Have you ever walked around an 19th century (or earlier) graveyard? It gives you a depressing snapshot of the old reality: so many young women dead in childbirth, so many children reaped by diseases. We’ve been fortunate, we residents of the late 20th and early 21st centuries, that so many of those lethal conditions are treatable, and we’re mostly able to live without fear of our children dying in our arms. But here in the United States, we may have been living in a brief window of time in which treatments are both available and affordable, and are moving into an era where they’re available, but only the lucky top few percent are actually available to take advantage them.
I’m one of those lucky ones: I’ve got a good secure job with adequate health insurance. I had my own little health scare a year and a half ago, and I obediently marched into the hospital for a full battery of the most up-to-date treatments, and I walked back out with almost all of the expenses fully covered by my insurance. I could even urge everyone to get checked out at the slightest twinge. But this isn’t true for everyone.
Take, for example, Kevin Zelnio: a smart guy with an advanced degree, working as a writer and scientist-at-large, relatively young and healthy, with a young family — and he’s uninsured, like almost 50 million Americans. When they get a cough or a nagging ache, they can’t just go to the doctor to get it checked out, to prevent something more severe developing. Even the most basic and most essential of preventive medicine is prohibitively expensive.
When I started my family 6 years ago, I was on a path to a career in research and teaching. We had amazing health insurance through my institution and my wife and children-to-be were generously covered, no-questions-asked by the state of Pennsylvania during, and a year after, the pregnancies. We never saw a bill. After I got “real jobs” upon completing my Masters degree, I entered a grey zone of contract teaching and research employment at universities. With a decent, regular salary we were ineligible for state aid, yet didn’t make enough to afford extra costs. Furthermore, the quality of the insurance kept lowering until I wasn’t even sure what I was paying for – even as the premium costs were rising.
It reached rock bottom last Spring when we attempted to actually use our insurance that I bought for $1400 every six months while a contract lecturer and beginning PhD student at a North Carolinian university. My boy was starting Kindergarten and needed to be current on his vaccines. Of course, both kids needed to be current, so we took them in one-by-one, got their shots and check-ups, handed over the insurance information, paid our co-pay and went on our way. Never thinking about it, assuming that insurance would do the job we paid them to do.
Exactly 6 months later we received bills, after I no longer had insurance (I had to leave my phd for variety of reasons), and addressed to our kids’ names and not mine, the policy holder, for substantial amounts. Apparently, my daughter owed over $400 and my son owed over $1600 to the doctor office, which was the net left over after the insurance contributed about $200 for each visit.
The Zelnios are paying more for simple vaccinations and check-ups than I had to personally cough up for a week of cardiac care and surgery in a hospital. That is a deep injustice. That is wrong. That shouldn’t be happening in what we arrogantly call the richest country on earth, but it is. And you don’t get to claim that people in these situations “deserve” it.
Most of the uninsured in this country aren’t lazy, freeloading hobos who don’t wanna work. They span a wide variety of demographics. As a 30 something, white male with advanced college degree who works full time as a self-employed consultant and writer are you surprised that I cannot afford health insurance for my family? In fact, the majority of uninsured are in my age range and are full or part time workers earning incomes above 100% the federal poverty level. The fact of the matter for many of the uninsured is that employment-sponsored coverage has been in decline due to the escalating costs of health care. Employers can’t remain competitive and pay double the costs they were paying a decade ago for insuring their workers.
The uninsured are locked out of basic health maintenance: now imagine a crisis, a life-threatening illness striking one of your kids. The Zelnios don’t have to imagine, it happened; read the whole thing.
This is madness. All this country has is this paltry compromise called Obamacare, which doesn’t even touch the fundamental problems of our rapacious insurance industry and complacent medical system, and the Republicans want to revoke even that. The people who are the heart of this country are driven into bankruptcy while the people who are little more than parasitic tumors, the obscenely wealthy, flourish. That is not a formula for survival.
(Also on Sb)
Its all a great big abomination.
And here in the UK, our PM, Mr Cameron looks to the USA for inspiration as to how to improve our healthcare system
Done that. In New England. There are a lot of large old churches everywhere and many of them have an adjacent cemetery.
What was really striking were the large number of baby graves. You can tell them because they have small grave markers. There were so many they weren’t going to waste the rock or space.
Not to be too whiny, but the uninsured are only the tip of the iceberg. What about the crappily-insured, such as myself? Neither of the options offered by my employer are particularly good, and I ended up opting for the high-deductible plan because the other one is barely any better but costs an arm and a leg more.
Now I chose the high-deductible plan knowing that means I could have some unexpected expenses, and I can find the money for it if I need to. But this is still a crappy situation, and here’s a perfect example: I broke my elbow a few weeks ago, but I didn’t have a whole lot of pain right away and didn’t know it was broken until I broke down and went in for X-rays the next day. I can afford all that it’s going to cost me, but I held back longer to get the X-rays than I probably should have, partly because I didn’t want to blow a few hundred bucks if I didn’t have to. Turns out it’s actually going to be a couple thousand probably, heh… which is okay, but the point is, I had a disincentive to seeking treatment. And I’m insured!
The 50 million uninsured Americans probably excludes another 50 million (or more) who just have shitty insurance. That’s not nearly as bad as the alternative, but it’s still a problem.
To state the obvious.
Who opposes and opposed Universal Health Care or any variant and version thereof is…the so called Pro-Family Tea Party?GOP.
Ricky the psycho Santorum is now claiming Obamacare is a satanic plot or an insult to god or something equally bizarre.
It’s all very Orwellian.
Lies are Truth
Freedom is Slavery
Unavailable Health Care is Pro-Family
Both the wife and I are covered by my particularly good company insurance. The 30-something daughter has no insurance. She is literally an automobile accident away from bankruptcy.
A year ago I went into the hospital through the ER and didn’t come back out for a week. I figure the total cost of my stay was about $8000, and I paid.. zero.
Guess where I live? Canada!
Well strictly speaking he might look to have such a system in the UK, but his powers only extend as far as England. Health is a devolved issue in Wales, Scotland and Northern Ireland.
But you are right that his and Lansley’s ideas for the NHS are idiotic. When even the GPs, who are supposed to be at the centre of the new policy, overwhelmingly oppose the changes something has gone seriously wrong.
But you folks just don’t realize: if those hospital beds aren’t kept full, the “health” industry may have its own GM/Chrysler meltdown.
Here in Canada, we do have quite adequate coverage for most health issues, although with hideous wait times that both vary across the nation for different procedures, and can be life-threatening at times.
We can use a second tier if the wait times become too extreme: The United States. It sucks sometimes, but it sort-of works. One set of parents last year didn’t see their newborn for some time because a bed in Canada couldn’t be found. The child was in the NICU a hospital in New York State, and the parents couldn’t afford the cost of going there (and also didn’t have passports).
The problem is, those who would debate health care in Canada keep getting yelled at that there are only two health care models on the planet: Canada’s and the United States, and they don’t want the American version (quite rightly). Apparently, to these, Europe and Japan don’t have health care, as they never want to discuss how any other country handles this issue.
I suppose it’s the same in the States: to the right-wing, you have Communist style care and free-enterprise health care, with no other option. It’s time to rip the band-aide off this suppurating wound and heal it.
Another problem in the US is the gap between early retirement and medicare. If I retired now to take care of the Redhead, we would be without health insurance we could afford until medicare kicks in a few years down the road. So I have to keep working.
The problem to me appears to be the fact that the Zelinos were being vastly overcharged by the physician office.
Doesn’t make the health insurance system right. Just don’t make them culpable in this instance. The insurance company paid $200 a visit (if I’m reading that sentence correctly). According to the Health Care Blue Book, the cost of a vaccination visit averages $110. So, what’s up, then?
Something’s fishy. And it’s not the insurance coverage.
Of course, I’ve seen this before, too. Those who are un- or under-insured get charged the “full” rate, while those with insurance are only charged what the insurance company will reimburse for minus co-pay. The differences are staggering. That’s where the unfairness lies here. If they had obtained a “regular” insurance policy, the company’s rules would have prohibited the physician from over-charging.
I don’t know if the Health Care Reform Law addresses this, but it should.
Most of these diseases are preventable, which is cheaper and more effective than treatment. Not just vaccinations but also public health measures (think about what is happening in Haiti). Of course the GOP wants to get rid of the EPA as well as affordable insurance. Bring on the pandemics.
Health insurance would go against life liberty and the pursuit of happiness right? rolls eyes…
Yeah our universal health care in Canada isn’t perfect but its a step in the right direction.
What a fucking shit.
Ya know, if I believed in any gods I’d thank them for not having been born in the USA, having a daughter with a “pre-existing condition”. Obviously her fault that she was born lacking a kidney.
Every time I moan about health-issues on TET, I’m getting a bad conscience because I only have to moan about my, you know, health issues. When I was pregnant with that kid, it was hard enough dealing with the fact that her health-status was unknown until after birth, I didn’t have to waste one fucking second thinking about the costs of a normal OB/Gyn, a team of midwives, a university hospital OB/Gyn and a university hospital urologist all fussing around us to ensure the best possible outcome.
And the story also proves that this, of course, makes health-care more important: With insurance the family most likely wouldn’t have waited that long to seek care. They could have done probably without hospitalization and especially EC.
Because people with health-insurance usually don’t have to gamble: Kid is seriously ill, kid gets taken to the doctor. If it’s just a cold, all the better.
Why does medicine cost so much?
For example, my daughters dentist charged $120 for an appointment in which she looked with her unassisted eyeballs into my daughters mouth for less than 60 seconds.
My gastroenterologist charges my insurance $300 for a visit best characterized as a five minute conversation.
When my wife was pregnant, the ob/gyn would charge $400 for a visit in which her vitals were recorded by a PA…she didn’t even see a physician.
We are fortunate in that we have insurance to cover most of this*…but I don’t understand how this cost structure can even be proposed without being laughed off the table.
*Except apparently when we call a dentist for an appointment as opposed to when they call us.
But you are right that his and Lansley’s ideas for the NHS are idiotic. – Matt Penfold
I must differ with you on this: they are not idiotic, but a deliberate, conscious plan to destroy the NHS. The key point is that they will open the NHS up to cherry-picking of profitable services by private companies – that this is the intention, not an undesired side-effect, came out in a leaked account of a meeting between Lansley (IIRC) and private health companies. The provision of medical services also thereby becoms liable to EU competition law and WTO rulings forbidding “unfair” exclusion of foreign providers. The fact that the “reforms” coincide with a demand for a 20% “efficiency savings” is not a bug as far as the coalition are concerned, but a feature.
Republicans are big on personal responsibility, which is fine, but they’ve worked very hard to make personal claims of bankruptcy very difficult on that basis. I forget the numbers, but a huge number of personal bankruptcy claims were the result of medical issues and no/crappy insurance coverage leading to personal financial default.
OK, a quick google says that the figure is 62% of bankruptcies are due to medical expenses, and 78% of those had insurance of some kind, but which was inadequate.
http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm
The fact that millions of the people who live in fear of being bankrupted by a medical emergency are not only not rioting about this fucked up state of affairs, but enthusiastically support it, is hard to comprehend.
Back when I was a grad student at Yale, my walk to classes took me past some graveyards along the New Haven streets. And what stood out was the young women who died in the prime of life, from giving birth. Some of those were from the first part of the 20th century.
And I wasn’t even looking for that. I was just casually reading the inscriptions on some of the gravestones.
We have come a long way since then. But we still have a long way to go to make better health care available to all Americans.
Even good insurance can have gaps. I am a federal employee. I am still paying off the debt created when we were trying to get a diagnosis for the developmental problems Boy was experiencing. Until we actually had a diagnosis, nothing was covered. He was finally diagnosed with Aspbergers, but not until we were deep in debt. And no, the insurance would not go back and cover any of the expenses associated with getting the diagnosis.
The GOP has also decided that federal workers having good insurance is unfair. So there are some bills working their way to various subcommittees which would strip all federal workers and retirees of their health insurance (no, it would not touch the congressional insurance). So rather than bring the rest of the country up, they want to push public employees down.
Which is odd, as this is exactly the argument used to avoid higher taxes on the rich.
I’ve never understood the mindset that affordable healthcare for your kids is a privilege and not a right.
Unfortunately, most of the people I know would read this and ultimately dismiss Zelnio for not having a “better” job.
No, it means the entire healthcare system is US is fucked up. Health insurance is only part of that.
In countries that have universal healthcare private healthcare costs are also cheaper than in the US.
One of the people commenting on his blog does just that. The good news is that the following comments tear the comment, and the commentator, to shreds.
It shouldn’t matter if they are. No one deserves to die from a treatable condition simply because the US is so fucking ass backwards.
Yes. There are several within walking distance of my apartment. The last cemetery that I ambled through wasn’t even that old (the oldest graves were from the 1930s) and there were still a lot of tiny, sad headstones.
I’m certainly glad to live in Scotland, where the Destruction of the NHS Act 2012 will have no effect, at least in the short term. In the past few years, one of my brothers and my sister (both living in England) have needed extensive and expensive treatment – my sister will need at least one more operation. Neither would have been insured if they had lived in the USA – my brother because a previous bout of cancer would have made it prohibitively expensive to insure against contracting it again, my sister because she has a congenital condition that greatly raises her risk of exactly the mobility problems she’s being treated for, and furthermore, had no job and no capital after the failure of a business. The NHS has served them both well, and free, but I fear for their future.
1.) Profit. That’s the obvious one
2.) I suppose another factor is that ultimately those who do have insurance and can pay for treatment have to cover the costs that those who simply can’t pay add on the system.
Much like with a banking loan.
This would also explain why the “full rates” are so much higher than the discounted ones:
If you want a loan and have a good rating, you’re grouped together with other people of low risk and receive a lower interest.
The worse your rating becomes, the higher the interest:
If you belong to a group where 20% of people won’t be able to pay the bill, the other 80% have to pay more.
The problem appears to be that they don’t have health insurance. You know, to cover for ordinary visits to your GP, and for the necessary treatment.
Making the point with the one physician, the black sheep (if they are) only helps in hiding the systematic, gigantic and utter failure of the US-illness-system.
Actually, I made an error @26: my brother is now just across the border in Wales! But how long the Welsh or even Scottish administrations will be able to hold out, I don’t know.
Amazing how people who can’t stand the idea of evolution are such enthusiastic supporters of social darwinism.
Our local humanist group is organizing a tour of the Beecher-Stowe center, so I’ve been reading Uncle Tom’s Cabin. One part that stunned me was an few sentences early on in which Stowe talks directly to the reader. She flat-out assumes that virtually every mother in the audience has had a child die — at an age old enough for the family to have a drawer full of the child’s favorite things.
It really puts the death of little Eva — the saintly little girl who knows she is dying, who touches the hearts of every one of the family slaves, who finally reforms the impish slave girl adopted by a family member — in perspective. The scene isn’t just a Victorian cliche. It’s an effort by a grieving mother to find some sort of sense in the death of a beloved child.
Once took a bike ride through Harleigh Cemetary in Camden, NJ (notable for being Walt Whitman’s current address.) Literally a couple of sections are filled with nothing but graves of children no older than 10. Some of them date to when my grandparents were toddlers.
Makes me think how lucky am I to even be here, given those infant mortality rates. Then I read articles like this and wonder how far we’ve come.
Regarding Obama’s HR reform: I’ve tried to keep up with the details, but is it really that horrible? The people I know who hate it are conservatives, who on principle hate the fact Obama even exists (not that hating Obamacare automatically make one conservative.)
@Moggie #19 From european standpoint it certainly looks downright ridiculous and mindboggling, that people who actually vote in US against universal healthcare, are in large portion those who would most benefit from it. One can only ask “what is wrong with humankind?” because this kind of idiocy is beyond measure.
I am personally happy to live where I live. In US, I would be either bancrupted or dead, probably both in short sequence.
Gilliel: But if profit were the motive entirely, why wouldn’t the uninsured be charged the maximum affordable rate rather than a rate that they would simply forego because they couldn’t afford it? After all, someone who decides to refuse treatment because they are unable to insure the debt is a $0 profit for health care providers. I’m under the impression that this occurs frequently, but I may be wrong.
As in all things, I am somewhat naive, but one of the differences between medical treatment and anything else that you might buy, is that you can’t get good estimates for the costs of a procedure up front…so it’s difficult to decide whether you should agree to pay for a procedure or look for a better rate, the way that you might if you were getting your car repaired. I don’t know if that is important or not. Just strikes me as exceptional.
Well the good news is that the Tories are unlikely to get a whiff of power in Scotland, and the only chance they would have in Wales is in a coalition, and they would be a minority party in a coalition so would be unlikely to get their way on health.
That, my friends, is exactly why I will never live in the great USA.
I love your country, but your healthcare system sucks. I’d prefer to not risk losing everything because of some freak hospital bill.
And the shocking, scary thing is not even so much that the system sucks, but that half your politicians seem to think nothing is wrong with it.
What bothers me is that Medicare takes the bill from the hospital, for instance an ablation procedure lasting 8 hours with around 6 to 8 people working on you shows cost of thousands and then Medicare takes this and only allows something like one tenth the amount. I can’t help wondering which of these two figures I would be charged if I had no insurance. If the larger figure, I can’t do what Medicare does and reduce the allowable amount. My guess is that the hospital inflates figure so that they get closer to what they want once Medicare reduces the allowable amount. Still, the amount Medicare allows seems too little. Makes you wonder why a hospital would accept Medicare patients.
I live on my Social Security (less than $1000 a month) and occasional jobs. Medicare A (hospital) comes with it, but Plan B (doctor visits) premiums would be 3% of my income. That doesn’t sound like much but it’s significant to me. Fortunately, I’m very healthy, have no conditions or need any drugs, but the need to pay for a doctor looms uneasily in the back of my mind.
As a Brit whenever I hear stories like this out of the US I am reminded why, for all that it is one of our national pass times to complain about it, we are very fortunate indeed to have the NHS*.
Unfortunately, as grahammartinroyle points out @ 2, we may not have it in its current state for much longer, since Cameron seems determined to get his cut-happy meathooks into it at the earliest opportunity, and is crazy enough to look to the US system as a model for ‘reform’.
——————————————————————
* And, contrary to the claims of Teaparty idiots like Sarah Palin, there are no ‘death panels’ in the NHS with the casual, unaccountable power of life and death over citizens. Also, Profesor Steven Hawking would not be dead under the auspices of the NHS as one of her high profile supporters famously claimed – he is only alive due to NHS care.
I am one of those people who had a small retirement fund for a few years … and then I had none.
I had an accident while hiking and used every bit of savings I had to pay for reparative surgery and the follow-up physical therapy. After my savings were gone, I still owed money to several providers. The providers where kind enough to set up payment plans. Four years later I had paid the healthcare debt, but I almost lost my house in the meantime.
Which bill should I pay, the mortgage, or the monthly payment to anesthesiologist etc.?
During the time of paying-off-healthcare-providers I had another health scare and needed some sophisticated tests to determine what had gone wrong and/or what terrible death-dealing problem lurked in my brain. I could not afford the care. Couldn’t afford the tests. Couldn’t afford preventative care. Friends got together and paid for the tests.
Long ago, when I worked for a company that provided health coverage for employees, I tried to use the insurance to pay for having two small spots of skin cancer removed from my forehead. The insurance company paid for less than half of the cost, leaving me to make payments to the doctor to cover the rest. The company I worked for was paying that insurance company $500 per month for what was supposed to be top of the line coverage. (This was more than ten years ago, so that $500 per month would be more now.) The insurance coverage was for employees of a small company. A larger company might have had more leverage to make the insurance company provide reasonable reimbursement.
As far as I could tell, the insurance company’s automatic response to all claims was to make an effort not to pay. If they got away with that, fine. If they didn’t get away with that, their next line of defense was to pay less. How much less depended, in part, on how much trouble the sick person was willing to go through to force them to pay.
As just one example of the we-don’t-pay-for-that tricks, the insurance company representative told me that because I had two procedures done in one day, they would pay for only one. It’s right there in the fine print. Guess what, a surgeon can remove more than one small spot of skin cancer in a single appointment. The microsurgery costs, and the cost of the testing that accompanies the microsurgery, are high. Follow-up visits are required.
My plan now is to die if I get sick or injured.
Guest Speaker says: “I’d prefer to not risk losing everything because of some freak hospital bill.
And the shocking, scary thing is not even so much that the system sucks, but that half your politicians seem to think nothing is wrong with it.”
I couldn’t agree with you more. Our healthcare system really has its problems. Obama tried to fix it, but was forced to heavily compromise. Even so, it is better than what we have. That said, the Republicans still want to undo it. SAD!! They have theirs but don’t seem care about those who don’t. I can’t believe it when my so called religious right wing friends, who Jesus tells them to love one another, are so quick to want “Obamacare” dismantled. When I ask “what about those who cannot afford health insurance to no fault of their own and then fall ill and end up bankrupt”, my words fall on deaf ears.
Antiochus Epiphanes
I didn’t say it was the only motive. Probably most people who work in healthcare do so because, at least when young and enthusiastic, they actually want to help people.
Let’s face it, if you have the brain, rime and money to study medicine, there other professions you can enter where you make more with better work conditions and better pay.
Also, I think they are charging the maximun affordable rate. I mean, if you have to die or lose all your money, what would you chose?
True; but I find it hard to believe the bastards won’t find some way of forcing the devolved administrations into line, if they get away with this and retain power at the next elections – which they may, as the LibDems have clearly sold out completely and are just Tories under another name.
The prosperity gospel may be the most pernicious meme extant in the US today (well, along with ‘cutting taxes solves everything’). By implying that being a good Christian will result in worldly success (or more than implying it), Christians are conditioned to view anyone without a good job, without insurance, without an SUV, without a job, as a bad Christian. Giving them money or health care will not cure the underlying disease; only witnessing them to a narrow, and quite bigotted, version of Christianity will give the poor and uninsured access to good medical care and the middle class dream.
What I want to know about these prime ministers is, what the hell? Why are they looking to a country that is drowning in debt and horrible healthcare, for inspiration on how to CHANGE the system in their homelands? They must all be sadists – the US the last country they ought to be looking to for ideas on healthcare. Or, like someone said in an earlier incarnation of TET, they are blinded by the Just World bullshit and don’t realize that reality likes to chew people up and spit them back out, regardless of what they believe. Really, go find a better candidate to draw inspiration from, because all you’ll get from the US are plenty of ways to wreck everything that makes your country a good place to live in. And I say this as someone who lives there, PM Cameron.
Fuck, I’d move if that were a feasible plan of action. As things stand, it’s not.
I guess cruelty is the essential ingredient to be a GOPer. That’s all these people know, how to be a bunch of cruel, greedy nutbars. The few sane ones would be better off leaving now while they still can and forming their own party. To hell with party loyalty – why stick around if your own interests would be better represented by a different than the one you’re currently in? It makes no sense to me.
If Obama gets a second term, I hope he finds it in him to step and get some real reform done. That compromise was a step in the right direction, but it’s not enough.
Health insurance company executives need to be first, not second, to be up against the wall when the revolution comes. Tobacco company execs will just have to wait their turn.
Private health insurance companies have an innate conflict of interest: Health care costs money and the basic purpose of any private corporation is to make money for its stockholders. Therefore, HIC have strong motivation to deny coverage-and they do.
I often say that when we have universal single payer insurance we’ll have to get our health care approved by some faceless bureaucrat who couldn’t care less if we live or die-and that this will be a vast improvement over the current system which involves a faceless bureaucrat who is actively trying to deny us the care we need to live.
And yet even that is better than not having any insurance…lack of insurance kills. Bad insurance kills. The only fair thing to do is to put everyone on the same plan and work from there.
@scifi, 36
It depends on the hospital you are in. The last one I worked for did do specific cash quotes for cash pay patients. They were considerably less than what would have been charged to the insurance company. They were much closer to what the actual cost was to the hospital, of course the quote still had a healthy profit margin built in.
The very first step toward healthcare reform should be to delete all health insurance benefits from the pay packages of congress critters and senators. No healthcare insurance for them, and none for their families.
After they take two or three years getting a clue, they can come back to the healthcare issue and come up with a reasonable plan for universal coverage.
the US the last country they ought to be looking to for ideas on healthcare.
Oh, come on there’s worse. Like…hmm…well, Afghanistan. Or Iraq. Lots of well documented excess mortality in Iraq since…well, since the US invaded.
@Lynna #47:
I like your idea in principle, but in practice I think it wouldn’t work. Far too many of them are millionaires and can afford to pay for any treatment they might need.
But what if all your money is still not enough? Denial of healthcare because of inability to pay happens, doesn’t it?
If it is emergency care, it is illegal to refuse treatment (though it does happen). Refusal of ongoing, preventative, or non-emergency treatment due to innability to pay happens all the time. I cannot count the number of times I have seen tins in quicky marts asking for donations to help pay for cancer care.
AE:
Yes, it does.
No hospital has any obligation to take you unless 1) you’re actively dying or 2) you’re in labor. If you’re dying, all they are on the hook for doing is stabilizing you, then it’s perfectly legal for them to boot you out.
I’ve got two master’s degrees but unfortunately they’re in the arts, so I don’t make a lot of money. The business I’ve been employed by for almost 30 years is very small–only 5 people at the max–and cannot help provide health insurance or benefits of any kind. But I’m lucky to have this job and am not complaining.
I live in a state that will insure anyone, but you have to be able to pay for it. The reality of it is that it would take over 50% of my monthly income to buy it. So I have to pay as I go. Twelve years ago I contracted pneumonia, went to the emergency room and ended up for one day in the hospital. The bill was over $4,000 for one day. Like Lynna, if I get seriously ill, my plan is to die. Doctors won’t treat you if you can’t pay them. There’s something wrong with that, but I’ve had to accept it. Not much choice.
Oggie:
Not really. See my #52.
If you go to the ER with, say, a broken arm and cannot pay, the hospital is not obligated to treat you.
Dr. Audley:
I apologize for my mistatement. By emergency, I was trying to refer to a life-threatening condition. I was using my EMS glasses and phrasing and screwed up. Sorry.
Oggie:
Hey, it’s all good.
Antiochus Epiphanes @ # 16: Why does medicine cost so much?
The US system includes a very negative positive-feedback loop:
If anything goes wrong, patients face gigantic expenses – and so have little choice but to sue their physicians.
Therefore the doctors have little choice but to buy malpractice insurance, and in large amounts (a mere million won’t cover much).
Thus these costs – both for remedial care and for litigation – get passed along, to the patients and to their insurers (who in turn file suit any time they see a chance of externalizing expenses).
All this not only adds to but multiplies the burden of self-protective paperwork, estimated to comprise about 15% of US hospital expenses (just for matching descriptions of illness/injury to terms of coverage in countless different policies).
If we had single-payer/national insurance, doctors (and nurses, institutions, etc) would need to buy malpractice insurance only sufficient to cover penalty awards for suffering, negligence, etc, as actual treatment (all that most patients would probably want) would be taken care of. This would lower expenses all around, possibly as much again as the streamlined paperwork due to standardized administration, maybe even as much as excluding the profiteering parasites from the cash flows involved.
Not really. It annoys me when I do this. I used a bit of internal jargon (a specific meaning within my organization) which I really shouldn’t do (here or at home (or anywhere outside of work)). And it really does annoy me.
As a Canadian, it is mind-boggling to me when I look to the south, and see on the one hand people with horrific stories of going bankrupt and even committing suicide because of health care costs, and on the other hand those protesting and rallying against universal health care, and somewhat higher taxes to pay for it because it is “taking away our freedom”.
WTF? As a top ~20% income earner (well, the lower part of that!), I pay ~34% taxes (including all deductions for gov’t-mandated pension (CPP), employment insurance, health care premium, etc). Horrific right? Scary right? Not free right?
Well, it is not even on my radar screen to worry about multi-thousand dollar bills showing up, or worse, bankruptcy, if I have to go to the doc, or get an operation, or get injured in an accident. It is covered. My elderly dad is in a nursing home, and his cost is pro-rated to his income…otherwise he’d be pushing a shopping cart on the street.
Sure, if you have some problem where your demise is not imminent, you’ll have to wait awhile, and I personally would like to see a secondary private system here where you pay more if you want to get it done right away (and subsidize the public system with those payments) rather than having those health-care dollars going south, but my experience is if you have something serious you get in right away, and you are professionally, and compassionately looked after.
So, the bottom line is that you *can* pay thru higher taxes to spread-out costs and have a compassionate society that doesn’t see a huge division between the wealthy and the rest when it comes to health care. And I don’t feel “imprisoned” or that the gov’t is taking over, or hard done by by my tax rate. I know the benefits it provides, and I know that down the street someone less fortunate is getting care when they need it. It is worth the price.
It all depends on what kind of society you want to live in…
Last summer while studying abroad I met people from all over the world, mostly from Europe. Speaking to a couple of Brits I mentioned that their complaints about the NHS often came up in the U.S. as reasons not to implement national health care. They explained that as Brits, they complain about everything, all the time. I asked if they would prefer the U.S. health care system then I could swear I saw them both go pale. They said emphatically not.
On cost containment: prevention saves an enormous amount. I wish I could footnote this, but recently I heard a social services person explain a money-saving program in Camden NJ which used computer software to find out where, geographically, and what, medically, cost the state the most in that city. The software zero’d in on poor, elderly people with diabetes and some other illnesses requiring medication and monitoring. Paying for someone to go around and check on people, make sure everyone was taking their meds, etc. cost far, far less than the ER visits and other urgent care problems at the hospitals serving this population, which reduced as a direct result of one person (I think only one, or one a day?) going around and checking on people.
Sometimes the answer is that simple.
lucky me, living in germany…
where a evil leftist communist person in power has taken away my freedom…
;)
Oli
What I don’t get is how PZ is criticing the Affordable Health Care Act before all of its provisions have actually come into effect. Some of the things PZ criticises, and rightly so, are meant to be alleviated by the law… (since it will take until 2014, of course this means that if Obama loses, there is a good chance the bill will be repealed. Once it takes effect, it will probably be hard for Republicans take it away at a later date, say 2016 or so).
Devolution in the UK
It’s my understanding that Parliament could revoke that with a simple bill? Though Cameron would probably not be able to so do politically.
Drug costs
Drug companies claim that developing new drugs costs them 500m-2b, with no guarantee of success, i.e. that successful drugs have to recoup the losses from less successful ones.
Apparently two studies have shown that costs averaged indeed around $800m (http://www.enttoday.org/details/article/531895/When_It_Comes_to_Drug_Development_What_Do_Our_Dollars_Buy.html)
One could argue that in a universal health care system with a public option (or even completely state-run) the state has an interest in keeping drug costs down, and might set price brackets that will deprive the companies of some of their profits.
But I think there are two things here:
1. a society should still value human life more highly than company profits, which means ultimately it should value real human beings more than imaginary ones that purportedly would be saved if the industry would be allowed to use their profits for new drugs, just at the cost of “sacrificing” the very real human beings due to their inability to pay. I also think that pharmaceutical companies would be adaptive enough to be able to continue innovating.
2. Even in state-run systems, governments understand the need for innovation in the pharmaceutical industry and will try to provide market conditions conducive to innovation. Usually, the drug industry is part of negotiation processes about pricing, alongside healthcare providers and the government.
And I’ll bet dollars to donuts that some GOP asshat either has complained, or will complain, about this horrible government intrusion into the privacy and freedom of private and freedom loving Americans!
I read about experiences like this and shudder.
My husband and I are film makers who run our own business, mainly making documentary programs for television. We make a decent living, but aren’t raking in scads of dough.
Two years ago when our older daughter was 12, she broke her hip. It was a freak accident and involved a congenital problem at the growth plate. It was a bad break, which meant that she had to be in traction for four days to realign the bone, then surgery to pin the break.
We live in Canada. Because of that fortunate fact, we didn’t have to worry about whether we were going to lose our house and our business while we held our baby’s hand through excruciating pain. There were no forms to fill out, no worrying that the insurance wouldn’t cover us because of a pre-existing condition. We could focus on getting our girl through a tough time.
Our system isn’t perfect. Hospitals are often understaffed and doctors, especially specialists, are often overworked. A friend of mine is undergoing treatment for cancer and the bureaucracy is sometimes staggering. (Canadians do bureaucracy better than anyone, I’m convinced of it!). There’s plenty of room for improvement. But you don’t face financial ruin for medical bills, and it boggles my mind that the US won’t have universal medical care. I just can’t understand it. I couldn’t do the work I do if I lived in the States. I’d have to work for someone else, which seems contrary to the idea that the US is the “land of opportunity”.
The situation with health insurance is awful and all the Rethulicans and many Demoncrats can talk about is protecting the “free market” for the insurance industry and medical profession.
I was laid off two years ago. My wife has been unemployed for years (depression due to our son’s ASD), so we had no fall back. At our ages (61 and 51), getting a job in the youth economy has been difficult…I guess no 30-something hiring manager wants to talk to us old codgers.
Oh, and nine months after I was laid off, my wife had angioplasty (4 stints…yes, about the same time as the PZ event).
We were able to continue our good insurance under Cobra. Due to my age, we had a government subsidy that reduced our cost to only $650/month. That is, until the last few months when it went up to $1900/month. But our Cobra coverage was ending and we were scrambling to come up with insurance.
Fortunately, my tax guy is also an insurance agent and he proposed a strategy: my wife and I formed a partnership through which we were able to get health insurance. Not cheap, not comprehensive (no dental/vision), but at least we can get care.
But, isn’t it just ridiculous that a married couple…essentially a form of legal partnership…has to form a business partnership to get health insurance coverage.
Oli,
You probably know that Bismarck did this because he feared the Social Democrats, and wanted to steal their thunder. Often, conservatives show compassion when they fear that due to economic inequality, the people might just rise up and sweep them from power.
In the US, the New Deal was also a reaction to the Great Depression. AFAIK, after that, in the 40s, Truman was considering a bill that would have introduced universal healthcare, but for some reason it didn’t happen.
I’m lucky enough to get good health insurance through work.
But I work in a industry that is notorious for boom-and-bust cycles and for discrimination against older folks. I’m very much aware that I could find myself out of a job in my field permanently. During my last period of unemployment, my COBRA ran out and I had to try to get private insurance. I was turned down for the regular rate because a common and cheap-to-treat condition–hypothyroidism–and because I had suffered from post-infection irritable bowel syndrome for several months after being sick. Even though it resolved and hadn’t been an issue for a couple of years, my “unknown bowel condition” was still cited as a reason to turn me down.
What this means is that I am very much aware that every time I access the medical system, it’s going on record. And that record can be used to turn me down for insurance in the future. This absolutely does affect my decisions on whether or not to go to see a doctor and what exactly I say to the doctor when I see them. The screwy health-care system we have in the US negatively impacts even those of us lucky enough to have insurance.
We were lucky when my mom had a stroke at the top of the stairs that my parents were covered by exceptionally good insurance. We’d probably have ended up in a small apartment in the next town over where it’s cheap otherwise. My dad has very large savings(after seeing a couple of my moms pre-insurance bills, I stopped thinking dad was cheap), so we might have pulled through ok, but a lot of stuff would have to get sold to supplement his savings.
That is so disgusting. I don’t know what else to say; Having access to affordable health-care is a human right and it’s unbelievable that people are refused that right because of… well, because of what exactly? Higher cost? There are dozens of models for comprehensive health care systems all over the developed world that cost less and are more effective than that in the states. Freedom? Like, the very specific kind of freedom that allows poor people to choose between food and chemotherapy but prohibits women from making their own reproductive choices? I just don’t get it.
Oh, but apart from the insurance craziness, it also seems to me that pharma companies and doctors are allowed to charge pretty much whatever they’d like to – is that the case? I’ve seen a post on Pandagon where it said that the cost for BC-pills is between 70 and 95 $ a month – I live in Germany and pay 10 $ a month (as BC is not covered by insurance for people over the age of 20). The ingredients shouldn’t differ that much…
The 50 million uninsured Americans probably excludes another 50 million (or more) who just have shitty insurance. That’s not nearly as bad as the alternative, but it’s still a problem.
We’re in that latter category.
We have shitty insurance (BCBS is pure evil), so I don’t go to the doctor when I need to. And I definitely need to. The doctor was almost 100% certain that I have MS, but I needed just a few more tests to verify that suspicion. However, I can’t get the tests done.
So I’m sitting here with possibly a deteriorating neurological disorder, but I can’t even begin to get it treated because I can’t afford to get the tests run to verify that I have it. Even though I have insurance. Right now, we just can’t afford the deductible.
Co-pays to visit the doctor? Spare me. Get this catch-22: Because BCBS has this nasty habit of dragging out their reimbursements of doctors, all the doctors in San Antonio demand the full payment for a visit up front for anyone who hasn’t reached the deductible, and they tell us to get our reimbursement ourselves–which we have never, ever gotten. BCBS never–ever–reimburses us. Have you seen the paperwork to get reimbursed? Trust me–they always find some piddly bullshit i you didn’t dot, or t you didn’t cross, and reject your claim.
Always.
For us, it’s probably better to just cancel the insurance, and use the money we’d save every week to pay for basic care ourselves.
Maybe if we get a tax refund this year, I can finally go to the MD and get my tests taken care of.
Maybe.
Well, and not only for you, it is so for the lowest 20%, too.
I mean, unless you’re really in the 1%, you will have friends, family, people you care about who are not that fortunate.
My mum in law is a breast cancer survivor. They are living slightly above German social security level, so I guess well above US level. We are already supporting them with money. When she needed therapy we paid for a good, individually made wig so she wouldn’t have to wear the roadkill one healthcare gives you.
But we didn’t need to pay for her therapy, we didn’t have to bankrupt ourselves so mum could live.
If I have to, I can always go to the VA, but I hesitate to do so because their resources are limited, and there are those who’s need is greater. My wife is not so lucky.
First of all, we live in Arizona, where Gov. Brewer and our malicious legislature have cut off funding for healthcare for those who are well below the poverty level. Secondly, being of Mexican (and Mescalero Apache) decent doesn’t help much when she’s sitting across the desk from some frustrated, bitter, tea party bureaucrat, whose twisted vision of utopia is one where everyone is a blond-haired, blue-eyed Christian.
It almost makes me wish there were a hell.
Another word on health care affordability, anecdotal evidence and cost containment.
Put a bit too simply, we have two kinds of “risks”: good and bad. These are not pejorative terms, they are technical terms. We all become “bad” risks if we live long enough.
The U.S. allows private insurance companies to “poach the good risks.” This is very easy, as good risks do not, as a group, have expensive long-term illnesses or sustain injuries with long recovery time. Now and then a good risk incurs a long-term high cost, but on the whole insuring only the good risks is a bit like printing your own money. The anecdotes we read in the comments and in PZ’s initial post involve the bad risks or the people without enough money to pay even the “less expensive” rates the insurance industry charges for the good risks. They do not pass along all the
“cost savings” to the good risks – they only need to under-price the policies that insure a pool with a mix of good and bad risks. As the good risks leave the mixed pool, the rates for the pool with more and more bad risks has to rise in order to cover costs. As the price of coverage for the pool containing more bad risks rises, the price of coverage for the pool with only good risks can rise as well as the company need only underprice the pool from which its poaching the good risks. The people in the “bad risk” pool can not afford coverage while each of the executives running the company that poaches the good risks can afford a villa in Tuscany.
Literally every other industrialized democracy has figured out that the solution this situation is one big risk pool with everyone in it. In some variations private insurance is allowed, but it can not underprice for the purpose of poaching the good risks.
I have good health insurance, because I’m in a large union. I’m also a state employee, so I’m exactly the kind of worker that Republicans want to drag down into the depths of poverty because nobody but them ought to get good health insurance, I guess. And I feel fucking guilty all of the time that just by accident of the job I happened to get, I have none of the worries that most people have with regard to catastrophic health problems.
And all of our health care problems in this country don’t even touch how dental and vision coverage is considered an optional perk, and mental health coverage is a unicorn most of the time.
Utterly depressing.
Maybe I’m crazy here – and tell me if I’m being crazy.
But assume for a moment that you’re obscenely rich, right-wing, conservative. Stick that hat on.
Then consider where your wealth comes from?
Your wealth comes from, essentially, the people who work in the companies you own. For the sake of argument, assume that in Scenario #1 a significant number of these are American workers.
Now: Are you better or worse of with healthy workers?
Seems to me you’re better off. Healthy workers are productive. Sick workers are not only not productive, but incur unproductive costs in the form of sick leave.
Surely it is in your interest to have healthy workers, which means workers with access to healthcare. Right?
Even so, I can see that paying those expenses yourself in the form of insuring your workers might actually be more costly than the benefit of having a healthy workforce. So following the cold and brutal logic of maximizing your own profits, sure, I can see why you might choose to ramp down the quality of insurance on offer to your employees. It would be hard to stay competitive otherwise.
But look again: Isn’t that just the tragedy of the commons again?
If everyone were to contribute to healthcare in the form of tax-driven universal healthcare, wouldn’t that mean that you yourself would get to have a healthier, more productive workforce and stay competitive and reap the benefits of being a competitor within an economy that has a higher rate of economic growth as a whole due to the increase in overall GDP provided by having a workforce with access to healthcare?
I see universal healthcare as being in the interest of the rich as well as being in the interest of the poor. Not as much, but still an interest.
The only people who lose in such a situation are the insurance companies themselves, who have to dial back from being a necessity to being an optional privilege.
Daniel:
Now that’s Commie talk!
IIRC, the CEO of Ford supported single-payer healthcare for the obvious reason– it would make his company more competitive with foreign car manufacturers who don’t have to worry about that cost. It wasn’t about healthy workers, it was about how much money Ford could save (increased profits!) by completely eliminating the need to buy health insurance for its workers.
Because of ideology.
In the 1910s, the US was considering, quite seriously, a universal health care bill. The Russian Revolution gave the reactionaries a fig leaf big enough to scuttle it. After WWII, Truman tried again and the Chinese revolution and Stalin gave the reactionaries another big fig leaf.
Depends whether or not the pharmaceutical companies are for-profit or not, and also weather the government is willing to subsidize them. My daughter gets the once-every-three-months shot and pays a $10 copay, so that may also be it. Lots of reasons.
===
Daniel Schealler:
The problem in your reasoning is that the rich know that for every worker who gets sick and has to leave, there are two people who want that job. And they are doing everything possible to keep it that way.
this story (and others like it) are precisely the reason why I want to GTFO of this country as soon as I’m finished school. For example, a month ago the boyfriend needed to go to the ER because he cut his hand on a glass bottle. Price-tag on 2 hrs in the ER and 20 stitches? $1000
I’m still hoping Canada will take me, but if not, I’m going home to Europe
In America, you’ll often hear anecdotes or stories of for-profit hospitals “transferring” their low-profit beds to other hospitals. Sometimes the receiving hospitals don’t accept them (because their full, e.g.). What’s funny about our system is that this sometimes results in people literally dying in the street.
Good news, everyone! Our legislators are deep in the thrall of those same companies due to their funding election campaigns. Sheesh.
(Just another example of how campaign finance reform is the root of a lot of problems.)
I’m so embarrassed. They’re full, I meant to say.
As I assume every citizen of a country that has universal health care thinks, whenever they hear a story like this, I wonder why the U.S. seems to be so resistant to the idea? My understanding is that the difference in cost between providing health care for everyone vs. just those that can afford it is insignificant.
I love the hypocrisy of people like Sarah Palin though, who are against universal health care, yet go over the border to Canada to get medical care/cheaper prescription drugs.
it’s not that simple. by that logic, plenty of people “chose” to die; because a $1000 ER visit will scare them off and they’ll try to pretend nothing is wrong, or wait until the insurance from the new job kicks in before getting diagnosed, or try to fix it themselves. With entirely predictable consequences, ultimately. But it is a way of thinking you fall into incredibly easily if you live without insurance for long enough.
Health care in this country is specifically used to benefit the wealthy.
The rest of us are the “test subjects” that the medical profession uses to find cures for the wealthy.
Why is this a surprise to anyone?
you only say that because you’ve never had the “pleasure” of dealing with a post-communist bureaucracy. :-p
@Ogvorbis:
Well, looks like they’re running out of fig-leaves – so it should become harder and harder to defend the status quo (although what I’ve seen from the last bid health-care debate the reactionaries don’t even need any real life socialist regimes to point at as a threat…)
I googled prices for BC and found that – for example – Yasmin (Bayer) costs 86 $ a month in the US and about 20 $ in Germany (both without any insurance). I couldn’t find anything about the pill being subsidized here (for adult women), so at least some of this huge price gap seems to be pure profit margin.
But you Yanks only have yourself to blame.
If you had only stuck with the Mother country instead of wanting self determination, you too might have universal health care.
On a more serious note. I have to agree with one of the other contributors regarding US decision makers. These people are in a bubble which is paid for by the very people who are in some cases literally dying for decent healthcare.
I have just looked at my salary slip and how much tax I pay each month.
It think this Brit will stop moaning (just a little bit) knowing medical costs are not going to bankrupt me.
as long as you can fire the ones that become unhealthy and replace them with new
victimsworkers, you don’t need to care. easier still is getting your labor from temp agencies.and on the note of being better/worse off with healthy workers: around here, there are PSA billboards begging people to stay home from work if they are ill. They of course make sense, since a single ill person is cheaper for everyone than an entire office + a bunch of customers getting ill.
But there is no such thing as sick pay, and you have to have a doctor’s notice if you stay away for more than a couple days, and in many cases, you aren’t even allowed to just not show up unless you can get someone to cover your shift (at the places I worked at, not showing up could get you written off, and they’d only send you home if you were puking and/or having diarrhea (or were a good enough liar to convince them that you do)); so of course people don’t stay home when they’re ill.
Technically that would be possible, but it is highly unlikely that he could get such a bill through both houses. It is convention that matter such as devolution are subject to a referendum, and not holding one would also cause him no end of problems. On top of that it would almost certainly result in Scottish independence, and the Tories could say good by to having a representation in Wales for generations. I don’t even want to think about what would happen in Northern Ireland, except I would not want to be there to find out.
One of the things that really annoys me is that the Tory right will use the fact the NHS has a relatively high number of days lost due to staff sickness every year as evidence it is badly managed with a lazy workforce.
They wilfully ignore the fact that 1) nursing and other jobs are physically demanding and 2) you do not want staff coming in when they ill since they will be around people whose immune systems are not functioning as well as they should. A healthy adult can shake off a stomach bug in a few days. It could seriously harm, or kill, someone who is already ill.
gah! I’m just now reading the comments on the article in the OP. This one makes me want to slap the person who made it:
go stuff your “herbal medicine” where the sun don’t shine, asswipe.
grr.
What a horrific story. I’m in the UK, and yes, we complain about the NHS. But those are, in general, just idle grumbling. I would never consider moving to a country without universal healthcare.
The NHS provides universal free-at-point-of-use healthcare. Children are vaccinated, emergencies are treated, illnesses are cured. And as a country we spend far less per-capita than the US on a much more universal and easier to use system.
I find the idea that one would have to consider carefully on financial risk grounds, whether an illness is serious enough to take it to a doctor. We did away with that thinking in the UK over sicty years ago, and no-one in the Uk wants to go back to that.
My daughter has Crohns’s disease, now thankfully under control and in remission. The weeks of tests and hospitalisations, the special diets, the surgery and recovery, the blood tests and followups and regular checkups: All free. We never even considered the cost.
On a more prosaic level: Over the past six months, my shoulder has started aching more and more often, and I started to notice movement limitations. A GP visit and three sessions with a physiotherapist have me on the road to recovery from a frozen shoulder. All free.
How the average American has been hood-winked into thinking that a universal health care service isn’t in their best interest bemuses me. I just can’t see how its been done.
American pharmaceutical companies charge as high a rate for their drugs as they can here in the US so as to recoup their R&D costs and make a profit, and then sell them for a much cheaper rate in other countries where they need to be competitive and aren’t protected by patents.
The NHS does well when it comes to purchasing drugs at a good price. It is the single largest purchaser of drugs in the world.
There is a problem in the UK with people going to their GP/calling the out of hours service/going to A&E for minor ailments that can be treated at home with OTC medication. There is also a problem with people not going to their GP/calling the out hours service/going to A&E when they have a life-threatening illness.
This is a better problem than having people die because they cannot afford healthcare, and one that is solvable with education.
I understand that.
In the original story PZ linked to, I can almost tell the exact day I took my daughter to the doc the last time she had those symptoms. Fortunately, she did not have pneumonia, I was told to give her cough potion, love and rest. It was just an ordinary cold.
But had it been pneumonia, she would have gotten the treatment early.
The family in that case could not just take the kid there. They had to wait until there was no doubt that there was something seriously wrong.
Of course, overall, my kid getting taken to the doc 9 times for a basic cold and 1 time for an early pneumonia still causes less cost overall than one emergency care pneumonia kid.
One thing that drives me absolutely crazy is a libertarian friend of mine who asserts that since I’m just as smart as he is, and just as capable, I should be able to do what he’s done: amass a small fortune, then strike out on my own. That’s what he describes as “equality of opportunity.”
What he deliberately forgets is that, unlike himself, I have a wife and two children. My wife has a rare form of global epilepsy: seziures are rare but physically devastating. The medication to control it is $1160/mo, and insurance covers half of that for six months, and none of that the rest of the year.
He and I are not starting out with the equality of opportunity: he starts out with a much broader capital base than I ever could, because I choose to honor my commitments to my family. My blue state values (you know, family and children and all that) “hold me back” from doing the one thing red state values admire: making cash.
It is obscene that people profit from illness.
Heh. More likely you wouldn’t.
go stuff your “herbal medicine” where the sun don’t shine,
They often do. It’s known as a colonic.
As a continental European, I’m constantly wondering how the US system even works… or at least is supposed to work.
When I read stories like the ones that came by in this thread, I’m pretty glad that in Belgium, all I have to pay is 13,09% of my gross income and I know that my basic healthcare, possible unemployment, possible child support and hopeful retirement are covered.
Of course, the system isn’t perfect. People do complain at times because certain treatments are not or no longer in the basic heathcare package, but taking an additional insurance is pretty affordable as well. You can have a good hospitalisation insurance for about 30€/month.
I’m actually surprised that at those prices, there are so many people who don’t have a hospitalisation insurance. Most cases of run-away debt due to medical costs are due to a lack of hospital insurance. Personally, I think it would be in everybody’s advantage to have this insurance mandatory as well.
But I do think it’s worth mentioning that in times of economical crisis, when the government is bickering of how to realise an additional € 5 billion expenditure cut, not a single party, not even the most right-wing conservative ones, even thinks of touching our health care.
It just boggles my mind that it’s possible for US candidates to actually have a platform of worsening people’s health care. It’s like having a butchery where the cattle walk in and they slit their own throats.
Another bizarrity of medical insurance in the US: Remember that copay? Ever wonder why your doctor insists on collecting it even though s/he knows you can’t afford it and miss appointments because you can’t pay it? The reason is…it’s illegal. You can not legally waive the copay if the insurance company is charged. Discrimination against the insurer. I swear I’m not making this up. There’s some chance that the person who told me this was because she knew I’d be bypassing copays if I could, but I’m reasonably sure it’s true.
@70: Aquaria, this may be utterly useless advice, but have you tried UTHSCSA? The ambiance is awful and the waits long, but I’m pretty sure that they’ll take uninsured patients.
elfsternberg, I wonder what your friend would think of the fact that, in most colleges, faculty have widely differing salaries based solely on the subject they teach, even though they all have the same workload. Where is the equality there, even though all of them have seized the same opportunity to take a job as faculty? And that doesn’t even begin to touch the issues surrounding family responsibilities, as you brought up. Not to mention that people have differing amounts of support from their extended families as well. Take two families with the same salary and number of people in them, but one with a grandmother nearby who watches the children while the other family has no relatives and has to pay for childcare to the tune of a thousand dollars or more a month. Equality?
Dr. Audley Z. Darkheart #77
Of course it all boils down to profits. That’s to be expected.
Universal healthcare still benefits Ford because it improves the economy, and therefore the domestic market is stronger.
The issue with international competition should be met (in my view) with carefully managed trade. Subsidize exported cars to improve international competitiveness and therefore apply a braking effect on America’s balance of trade getting even worse.
Additionally, increase the tariffs on imported cars to help protect the domestic industry by ensuring Ford can reap the benefits of a domestic market that has been strengthened by universal healthcare.
…
What’s that? A universal healthcare tax and mercantilist/protectionist trade policy! Clearly this is the slippery slope to communism!
We need capitalism to prevent us from the scourge of the state taking on ownership of private assets, because… wait… hang on a minute…
^_^
PFC Ogvorbis (Yes, they are)
Actually, that’s not relevant.
The workers on the way out will still cost money in terms of sick leave before they’re finally gone.
And the workers they’ve got will still continue to under-produce due to failure to remedy treatable non-critical illnesses.
As I see it, the only benefit to the owners of capital in the current arrangement is that increased desperation due to healthcare costs gives employers greater leverage over their employees and their unions – which increases their power to exploit their workforce by de-coupling wages from productivity.
That can certainly work to their benefit in the short term. But it should be obvious how this will cripple the domestic market. If the American market goes down the gurgler then all the overseas countries that are gearing up their economic policies to produce cheap labor for exporting to the US will have to stop doing so, so the owners of capital can say goodbye to cheap foreign labor as well.
In the long-term carrying on with the status quo is a financial disaster for the wealthy. Less of a disaster than for the rest of us of course – but still a disaster nonetheless.
It’s the familiar old chestnut of short term vs. long-term reference frames.
Bugger. Formatting fail.
Apologies for (apparently) shouting.
There’s supposed to be a closing /strong tag after ‘PFC Ogvorbis (Yes, they are)’
I am blessed with several autoimmune diseases, called Mixed Connective Tissue Disease. My overlaps are Lupus, Sjogren’s, Rheumatoid Arthritis and Psoriatic Arthritis. I have Raynaud’s Syndrome, Meniere’s Syndrome and Spasmodic Dysphonia thrown in for more fun. My otolaryngologist thinks that my hypertonic leg muscles (which keep me from walking very well) is another form of dystonia, like the Spamodic Dysphonia. He thinks that I should be worked up for Spastic Paraplegia.
The thing is, that would require an MRI. Having one of those would mean $300-500 out-of-pocket. I’ve gotten to the point where I will just take the meds that I absolutely have to have (and the insurance will pay for) and I will just toddle along with my cane, husband or service dog for support until I’m confined to a wheelchair. We don’t need the added expense.
My husband is one of those Federal workers that the GOTP likes to demonize. Our insurance is adequate, but certainly NOT the wonderful coverage that the lawmakers enjoy.
I’m sure that there are many others like me, who are insured, but suffer along with minimum care because of the out-of-pocket expenses. We need a better system in this country!
The United States health system is pathetic and inhuman. Here in Australia I pay about $600 per year for Medicare, and that covers most health costs I may incur at a public hospital. People on a low income pay nothing for Medicare coverage. I also have the option of purchasing private health insurance directly from the insurer, instead of it being provided my employer.
I can’t understand the thinking of the decision makers in the US, who apparently don’t consider health care to be a human right.
Health care is prohibitively expensive, but most people I talk to are unaware of the external influences.
Insurance companies are beholden to their stock holders; NOT to their customers (you know, the patients…) A simple, ugly truth is this: the stockholder profits every time a drug/procedure/test is denied.
General practioners are rapidly vanishing, with good reason. They are squeezed by the government if they accept Medicare/Medicaid, by insurance companies if they accept insurance, and by malpractice lawyers at every turn. Their malpractice insurance (an uneeded legal expense, made necessary by lawyers, that we all have to pay for…go figure) is prohibitively expensive. They have their decisions questioned by someone with an associates degree, sitting in a cubicle thousands of miles away, weeks after rendering services, and ultimately get paid an amount that actually causes them to lose money.
Anyone who is willing to commit the time and effort necessary to complete medical school, and internship, residency, and board certification, has earned the right to earn a decent income. Maybe not millions of dollars per year, but let’s not complain about the cardiac surgeon making upper six figures…they deserve every penny.
Technology is pricey…I mean, an MRI machine, a marvelous piece of engineering around hard-earned physics knowledge, was unimaginably expensive to develop and manufacture. A hospital will commit many millions of dollars to MRI’s, CAT scanners, X-ray machines, and such…somebody has to cover the cost.
The list goes on and on…Ultimately, I think it will boil down to the choice between everyone getting better-than-nothing healthcare, or only the wealthy getting fantastic healthcare.
But I would like to ask everyone this: Is for-profit healthcare immoral? Would it be better if healthcare was non-profit?
yes and yes
I know that whatever I write here is ‘preaching to the converted’. But the Sarah Palin comment about death committees (or whatever) really peeved me off – she obviously has no idea.
Ok – I’m not in the UK – I’m in NZ. I haven’t got time to write in detail about the NZ hospital system and my Dad last year – 4 stays in the hospital between April 25 & his eventual death on the 5th July, numerous ambulance trips (most up to 1 hour long), weeks in hospital, expensive medicine, active treatment – all for a 74 yr old man with numerous medical issues where the chances were that he wasn’t going to get to the end of the year. He was still being actively treated until about 2 hours before he died – when it was obvious that anything more would actually cause him pain/discomfort he was quietly removed to a private room so that he and Mum could have privacy at the end.
This cost us nothing. Not a single cent. We did not have to worry about the cost of tablets ($100 each) or the fresh frozen plasma, or anything.
Yes – the system is not perfect. Dad was due to see a specialist and that did not happen – and it added to the complications. We had to pay for his nursing home fees when he wasn’t in hospital – but that was a cock up by the lawyer (long story). But the actual medical treatment, the medication outside of hospital, etc – nothing.
And I’ve just heard that a friends friend, over 90, fell, broke hip and had it fully treated – even though it is not sure she will make it.
So stick that in your pipe Sarah Palin and smoke it – when you are ill and need treatment you don’t need the extra crap of how to pay for it.
Health care costs could immediately be dropped by at least 20-30%, if the obscene profits to hospitials/doctors/therapist groups could be reined in. That means the uninsured could be covered with the same total amount of money we have been using for inefficient HC. Yes, HC profits are immoral, and HC would be better being totally non-profit. And one hell of a lot cheaper.
Huh. Had a pain in my groin area. “Urgent care” had me do a co-pay, found an infection, but did no blood work, or internal exams, and I left with a prescription for thankfully cheap anti-biotics, and some sort of inflamation stuff. Over all, maybe $60 total. A few weeks later, the pain was back. Went to the emergency room instead, in enough pain I just wanted them to get me the hell out of there, with something for it. Total cost – 4 hours of my life, a prescription for 800mg Ibuprofine, and them telling me, “Check with a doctor in 2-3 days.” 5 days later I went into the doctor, and got an appointment for 2 weeks ***later***. Visit to doctor – paid for, but all they did is take blood pressure, do the same stupid exams they did the prior two times (nudge here, press there), and from “my” description of the problem, instead of getting an MRI, I am getting an ultrasound for what may be a symptom, for all the hell I know, instead of the cause. Apparently this procedure is **not** covered, because I have been informed I need to pay like $160 for someone to stick a sound wave generator against me, and take pictures. Assuming the “doctor” doesn’t find something serious enough to bother with, I get to visit him again in **3 weeks**.
Why is it this bad? 1. Its a retirement area, so, if you are not over 80, don’t plan to get frakking sick during the winter, when all the old people move from places with snow, to where there isn’t any. 2. There are not enough doctors. 3. The hospital is making damn sure there isn’t a new hospital, and thus more doctors, aside from those in general offices, who don’t have access to all the labs, tests, and equipment they need. 4. Several of them decided, either that they would have to treat poor people, or kids, or lose some of their profits, with Obamacare, so decided that their over-stuffed fucking pay checks mattered more than the well being of their patients. Frankly.. As far as I am concerned, that should bloody well be ground for termination of their right to practice, if their goal isn’t to provide services to the wrong people, or at the wrong price, or to more than they want to, because all of the sudden more people might be showing up with problems, and a way to pay for treatment. It makes about as much sense to me as getting into something like space research, not because you actually give a shit about the research, but you really like eating in zero-G, so you quit because someone invents a way to bloody simulate gravity. Why the F@#% did you bother getting a damn license, if you where not planning to help people with their health care? Apparently, for some, its a) to avoid paperwork (like that wasn’t getting worse and worse under the existing idiocies), b) play golf, or c) get rich.
And, while I can understand the damn paperwork issue, that is a reason to bloody fight for less paperwork, better systems to handle it, and/or a system that has single payer, or the like, so you are not fumbling through the scene where the Boss talks to Bob about how insurance companies are about keeping people from actually *getting* help, in The Incredibles, every damn time you need to apply a damn bandaid to someone. Its not a reason to, such as here, screw people over even more, by taking an overburdened mess, and reducing the number of people able to dredge the bog for what passes as “health care”.
Seriously though, I am sure, 30 years ago, having the damn ER tell you, “See a doctor about this in 2-3 days.”, was responded to with, “OK”, not hostility, derision, or laughter, the last of which, even if they dressed as a clown to tell me, would be the *last* response they should expect from me, should I have to go in there again…
Yeah, the healthcare system in the US is horrible. My personal anecdote: when Mr. Jessa and I were dating, he developed an umbilical hernia that needed surgery. He was uninsured because his job didn’t offer insurance, and private insurance would cost more than half of his income. We discussed going down to the courthouse and getting married so that I could add him to my insurance and have his surgery covered, but I found out that my insurance considered his hernia a pre-existing condition, meaning his surgery was not eligible for coverage until after a one-year waiting period. So, after deliberation and number-crunching, we decided that he should go ahead with the surgery while he was still single. That way he could apply for a charity reduction for his bill, and only his income would be considered in the decision.
He was in the hospital for seven hours for a one-hour surgery. A few weeks later, we received a bill from the hospital for $11,000. Then, the bill from the surgeon for $2000, the bill from the anesthesiologist for $3000, and various additional bills from the original diagnosis and pre-operative checkups and tests. It got to the point where we dreaded checking the mail, because each time there was a new bill waiting. The grand total was close to $20,000. For a one-hour surgery and seven hours in the hospital.
We were fortunate that the hospital finally approved a reduction in their charges, but the process was a humiliating mix of stacks of paperwork and groveling. The entire experience has left me with a conflicting set of emotions. On one hand, I feel fortunate that we were never in danger of financial ruin. We’re still dealing with the monetary fallout, but we never had to choose between paying the bills and eating. On the other hand, I am absolutely incandescent with rage that our experience is considered a “good” outcome when compared with what many uninsured people have to go through.
Another comment from Australia, which has a health system which apparently makes the US system look like a Russian gulag. We pay 1.5% of our income in Medicare Levy (about $60 a month on the average wage), and in return we actually get looked after, at no cost to ourselves.
My mother had a heart attack and triple bypass a couple of years ago – ambulance to the airport, air ambulance to the nearest capital city, and three weeks in hospital, along with the 12 hour operation. The whole thing was absolutely free. Not only was she not out of pocket, when she paid for her return airfare home, she was reimbursed the entire cost of the ticket.
Yep, universal healthcare is a real pain. The GOP is playing Russian roulette with your health, except that every chamber appears to be loaded.
Sceptinurse 46,
That is interesting. I didn’t know that some hospitals quote a different bill for those with no insurance coverage, but it makes sense. BTW, I once called to make an appointment with a back surgeon only to be told by the receptionist that he did not accept insurance of any kind. I said “thank you very much” and found me a good surgeon who did take insurance.
@ Jessa 114 & others – aside from the general fucked-upness of the US healthcare system, what’s also lamentable is how much TIME navigating it takes. You and your boyfriend had to sit down and crunch numbers and research options – time that could have been spent doing any number of more productive or happy things.
I can’t think of any time with my insurance that I haven’t had to make at least one more follow up phone call to sort out what was supposed to be something simple like a 100% covered routine gyno exam, yet I got a bill for $200 anyway. Or my husband being referred to a sleep lab and I still haven’t figured out how much it is supposed to cost us despite several phone calls to both the insurance company and the lab.
My mother has spent countless hours on the phone to try to figure out what’s going on with bills and scheduled care for a family of five – and my dad has “great” insurance, by US standards.
TIME. Jesus. Time to take a walk, cook a healthy meal, take a nap. Plan a business. Write a letter to a friend. Instead we worry. Instead we’re on the hook to right erroneous bils. Instead we spend days deciding if the exam is worth it.
If I ever get sick, I will die. Period. No insurance, not enough income for out of pocket, stuck at home in a dead-end job with a family that makes JUST a little too much total for any help…yes, if i break a bone or get pneumonia or something, I may as well go play on the subway tracks.
At this point, if something like that happens, I will deliberately commit a crime to land myself in prison. Nothing violent, just some stupid bullshit like shoplifting a major big-ticket item. The point is I would be better off in prison than as I am now.
Pathetic. It’s time this country was “liberated” by a European coalition or something for our own good. We are third-world.
It’s also super fun to pay for COBRA when you have been laid off.
Also, working as a freelancer and paying for your own health insurance also sucks. The Canadians I work for, do not have to worry about that.
For those who read Kevin Zelnio’s story in the OP and wish to contribute to help him out, David Kroll has set up a Paypal fund: http://blogs.plos.org/takeasdirected/2012/02/10/iamuninsured-a-iamscience-story/
Yeah, I had a good time with that. I paid a buttload of money to continue coverage for a year, only to make a claim and discover that I had no insurance, because the Human Resources person at my former employer had failed to send in the paperwork before quitting the job.
Fortunately, one of the accountants at my former company noticed the fuck-up and reimbursed me.
But the argument about how a single-payer system “puts a government bureaucrat between you and your doctor” is particularly irritating. Like it’s better to have a corporate human resources department and a for-profit insurance company standing there instead?
It’s a small planet we are living on but it contains many different worlds. I live in Finland and in my world here public healthcare takes care of everything from coughs to heart surgery with a standard payment of less than 40$ (to see a doctor), 120$ (to have a one day surgery) or a hospital day fee of 40$/day in case of any treatment (including any surgery) during which you need to stay at the hospital. In addition to every sickness for which I’ve gone to see a doctor, I have had three knee surgeries with all the tests and MRI stuff and had to pay just those above mentioned fees. Of course, we pay for this in our taxes.
Leaving aside the abysmal US attitude to universal health care, the charges some doctors make are quite astonishing.
For instance, $2000, mentioned above, from an anaeshetist.
Given that the hospital has already charged for the anaesthetic equipment and drugs, which are their property, the anaesthetist is charging simply for the actual hands-on work they do. There are no infrastructure costs. He/she may have rooms somewhere, but these are paid for by consulting fees. the $2000 is, after income tax, about 1500 of clear profit. More if they have a business structure in place to wriggle out of tax.
Compare that to my charges.
4 consultations at $30 each, per hour = 120
Less 40% that the practice takes as overheads = 72
Less insurance =70
Less tax = $42/hr
That’s for a fully qualified doctor with 20 years of experience. And it doesn’t include all the work I do outside the consultation, such as documentation, referrals, results review, phonecalls etc.
I can double that to $84 if I add on what is known as the ‘gap fee’ that our practice charges to try and make sure that doctors get paid more than truck drivers. But I don’t charge a gap fee for under 18s, students, low income, over 65, contraception, pap smears, people with severe depression or cancer.
A very small proportion of my workload lies outside those groups.
I can’t imagine charging $1600 for childhood immunisations. If we can run a popular, busy medical centre charging rates as above, then how can anyone justify that sort of money?
This thread has made me appreciate the NHS even more. I hadn’t realised how many other countries with universal health care still required payment at point of use.
The only payment* in the NHS is the prescription charge. £7.40/prescription, waived for children, pensioners, and those on low incomes. For those with chronic conditions requiring frequent prescriptions, there’s a ‘pre-payment certificate’ that covers all prescriptions for a year for £104.
And that’s it. No charges for doctors visits. No charges for hospital stays. No charges for tests of any kind.
*Well, it’s slightly more complicated for dentists and opticians, and there’s quite a fuss about the problem with dentists on the NHS. But compared to the US? ROFL.
Dan you hit the nail on the head
“The only people who lose in such a situation are the insurance companies themselves, who have to dial back from being a necessity to being an optional privilege.”
Everywhere you can look there is an insurance company making money hand over fist.
as was mentioned above the doctors are forced to have malpractice insurance for which the insurance companies must because of the costs of settlements make large payouts and then subsequently must pass that cost to the doctors with the addition of administrative costs and an ample profit.
The biggest problem with the health care reform law is the insurance part which if I remember right was forced on to the bill with the help of the insurance industry lobby. they fought the single payer and a government system as a choice because they feared that if given a choice in the market no one would choose a private insurance plan.
Why would they think that would be likely?
uncle frogy
That only applies in England. Scotland, Wales and Northern Ireland have scrapped the charges.
As a Briton, born and raised under Nye Bevan’s NHS, I find it utterly inconceivable that anyone should be expected to pay for medical treatment in a country that calls itself “civilised”.
If it isn’t the first-priority job of the Government to look after their own citizens’ health and well-being, what is it their job to do?
http://truecostofhealthcare.org/introduction
There are many things I love about the United States and maybe I’ll go into them another time. For now, however, here are the top eight reasons I would never become an American:
1. Guns
2. Lack of public health insurance
3. Fundamentalist religion
4. Guns
5. Republicans
6. Not enough curling rinks
7. Jersey Shore
8. Guns
@129
The lack of curling rinks and good ice (not lumpy, not too straight, not too heavy) is deplorable! I’m applying for postdocs now, some in the US and some in northern Europe and this is a major consideration … ok maybe not major but it would be awfully nice to have a rink nearby :)
Pelamun and Ogvorbis: The New Deal was a defensive reaction to Communism. And Truman’s universal healthcare plan didn’t go anywhere because Southerners were aghast at the idea that those people might get anything free from the government.
Daniel: The corpocrats have figured out that they really don’t need Americans as either workers or consumers anymore. Too many options in other countries, plus computers and other labor-saving devices. So they don’t give a fuck, either about us or the “domestic market.” And the workers on the way out won’t cost money in sick leave, because they’ll just be fired for “taking a day off.” In most U.S. states, workers can be fired for any cause.
Jadehawk: The herbalist idiot got smacked down wonderfully by Luna the Cat and Tonbo.
Mishcakes:
Which, of course, adds to the overall stress that American workers are under, which leads to worse health outcomes…
Feralboy12: Gotta love Inhuman Resources. And by “love,” I mean “hate with the fire of a billion suns.”
Having read this post and the comments all I can say is that I am very grateful that I live in the United Kingdom. The National Health Service is not perfect, but it treats my diabetes, my mothers heart problems and everyone else’s various problems free at the point of delivery. OK I probably pay a bit more tax than the average person in the USA, but I don’t pay $2800 dollars a year to a health insurance company that does not provide cover when it is needed. Nor am I trapped in a job simply because it has good health insurance.
Our system of healthcare currently costs around half of what Americans spend on healthcare and we live on average about 2 years longer. It is unfortunately under attack by our version of the Rethuglicans, who say we can no longer afford it. I say looking at this example, we can’t afford to do without the NHS, and we definitely cannot afford the monetary or the social costs that come with the American healthcare? system.
Every time healthcare comes up on Pharyngula it reminds me all over again how lucky you are if you happen to be in a country with a decent health system – and how grateful I am to have the NHS, with all its faults. It’s probably the best, most important and most precious single thing the UK has ever come up with (on a par with the importance of access to sex ed, contraception and abortion).
Got a call this evening from a bloke canvassing for our local Labour MP (and also for the borough councillor), so of course it was uppermost in my mind to tell them that top among the reasons I’ll be voting for him again is his (very good) record on defending the NHS.
I know the NHS isn’t perfect. But it is infinitely better than the US model Cameron is so fond of.
I was wondering why he likes it so much, until I read the post higher up (can’t remember the exact wording to search for it, dammit) about the poor being nothing but a pool of guinea-pigs for developing drugs and treatments for the deserving rich. We don’t have that here now, but I don’t suppose Cameron would lose a minute’s sleep if we moved in that direction.
I remember the bill we got from the Swedish hospital where my younger daughter was born. The wife was in for four days and, of course, received excellent treatment throughout. One bit we really liked was the run-through afterwards when the midwife took us through all the readings from the monitoring equipment to explain what the staff did and why they did it – but the best bit was the button on the wall the new mother got to press on the way from the birthing rooms to the maternity ward, which started a light show in the fountain down in the town square to announce to everyone that a new baby had been born!).
The bill? $27.00.
You’re not safe in the US even if you *do* have insurance.
I recently took a job at a university med school/hospital. I went to the hospital pharmacy to pick up my generic asthma inhaler. AFTER the insurance, it was $40. The pharmacist, baffled, looked up what the hospital charges for the drug. It was $7. BCBS was charging me *five times* the price of a life-saving medication, just for the honor of going through their system.
Forget about the months spent trying to convince my previous insurance company that a ruptured, hemorrhaging ovarian cyst *is* an ER-worthy emergency, while that unpaid $850 bill ruined my credit score.
I have a PhD. I have a job. I have insurance. I did it right even by Republican standards! (Except for that whole “being a woman” mistake.) But I still don’t deserve decent healthcare, evidently.
/grumble
Ms. Daisy Cutter
O_O
Yes. Plutocrats don’t need American consumers, because who needs more money, right?
Look, the workers thing? Sure. Labor is moving overseas for a reason. It’s cheaper. Can’t get rid of everything – but that which can be outsourced, and is cheaper once outsourced, is going to get outsourced. Bad for the economy which will hurt the bottom line in the long run, but good for short-term profits.
Still, they probably can’t get rid of your US holdings altogether though. At the very least there still needs to be a sales office in the US so that you can invite key decision-makers in your industry around to win the contract in person.
But you think that the plutocrats think that they don’t need the American market anymore?
Seriously?
Look, don’t get me wrong – the world economy is a big place, and the American market is one among many.
But even as a fish in a big pond, the US of A is a [feynman]huMONgous[/feynman] market. If not the biggest, then still one of the biggest.
Any plutocrat that doesn’t want a slice of that economic output going straight into their coffers isn’t really a plutocrat. And they won’t be plutocrats for very long if that’s an example of how they think about entering and maintaining markets.
Really, it’s that bad?
Okay. Let’s make the assumption that any worker who takes a single sick day is fired for ‘taking a day off’. Not sure if that’s true. It sounds like a fishy piece of hyperbole to me. Yeah, I can see that things are grim, but that grim seems a bit of a stretch.
But anyway – assume it to be true.
Then people are even less likely to take a sick day, right?
So they’re just going to come into work sick, right?
And their productivity that day will be reduced, right?
And they will be more likely to infect their coworkers, right?
And those co-workers are also unlikely to take a sick day, right?
So those co-workers are also going to come into work anyway, right?
So they’ll come into work while sick, and have reduced productivity, right?
…
Lost productivity is a loss, particularly when it happens over a systemically large population base.
So there is a cost to the plutocrats (shareholders) due to sickness and illness in the losses to productivity.
It takes an extremely foolish and short-sighted view to tolerate that kind of situation.
As I view it, the only reason this kind of situation is maintainable in the US is as the result of winding up in the most dismal corner of a Nash equilibrium matrix.
The way to get out of that corner is to make a united decision to set the rules of the game such that defecting your way into a destructive equilibrium state will be punished to the point of becoming unprofitable and therefore undesireable. Then, everyone in the system can benefit from being in the not-worst-of-all-possible-worlds scenario.
Problem is that this is what regulation is for, and that’s a word that the American population have been conditioned to hate, particularly in the political arena.
Despite the fact that regulation happens in America all the time. It’s just that no-one draws attention to it, so the regulations that are passed are those that benefit the plutocracy, who secure their desired outcomes via lobbyists rather than votes.
When someone does try to put forward regulation that will rein in that spiral of destruction, and would be in the interest of the majority, the usual suspects cry ‘regulation, communism, evil!’
As a result, only the bad kind of regulation happens – and so the demonization of regulation becomes a self-reinforcing prophecy with a veneer of respectability.
In a nutshell: Y’all fucked – and in the long term, the plutocrats are fucked too.
One way out is for American voters to actually put the toes of the plutocrats to the fire. But identity politics of America are so overwhelmingly stupid, divisive and distracting from the real issues at hand that I’m skeptical that this will ever happen.
Example: The furor over Obamacare is ridiculous to me – the real controversy over mounting healthcare costs should be why the fuck the government is subsidizing the middle-man insurance companies when they could just be subsidizng the hospitals directly. It makes no sense whatsoever to have your healthcare structured that way, you’re placing a set of notoriously large and inefficient profit-hungry behemoths between the population and an essential service. That benefits no-one but the behemoths
But I’ve never heard this specific observation from an American, outside of a couple of people on the internet.
Don’t get me wrong – I’ve heard lots of bitching about the rising costs of healthcare and the immorality thereof (more on that below). But that points the finger at the healthcare industry. When really you should all be pointing the finger at the insurance industry that’s wrapped itself around the health industry like a damn strangler fig and is bleeding you all dry… Then ripping the damn parasite out by the roots by supporting federal legislation to subsidize healthcare directly without all the fanargling around with insurance companies.
The reason that bitching about healthcare costs isn’t the answer (or at least, not the complete answer) is because healthcare is going to be expensive. That’s not to say that you shouldn’t be looking for ways to make the medical profession as efficient and cost-effective as possible for the purpose of improving the health of the population, because you certainly should and I expect that there’s a lot of room for improvement.
However – medical expertise and equipment are expensive. They’re high-technology and high-skill areas. Even at the best possible outcome, and even when run to cover base costs and for only modest profit margins, medicine will still be prohibitively expensive.
Someone has to pay that cost.
The argument I’m trying to make here is that it is in the interests of everyone, including the wealthy, to see that the economy as a whole is serviced by a cost-effective universal healthcare system. The best way to do that without descending into tragedy-of-the-commons madness that got all of you into your current situation is a federal tax to subsidize the health industry directly.
Health insurance should be in America what it is in New Zealand – it’s a privilege you pay for if you can afford it, to get nicer rooms and shorter wait times.
If you can’t afford it however, you still get to be treated. It just takes longer and doesn’t have all the creature comforts you may have liked – but that again is the consequence of cost efficiency, and one I think everyone should be happy to pay.
Also: Stop suing your health providers every time someone gets a drop of soap in their eye while staying at a hospital. Seriously. The litigious nature of America does your health industry no favors. Legitimate cases of medical fraud or negligence, sure, go nuts. But seriously, dial it back a bit on the frivolous lawsuits. A bunch of mates and I went to America a while back. One of them had a nasty fall and concussed himself. We weren’t sure how much attention he needed, so we had the hotel medical staff take a look at him. They contacted some paramedics, that came in to take a look as well.
No one would give us actual medical advice. No one could tell me if our friend needed to go to a hospital or not.
When we asked why they couldn’t give their medical opinion, the reason was that if they gave their best medical opinion and it turned out to be wrong, then we might have grounds for a lawsuit.
…
The fuck? That shit is not helpful. Yes, accountability is important. But you’ve got to be reasonable. Medicine isn’t a perfect science. If someone gives sound advice based on sound medical reasoning, balancing risk and benefit, and the eventual outcome turns out to be wrong, that’s not the same as negligence and shouldn’t be pursued as such.
…
…
…
Okay, I got a bit off topic there.
Anwyay, back on track:
Bitching about the rich isn’t going to persuade them to do anything.
Your options are:
1) Bring about political change through grass-root activism to bring about a healthcare-direct subsidy and cut out the insurance companies. Part of this should be that the medical companies that are to receive subsidies need to live up to a set of government standards regarding improving cost-efficiency and minimizing waste.
2) Appeal to the long-term thinking of the rich. It really is in the long-term thinking of even the wealthy to have universal healthcare in America, because it improves the American economy, and therefore improves both domestic productivity (which will never be entirely outsourced) and the domestic market – and each of these things will have long-term and sustainable impacts on economic growth and, therefore, long-term profitability.
Ideally, do both at once.
Ah, forgot to spell out the key talking point:
A subsidy towards healthcare should be regarded as a long-term investment in infrastructure. Specifically, those part of the infrastructure that actually do the work.
The payoff to this investment isn’t a direct dividend, but instead a stronger economy. A stronger economy means a hungrier market within which to sell more things, make more profits, and employ more people.
You can’t replace infrastructure with debt forever.
DING DING!
That’s the point. There is not long term planning. This is a strip mine. Those who benefited from it will be able to just up and leave, everyone else is no longer a consumer or a employee…not their problem anymore.
… That’s interesting: It turns out there’s a limit to my cynicism after all. Not sure if I should be pleased or embarased about that.
Anyway: I don’t think that it’s quite as dire as that.
But I could of course be wrong about that.
Which is peculiar. Because if I am wrong about that, then what’s going on in America can’t even really be called capitalism anymore. Capitalism means an investment of capital with a view to collect future dividends.
Without investment and without long-term-dividends then you’re not really doing capitalism anymore – but something else instead.
Unsustainable banditry.
I don’t think that’s entirely the case.
… And I really, really hope I’m not wrong. Because if America is in that situation, then the bottom will eventually fall out of it. For all of America’s faults, I don’t want that to happen – it would be a disaster for most of the world, not just America.
You people really need to get your shit sorted. People are depending on you. ^_^
There are several flaws in your scenario which show you have not gotten into the head of an obscenely rich person who supports Republican politicians.
First, the workers in your factories do not make you money. They cost you money. What makes you money is your customers. If you could figure out a way to get your customers to give you money without you having to pay any employees to produce anything, you would do it.
Second, sick workers don’t cost you any money if you fire them as soon as they become sick to work and hire someone healthy.
To really get inside the heads of these people, imagine what factories were like in the 19th Century before there were any labor laws at all. That is their end goal.
no. not as long as that’s the only way for a person to avoid bankruptcy, the poor-house, and million-dollar debt (and you shouldn’t accuse people of hyperbole when you’re evidently very prone to it yourself)
Right, pillaging. Which is what has been the criticism of corporate culture since what, the late 70s?
what are you, stuck in the 19th century? The Capitalist class is no longer made up primarily of the owners of the means of production, seeing as many businesses are publicly traded now. It’s the CEOs who make up the top 1% in many cases, and those don’t give a fuck about the long-term, since they’re by definition only involved with a specific company in the short term.
And then there’s the Finance sector, which is almost completely detached from real economies for most of the time
And lastly, there are businesses like Bain Capital, which exist only to loot other companies.
Sure, none of these are survivable strategies in the long-term, but the long-term here is decades ahead, at a point where the plutocrats in question will have amassed enough wealth that it won’t matter to them or their families whether the US stops existing altogether or not.
truthspeaker #138
And again – I come up against another limit to my cynicism.
For some reason I’m currently leaning towards ’embarrassed’ rather than ‘pleased’.
It’s easy to demonize the other – in this case, the owners of capital that are typically Republican. It’s particularly simple when they are behaving poorly – which in this context means callous short-term interest that externalizes as many hidden costs as possible onto the population at large without a view to compensation.
I come back to the view that one shouldn’t attribute to malice that which can be explained by stupidity.
I think that the current situation is down to foolish short-term thinking, particularly a great forgetting that the value of a dollar is that it represents a share in the economic output of the country that minted it. Fucking over the economy to make more dollars is meaningless if those dollars aren’t worth anything anymore because there’s no more economy in which to have a share.
So no – I don’t think that in the heads of these people, that they think that their end goal is 19th Century factory labor. That may indeed be the consequence of their actions, but I don’t suppose that this is actually what they have in mind.
I think they’re greedy short-term planners, and that this is sufficient to explain their behavior.
I don’t need to suppose that they’re evil. That’s rhetorical hyperbole.
bah, i quoted the wrong part :-p
anyway, any whining about how mistreating workers is bad for business has been irrelevant to plutocrats since at least the mid-20th century. And capitalism has never been anything other than looting; it’s just that the looting was previously done in other parts of the world, not necessarily at home.
Did anyone in the UK just watch Panorama on America’s poor? I wish there was a ‘punch the interviewee on the nose really hard now’ button on my remote control. Featuring a quiet 6 year old who’d had to eat rats a guy with an life-threatening hernia, who couldn’t pay the 20,000 bill, and a British charity worker who stopped feeding the poor of the Amazon because America needed his help more. Also featuring arseholes from both parties who didn’t seem to think that this was something really important to deal with. The Republican versions were of course, by far the worse, and deserving of the ‘PTIOTNRHN’ button.
except that “stupidity” doesn’t lead to someone saying that we should cut social welfare because poor people are breeding like rats and we need to stop them. Nor does it lead to expensive drug-testing for welfare recipients.
What you fail to understand is the ubiquitous calvinist/”prosperty gospel” poison that says that no one is poor except by their own moral failing.
Jadehawk #140
I can’t accept that.
I can understand that the system is fucked, and I can certainly sympathize with someone for whom there is no way out other than a frivolous lawsuit.
But the point remains that the problems America are facing right now are systemic. People digging their way out of mounting debt through frivolous medical lawsuits doesn’t fix anything. It’s not a long-term solution for America. It’s short term thinking again. More understandable given that the person doing it has been so severely fucked over and is considerably more desperate.
But it’s still short-term thinking, it’s more of the same thing that’s causing the problem in the first place.
And all the money in the world isn’t worth squat if there’s nothing left to spend it on.
And also: You don’t have to assume these people are evil. Short-sighted? Sure. Greedy? Definitely. Callous? Yep.
But they’re not necessarily evil.
The actual destruction of the American economy is in no-one’s long term interest.
and what? people should martyr themselves in the meantime, until the system is fixed? go fuck yourself.
you think rich people spend their money on things?
lol. there already aren’t enough “things” to buy for all the world’s multimilionaires and billionaires
no, they buy power, which is always easier to buy when the rest of the world has no power, material comforts for them and their spawn are already assured for the rest of their lives
adorable. and what do you imagine changes when you stop applying “evil” as a label? the actions of modern plutocrats won’t be any less Marie-Antoinette-like for it.
but there are plenty of people whom such a thing won’t harm, while the process of doing the destroying is allowing them to be the ones who won’t be harmed.
When what they do is evil I have no problems calling them evil. Regardless of their intentions.
And if you feel that’s not evil we have to compare dictionaries.
here’s the gist of it: America is no longer what we’d consider a “society”; the poisons of individualism and of calvinism/prosperity gospel and capitalism have created an entire nation full of people who see others only as competition at best, enemy at worst(with the exception of very small in-groups). In such a place, those who are most successful tend to be so because they’re the most ruthless and best at not giving a fuck. Meaning, while not all of the top-spots in the US are occupied by sociopaths, sociopaths and people with sociopathic tendencies have much easier time getting ahead than everyone else, ceteris paribus. Such a place also means that most people are now simply struggling for survival, with little time, money, or willpower to spare for much else.
This could, theoretically, be fixed, and the USA returned to being a real, more-or-less cohesive, cooperative society. The odds are against it though, given the powerlessness of most people, and the mind-numbing disaffection for the welfare of others (to the point of being willing to hurt yourself to spite others). More likely, we are witnessing the fall of an empire. And moral outrage or” “helpful advice” isn’t really going to change much, other than maybe make yourself feel better.
Jadehawk #146
So you’re saying that calvinist-style prosperity gospel isn’t stupid?
O_o
I noted what you said earlier about wanting to flee America as soon as you can manage to do so, and I certainly wouldn’t blame you. By all means, vote with your feet. Canada’s certainly a good option. EU’s going through some pangs right now, but I expect they’ll pull through in the end.
Hell, come down to New Zealand and chill out here. We’re in a bit of a slump right now, and the domestic market is puny so there’s nowhere near as much money to be made, so wages are lower than in comparable larger economies like Australia (boo, hiss). But we were recently evaluated as the least corrupt nation in the world by an EU watchdog group. Plus, you get healtcare as a visa holder or permanent resident.
… Australia’s good too (mutter).
Or you could even try southeast Asia and to the ex-pat thing. If you can put up with the social constraints (I couldn’t) then you can do quite well for yourself because you’re foreign-educated.
And I can also understand your frustration at being so woefully betrayed by the American system that lets short-term thinking from special interests to run rough-shot over any hope of sound economic policy – so the pot-shots at the American system are certainly justified.
However – and this is a big point – while it’s in your interest to leave, and while I have no interest whatsoever in moving to America, it is in the interest of most of the rest of the world for America to pull out of its tailspin and actually get back to being an economic superpower with long-term potential.
So I’m not satisfied to take pot shots and then let the whole thing burn to the ground. I want to find a solution and, within my limited abilities and understanding, that is what I’m trying to think through here.
You’re tearing down a lot of what I’m saying – and sure, maybe what I’m saying doesn’t have nearly so much merit as I think it does. I’m no expert in this stuff.
But I really don’t think that having everyone paint the wealthy as explicitly, intentionally evil and dedicated to the eventual destruction of the American economy, moaning a lot, and then leaving the country is a solution that will work for America. Again – if it works for you, then go ahead, I certainly wouldn’t blame you. And everyone trapped in the system without wealth or power obviously need to do whatever it takes to secure themselves.
But if it’s an actual solution we’re after – and that’s what I want for America – it will require us to explain the problem in descriptive terms so as to be able to make sensible predictions that can lead to action.
In this case, I think that the problem is a combination of short-term thinking on the part of the wealthy and powerful, coupled with an immobilizing circus in the political arena that distracts voters from the real issues at hand, thus keeping bad policies insulated from accountability.
As I see it, the solution to that problem is a combination of grass roots activism to try and bring political pressure to bear on the specific points of policy that require change (in this case, direct subsidy of universal healthcare conditional on improvements to cost efficiency within the medical industry, reducing the medical insurance companies from a necessity to a genuine option – which also fosters actual competition on the part of the insurance companies rather than oligarchical price-fixing madness that comes from forcing insurance on an inelastic demand… but again, I digress), while at the same time making a case based on sound economic theory that can show why such a system is economically valid AND why the current mode of thinking is economically flawed and will cripple America’s long-term potential as a global superpower.
Granted, that solution may not work. Perhaps I’m being too optimistic or naive, or perhaps I’ve overlooked some key issue. All valid criticism.
However, I’d much prefer the combination of valid criticism combined with an alternate solution.
If you’ve got a better idea, I’d love to hear it.
This is the issue that turned me from libertarianism (some of you may remember me) to… I’ve been told it is “socialism,” this conviction that the whole idea of having a society was for it to function for the benefit of the individual people who live in it. Funny, I actually always believed that. But the missing piece was compassion, for others but also for myself.
However, I’d much prefer the combination of valid criticism combined with an alternate solution.
If you’ve got a better idea, I’d love to hear it.
No, not a better idea. But is it OK if I leave the US and move to a place where the viable options for me, if I were to get a life threatening illness, are not limited to suicide? I think nbot having to deal with that fear is a bit more conducive to productive thinking on important issues.
Weed Monkey #151
There’s a difference between:
1) Wanting to make money and failing to see that consequences of your actions are destroying America’s economy (my position as to what is most likely actually going on),
2) Wanting to make money and not caring that the consequences of your actions are destroying America’s economy, and;
3) Actually wanting to destroy America’s economy.
To me, 1) is stupid, 2) is stupid and callous, but only 3) is evil.
* Note: Fucking over the economy = fucking over the general population by not only harming the poor, but also making people poor.
If you don’t like that usage – that’s fine. Give me another word or phrase to use instead that matches my intended usage, and I’ll use that instead.
speedwell #155
Sorry about the HWoT.
This is me, from earlier:
I’m not being smarmy or sarcastic there – if it’s in the best interest for individuals to leave, then by all means get the hell out of there.
My attempting to think aloud about potential routes the ship of America could take to stop it from sinking so appallingly doesn’t imply that I think it’s wrong for people to flee a sinking ship. To the contrary – so long as it stays on the present course, that ship is going down and the political circus running the show grants you no real representation. So by all means, vote with your feet and get the fuck out.
See my earlier post about suggested destinations.
(HWoT = Huge Wall of Text)
Okay – this is now officially taking up way too much of my time.
I’ll come back later.
To Daniel and the other person who stated that a large cost of medical care is due to malpractice insurance caused by “frivolous” lawsuits: I’m sorry, but you are wrong. Some U.S. states have passed legislation limiting punitive damage awards to ~$250,000, called “tort reform”. You may think this is a large amount, but to insurance companies this is chicken feed. So, their costs are capped at true damage caused by provable malpractice plus a maximum of $250k. The difference in cost of malpractice insurance between states with no limit and states with this limit is … essentially zero. Malpractice insurance companies gouge MDs for all they can get. (Another study showed that insurance premiums in general rise in only two cases: (a) major state-wide catastrophes, and (b) when stocks prices fall, with (b) being the more important factor.) It’s all about profit.
To the lady or gentleman who stated that U.S. drugs costs are high due to expensive research and clinical trials: Roughly half of all blockbuster drugs are discovered by government and university labs, reducing big pharma costs. Clinical trials are expensive, but the actual cost is a secret. A large portion of drug company costs is advertising, promotions, and administration. The last revealing study I saw showed something like 7% of big pharma costs are for R&D. Their US drug profit margin is on the order of 15%, when most comparably large companies profit is in the 5% range. (Insurance company profits and executive bonuses are in the 35% range, for comparison.)
By the way, the US Medicare part D law (drug coverage for senior citizens) states that this program can NOT negotiate drug prices. The US Veteran’s Administration can negotiate, and gets ~30% discounts, but Medicare is not even allowed to use that… The guy who wrote that law, ex-Rep. Billy Tauzin, retired to become the head of the drug industry lobby group for $2 million per year. Can you say “bribery”? I knew you could.
Oh, one final thing:
There seems to be a recurring point coming up in people’s responses to me. I think I know why.
The article and the thread started out by talking about the human cost of the problems America is facing, and I’m coming along by trying to describe the system dispassionately. In so doing I’m not talking about the human cost. By not discussing that cost and instead trying to talk the talk of economies and market forces, it might look like I’m not acknowledging the human cost.
That’s not true. I do – the costs are real. I had a little sub-story earlier about how a friend of mine was injured while in America and had a hell of a time. Short story: He had insurance from his Canadian bank – but when he tried to collect the bank pointed out that he wasn’t covered for injury that takes place while intoxicated (he was a bit drunk, but not that bad). So they bank decided not to cover him. Suddenly he was up for the $2,500 in fees for the ambulance trip to hospital and the scan to make sure his concussion wasn’t going to bring about long-term harm… And then the bills kept on coming.
Fortunately he lucked out – his student membership at Canada included a healthcare clause that applied to his situation, so he was covered that way. But for about a month he (and through him, the rest of us) got to take a little glimpse at what it would be like living in America full time, where that standard of care was the norm.
And here’s the thing – me and my group of mates, while not exactly buying yachts or anything, are all university-educated. That mate of mine is currently finishing off his Masters in Law so isn’t working yet, but with that exception we’re all currently employed as professionals in our respective fields and earning over the average wage for the countries we’re currently living in.
And for us, the impact of those fees to the injured friend of mine were extremely harsh.
I expect that I couldn’t really understand how ruinous those kinds of fees would have for someone earning minimum wage without living it myself first – but I can try to imagine, and from what I can see it would be horrible to the point that descriptions like ‘horrible’ become trite and meaningless, but I can’t think of anything better.
So I can understand how for people living through that, or people living side-by-side with people who live through that, as a fucking norm would get upset when I don’t acknowledge that in my thinking-aloud-for-solutions that I’m doing here.
Which is actually fair enough – and I apologize for not addressing these issues specifically in what I’m saying.
For what it’s worth, I was trying to examine the problem.
It’s like, if you want to treat HIV, you need to understand what HIV is and how it works, you need to learn to describe it and understand it. You can talk about the fitness of HIV to understand what makes it thrive. You can even be a little bit impressed by the virus in its virulence and seeming immunity to treatment.
That’s the stance you have to take when the goal is treatment. And while you’re discussing and analyzing and writing and theorizing over your specialty virus, I expect that the people suffering from that virus would find little comfort in your sophisticated technical understandings and the trial-and-error um-maybe-this-might-work-but-maybe-not style of solution-finding.
But the dry analytics is still an important part of understanding the disease in order to treat it.
That’s the voice I’m trying to bring while thinking aloud here. I’m trying to get a real understanding for what’s gone wrong, including the motivations of the wealthy and powerful, so as to work out possible solutions that can fix the problem.
So when I talk about the motivations of the wealthy and powerful, it should be read as if I’m talking about the relative fitness of HIV in different environments. I don’t defend the motivations of the wealthy and powerful that are driving us into the wrong end of a Nash equilibrium. But those motivations are an important part of the problem, so appealing to them and trying to change them from short to long-term could be a potential part of a solution.
And a solution is important, because there’s really only four options:
1) Put up with it.
2) Leave.
3) French-renaissance style civil war.
4) Some kind of regulatory solution.
I’m looking for a solution for America because I want it to remain in place as a superpower. I want America to be available as an export market for my own country. And I want America to stay in place as world power to balance against autocratic countries on the world stage. A crippled and bankrupt America has dire consequences for more than just Americans. So to me, I want a solution for the country.
2) Isn’t a solution for the country, it’s a solution for the individuals in the country. So for anyone trapped in the American system, again, I’ll repeat myself: By all means, get the fuck out. I certainly wouldn’t hold it against you. To be frank, I’m a bit confused as to why more of you haven’t left already. America was a nice place to visit, but I wouldn’t stay there.
However, a solution for the individuals – while important and valueable – doesn’t change the fact that if America fails as a country then there’s dire consequences for more than just Americans. It impacts the rest of the world. Significantly.
Hence, I want to see a solution for the country. Not because I gloss over or disregard the plight of the individuals. To the contrary, the plight of the individuals in America is itself what needs to be repaired, that’s what the economy is. That’s what’s broken. That’s what needs to be fixed.
That’s where I’m coming from – the need to find a solution instead of just bitching about how wealthy people are evil and the problem.
Because, okay, yeah, sure. Let’s just say that wealthy people are evil. Fine. Grant that assumption.
Then what?
If you think the wealthy and powerful are the problem and that they are irredeemably evil and cannot be reasoned with, then why hasn’t anyone in this thread seriously suggested civil war as a potential solution? Because that’s the only alternative to fleeing the country or just putting up with it.
Alternatively, if the wealthy and powerful aren’t irredeemably evil so much as short-sighted, greedy, and either ignorant or callous as to the externalities they’re inflicting on the American population… Well then, in that case they don’t drink the blood of puppies, hate sunshine and jerk off to videos of crying children. They can be reasoned with as to the real long-term harm they’re causing to the markets on which they depend.
In addition to which, in specific instances such as healthcare, there are legislative solutions that could be brought to bear with sufficient political pressure from the voter base. Build sufficient support to make it an election-winning issue. Politicians like money, true – but they need money to get votes. Votes are what they really need. So try getting votes. Lots of them.
Or just throw a lit match on your way out. Doesn’t do much to help the people you’re leaving behind. Because fuck them, right?
no; I’m saying that it’s not stupidity that’s causing the US situation. and calvinism is more evil than it’s stupid. for those who invented it, it’s actually pretty clever.
oh honey.
sorry to tell you, but that is all that you’re doing, and all that you are going to be able to do. Americans do have a minuscule chance of getting their country to not self-destruct, but the rest of us can only watch and prepare for the worst.
intentions are irrelevant. their actions, based on their selfish interests, are evil.
I have explained it in descriptive terms. and the solution will not, cannot be to appeal to the better nature of plutocrats. that’s fucking idiotic and has never worked. the only thing that can work is a massive movement that 1)re-establishes a sense of solidarity in a majority of the US population, and 2)takes over the US government and in short order destroys the massive income and wealth inequality here, together with the systems that produce it. Like I said, it’s theoretically possible but realistically highly unlikely, given the current situation, the time-frame, and the increasing difficulty caused by the epic natural disasters the world is starting to face now, too.
aww. you sound as if you thought the US was a democracy. how precious.
in that case, it’s you who’s stupid. such “evil” only exists in cartoons. The real-world evil of not giving a fuck exists and is dangerous no matter your idiosyncratic definitions of words.
because a civil war in the US, at this particular moment in time, would be waged by the teabaggers. it would turn the US into a theocracy, which isn’t any sort of improvement.
how many more times do i have to explain this? the plutocrats don’t depend on the long-term survival of the markets, or the individual companies they are sucking dry. that link was broken a very long time ago.
besides, if it were possible to appeal to the rationality and long-term thinking of business interests, we wouldn’t be going backwards in attempts to fight AGW, either. Solutions must circumvent business and/or force it into compliance, not trying to appeal to their empathy for people they don’t know in a future they won’t live to see.
I pause.
This usage to me is odd. You said you CAN’T accept it…not that it’s wrong or that there’s some other facts, but that you can’t accept it. Why would you use that term? To me that sort of screams “I HAVE AN IDEOLOGICAL MIND BLOCK!”
Not “don’t” but “can’t”
Ms. Daisy Cutter,
the Great Depression exacerbated the wealth gap, thus leading the rich to fear revolts from the poor, a situation which could have benefited the communist movement. I don’t think it’s either-or anyway, rarely do you find a simple answer when studying history.
Daniel Schealler,
America’s potential as long-term superpower? Wake up, it’s already on decline, the power balances in the world are shifting. Which is not necessarily a bad thing. Half of the BRIC nations are already reasonably democratic, hopefully a trend that will deepen and expand. Welfare systems though, are abysmally deficient in all of these countries, I hope they find ways to improve those systems.
For the US domestically, of course I wished Americans would elect politicians willing to tackle the wealth gap problem, but so far we’ve had to settle for the Affordable Healthcare Act. Let’s wait until it fully takes effect in 2014 (though probably only if Obama is reelected. Someone said somewhere, maybe on this thread or another, that there wouldn’t be much different under a President Romney, but I’d doubt that he’d veto a healthcare bill repeal).
@We Are Ing
Sorry, that should have read:
I can’t accept that [as a long term solution].
So Jadehawk wasn’t wrong in the sense that a person in that situation has no other option and shouldn’t be judged harshly (which was not my intention).
But it’s only a solution for that person. So it isn’t a solution that I think will work in the long term.
You’re right – my usage was funny, and I should have been more explicit/clearer. Mea culpa.
@Jadehawk
I think you’re wrong.
You think I’m wrong.
I’ve given it my best shot, and I’ve failed to persuade you.
I don’t think that we should ‘agree to disagree’.
But I think that talking at each other isn’t going to be productive anymore, so I’m going to stop now.
All the best in your efforts to flee the ship.
pelamun
>.<
I'm starting to get a bit tetchy now at the constant misrepresentation.
There's no need to tell me to wake up to America's decline.
I know America is in decline.
I view this as a problem and would like it to be fixed. Acknowledging that the decline is happening is built into what I’m saying.
But if the problem in question is that no-one can afford healthcare, then just letting the American economy slide into oblivion is going to make the situation worse, not better.
Ah well – deep breath, count to ten… Whoo-saaa.
I shouldn’t get tetchy. Misrepresentation is the norm online… I just wasn’t expecting it here, in such volume, from so many.
I just have higher expectations here, so it bugs me more than it would if it happened somewhere else.
One question though, Jadehawk.
Is there any nation in this world that qualifies as a democracy for you, and if so why?
I’m just asking because democracy can mean many things and since I view even Indonesia as a (albeit dysfunctional) democracy, the United States would of course qualify as one too…
see now, at least for what you said about malpractice, that’s simply not true. this is what you said:
that’s 1)hyperbole, and 2)telling people how to behave, not addressing the systemic causes of malpractice suits
@#62 pelamun:Devolution in the UK
It’s my understanding that Parliament could revoke that with a simple bill? Though Cameron would probably not be able to so do politically.Yup it’s perfectly legal (Parliamentary sovereignty and all that), but “probably not be able to so do politically” is a big understatement. I think if the government even proposed this, overnight the minority supporting independence in Wales and Scotland would be turned into a large majority.
I can’t think of any technical democracy. There are countries that are democratic representational governments but not democracies.
Daniel,
you said “I want it to remain in place as a superpower”. Granted, on two other occasions you used words to the effect of “get back to”. But maybe you should make up your mind first.
I’m puzzled, though. Why would you want it to remain/get back as a superpower? Are you StevoR 2.0?
o some degree or another, yes. But elections alone don’t make a democracy. A broken civil society and bought elections mean that a country has the trappings of democracy, but isn’t in any meaningful sense a democracy, since “the people” aren’t the ones doing the governing.
Jadehawk
That was a digression.
If it helps – I regret and retract everything from that digression.
Can you get back to the rest of it now, please?
and in the us, you also get the added bonus of electoral colleges, winner-takes-all states in national elections, the massive campaign of voter suppression currently being perpetrated by the Republicans, etc.
basically, the democratic functions in the US are severely restricted, so that the people’s influence on their own governance is very limited. that’s not functionally democratic, not even in the representative democracy sense.
what do you want. I already explained the situation in the US, and what it would take to fix it. and I also explained that us foreigners can’t do shit to change the situation, other than occasionally order pizza for protesters.
pelamun
Even if we assume that my semantics were wrangling – so what? Is it really that big a deal if my semantics were a little bit off? Can people really not fill in from context? Do I really have to think like a lawyer when making an informal comment on a blog, dot every i, cross every t, and cover every possible ambiguity in everything I say, in order to take part in discussion without being bogged down with semantic minutiae?
…
Deep breath, deep breath.
Anyway:
In my view, America is still a superpower right now. But it is on it’s way out. It’s position is weak, and it’s long term potential as a superpower is becoming more dubious.
So I can say both that I want America to stay in place as a superpower, and at the same time say that I want it to ‘get back to’ being an economic superpower with long-term potential.
These statements are not contradictions – they’re mutually reinforcing.
…
Whooo-saaaaa.
Daniel,
you still haven’t answered my question. WHY would you want America to become a superpower again? What kind of fucked up world view is this?
Jadehawk,
yes, I’m aware that the US was originally conceived of more as a republic rather than a democracy.
But over time it has gotten more and more democratic:
– electoral college: most electors now basically pledged.
– senators now elected directly (though for a federation, a case could be made for appointed reps of state govts, but then the Senate would have to hand over its various powers to the House).
– electoral system: there is an argument that can be made for winner-takes-all in political theory, though I personally prefer a proportionate system myself.
– voter suppression: yeah in that regard the US seems to be dysfunctional. The DOJ needs to exercise its oversight more forcefully here.
@Jadehawk
Ah. You mean this bit?
Interestingly, we agree on 1). That’s what I had in mind as a grass roots movement.
We just disagree about the goal of that movement.
I’m suggesting the goal should be a federal amendment to legislate for a health-care tax on income that will be used to conditionally subsidize the health industry on the provision that cost-efficiency and waste reduction measures are put in place and enforced. This wouldn’t solve income inequality as a whole, but it would go a long way to resolving the specific health-cost problems that are right now one of the most pressing and harmful symptoms of income inequality.
You want the goal to be a wholesale revolution of some kind where the system is deconstructed and replaced.
It’s not clear from what you’ve said exactly what kind of revolution you had in mind.
It sounds a lot like you want the working class to rise up and seize the means of production. Which I’m not ideologically opposed to. That sort of thing has historically turned out to lead to a sort of animal-farm-style swapping of one corrupt ruling class for for another – but perhaps you have something in mind that could prevent this?
I’d be genuinely interested to hear what you have in mind. I’ve already suggested that civil war is an option for reform – I just did it in a way that indicated it was undesirable (in my view).
Is this sort of thing what you had in mind, or were you thinking about something else?
plenaum
That’s a bit strong.
1) While I think America needs to scale back its consumption of traded goods considerably in order to return to sustainable growth, I wouldn’t like to see that market collapse altogether. America is an important market for international trade. It would detrimentally affect a great many other countries if America were to collapse into insolvency, which it very well may do.
2) While I think America has largely misused its military strength, and its military spending is too high and should be dialled back considerably, I still prefer to live in a world that consists of China and America as military/economic superpowers, rather than just China as the main military/economic superpower.
My geo-political knowledge isn’t the best, so I’m happy to be educated here. But basically, I’m frightened enough of a militarized CCP that I think that the world stage is better off with American as a counterbalance than without it.
That’s not to say that I endorse everything America does with it’s military strength, because I certainly don’t. But there’s a big difference between wanting America to stop abusing its military power (that’s me) and wanting America to not have any military power.
Again – my geo-pol isn’t the greatest though, so I’m happy to take some education on this area if you think I’m grievously mistaken.
Most of what I had written while reading has already been said.
Daniel Schealler,
“Job creators”.
Last I heard posted here (on a different thread) was someone that actually looked into moving to Canada/NZ and was turned down due to medical conditions/lack of skillset (may be misremembering details). I’ve yet to look into this myself, but am strongly considering doing so in the near future.
Also don’t forget that it costs money to move.
Intent isn’t magic. You are judged by your words.
Daniel,
I don’t think that’s how you use the term “superpower”, which usually refers to a dominant (hegemonic) country within the international system. A unipolar, or bipolar world order gives the one or two superpowers an enormous amount of power, for the perceived benefit of keeping the system as a whole stable. I don’t think the US has done a very good job after trying to “go it alone”.
The world has been moving towards a multipolar system, which would be better than a bipolar US-China system. There’s the EU, there are the BRI countries (BRIC countries minus China), there’s ASEAN, regional blocs in the Middle East, Central Asia, Africa, Latin America and Oceania etc. Ultimately, I would also argue that a multipolar system would be more stable than a bipolar one (but there are arguments against it), but to me, the biggest argument in favour of it would be a more even distribution of power (and thus resources) globally.
The US can be prosperous without being the dominant superpower in the world. Nowhere was I advocating or welcoming the collapse of the US economy.
(I also think that historically, nothing good has come from trying to restore declining empires to former glory. But I’ll be glad to hear about counterexamples)
Therrin
So weird. You’re coming at me from the opposite of Jadehawk.
Maybe I should just get you and him to knock it out? ^_^
Actually, no. I disagree with you here.
Just creating jobs isn’t enough. You need to create the right jobs. Jobs that add value.
I’m not opposed to heath insurance companies altogether. I have some limited affordable health coverage myself despite the fact that I live in a country with public healthcare. I can (just barely) afford it, and the privacy of a room to myself if I ever do need to be hospitalized for an extended period of time is a luxury I’m prepared to pay for. So for me, that health insurance does add value. So that’s fine.
The problem with the US system is that people are being forced to use an insurance company as a necessity to get the government subsidy that is (ostensibly) intended for what they actually want – which is basic healthcare.
In that situation the insurance company isn’t adding any value at all from the perspective of the customer – the healthcare industry is providing the value.
It’s just artificially increasing the costs to the consumer without providing any value by way of compensation.
If demoting insurance companies from neccesities to options means that they have to downsize, then so be it – those jobs weren’t producing value, they were more of a drain than a boon. (Note: It’ll also mean that competition would have to rise, because insurance companies would need to compete with the government-subsidized option rather than be the government-subsidized option.
Go back to that bit you quoted.
You’ll notice that in that point in time it was implied that I was trying to suggest that people who could leave and had the ability to leave shouldn’t do so for some reason. I was just trying to indicate that that wasn’t my position.
So yes – it’s not always all that easy to move countries. I know. I prefer an actual solution to just fleeing – but if someone wants to leave the country and move overseas, and are able to do so, I see no problem in that.
If they can’t move, then something else clearly needs to be done – and you’ll note that the ‘something else’ is actually my main focus here.
Ah – but I’m not being judged for my words.
I’m being judged for what people think my words are, or for a very limited sub-selection of my words.
If I was being unnecessarily obfuscatory or misleading then I suppose you’d have a point – and I have been called out once already for poor wording, and granted the point as soon as I saw it.
But I think I’m doing a reasonable job of clarity, given the context – but I’m constantly being misrepresented anyway.
I think my frustration is justified.
If you think any particular part of what I’ve said so far is misleading or ambiguous when read in context then please, by all means, point it out.
Citations are welcome.
pelamun #184
Actually, those are all really, really good points.
That is a criticism that I can get behind. Thanks for that.
But yes, it seems that according to your usage I’ve been using the word ‘superpower’ incorrectly, because I didn’t mean it in the sense of a world-domination-hedgemony sense, but rather as a ‘significant actor on the world stage’ sense.
I also didn’t mean to imply bi-polar hegemony either, but granted that was not clear at all from the way I phrased it. As I said – geo-politics is definitely not my strong suit.
A multi-point system is what I had in mind. I’m not trying to argue that America should stay at the top of the pack (if we were to argue that it was at the top at the moment, which is definitely open to debate).
But I still want to keep it around as a significant player in the world system. Just not a hedgemonic one.
Thanks for the information and the clarification. Greatly appreciated.
As far as I’m concerned it’s an irrelevant distinction, and personally I have more contempt for bad planning than for malice.
Very few Americans are ever involved in violent crimes involving guns. The fact that most citizens can legally own handguns has pretty much zero impact on my life.
@ #109: Yes, and that’s why for-profit health insurance companies aren’t allowed to operate in my state.
Seriously? Are you seriously that uninformed?
It wouldn’t happen at my office job. It wouldn’t happen at PZ’s university job. But the guy who delivers your pizza? The woman who rang you up at the grocery store? The people who clean the grocery store from 11pm to 7am? They can be fired for taking a sick day. It’s legal, as I’m sure you know, and it happens, which somehow you didn’t.
Yes, it is that bad out there.
As for losing the US market – the plutocrats can keep a decent American customer base even if 70% of the population is living in poverty. Probably 80%. Sure some of those 80% will riot from time to time, but that’s why it’s important to introduce new police powers whenever you can.
Probably because many of us are of the opinion that revolutions by means of nonviolent civil disobedience are much less damaging than violent revolutions. I assume you’ve read Eugene Sharp, right?
truthspeaker #190
I’m not living in America, remember?
I’d have assumed that anyone making that claim about America was just getting into America-bashing hyperbole and dismissed it as such.
Look – if that really is the case, then things are even more fucked up in the states than I realized.
I find it hard to believe that that level of naked injustice really is in effect in America. It’s just… So big that I’m incredulous. It sounds like something someone made up.
I mean, sure. Sweatshop workers in developing nations? Yeah, okay. Nil job security. I can buy that.
But to have that level of job security in a developed nation is just flabbergasting. I mean… Fuck.
Even with what you’ve said here, I still find it hard to accept. I know things are messed up – but that messed up?
If it actually is true then in my defense it’s a seriously bitter pill to swallow and I’ve got some difficulty with it.
Gah. Formatting fail again.
Preview Key, Daniel. It is your friend. Use it.
Ok, ha ha, you got us, we’re all just funning you.
o.o
*sigh*
Occupy is a grassroots movement. It is not causing solidarity to break out across America. cultural shifts require a bit more than that.
the former is not actually possible without the latter, at least in the sense I was talking about, rather than the “tear everything down and start from scratch” sense you seem to assume here.
*rolleyes*
sorry to disappoint, but I’m not a communist.
and I already told you why it isn’t.
obviously. World Systems Theory; look into it, and then come back and tell me if you still think Capitalism isn’t looting, and unilateral US hegemony is a good thing.
HAHAHAHAHAHAHA. no, therrin isn’t. your sarcasm detector is broken
oh thank fuck, it’s finally starting to get through.
seriously, how many stories do you need to grok it? how about the one where Walmart eliminated its entire deli department because workers were rumored to maybe be thinking about unionizing?
How about the Crystal Sugar lockout, where all the (unionized)workers were literally locked out of their job for the entire season and replaced with scabs, so that they weren’t able to make any money all year? How about all the students I know who missed exams because their bosses threatened to fire them if they didn’t show up for work instead of going to class?
Jadehawk, for those of us not living in the states, in that privileged position where we aren’t one medical emergency away from bancruptcy, where we don’t have to worry about a sick day taking away our jobs, it can be hard to imagine a system that fucked up.
Which isn’t to say we don’t have our own ‘first world problems’ but we do at least have a reasonably stable place to stand while we address them.
I know that I am lucky. I am probably unaware of exactly how lucky I am. But I’m trying to learn.
I have no problem with “hard to imagine”; I have a problem when those with privilege tell those without that they must be wrong because otherwise that would be just horrible blah blah.
I thank God that we have got a decent(relative to the US system) healthcare system in Britain, even if our current government is trying to destroy it. People here, the majority who are not rightwing ideologues, believe in making it work.
Why would you do that? It’s not like God had anything to do with it.
Wrong. My boss has threatened it despite it being illegal.
Yea ago when I was not eligible for my parent’s insurance because I was too old I used my schools insurance. I had something really nasty so I went to the emergency room and found out it was stomach flu so they said I need fluids until it passes over.
I get back home and a month later the bill for my visit comes in. it is $520 for the visit where they gave me fluids and some medical tests. That is about half a month’s pay at my job so lucky my parents helped pay for it but that kind of scare stayed with me. Knowing that a person could get wiped out from one visit is horrible. How can some one claim to be caring and will not offer basic services of health to others?
And, lets not forget the places where “winner take all” results in more districts voting primarily for Dems, but where the majority are marginally Republican, so they had to “fix” them by passing legislation to do the complete opposite, and make every vote count instead.
Personally, I think a mixed system would be better. There are clear cases where the best interest of a state might be handled by the best interests of each district, over all, and other cases, like electing some officials, or Presidents, where.. maybe this is less useful. The whole point of “winner take all” is kind of interesting. It prevents tyranny by the majority, in some cases, and creates tyranny by the “caste/social status/rural vs. city” type distinctions instead. If you live in an areas with high numbers, your “interests” may not be the same as the rest of the state, because you are in fact in a big city, and the problems you want addressed, rational or otherwise, are not even on the radar of 90% of the rest of the state. But, by the same token, the rest of the state might have completely different ideas on what is a priority, whether reasonable, or completely nuts, and could end up voting in enough districts that you can’t hope to have an effect. All in all, what ever the intent may be, its screwed up whether a) every vote counts, b) every district votes independent, or c) all of them decide to back one candidate, and throw the whole damn state at them. All of them have potentially disastrous outcomes, depending on the candidates available, and how many people they can dupe into voting against their own best interests.
Sorry, just can’t help myself in asking this: “So, a schizophrenic government would be better than a bipolar one?” lol
I would argue this is the #1 problem with *all* self-proclaimed “job creators” in the US. You hear a lot, or did, about the magic of the US becoming more and more of a “service industry” job creator. Servicing who exactly? You can afford to pay, say, a cook, to serve a restaurant full of people with money, but what do you end up with when everyone in the place is a cook, from the next one down the street? Where is the added value? It costs to run one, it costs to spend time making all the food. In the long run, the costs of having a damn X number of buildings, in which you basically just trade each other the current cost of making a burger is X number of closed restaurants. Why? Because, even though you are adding value, the value in question is all in the scenery, not the actual product, so, in the long run, you are paying everyone *except* the ones that actually need the money to by your service.
And this is the case with all of it. 4 million 20 hour a week, Federal minimum wage jobs would ruin the economy slower than 4 million without them, but it would still ruin it, because all those people can do with what they get paid is buy services, and no one *anywhere* in such a system is producing the things used, as a means to produce the service. And that means no extra income to, say, eat at Joe’s, instead of eating at your own, and thus keeping everyone in business.
The only reason it has kept working, at all, is because fast food was invented, so they could provide shitty food, with minimalistic service, and… ironically, sometimes pay as much as a dollar more per hour, for what little hours there are, than all the other “services”. That, and productivity keeps being pushed, and pushed, and pushed, so they can reduce how many people they actually *need* to do the same job. And, its service, not auto mechanics, so all you need is someone able to flip burgers, without burning themselves, or push buttons on a machine, and replace parts, until the car works again. No one has to know how to really cook, how to really diagnose a problem with a car, how to count, etc. All they have to be is bright enough to do X number of them, in Y time, without getting too many wrong. Being able to think, plan, etc. beyond real basic stuff, isn’t necessary, its either middle management material, of which there are far too few positions available, or a liability. After all, if you are smart, you might question how one person is supposed to, for example, keep all but 9 shopping carts off a lot, while bringing them in at a “safe” maximum of 5, at a rate of each five every minute, while there are 10 shoppers leaving the building **in the same minute**.
See, its not that its impossible, its that you are not trying hard enough, like with every other “service job” in the country. What matters is not knowing what the hell you are doing, but being fast at it, so they don’t have to beg corporate to hire more people (more of which, if you are someplace with seasonal changes in population, will be laid off anyway 6-8 months later.
“Job creators” my ass. They are no more job creators, in any useful sense of the word, than someone who throws garbage along the road is, “providing employment for work release programs”. The “value” you add to the system has to be something intrinsically useful in and of itself, not by the pure happenstance that you need to create it to enable the transaction of something else, which takes away more than the value you just added in the process.
I consider myself fortunate to live in Australia where we have a combination of health care paid from a 1.5% Medicare levy on federal income tax and if you choose personal medical insurance. The medicare levy covers most of the costs and the unemployed can also have essentially free medical care as necessary. Given that it is free, non essential medical care usually requires a wait but life threatening conditions will be treated immediately. There are also doctors who will treat a patient for the standard fee without charge.
Medical Insurance in Australia is not tied to employment and there is a choice of insurers and insurance packages. I am 71 years old and my single person insurance costs me $96 monthly and covers most of my medical and hospital bills. For example, I will need surgery for 3 known hernias and one potential hernia and removal of some lymphomas which will all be done at the same time. Total cost for me will be just under $2000 plus overnight hospital stay. This is a result of government controlled medical costs where the government sets a standard fee and the copay amounts. Doctors are able to charge more than the standard fee but the presence of the standard fee puts a damper on excessive charges and few doctors actually do charge much more than the standard fee.
The other factor controlling costs is that medical insurance is universal so that actuarial costs are spread across the whole community, not maybe only on 5 employees in the local pizza shop. So while for years I paid for medical insurance that I did not use, now when I need it more I do not have to pay exorbitant rates.
I lived and worked in the USA for 3 years up until the beginning of 2001. I was fortunate in not needing much medical care during my stay but some contrasts are relevant. At that time a GP consultation cost about $75 in the USA which was double what it cost in Australia. Fees for a CAT scan in the USA were more than 3 times what was charged me when I came back to Australia. Since there was no standard fee for these procedures the medical industry in the USA seemed to charge different patients different amounts and the CAT scan cost the insurance company 2/3 of the cost to an individual.
It also seems to me that where you have a profit making insurance company which presumably makes more or less constant margins on its services, there is a big incentive for it to pay more for a service as this increases its profits, providing of course this can be recovered from premiums or other sources such as subsidies from government. This is quite different from the situation in Australia where many of the medical insurers originated in non profit mutual societies whose aim was and is to insure people at minimal cost.
The situation in Australia is not perfect but it works reasonably well for most people and the doctors still seem to be able to drive BMW’s and have a comfortable life.
When flu shots weren’t covered, I paid $35 for mine at a local walk-in clinic, in Canada. The “visit cost” was paid by provincial health insurance. The province paid for “at risk” folk, e.g. over 65, small children, child-care or health-care workers (as I recall–I’m sure about the senior citizens). In a couple of years, the province realized the benefit of flu shots compared to having people ill with the flu and covered everyone, for free, with organized clinics doing nothing but immunizations. When the H1N1 emerged, I got two free shots — one for the usual ‘viruses circulating last summer’ and one for H1N1.
The larger Commonwealth countries — Britain, New Zealand, Australia, Canada — have similar healthcare systems with one non-profit payer, the government, which sets reimbursement rates. Doctors get their bills paid reliably and everyone is covered. Migrant workers are covered the day they enter Canada for employment. People who just move here are covered after three months. (Usually they are moving from another province, whch covers them for that period.)
Please, get up on your hind legs and demand universal medicare now. No one should be one illness away from bankruptcy.
Markita Lynda,
You can weaken that and still be accusatorily provocative, when referring to developed economies:
“No one need be one illness away from bankruptcy.”