About Rationally Speaking


Rationally Speaking is a blog maintained by Prof. Massimo Pigliucci, a philosopher at the City University of New York. The blog reflects the Enlightenment figure Marquis de Condorcet's idea of what a public intellectual (yes, we know, that's such a bad word) ought to be: someone who devotes himself to "the tracking down of prejudices in the hiding places where priests, the schools, the government, and all long-established institutions had gathered and protected them." You're welcome. Please notice that the contents of this blog can be reprinted under the standard Creative Commons license.

Sunday, July 08, 2007

Sicko

I don't want to hear any bullshit about how Michael Moore is biased and slanted and inaccurate. If anyone comes out of seeing Sicko and is not angry and wants to start a riot and march on Capitol Hill, there is something seriously wrong with his heart (in a metaphorical sense, not necessarily health care-wise).

Yes, Moore's movies are not “fair and balanced” (news flash: if you think Fox News is, I'd like to sell you this beautiful bridge here in Brooklyn, real cheap...). But, unlike certain notorious right-wing outlets (like, say, Rush “I can take drugs, but you are immoral if you do” Limbaugh?), Moore is on the side of the downtrodden and against big corporate and political interests, and that's the way anyone with a sense of decency and fairness should be. I mean, conservatives keep telling us that how and with whom we have sex is a “moral issue,” but somehow their so-called family values do not extend to making sure that everyone has access to a minimum level of health care. Assholes.

Moore's movies are clearly not documentaries. Think of them rather as op-ed pieces, where you know exactly what point is being pushed and why. But, just like a good op-ed, having a point of view doesn't mean that one is inaccurate, unfair, or “biased.” I strongly defend the “point of view” that the earth is about 4 billion years old, give or take. If you think that's just my opinion, you should have your reasoning abilities checked immediately. Seriously.

Sicko is touching and funny, and it makes a compelling case for one fundamental point: the health care system in the United States (started by none other than Richard “it's ok to go illegal if it allows me to win” Nixon) is rotten to the core. The reason for it is that it is in the hands of private corporations whose goal is to make a profit, that goal is reached by doing exactly the opposite of what they are supposed to do: instead of giving you care, they deny it as much as possible.

I clearly advocate a single-payer system like the ones in Canada, Britain, France, and Italy, to mention a few (and yes, they do work; and no, the waiting times are not long; and yes, the quality of care is actually higher than in the U.S.). My father used to complain like any good conservative when he was paying taxes in Italy, even though, for instance, I went to college for free and therefore didn't start my life burdened by tens of thousands of dollars of debt. But even my father eventually stopped complaining. First when my grandmother had to be hospitalized for almost two years toward the end of her life, and we paid one thousand lire (50 cents) of “co-pay.” Then when my father himself was hit by three different types of cancer, had to undergo several operations and treatments, and – again – the whole thing didn't cost us a dime. In the US, we would have gone bankrupt after the first bout.

Still, even if one just couldn't stomach the idea of a single-payer system, and wished instead to maintain some level of private bureaucracy because one just doesn't trust the government, then the crucial reform to implement should be obvious and simple: let doctors, not bureaucrats (private or public) make decisions about health care. Period. It is simply insane that someone who has not seen the patient is able to override a doctor's decision over the phone. Especially since these bureaucrats actually get bonuses and promotions based on the number of cases they deny. And make no mistake about it: this is by design, not accident, and it costs lives.

And at any rate, as Moore so clearly states at one point in the movie, what's up with this congenital knee-jerk reaction against government-run systems? We have public fire departments, police, schools, and military, and they all work remarkably well (not to mention that Medicare, the government-run health care system for the elderly and the disabled, actually works much better than the so-called efficient private systems in this country). So why not health care? Put simply, because Congress and the White House are in the pockets of the health care industry (the movie has a funny scene where several congressmen attend a health care industry-sponsored event, and each one is labeled with the amount it took to buy them off – the biggest prize went to George W.). Meanwhile, Americans are too scared of loosing their jobs and whatever little coverage they have to mount any significant protest. Remember that a study done at Harvard recently showed that the number one reason for personal bankruptcy is the inability to pay health care bills – and we are talking families who are insured!

Go, watch the movie, and see if you don't get pissed at the story of the guy who had to choose which severed finger to reattach because of the cost (tens of thousands of dollars) of doing the operation. See if you don't scream bloody hell when you find out what sort of medical coverage they have in Britain or France. And see if you can help being moved by the stories of our heroes of 9/11, who are being denied coverage because they volunteered their help without checking first what sort of insurance they might rely on if they got sick.

Moore may be over the top, and I'm sure his populism irritates even some progressives, but this country needs a hundred of him, urgently. More importantly, we need to start learning some simple lessons in democracy from, say, the French: let's march on Capitol Hill and kick the ass of a few corrupt politicians, beginning with all those who voted for Bush's bill on prescription drugs for the elderly. Now, that sounds like a good beginning!

42 comments:

  1. What is the real solution, if Michael Moore’s government sponsored universal health care is not the answer?

    The crux of the "SICKO" documentary is the disconnect between our expectations and the reality of health care. We are expecting compassionate care from another human being, and instead we get a faceless corporation. The person behind the desk or window is an agent of a health care corporation, which is not a human being, whose primary goal is to increase corporate profit.

    This is America, and corporate profit is good, the profit motive forming the basis America’s greatness. Right?

    The basic problem is that a corporation is not a human being. Therein lies the fallacy of replacing a corporation with a government agency, neither of which is a human being, when what we really want is a human being to deliver compassionate health care, and assist in serious health care decisions.

    Review of "SICKO", by Jeffrey Dach MD

    Jeffrey Dach MD

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  2. Wow! Jeffrey is pasting this comment everywhere.

    I live in Canada, always have, and have had acute conditions as well as a serious chronic one, as have others around me.

    *Where* do you get this idea that "government agencies decide" ANYTHING relating to the doctor-patient relationship in countries with real health care.

    I have never, ever interacted with a bureaucrat around money issues of any kind, and my doctor has never seemed in the least bit restricted by some kind of budget in his/her treatment of me. It's all about the health issue - zero money issues. ZERO!! It's ALL PERSON TO PERSON between doctor and patient, and it's ALL and ONLY about health, not payment.

    Look, say you put doctors on salary, and tell them to go to town making the nation healthier. They could do ONLY person-to-person interactions, never having to think about billing. I wonder if you ever saw Sicko! The Canadian doctor, British doctor, and French doctor all said they would hate to work in systems where they had to even *think* about money, instead of just focusing on the patient.

    You are regurgitating stale red-scare nonsense wrapped up in a warm folksy hug. Ronald Regan would be proud. Maybe you should produce LPs!

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  3. Come on M! I, for one, will not be seeing Sicko because I don't need the stupid, barely funny, and highly manipulative Michael Moore pulling at my heart strings to tell me that a single payer system would be better than the private system we have now. That conclusion can be argued thoroughly without any appeal to emotion or pointless attacks on the 'corporations' for trying to make a profit (as if that were a surprise to anyone). The facts, which I'm sure Moore replaces with some sob story, speak for themselves: 1) private insurance is inefficient because of high administrative costs; 2) it makes workers reticent to switch to better jobs because of losing health insurance; and 3) the US government already spends as much or more per person than Canada and Europe just for medicare and medicaid! I hope we get public health care soon, but my prediction is that Moore's unambiguous political agenda and polarizing style will only galvanize those against public insurance and provide more sloppy reasoning for its defenders. Thanks!

    PS - dach, you are an idiot. stop using straw men.

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  4. While conservative pundits exaggerate them, there are real wait times in Canada. The US may be ranked 37th by the World Health Organization, but Canada is ranked 30th (France is ranked first).

    The problem with Canada’s healthcare system is that the Liberals (under substandard Finance Minister Paul Martin) butchered the healthcare system by draining it of funds.

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  5. A "taste test" of gov health care.

    My hub goes to the VA even tho we have a reasonably well structured health care plan for individuals. He goes to the VA because does not want to deplete the med savings account as it rolls over into retirement at the end of every year. Therefore 75% of what we pay in, we generally will not lose.
    I think people really should first look into something like this instead of trashing the whole concept of privatization.

    As far as the VA is concerned (aka government health care),
    don't even know where to begin. We just feel sorry for those for who that happens to be their only avenue for health care.

    My husband had a condition (very painful) last fall and winter which the physicians he saw at the VA just could not get to the bottom of. A scheduled MRI at the VA for the mysterious condition was to be two or three months out. Etc etc.

    Fortunately for us, a PRIVATE Seventh day adv. hospital outside of Ft. worth was willing to let him be treated while we were visiting around Christmas and a very nice Pakistani dr. figured out in five minutes what the VA could not figure out in the previous two months.

    So if that is any indication of where health care will go when privatization is not an option, who needs it? Matter of fact, who wants it? "Free" is no good if one cannot be either seen or diagnosed.

    cal

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  6. DRM: I'm sure that 30th is better than 37th, somehow...

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  7. Under the Canadian system your doctor is still your doctor, but he bills the Province, not you.

    My own doctor is very conscientious, and competent. The only time I have run into problems is when I have had to go to an After Hours Clinic. A couple of times I found the service there quite perfunctory.

    It is true that Martin cut the health care budget (in order to reduce the deficit and balance the budget). But there has been some movement back towards refunding the system, and I think the effect is gradually being felt.

    The main thing is that the health care we have is universal. If you don't start with universality, it is extremely hard to achieve it piecemeal. Conversely, if you already have universality, you'd be nuts to give it up.

    Under some circumstances, you can seek health care at private clinics in Canada. The Supreme Court recently ruled that if you are subject to an inordinate waiting period, you can seek treatment outside the system (the viwe being that your heatlth & well-being is a right). This decision prompted a flurry of extra funding by the fereral Government, so as not to jepoardize the system.

    By the way, if you come into the hospital with a breathing problem, or some such thing, the waiting period is somewhat reduced- to about 5 minutes (yes I have sat in envy!)

    My wife and I have raised three children under this system, and it has served us extremely well in all circumstances from oxygen tents to embedded fishhooks.

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  8. Yes, Canada is quite better than the US in terms of healthcare. But innovation has been inhibited and privatization is creeping in, bleeding funds from public healthcare.

    Paul Martin cut funds to healthcare well beyond what was necessary to balance the budget.

    For clarity, I’m not advocating a return to for-profit healthcare or a two-tier system. I’m supporting increased funding, modernization, and anti-privatization initiatives with healthcare in Canada.

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  9. Remember that a study done at Harvard recently showed that the number one reason for personal bankruptcy is the inability to pay health care bills – and we are talking families who are insured!

    THAT is scary. Not to detract from that message, but you've been tagged. Don't blame me. I'm just following orders.

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  10. let doctors, not bureaucrats (private or public) make decisions about health care.

    Maybe that's a better alternative, but can be abused a lot, as in my country (Brazil). Not all doctors are ethical and with the best interest of their patients at heart. One example: C-sections. In Brazil, 82% of birth labors paid for by a health insurance company are Cesareans, while 30% of the ones performed at the public system are Cesareans. By the way, that's a lot -- the WHO recommends a maximum of 15%, or so I've read somewhere.

    So, what's going on? Well, C-sections are much better for the doctor, while usually being worse for the mother. For the doctor, it's convenient (no waking up in the middle of the night), quick and pays much better. For the woman, it might be less pain during labor, but it's way worse later.

    I'm not sure how the public system there works exactly, but I think it's more of a "salary" thing for the doctor than when s/he bills the health care companies. So, much less economical incentive to ask for the C-section.

    Now, just because the Americans are too incompetent to set up a government run system that works, that does not mean it's impossible, right? So, think of that before telling your horror stories (I have had one here too, let me tell you...), and remember that governments are not abstract entities floating in space, severed from society. Or in other words: like people, like gov...

    Cheers
    J

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  11. Just a sidenote:

    In Canada drugs prescribed during a hospital stay are usually covered, but drugs prescribed in a doctor's office are not. Most working Canadians have a supplementary health plan for this reason.

    I am thinking that this may help account for Canada's 30th ranking by the WHO.

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  12. Notice on the WHO standings that Saudi Arabia and Colombia are also ahead of the US/Canada. I doubt it's because of their great public health care. Cross-sectional comparisons of this kind can lead to spurious conclusions. The proper study would use a times-series analysis of countries before and after health policy implementations, controling for confounding factors. I'm sure studies like this have been done, but I don't know what they conclude.

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  13. The hypocrisy stinks. Conservatives, who advocate laissez faire economics and who stand against universal health care, are perfectly willing to accept corporate welfare.

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  14. Of course Moore is slanted and biased, and well he should be. Does anyone think for a moment tthat the right wing mouths are middle of the road objectivists. Well maybe Cal.

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  15. Uh, not so fast wrt "great" Canadian care. I am an American with 2 artificial hips - waiting time was about 2 1/2 months - mostly for doctor's 1st available opening and logistically it takes a month to get ready. I have talked to a professional mountain guide in Canada. His wait time: almost a YEAR (sic) to see the nearest doctor (in Alberta) to get on the waiting list. Then he was told since he was in BC, he would need to see a BC doctor. He wound up going to India.

    I ran into somebody else who had a shoulder injury which was mistreated because it took a month to see the orthopedist who said it may never be right because it was mistreated.

    I have a sister-in-law in Alberta who has a year wait to get one of those procedures you really should get when you are over 55. My wait time: a couple of weeks, my wife's: a couple of days.

    Don't even get my started on the difference between the treatment my wife received for her breast cancer in the states vs. what she directly heard from Canadians who went through it.

    Compare wait times for MRIs: my wife's last wait time was 2 days, in Canada I have heard directly it is months.

    OTOH: my mother-in-law receives excellent (preventative) care and her by all accounts superlative nursing home care is $1500/month (sic!)

    My impression: Canadian care is great for most life threatening issues and preventive care, sucks at anything else.

    Let's be honest - the demand for medical care is much greater than the supply. One way or another is is rationed. Not that I am a big fan of the waste in the American system, but I would hardly consider the Canadian system a model.

    BionicHips

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  16. Dennis: Of course Moore is slanted and biased, and well he should be. Does anyone think for a moment tthat the right wing mouths are middle of the road objectivists. Well maybe Cal."
    P
    People on both sides of the political spectrum want to live longer and happier lives. I think that if the politicians on the right were convinced that socialization of medicine would bring that about, they probably would be all for it. Coming from a state which I think is pretty much socialized already, you can't convince me that such measures will bring about BETTER health care, as Doctors don't even want to live and work here unless there is some other reason to do so. Right and left politics aside, this is a FACT of life here, today.

    There are no physicians that I have ever heard of simply dying to come to New Mexico and work under this system. And further, you and others are literally fighting for an innovation that 9 out of 10 people DO NOT EVEN understand the outcome of.

    cal

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  17. qzotbcxoCal, We were traveling in NM in April of 2006 when my wife became quite ill. We ended up going to Santa Fe Urgent Care, and while their facilities were pretty antiquated, the staff was excellent, they treated her immediatly and accepted our insurance without question. I don't know if that facility is part of the New Mexico "system" or not, but we were more than appreciative of the care my wife received.

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  18. ThumpalumpacusJuly 10, 2007 6:08 PM

    Normally I love the stuff I read here, but this is outside the scope of your blog. While I admire your zeal to right the wrongs of the world, starting with America, I would point out that your blog is titled "Rationally Speaking", something which Moore rarely does, and something you are not, alas, practicing here.

    Naturally our healthcare system has problems. They all do, seems to me. While anecdotes aren't evidence, my ex-wife's breast cancer was efficiently and compassionately treated. At no time over the course of five years was she denied treatment. And other than the high prescription costs, she's had very little financial hardship.

    Further, Moore's previous excursions into dishonesty give me a deep skepticism of his films. I do not mind his bias, nor the force with which he projects it; but even opinion must be based on fact, at least if you wish to persuade me. Passion is a great motivator, but a lousy reference.

    Finally, I believe the system would work much better not being federalized, but simply by the accountants being humane.

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  19. Massimo,
    Great post and thank you for standing of for Moore!

    It seems quite fashionable, even from people who lean to the left to trash him.

    One criticism I get sooo tired of is this fallacious argument that goes something like this:
    In Canada, or Britian, or Timbuktu they have this horrible problem with their national health care system. Therefore, if the U.S. implements some sort of universal health care system, then we will have those same problems.

    Of course nobody is proposing that the U.S. copy exactly any system from any other country. In fact, this is a great opportunity for us to look at what might go wrong in Canada or any other country (but probably not Mali) and work around those problems.

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  20. Cal: you are wrong. Politicians don't follow the rational course of adopting the most propitious system; they follow their dogma. Just look at the Bush adminstration's willful disregard of science concerning stem cell research, and their meddling in climate change research and even NASA.

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  21. Dennis: We were traveling in NM in April of 2006 when my wife became quite ill. We ended up going to Santa Fe Urgent Care, and while their facilities were pretty antiquated, the staff was excellent, they treated her immediatly and accepted our insurance without question."


    Smaller markets always fare better socialized or not. My husband goes to a VA clinic in SF and generally things works out okay there. Blood pressure monitoring and moderate health issues is what they handle. That clinic has contract with St. Vincents (The major hospital in SF) to carry out some procedures for them. Like, for instance, if a person was having a heart attack or had just been in a serious auto accident. But if what you need is not in those listed procedures, the wait in Albq. for those other items could be 2-6 months.

    My husband had a couple of ribs out of place late in the fall which a sports med doctor put back in place. The problem was, the inflammation around the connective rib tissue would not go away. It was so painful it was making him nauseated sometimes, and the physicians he was seeing at the VA could not seem to zero in on the source of the intense pain behind his left shoulder. I thought that the ribs and the pain had a connection, but no one at the VA would listen to me. Turns out that the condition was referred to as "Incostal neuritis". Had to go to another state to find that out tho.

    I really am glad your wife did get good care in Santa Fe at that time. Getting good care here tho sometimes can depend on far too many bureaucratic factors. I am also glad that my husband's issue did not turn out to be something more serious like a tumor behind his lung. (he smoked for 20 & some years)
    His brother is a pharm rep for Roche Pharmaceuticals. So he sees the real state of affairs/ attitudes with physicians and health care. And if there is one thing we all know, it is that this is just not a good place for quality in health care.

    cal

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  22. Thumpalumpacus said...

    "Finally, I believe the system would work much better not being federalized, but simply by the accountants being humane."

    And therein lies the problem. The accounts represent the interests of the corporation (insurance, pharmaceutical, etc) whose only interest, by definition, is the bottom line. Corporations have NO humanity therefore their representatives at the table are bound to consider profits and profits alone.

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  23. This is a good opportunity to mention some of the ad hominem and straw man attacks againgst Michael Moore I have heard on cable news programs this week. Quotes are approximate.

    "Moore wants us to buy into the Cuban health system". O'Reilly

    Tucker Carlson and Governor Hucklebee (Rep. Pres. Candid.), shifted the conversation to Moore's weight and how people like him are contributing to high health care costs.

    Glen Beck and his Cato Institute guest brought up the fact that some member of royalty from some country did not go to Canada when they needed an important procedure done, but came to the good ole U.S.A..

    I am certainly relieved to know that even though I cannot afford health insurance and do not have it, at least the world's royalty and elites have such a great health system to tap into!

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  24. "I am certainly relieved to know that even though I cannot afford health insurance and do not have it, at least the world's royalty and elites have such a great health system to tap into!"
    sheldon,
    You should be able to put the plan that we have to use in Co. You'll need an honest insurance agent to craft it for you tho. Most agents won't willingly suggest doing a plan this way, it is not too much to their benefit to sell plans like this.

    For a family of five we pay about 174. 00 monthly into a high deductible plan with Blue cross. The deductible is a bit over 5000. To compensate for the possibility that deductible may have to be fulfilled, the gov allows one to place yearly about 5000 and some in an HSA (tax protected account). That is a bit over 400 dollars every month. For that latter account, one receives a bank card that can be scanned for health related matters only. Even dentists and pharmaceuticals. One can use it with any physician or health plan really.

    At the end of every year, every thing that has not been spent rolls over into an retirement account of your choosing.(ours is bringing better than 10% right now) The thing is, everything you go to the dr. for is also discounted because it has to be processed through Blue cross. Characteristically, a 150 dollar visit becomes 75.00 and so on. therefore that is all that will come out of ones medical HSA for that visit.

    At the end of a given year, one could easily have 4500k left in the HSA,(that means one has spent about 700 of it). And in five years that could amount to 20-25k in a retirement account. Not bad, huh.

    It has worked really well for us. But to be honest we, have not tested the Blue cross on any catastrophic claims.
    Our total health insurance bill for every month is 5-600 dollars. But you only have three in your family, so I think it might be less.

    cal

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  25. Most agents won't willingly suggest doing a plan this way, it is not too much to their benefit to sell plans like this.

    Maybe that's because the agents and the insurance companies know they can't afford to give good deals to everyone. Your example merely proves the point that in a 'market' system controlled by insurance companies, only those with sufficient resources can access good health care. Your resources may come in the form of connections to sympathetic, knowledgeable insurance agents who can bypass the system (instead of outright wealth) but they are unequally available nonetheless. You're arguing from the logical fallacy of "Generalization/ statistic X is not true because I am an exception."

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  26. ThumpalumpacusJuly 13, 2007 3:04 PM

    "And therein lies the problem. The accounts represent the interests of the corporation (insurance, pharmaceutical, etc) whose only interest, by definition, is the bottom line. Corporations have NO humanity therefore their representatives at the table are bound to consider profits and profits alone."


    Dennis, I do agree; but the unspoken premise in the socialization argument is that government bureaucrats will not suffer this failing. This, I suggest, is not so. First, many of the same people running the system will remain. Secondly, in any bureaucracy there will be institutional anonymity to shield the heartless;, and thirdly, they will now not only have an institutional bulk behind them, they will add the force of law to their decisions. And finally, given the scandal of current military health care, it seems optimistic to assume that government hacks will do better for civilians, who do not fall under the rubric of "support our troops." For these reasons, I remain skeptical.

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  27. g: "Your example merely proves the point that in a 'market' system controlled by insurance companies, only those with sufficient resources can access good health care."

    It may be that to a certain extent, but if one needs something, you keep working at it till it comes out right, i.e. a solution you can live with.

    You seem to be making the claim here that "poorer" people may not have the wits to figure out how to either use a gov funded health care or a plan like this? Anyone with a better than 10th grade edu can do the math on this health plan. If one does not have at least 174.00 a month, believe me, in our state at least, that person has access to gov funded health care.

    The left has used class warfare arguments for so long, (with the claim that it is inevitably "the opposition", who have caused whatever the given inequality is at the moment), one would think that the left had done nothing whatsoever to build the society that we see and exist inside of today. Class warfare beliefs and propaganda, it has been proven, do in fact cause and suggest to some people in our society to step back and NOT EARN a decent living for themselves.

    And that is your most notable contribution to our world.
    cal

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  28. Cal,
    Is it true? Do we actually live in the same state? Wonderful, colorful Colorado? Wow! Let me guess, you live in Colorado Springs? Just kidding in case you don't.
    I would certainly be interested in looking into this plan you speak of as a stop-gap measure until we I can get a more permanent job with bennies. And regardless, I still support universal single payer health plan for America.

    "Class warfare beliefs and propaganda, it has been proven, do in fact cause and suggest to some people in our society to step back and NOT EARN a decent living for themselves."

    The fact is class warfare exists in the form of top down elites maximizing their wealth and power at the expense of the welfare of working people. And that is total BS about people just stepping back and deciding not to earn a decent living for themselves.

    Where has this even been alleged to have been proven?

    The real class war propaganda is the ideological belief that the wealthy create their wealth solely by their own efforts, and thus are rightly due all the the rewards they can accumulate.

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  29. Sheldon,

    Look below you! New Mexico.
    Not exactly the "Springs" is it. ;)

    I'll try to ask our insurance agent who might sell this in Co. Maybe he will know.

    S: "The fact is class warfare exists in the form of top down elites maximizing their wealth and power at the expense of the welfare of working people..."

    It's a sign of a truly flawed, unmathematical economic theory to suggest that the upper class is not an absolute necessity to the working class.

    And in reference to that thought, I don't know who the "Sheldon" in the following comment is, I just know that he is a libertarian and I happen to agree with some of his historical anyl, tho not necessarily his conclusions.

    "As everyone knows, Marx, at least in some of his writings, thought only workers were industrious, with owners of capital belonging to the exploiting class (with the state as its “executive committee”). He placed owners of capital among the exploiters because of his labor theory of value (inherited from Adam Smith and David Ricardo): since the value of goods was equivalent to the socially necessary labor required to produce them, the profit and interest collected by “capitalists” must be extracted from workers’ just rewards — hence their exploitation. If the labor theory of value fails and if exchange is fully voluntary, void of state privilege, then no exploitation occurs. (Marx’s exploitation theory was later systematically refuted by the Austrian economist Eugen von Böhm-Bawerk.)" by Sheldon Richman

    How do I prove that such theories wreck incentives to work (for some people?): New Orleans, for staters. Also, the amount of alcoholism in Native American tribes is, and has been for quite some time, evidence that setting a race or class apart in such a fashion as a "special case" is a terribly bad idea.
    cal

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  30. John FitzGeraldJuly 16, 2007 8:00 PM

    Canada ranks 30th because the health care system is badly managed and consequently technologically backward. However, last year's Commonwealth Fund report on health care in industrialized nations found that the two countries which were farthest behind technologically were Canada and the States, so clearly that problem is not created by universal health insurance. As for drugs, in Ontario at least (health is a provincial responsibility in Canada) there is a provincial drug plan for people without private insurance. The deductible is based on income and consequently high for most people, but it protects against catastrophic costs and it keeps people working and paying taxes instead of going on welfare. No premiums, either. It's better than any plan I could be on in the States, because I have an inherited protein deficiency which would disqualify me there from any health insurance. Three other points above that I would like to confirm -- 1. The first thing you do when you walk into an emergency room is see the triage nurse, who decides how quickly you go in. 2. During the 40-odd years we've had universal insurance all decisions about my health care and my family's have been made by physicians. 3. If you want quick, cutting-edge medical care (especially the expensive variety) and you have enough money, the States is the place to be; if you want good public health management, though, even the sad sack Canadian system outperforms the American.

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  31. "It's a sign of a truly flawed, unmathematical economic theory to suggest that the upper class is not an absolute necessity to the working class. "

    Cal,
    For the sake of a very short argument here, let hypothetically grant your premise as true. Yet it would still be the case that in the U.S. corporate executives are grossly overpaid in relation to what lower tier workers make. A good contrast would be Japan, a capitalist country, where the income gap is not so ridiculously wide, and more profit is put into futher investment.

    And is that the best you can do? just cut and paste what one economist says. I could go and find a quote from another economist refuting what yours said. Whats it prove?

    Love New Mexico, be there soon.

    More later.

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  32. Sheldon,

    Corruption plainly exists, and often even more so in most other countries in the world. i.e. mob activity /black market /terrorist factions, etc. (When I was 16 I was Guat. when terrorism was very bad and citizens were regularly being machine gunned down. It is better now.)

    The US, otoh, gives more in terms of charity and medical aid to other nations than most other countries combined. One must be profitable, you see, to lend aid to the cause of world hunger and diseases. And tho it is true that some executives may reap more than they should in terms of profits, i really think it is the given corporations job to curb that imbalance, not the gov. Even if it could be proved that we tended to be more ethical in many respects than (some) other countries, it would never be enough for the detractors of the US.

    Thankfully (to me) we live in a free market, freewill oriented society. And in spite of what the rest of the world may drone on about, I still think it is one of the better places in the world to live. A disproportionate % of the world has evolved into this obviously envious thing against us. But that only because it does not have the guts to not be under a procrustean system.

    That is the easier way, you know?
    (a) to not choose freedom for oneself
    (b) blame others for the the outcome.

    And they have contempt for us? Hilarious.
    cal

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  33. Cal,
    A couple of things that bother me about engaging in discussion with you is that you move grounds of the discussion around so much I can hardly keep track of what we are discussing.

    One of the things that is great about America, and some other countries also, is that we as citizens have the ability to identify problems, discuss them, look for solutions, and organize to implement those discussions. Its called DEMOCRACY!

    Now it seems to me that those on the right, who often make arguments like those you are making want to pretend that some things are not problems. They seem to get seized by this defensive patriotism to many things that threaten their ideology about what they think America is all about. Yes, perhaps you have your own set of problems you wish to address.

    But just imagine that if in a democratic country if everybody thought that everything is just right and started to close their eyes to problems. Pretty soon that would result in a dead democracy.

    Now back in the day, I would be interested in arguing about the abolition of capitalism, but now I am not. Just reforming it to make it more humane. Nor am I arguing for some notion of absolute equality. So don't shift the grounds of discussion like thats what we were even talking about here.

    However, the American dream is dependent on some level of equality, of opportunity, and yes of outcome. The wealthy owning class do not make their fortunes by themselves, and they are also dependent on favorable social conditions.
    Now there has been a general trend of a growing inequality in the U.S. for some time now. Growing insecurity for the middle class etc..
    The health care crisis is one manifestation of this. Half the bankruptcies in America are due to people being swamped by medical bills from not having adequate health insurance. People lose their homes, their American dream etc.. People die because they aren't treated early enough.

    Now you can pretend that it is all alright, that the situation is just, and their is no need of a solution. Go ahead, cut and paste pieces of articles from libertarian economists that you don't really understand. But that doesn't make it so.

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  34. "Notice on the WHO standings that Saudi Arabia and Colombia are also ahead of the US/Canada. I doubt it's because of their great public health care. Cross-sectional comparisons of this kind can lead to spurious conclusions."

    Chris,
    While you have a point, I wonder what image you have of Saudi Arabia. They have a very small native population, and huge amounts of oil wealth. Even if the greedy bastards don't spread the wealth around very much, the whole society seems pretty well off, whether its from a public health system or not. Colombia is probably a different story.

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  35. John FitzGeraldJuly 18, 2007 9:06 AM

    Of course the United States is a great place to live. So's Canada. One might think, then, that the citizens of both countries would be interested in improving their crappy health care systems. Instead they prefer patting themselves on the back about how great their health care is. If you want evidence that neither system is good, go to the Commonwealth Fund website and read their report on primary care in seven industrialized countries, including the U. S. and Canada.

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  36. Sheldon,
    "The health care crisis is one manifestation of this. Half the bankruptcies in America are due to people being swamped by medical bills from not having adequate health insurance. People lose their homes, their American dream etc.. People die because they aren't treated early enough."

    Are you you not libertarian?

    I would like to see the actual numbers on the matter of half of the bankruptcies being due to medical bills. Thought the more recent trend was towards folks who used adjustable rate mortgages. I know of one young couple who filed a bankruptcy because of a major surgery, but that is about it. They really are doing great now.

    We are in no way "pretending" about anything when we claim that one can't just shift the bulk of the blame on the right for the social ills of the world or the US. To do so obviously leads to further polarization (cuz everyone is human) of parties and then even less gets accomplished towards legitimate solutions.

    have great day, sheldon. :)


    cal

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  37. "Are you you not libertarian?"

    Cal,
    Depends on what you mean by libertarian. I am very much a social libertarian. But go on to Massimo's next post, where Mike claims all taxes are theft and there are no fair taxes. I am not one of those!

    "We are in no way "pretending" about anything when we claim that one can't just shift the bulk of the blame on the right for the social ills of the world or the US."

    See what I mean. I didn't actually say that. One can't discuss anything with you because...oh never mind.

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  38. Sheldon,

    ...because defending one's position too adamantly is like acting as if GOD IS NOT in control???

    You are right. Politics (in the most political sense of the word)is not the most important thing.

    I do know of a libertarian who ran for a seat in NM. In my humble opinion, he is one of the more disturbed, unhappy people I have ever met. And surely that is not representative of all! The only reason I consent to discuss some political stuff with him sometimes is if I think I can help him calm himself down. I do feel compassionate towards him tho because he is the same age as my bio dad. And he was (lets' put it nicely) taken off course because of things that occurred during his military service..

    My "second life", as it is sometimes said of the net, is probably not particularly representative of my true temperament. My daily, weekly life has me doing a lot of listening to what is going on with people more so than actually giving much of my opinion. There may be times when there really is much more I would like to say on a matter, but try to gear discussions toward simple problem solving instead. Discussions that revolve around politics usually lead to anything but.

    I can certainly be wrong, Sheldon. But I try not to be.

    cal

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  39. Fair enough, Cal.

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  40. I don't really have time, and it's too damned hot, to go into a detailed discussion here. Just let get straight to the nub: I had to LEAVE the US because of health problems, POOR QUALITY and IMPERSONAL care for the mentally ill, and all of the extroardinary associated costs. I now live in Italy (#2 on that list!!). Hospitalization costs nothing, most prescription drugs cost nothing, the quality of care varies from place to place and doctor to doctor obiously (just like in the US!!). I have never experinced longer waits for medical attention of any kind than I did in the US. There are NO uninsured, I have received all of the tests that I have ever asked for (even though they found nothing wrong me),which was not the case in the US. I could go on and on. Of course, there are defects. No system is perfect. But what you have in the US in an international disgrace and a humanitraian disaster of third world proportions!! I don't need stats, which are always and easily manipulated. I lived in both places and I KNOW what's going on.

    @ Jeffery Dach, don't worry about your three mansions and six Ferraris. You will still be inordinately wealthy under "socialized" medicine. I have yet to encounter a non-millionaire doctor in all of Italy (and I live in the deep boonies in the heart of the poor SOUTHERN region of Campania!). You may have to get one or two of the Ferrari's etc, you sick greedy-ass MF.

    WAKE UP, AMERICANS!! Hopefully, now you will realize that the time to do something about this catastrophe is well overdue. If you don't....well, I'm sorry for those of you who will continue to suffer the consequences. I'll be fine.

    Ciao,

    FF

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  41. "...because defending one's position too adamantly is like acting as if GOD IS NOT in control???"

    Cal,
    Now what are you talking about? And you know I am an atheist, so why appeal to god in this?

    FF,
    Thanks for your passionate input. Thats another thing about having to buy your own insurance on one of those high deductible plans suggested by Cal. It generally only is for catostrophic coverage. If you have any sort of pre-existing condition, like depression, they are not going to cover your meds.

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  42. I am a retired hospital executive who has run hospitals, and groups of hospitals in both the United States, and the U.K. Absolutely anyone can point out deficiencies in hospital care systems world wide. The real point is that for every fault found elsewhere things in the U.S. are worse. When I was in England one of our directors of nursing suffered a back injury. She still could walk, but she was unable to work. As this was considered elective surgery she was told she was on a 6 month waiting list. We didn't want to lose her services so I had the company pay for immediate surgery in a private hospital (yes, private hospitals and medical insurance are still to be found in the U.K. for those who don't want NHS care). Well, so what. Here in the U.S. millions of Americans would have to totally forgo this type of expensive surgery. They have no insurance, and can't dig up $60,000 or more out of their own pocket.

    The movie indicated that insurance companies look for ways to weasel out of paying medical bills. In addition they try to get away with paying hospitals less money than it costs to provide the care. Then hospitals start cost shifting. They have to provide care to the HMO, PPO, or carrier at a discounted rate, as they do with Medicare and Medicaid. They will provide reimbursement of, lets say, $600 for a service that the hospital prices at $1000. Now lets say you come in the hospital for this $1000 service, and you have no insurance. The hospital will try and get that full $1000 from you. Is this fair? Well the hospital often does need the money, but from your standpoint why should the uninsured pay more than then third party payors.

    I become enraged when some pompous politician stands up and says we have the best health care in the world. Well, the old saying is that if you repeat a lie often enough people will start believing it, but what a whopper this lie is.

    According to a new book of statistics published by The Economist life expectancy in the U.S. now ranks 40th in the world, below countries like Costa Rica, and the Virgin Islands. Saudi Arabia, and Algeria have lower death and infant mortality rates than we do. We now rank fifth highest in the world in obesity.

    And now we find out after the Minneapolis bridge collapse that there are 70,000 deficient bridges in the U.S. A new book is out showing how seriously our education system is suffering from the no child left behind act. Schools are more and more simply teaching for tests. Education has become more and more expensive, and educational grants reduced. These latter comments have nothing to do with health care, but are made to simply point out that this country is not the great country that some would have us believe. We are beginning to suffer in many areas. We seem to have a policy that it is better to spend our money to send soldiers off to kill people, than it is to provide for the needs of American citizens. This is very very wrong.

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