve worked for are still in business and one of them is my current employer. Also every single one of that went out of business did so less than a year after I left. So far I’ve been lucky with the musical chairs but sooner or later my luck is bound to run out.
Compare this to the entirety of the healthcare industry where there is absolutely no competitive pressure on anyone. For god’s sake even the *clerks* do pretty much nothing all day and then take umbrage if you show the slightest impatience for them to get off of what is obviously a personal call. If you ever wander by the typical nurse’s station in an average hospital what you’re most likely to hear are the nurse’s discussing their boyfriends and which one has the bigger penis. I swear to god that I've overheard this exact conversation, and at Lahey Clinic no less, best care in the world. Also if you're interested ask me about how Lahey's incompetance toe tagged a friend of mine.
I also object to the concept that the doctor’s time is so god awful valuable and yet my time is superfluous. Excuse me, but my time is both valuable as well as critical to keeping my job so that I can continue to afford the ridiculously high health insurance premiums that keep the system such as it is treading water. There have been many times that I have eschewed medical service simply due to the time off from work that it would require.
You hear about how many hours’ doctors put in, well I just wonder where it is that they put these hours in *at*. It’s certainly not in their office, just try getting an appointment before 9:30 or after 3:30. And it’s not that they’re making rounds either because I know for a fact that my Primary Care Physician makes his rounds on Tuesday only in the mornings and yet he takes the entire day off from appointments. Like I said *two months* vacation each and every year and a 4 and a half day 9am to 4pm work week. Great job if you can get it.
Look, I’m sure there are some doctors that work quite hard, and are dedicated to their patients’ well being, it’s just that I’ve personally never met such a doctor.
So hopefully this gives folks some idea as to the basis for my claim that I feel doctors make *way* too much money, but I’m willing to hear evidence to the contrary and perhaps you might even convince me that doctor’s simply make too much money, as opposed to *way* too much money.
So yeah, this is a topic about which I have a certain degree of passion. Please explain to me where I'm "blatantly false". I can possibly accept that my opinion is wrong, however no one can claim that I didn't come by my opinion honestly.
[edit] For those that are already or trying to become doctors you should keep in mind that this is how at least *some* people view your chosen occupation, whether rightly or wrongly. From your point of view it is of course wrong and you must certainly hope that I represent a *very* small percentage of folks that feel this way. But if this can help you avoid the "god complex" then perhaps it's done some good. Also if it's any solace I feel pretty much the same about lawyers except that lawyers don't hold my health hostage in order to ensure their own wealth. [/edit]
I'm using italics for quoting, as it's faster than putting in manual quotes. *edit* that didn't work very well, so I put in the manual quotes */edit*
Yes, it's only the far extremes of *both* sides that I have problems with. And while I agree with you that many of the right wing nuts have crossed the line to fascism, it's equally offensive for left wing nuts to refer to the "normal" right wing - or even the center - as fascist themselves. And in my experience, it's the people of your generation that tend to sling the Nazi labels the fastest, at least in person. On the internet, of course, pretty much anything is in play.
Most people consider me to be conservative, even though I'm closer to being centerist than anything. If anything, the closest description would be a centerist version of Libertarian - certainly I don't accept the social philosophy of the current Republican party.
This would also indicate that we might need to address the cost of medical education as part of a comprehensive reform of the field. I've known a few people who ran themselves into bankrupcy putting a spouse through school. Perhaps if the entry fee wasn't quite so high, we'd get a wider range of people entering the field. Of the handful of well-off doctors I've known, all spent the first 20 years of their career not much above breaking even.
[quote]And how hard do these doctors work to live so high off the hog? Well again I haven’t done an exhaustive study on the subject but to take my own Primary Care Physician as an example, he takes the entire months of July *and* August off *every* year. Name me *one* other occupation where you get a deal like that.[quote]
Primary/secondary education. Surely you don't think THEY get paid too much, do you? Many of them need to take supplemental employment to survive the summer.
Again, from the highly limited selection of people I've known, the entire profession has a high bullshit level; stuff that only the money makes it possible to put up with. Of course, medicine is hardly the only field that that could be said about. Yes, there are many people who are in it for helping people; as you well know from personal experience, there are many more who are not. I fail to see how decreasing the number of doctors by getting rid of the ones in it for money is going to improve our health care system in any way.
Primary/secondary education. Surely you don't think THEY get paid too much, do you?
Just to be clear for those from foriegn countries, as an undergrad I spent 4 years in undergrad (I actually spent 5) with a major in biochemistry and molecular genetics. I spent a large amount of time studying english, politics, and philosophy. Now I have completed the first 2 years of my 4 years of medical school before a minimum of 4 more years of residency. In undergrad, this was a particular interest of mine and I studied UK, Germany, Norway, Canada, and the U.S. in a great deal of detail. Due to my interest in the topic, I also talked to university physicians from foriegn countries who have testified to congress on various subjects including healthcare policy. They were from Norway, Sweden, South Africa, UK, and France. At this point, 3+ years removed from undergrad, I am hardly an authority on the subject, nor was I then.
I would kill for one actual statistic in this entire long post. Seriously, this is one or two out of the ordinary experience that you are taking as fact for an industry as a whole. And if you want to talk about not having a flame war, I'm not sure this is much better. You are basically blanketly ripping a profession based on a handful of experiences.
I don't know of any doctor making any real money who has these hours. The doctor you are talking about sounds semi retired. He likely made a killing in the 80's when insurance was really talking off and doctors made money with little paperwork. He also is likely one of the many doctors I have met who complain about how when he left med school he had 20k in loans. Today the average medical school student debt is 270k.
Basically we (physicians) hear that you are upset about a system that is just as broken as we see it. You are seriously wrong if you think this is a vehicle to wealth though. Yes, you can live quite well but there is also a serious amount of work. I would kill for a 60 hour work week at this point. Two months ago before I started research. Before that, I worked 80 hours a week at the hospital and then went home to study for 20-30 more hours. Nothing like a 110hour work week for 8 weeks straight while watching patients die for the first time. When you consider I pay 60k a year for that, yes, I feel like a rich god, clearly. Unfortunately all misanthrops tend to do is convince people we are out to make money and don't really care about your health. That is just plain not true. We bust our asses trying to make people healthy, often times people who don't really help themselves. And no doctor has ever "held your health hostage", if they do, you can find someone who won't. You may have to go to a teaching hospital and deal with me, then a resident, and then an attending, but then you would complain that too many people who don't know what they are doing are wasting your time. At my school, like every other place that is a public teaching hospital, we don't turn down anyone. Unfortunately that often means that, like canada, we have a wait time for outpatient non-emergent cases, while wealthier patients don't by going to private offices.
Though I am annoyed by the misinformation you are spreading on physician pay, I am more concerned about other points. I really don't want to get into this here. This will end up being an extremely long series of posts and I am a slow typer. Let's just pretend I never came in here.
Forget Norway!
If Kenya were to physically as well as hypothetically urinate on Norway, this is the approximate trajectory ...
"Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs."
"Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."
"Most of the medical bankruptcy filers were middle class; 56 percent owned a home and the same number had attended college. In many cases, illness forced breadwinners to take time off from work -- losing income and job-based health insurance precisely when families needed it most."
"Families in bankruptcy suffered many privations -- 30 percent had a utility cut off and 61 percent went without needed medical care."
"The research, carried out jointly by researchers at Harvard Law School and Harvard Medical School, is the first in-depth study of medical causes of bankruptcy. With the cooperation of bankruptcy judges in five Federal districts (in California, Illinois, Pennsylvania, Tennessee and Texas) they administered questionnaires to bankruptcy filers and reviewed their court records."
Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."
"Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878."
"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program."
"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."
Of course some could argue that this doesn't prove that people's health *is* being held hostage for what is in effect their entire net worth but it sure seems that way to me. Is it all the doctors fault? Of course not, but they are most certainly a part of the problem.
That was obviously sarcasm on my part.
Yes, there are many people who are in it for helping people; as you well know from personal experience, there are many more who are not.
Next time, please read the entire sentence. Perhaps I should have made it two entirely different sentences.
Yes, there are many people who are in it for helping people. As you well know from personal experience, there are many more who are not.
That is the way it should have been read. I just hate writing like that, it makes me sound like I'm still in grade school. Grammatically, both wordings say the exact same thing.
Removing the income incentive IS effectively getting rid of them. If they wanted to work harder for less money, they'd do something else.
Thanks for the list, Mumble.
First problem, health. Lard asses drinking a six pack of beer with their microwave dinner and chain smoking between meals. Look at the population statistics in other countries. The fat, beer bellied lard ass with lung cancer should be told to pay for it or piss off. Your health is something you should look after, not something I should pay for. If we were a reasonably proportioned country filled with non smoking individuals that walked to work every day and had a glass of wine with dinner, our costs would be a fraction of Frances. It's surprising just how low that number is, the average yank is a fucking grease ball by most countries standards and we're only twice as high as the socialists are.
Second problem, controls. We fund the research while the rest of the world benefits from it. Those countries with the lowest costs are squeezing the drug companies the most. Check their margins, find the development and manufacturing costs, compare them to the price changes. Those rich drug companies don't exist anymore if the US starts paying the prices that France is. That's just the US, forget adding in the rest of the countries that are still paying somewhere in between. Yeah, we could get the latest and greatest cutting edge pharmaceutical for half the cost, but it would be the end of most development.
As for the wonderful commentary on health care being a public good in line with civil protection and education, get a clue. First, your health is primarily influenced by your own choices. You do not choose to get mugged, hit by drunk drivers, or raped and murdered. You choose to eat at McDonalds every day without using your legs for anything but holding down a foot rest. Yes, shit happens, but shit happening doesn't elevate health care as a whole to a public good. As long as taking care of yourself isn't a requirement for getting that state funded care, we're fucked.
Considering the police arrive after the fact to nearly every crime reported, are themselves equally criminal, if not more so than the general population, and have a conviction rate well below 100% of those they catch after the fact... Even if it were a public good, giving the US government control shows a lack of mental competency on the part of the deciding party. There isn't a single government controlled entity that hasn't been a colossal fuck up with the arguable exception of the military. I say arguable because at present it appears relatively effective, they've botched every real war we've been in throughout history though. Their biggest mistake was the training program that taught soldiers to fight by charging gun emplacements with infantry all the way up through the Korean war. The infantry charge died with the musket as anything but a suicidal tactic and they never figured it out. Depending on the US government to protect and care for you just gets you killed most of the time.
Great rhetoric, but not an easily supported fact claim. We're barely scratching the surface of the role of genetics in our length and quality of life, and we have a food production system that is nothing short of the largest experiment *ever* in testing the effects of industrial chemicals and 'medicines' on both human health and the environment.
But your take is understandable, given the tendency of U.S. folks to vastly overestimate their own 'freedom.' It's a big theme in our civic religion, so it's natural that many of us are made uncomfortable when research (or gasp, even philosophy) reminds us that almost all choices are constrained by factors beyond your control, and that in our modern context, many of those contstraints are actually a result of having *too many* options to rationally assess at a given moment.
Cell phone stores are a great example of the latter--the average shop has a truly ludicrous number of potential 'packages' you can walk out with given all the possible combos of plan+phone+accessories. Decisions about your health are similar, especially if you've lived several decades already and have any weakness for the opinions of 'professionals,' or worse, fad-makers. Anyone up for some Phen-fen?
[...]
Thanks for the post. It's a fresh take on the topic in this thread and one that I think bares a lot of truth.
Nonetheless, that pales in comparison if you consider the crap that most americans eat. Our food in general may have all sorts of chemicals with unknown effects, but that is hardly an excuse for the fast-food mentality that has gripped the nation. But frankly, even given that, it's extremely obvious that a combination of excersize and eating well are one of if not the single most important factor in individual health. There are exceptions, obviously - notably genetic disorders and genes in general. Now I think that the hundreds of untested chemicals in our food and water are a threat, it seems like a generational threat, and doesn't really cause many immediate health issues. In a way that's even more dangerous, because it means that it won't be considered a problem until the damage has already been done...
I agree with psychoak that people have no basic civil right for you and me to pay for their health if they refuse to take responsibility for it in the first place. Why should we have to pay for a chronic smoker's emphysema, considering he was well aware of the risks of smoking but continued to do so? Addiction is hardly an excuse, anyone can stop smoking if they are determined enough. On the other hand I have no problem for paying taxes in order to help pay to treat someone's breast cancer, or most forms of cancer.
Basically, I think the ideal public healthcare system would only cover medical problems that aren't the result of negligence of one's own health. Costs of any complications that arise due to poor life decisions despite being aware of the risks, like horrible eating habits and no excercise, or smoking, would be personal costs. Such a system would never work, though, because there's the impossible problem of determining what is covered and what isn't.
Like psychoak said, one of the most important things we need to do, maybe even more important than fixing our healthcare system, is to convince americans to start taking care of their own health again. Prevention is much more effective and much less costly than treatment.
With Sanjay Gupta as Surgeon General how can we go wrong?
My prediction is that whatever we come up with on healthcare will be unsatisfactory to *everyone*, left, right or center.
I agree
That's what the government is best at.
There is a lot that could be done. One is tort reform. When lawsuits are so prevalent that doctors actually leave the profession or region there is a problem. There is a difference between negligence and cost effective prevention/diagnosis. Cutting the wrong leg off is negligence or incompetence. Not ordering the 6 most expensive tests for a 99.999% diagnosis vs a 99% diagnosis could be the difference of several thousand dollars.
The second is knowing what you are paying for and determining how to pay it. Last time I went to the doctor he ordered a 660 dollar test for myself and my girlfriend. After the tests came back we found out it that it did not matter what my tests were (baby DNA testing). Next time I will wait before I pay for a test so I can make sure it is necessary.
Also there is nothing wrong with a multitier health care system. Not everyone needs a specialist and not everyone needs the ultimate in healthcare. Many generic drugs are witin 95% of the effectiveness of name brand and cost 4-5 dollars for a monthly prescription. Not everyone needs the premier healthcare system where you pay 5-10 times as much. Good is good enough and if you want a second opinion then you should go for it. Yes, healthcare is plenty expensive, but there are things we can do as a consumer to reduce the cost for ourselves.
And those weak lilly livered liberals that claim that it wasn't their choice, well that's just wrong. The parents could have easily been tested to determine their risk of passing on poor genes and either chose not to do so because of their own ignorance or went ahead and had children fully knowing the risks. Again why should I pay for their poor choices.
Sure the free market can be efficient but the free market has no conscience. Just ask Madoff's victims. Nothing funnier than taking money from a rich person and turning them into a poor person, and we all know that the only reason anyone is poor is because they are both lazy and stupid. Oh I'm sorry, that's not precisely correct, anyone that *stays* poor is both lazy and stupid, or perhaps they just happened to get sick at the wrong time.
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