Pharyngula

I’m not so sure about this pick

It looks like Obama has picked Sanjay Gupta to be surgeon general. He seems a bit of a lightweight, to me — he’s mainly known as a congenial talking head on television news. He’s also an apologist for US health care, which does not give me any confidence that we can expect the slightest effort towards health care reform. I suspect Obama has just picked a pleasant smiling face to act as a placeholder, and that disappoints me.

We’ll have to see how that ol’ conservative, Orac, reacts to this news.

Comments

  1. #1 dhonig
    January 6, 2009

    Yup, a talking head. Disappointing.

  2. #2 Shaden Freud
    January 6, 2009

    Well, at least it wasn’t Dr. Phil….

  3. #3 Glen Davidson
    January 6, 2009

    No flake, anyway.

    It should have been someone who recognizes that our health-care system is broken, though. But Obama never did push that angle much.

    Glen D
    http://tinyurl.com/6mb592

  4. #4 Kirk
    January 6, 2009

    Well, he is a trained neurosurgeon (operated on kids in Iraq, as many of the Kos posters mention), and I believe he has done some sort of health advocacy. Not sure on his public health creds or what sort of programs he’d be pushing for.

    As long as he doesn’t call for increased abstinence programs, we’ll be doing better.

  5. #5 Jadehawk
    January 6, 2009

    thats depressing. there have got to be better doctors in this country somewhere. as a matter of fact, he could have made a better decision by asking in an online poll ;-)

  6. #6 SC, OM
    January 6, 2009

    He’s also an apologist for US health care

    Ew. Didn’t know that. Will have to look into him more closely.

  7. #7 joeyess
    January 6, 2009

    Is there a cabinet position that the Dog Whisperer would fit in?

  8. #8 Matt
    January 6, 2009

    I can’t wait till a Single-payer system comes to America. Not because I think its a good idea, but because I don’t think Americans have been exposed to the problems inherent in single-payer systems. When a congresscritter’s daughter gets told she will wait 6 months for an MRI on a brain tumor, they might figure out their mistake.

    Not to say the American system as it stands is great. It is actually pretty awful. But those other systems are way worse.

  9. #9 dead yeti
    January 6, 2009

    Bet Michael moore’s not enjoying 2009 as much as he had hoped

  10. #10 Jadehawk
    January 6, 2009

    seriously, I’m weirded out by the fact that a Time Magazine columnist gets to be Surgeon General. on a more professional note though, it would have really been better if he were more aware of what a disaster the American health care is. not that Obama was planning on fixing it anyway though, so i guess that’s not surprising. :-/

  11. #11 Jadehawk
    January 6, 2009

    But those other systems are way worse.

    except they’re not.

    I swear, if I ever get pregnant I’m instantly moving back to Germany, even if it means moving back in with my mom. I’ll probably pay dearly for my current sting in America as it is. I’m already developing hypochondria from imagining all the undetected cancers that may or may not have developed since the last time I could afford a checkup :-/

  12. #12 joeyess
    January 6, 2009

    Matt, your full of shit.

  13. #13 Bill Dauphin
    January 6, 2009

    Since much of the Surgeon General’s job has to do with being a health policy spokesperson (and a bestower of medals and awards), I’m not at all sure a press-savvy person is a bad choice. Do we really think Sanjay Freakin’ Gupta is going to be substituting his personal policy ideas for those of Obama?

    Not for nothin’, but we’ve had experience with Surgeons General who believed in all the right things, but set the cause back through their tin-ear public pronouncements (can you say “Joycelen Elders”? I knew you could…). A guy who actually can imagine how what he says is likely to sound once it gets on the news might not be so bad.

  14. #14 Meng Bomin
    January 6, 2009

    To my knowledge, the Surgeon General is mainly a PR gig, not a policy gig, so I don’t care that much about his opinions regarding health care reform so long as he keeps them to himself in the role.

    In fact, I think that his mad TV skilz may come in handy.

  15. #15 Don from Rochester MN
    January 6, 2009

    From Daily KOS:

    >I’m not sure how I feel about that pick.

    . . . which I read as “I’m not sure how I feel about that prick.” and wondered if I was reading too much into it . . . .

  16. #16 AaronF
    January 6, 2009

    I think we need to distinguish between the Health Care System (i.e. Hospitals, Doctors, etc) and the Health Insurance Industry. We have one of the most advanced health care systems in the world (scientifically speaking), and your chance of survival is quite high for serious illnesses. That is, if you can afford it. Maybe much of the perceived poor quality of the American Health Care System could be attributed to people refusing treatment because their insurance companies will not cover it. Do these studies that rank the health care quality of a country take factors into account such as the diet of the people living in those countries? I think few could argue that as a whole, Americans have a poor diet, which I’m sure leads to more sickness.

    I’m personally not exactly sure that socializing medicine is going to improve the situation much if we can’t start getting people to want to live healthier lives. Making hospital or doctor visits cheaper, or even free, is not going to reduce illnesses if people continue to eat junk food and plaster their bottoms in front of the television all day. Maybe it will have the reverse effect. Maybe if people expect free hospital and doctor visits, they might not be as careful or conscious of their health as they otherwise would be.

  17. #17 nigelTheBold
    January 6, 2009

    Matt@8:

    A system in which someone has to wait is better than a system in which 17% of the population get no health care whatsoever, and another 10% has only minimum health care. That’s logical.

    We pay more per-capita for health care than almost all single-payer systems, and receive (on average) worse health care coverage. Instead of the government selecting our physicians for us (something that a lot of conservatives use as a scare tactic), we let our insurance companies select our physicians for us. Ah, yes. Let’s let the one group that stands to make the most money decide what kind of health care we can get, and from whom.

    Most single-payer systems are not as bad as you are making them out to be. Emergencies are dealt with as they are in the US, on a first-come, first-serve basis.

    Also, a congressman would probably be able to afford a private physician, so while you may be concerned for their level of health care, it will remain superior to yours.

    There may be problems with single-payer systems (I’m not saying there isn’t). But *any*thing has got to be better than this failed system we are using in the US, where insurance companies hike prices, reduce coverage, and cut services.

  18. #18 Zach
    January 6, 2009

    Matt obviously hasn’t ever actually lived in a country with a single-payer system.

  19. #19 Matt
    January 6, 2009

    @Jadehawk

    Isn’t that what insurance is for?

    I pay about $120 a month for a mid-deductible plan, and I’m in a really expensive state. If you can’t afford to pay, hospitals are still required to provide the same treatment as if you could pay.

    That isn’t true in quite a few other countries. In Canada, you don’t have the right to treatment. You have the right to wait your turn, whether you are paying in to the system or not. If you are #100 on the waiting list, you aren’t guaranteed to be the 100th person seen. In the UK 33% of hospital beds go unused, while people remain on waiting lists, as the government hasn’t funded them correctly. There is a reason all the politicians in the EU fly over the pond whenever they need surgery.

  20. #20 RobC
    January 6, 2009

    In grad. school, I had a chance to hear Dr. Gupta lecture about the US health care system, and was really impressed.

    He is head or assistant head of neurosurgery at Grady Hospital in Atlanta-one of the biggest public hospitals in the US, and chronically suffering from funding issues. If I recall correctly, he also wrote policy briefs and positions for Hillary Clinton when she was first lady.

    His public image might bring some prestige to the office. Who here can actually name the current or past few Surgeon Generals?

  21. #21 NewEnglandBob
    January 6, 2009

    From Wikipedia:

    Gupta specializes in all facets of neurosurgical care with a strong interest in complicated spine, trauma and 3-D image guided operations. He has recently had articles published in the Journal of Neurosurgery and Neurosurgical Focus on percutaneous pedicle screw placement. He has also published on brain tumors and spinal cord abnormalities.

    People here think this is a lightweight? A talking head?

  22. #22 Watchman
    January 6, 2009

    Matt obviously hasn’t ever actually lived in a country with a single-payer system.

    Matt has probably been living in a country where “single-payer” has been progagandized into meaning “socialistic”.

  23. #23 Matt
    January 6, 2009

    “Matt has probably been living in a country where “single-payer” has been progagandized into meaning “socialistic”.”

    No, Matt has read quite a bit of literature on both sides of the issue, and he has informed himself. I also have some family in Scotland who pay out the nose for private coverage to avoid the single-payer system there (and they have to contribute to that single-payer system).

    Is this kind of thing really acceptable in a first world country?:
    http://www.youtube.com/watch?v=H4u5x9XAsAs

    Or this?
    http://www.youtube.com/watch?v=Jc2n8JxYXgs&feature=channel_page

  24. #24 Ragutis
    January 6, 2009

    Thank you, Matt, for making your ignorance so obvious. You’ve saved a lot of us much time wondering whether your opinions merit consideration.

    As for Dr. Gupta, if that’s true, it’ll be interesting to see if putting a young, friendly, semi-celebrity face on health issues will be more effective in educating the public. We see the damage Jenny McCarthy and other wooful celebs can do, maybe this is a bit of fighting fire with fire? (Trying to be optimistic here…)

    Ah well, I guess I’ll just be grateful it’s not Dr. Oz, Kevin Trudeau or that creepy colon cleansing guy on the late night infomercials.

  25. #25 The Science Pundit
    January 6, 2009

    Sanjay Gupta goes after Michael Moore over the facts in the movie Sicko. That’s just responsible reporting.

    It turns out that the facts are on Moore’s side and a minimum investigation before the interview would have revealed that. Oops! Maybe he’s just sloppy?

    Now check out this 2007 interview he did with Deepak Chopra (sorry it’s only a transcript; it appears the video is no longer available). Count how many times he goes after Chopra the way he went after Moore. Hell, count how many times he goes after Chopra at all. (Hint: zero)

    Needless to say, I do have some issues with Dr, Gupta.

  26. #26 Matt
    January 6, 2009

    “A system in which someone has to wait is better than a system in which 17% of the population get no health care whatsoever, and another 10% has only minimum health care. That’s logical.”

    That sucks, and we should do something about that. But I would bet that the government is doing a lot more to create that program then they are to solve it.

    “We pay more per-capita for health care than almost all single-payer systems, and receive (on average) worse health care coverage.”

    Is that really, true, that we receive worse health coverage? The statistics most cited on this seem to be that our life span is shorter (have you seen what we eat here in America?), that infant mortality is higher (this uses statistics straight from the countries themselves, who take those statistics in different manners. This renders the entire data set worthless), or that WHO study where we came in 37th or whatever in healthcare. If you support that study, why don’t you give me a list of the criteria they used to come up with that score. I think you’ll be surprised, when you dig deeper.

    And remember, hospitals in America ARE NOT ALLOWED to deny care to anyone, regardless of ability to pay. Saying people are kicked out of the door is an outright fabrication.

    “Instead of the government selecting our physicians for us (something that a lot of conservatives use as a scare tactic), we let our insurance companies select our physicians for us. Ah, yes. Let’s let the one group that stands to make the most money decide what kind of health care we can get, and from whom.”

    Right, but my changing insurance companies is a phone call away. Actually, I’m doing that right now, as I think my current plan is ripping me off, and I found a much better deal. Changing governments? Not so easy.

    “Most single-payer systems are not as bad as you are making them out to be. Emergencies are dealt with as they are in the US, on a first-come, first-serve basis.”

    I’ll agree on the emergency care. I’m sure they do a pretty good job with that (although there was that horror story a few weeks ago where 2 NHS patients died because there was 2 doctors for 100 patients though). Its the bigger stuff like getting cures for cancer or getting joint replacement which would worry me.

    “Also, a congressman would probably be able to afford a private physician, so while you may be concerned for their level of health care, it will remain superior to yours.”

    This is assuming private care isn’t outlawed, as it is in several parts of Canada. I see no reason it couldn’t happen here.

    “There may be problems with single-payer systems (I’m not saying there isn’t). ”

    I don’t here a lot of that when I discuss health care policy with liberals.

    “But *any*thing has got to be better than this failed system we are using in the US, where insurance companies hike prices, reduce coverage, and cut services.”

    Our system does suck. But we can make it better without going to something like the NHS or CHA.

  27. #27 monson
    January 6, 2009

    I live in Canada after living in the U.S. for 35 years. I have been here for 6 years no problems with the health care. I have not heard of anyone with a real problem. Sometimes the wait for non life threatening problems is long but we all have good health care.

  28. #28 Matt
    January 6, 2009

    “Thank you, Matt, for making your ignorance so obvious. You’ve saved a lot of us much time wondering whether your opinions merit consideration.”

    Keep those fingers shoved firmly in your ears. Wouldn’t want to damage your sensibilities.

  29. #29 Sharon
    January 6, 2009

    Is there a cabinet position that the Dog Whisperer would fit in?

    Secretary of State. He’d have the Israel/Palestine conflict cleared up in no time, and have Iran work out all its aggression. We’d have world peace in a month.
    :)

  30. #30 'Tis Himself
    January 6, 2009

    Matt has read quite a bit of literature on both sides of the issue, and he has informed himself.

    Matt is also parroting several of the conservative “oh no, socialist medicine” scare points. Matt hates the idea of government bureaucracy having a say in medical treatment. Instead, he’s much happier with corporate bureaucracies dictating what treatment will be given. Because, as we all know, corporate bureaucracies care only about the best interests of the patient. Besides, under a single payer system, corporate executives will be out of work. Who wants to see a CEO go from making millions per year to begging in the street? Not our Matt.

  31. #31 SC, OM
    January 6, 2009

    …Now check out this 2007 interview he did with Deepak Chopra

    Ew yet again. I don’t know where I got the impression that he was pretty vocally antiwoo.

  32. #32 Matt
    January 6, 2009

    “Matt is also parroting several of the conservative “oh no, socialist medicine” scare points. ”

    So argue against them. All I see is people in here attacking the messenger or putting on their earmuffs instead of addressing the very real issues with single-payer systems.

    “Matt hates the idea of government bureaucracy having a say in medical treatment. Instead, he’s much happier with corporate bureaucracies dictating what treatment will be given.”

    Again, switching insurance companies is a phone call away. Where do I call to switch my government? Or I could just tell both to go to hell and work out a price directly with the doctor, which is becoming more popular here. That is what happened before the government passed the HMO act of 1973.

    “Besides, under a single payer system, corporate executives will be out of work. Who wants to see a CEO go from making millions per year to begging in the street? Not our Matt.”

    I couldn’t care less for the executives. If they provide the service I want, great. If not, fuck em. They don’t get my money.

    Doesn’t quite work that way with the government. They will send men in costumes to fetch my money for them if I don’t pay into that system.

    So does anyone have anything besides an ad hominem (besides nigelTheBold he was cool)?

  33. #33 noodles
    January 6, 2009

    Sanjay Gupta objects to health care workers being permitted to refuse participation in medical procedures if they have a religious objection.

    “It’s a bit of a slippery slope. I mean, when you say, I’m not going to provide care based on my own conscience…you can imagine that opens up a whole wide range of possibilities, in terms of what is going to be treated and what is not.”

    http://newsbusters.org/people/television/sanjay-gupta

  34. #34 Interrobang
    January 6, 2009

    In Canada, you don’t have the right to treatment. You have the right to wait your turn, whether you are paying in to the system or not.

    Actually, you do have the right to be seen. See the Canada Health Act. You claim to have done all this reading. Where are you getting your information? That hotbed of serial liars, the AMA? Under the law, healthcare is a basic human right. You may have to wait your turn, but that’s because we don’t have a multi-tier system like a lot of countries (including the UK do). No queue-jumpers here. That’s fair. Also, you don’t usually have to wait that long. The last time I needed a scan I had one in less than two weeks, and the last time I needed non-emergency surgery, I had my procedure done within six weeks of the initial surgical consultation.

    On the other hand, unlike all of my American friends, who have to wait and wait and wait to see their regular doctors, or else go to the ER if it’s really urgent, if I need to see my doctor, I can usually get in to see someone at my clinic the same day. If not, well, there are walk-in clinics all over the place, and I can go to the Urgent Care clinic or the ER if I really need to.

    Also, you cannot “opt-out” of the system, so there’s no issue of “whether you are paying into the system or not.” Either you’re paying taxes in Canada, in which case you are paying into the system, or you are not, in which case you’re going to be billed for services sought and/or rendered. It cost $65 and some paperwork to get my British friend an appointment at a walk-in clinic when he came down with strep throat while here.

    Also, nobody waits six months for an MRI for a possible brain tumour. That’s a stupid lie. The only possible exception to that might be someone who lives way up in some little remote town that doesn’t even have roads, it only has an airstrip, and where people don’t have a mailing address, they have a map designation, and chances are, that’s only because it’s midwinter and conditions are so bad they can’t risk flying the person to the nearest city. In which case, they’re also going to be waiting months for their mail, so what’s your point?

    I have much better care than anyone I know of in the US, including the people who have good insurance, even though I don’t “get to” see nearly as many specialists… On the other hand, since GPs here do things that American GPs apparently consider beneath them or something, I don’t need to.

  35. #35 DrBadger
    January 6, 2009

    #24: “Ah well, I guess I’ll just be grateful it’s not Dr. Oz, Kevin Trudeau or that creepy colon cleansing guy on the late night infomercials.”

    … yeah or as others said, some new-agey idiot. I just felt that Gupta reported whatever CNN fed to him. I’m sure there are better candidates out there. I’ve been pretty dissapointed with the majority of Obama’s choices so far.

  36. #36 Teleprompter
    January 6, 2009

    Obama couldn’t have appointed Gregory House?

    Seriously, I think Gupta isn’t a bad choice – a media savvy personality in what amounts to a PR job. It seems like a good fit.

  37. #37 Alex
    January 6, 2009

    But what about Wolf? …or Kiran Chetchry? We need more cabinet positions.

  38. #38 Randomfactor
    January 6, 2009

    There is *ALREADY* a federal program in place for handling the serious medical costs of health care in those who cannot afford or cannot obtain insurance.

    Unfortunately, it’s called “bankruptcy court.”

  39. #39 eli
    January 6, 2009

    Let’s tackle the healthcare issue from an economic viewpoint, the $70+/hour figure for US autoworker labor included the healthcare for the workers (including pensioners healthcare), how can we compete with companies who exist in countries with national healthcare systems (japan/germany). The issues of healthcare expand well beyond those providing and receiving care.

    The fact of the matter is that it is DOCTORS making healthcare decisions. If a national system follows the advice of doctors (and should be worded as such) as to what care it should/shouldn’t provide then it’ll be better than insurance compaines consulting their accountants and risk assayers to determine what they will and will not cover.

  40. #40 Meng Bomin
    January 6, 2009

    Again, switching insurance companies is a phone call away.

    Matt confirms that he doesn’t know how America’s healthcare system works. If he thinks that that is an accurate portrayal, then he doesn’t know what he’s talking about.

  41. #41 WTF
    January 6, 2009

    I’m very disappointed with this pick. It is starting to seem to me that Obama is just picking the most famous people he can find…First Rick Warren and now this retard…I am very disappointed.

  42. #42 Matt
    January 6, 2009

    “Actually, you do have the right to be seen. See the Canada Health Act. You claim to have done all this reading. ”

    If you have a joint that needs replacing, go into a hospital in Canada and demand they replace it. They won’t, the surgery needs to be scheduled, surgery and step down beds need to be booked, the surgeon needs to be booked, etc. If any part of that chain gets interrupted, you are back on the waiting list.

    “On the other hand, unlike all of my American friends, who have to wait and wait and wait to see their regular doctors, or else go to the ER if it’s really urgent, if I need to see my doctor, I can usually get in to see someone at my clinic the same day. ”

    That’s odd, considering the WHO listed the US as #1 in wait times out of everyone else. Canada’s average wait time for major conditions is about 18 weeks, not including the wait times to get to your GP in the first place.

    “Also, you cannot “opt-out” of the system, so there’s no issue of “whether you are paying into the system or not.” ”

    Well gee that’s kind of the whole point, isn’t it. That you pay whether you get treatment or not.

    “Also, nobody waits six months for an MRI for a possible brain tumour. That’s a stupid lie. ”

    Well why don’t you take a look at that stupid lying video I posted earlier detailing what a family had to go through to cure the husband’s brain cancer.

    “I have much better care than anyone I know of in the US, including the people who have good insurance, even though I don’t “get to” see nearly as many specialists… On the other hand, since GPs here do things that American GPs apparently consider beneath them or something, I don’t need to.”

    Great, but that is anecdotal evidence. Lets see some statistics on the quality of our systems to back it up.

  43. #43 Bill Dauphin
    January 6, 2009

    Let’s tackle the healthcare issue from an economic viewpoint, the $70+/hour figure for US autoworker labor included the healthcare for the workers (including pensioners healthcare)

    Yeah, my dream scenario (and yes, I realize it’s only a dream) is that we pitch single-payer health care as an auto industry bailout… and then when people claim it’s manifestly unfair to give such a valuable advantage to just a few companies, we fix the “problem” by extending single-payer to all Americans. QED.

    Hey, I can dream, can’t I?

  44. #44 Jadehawk
    January 6, 2009

    @Jadehawk

    Isn’t that what insurance is for?

    I pay about $120 a month for a mid-deductible plan, and I’m in a really expensive state. If you can’t afford to pay, hospitals are still required to provide the same treatment as if you could pay.

    god you’re stupid.

    health insurance would cost me a minimum of $150, and that only covers the worst emergencies, not preventive care. the insurance that would cover all preventive care as well would be easily $400-500 a month. which is 1/3 or my income at the best of times.

    and that only for as long as i work 40 hours at some crappy job (and most jobs here give only 38 hours a week); since my primary income is from being self-employed, i’m doubly fucked.

    nice that you have such cushy circumstances, but for some people healthcare just isn’t possible

  45. #45 DrBadger
    January 6, 2009

    @#33, that’s good news. The federal conscious clause that Bush just sneaked in before leaving office is terrible. If Obama doesn’t get rid of it, all my patients are fasting for Ramadan.

  46. #46 John Morales
    January 6, 2009

    Matt, might it be that the effectiveness of the health care system of a country correlates with the life expectancy therein?

  47. #47 Matt
    January 6, 2009

    “Let’s tackle the healthcare issue from an economic viewpoint, the $70+/hour figure for US autoworker labor included the healthcare for the workers (including pensioners healthcare), how can we compete with companies who exist in countries with national healthcare systems (japan/germany). The issues of healthcare expand well beyond those providing and receiving care.”

    Well remember quite a few Japanese/german cars are produced domestically. My Toyota Camry, for instance, is made in Kentucky. The Japanese government isn’t paying for their healthcare.

    “The fact of the matter is that it is DOCTORS making healthcare decisions. If a national system follows the advice of doctors (and should be worded as such) as to what care it should/shouldn’t provide then it’ll be better than insurance compaines consulting their accountants and risk assayers to determine what they will and will not cover.”

    I would like to move to a system where decisions are made more by individuals and their doctors instead of governments or insurance companies. But I really don’t see that happening by moving to a euro-style system.

  48. #48 Marcie
    January 6, 2009

    Fellow Canadian here nodding along with Interrobang.

  49. #49 Meng Bomin
    January 6, 2009

    @WTF #41

    I’m very disappointed with this pick. It is starting to seem to me that Obama is just picking the most famous people he can find…First Rick Warren and now this retard…I am very disappointed.

    This is just conjecture, but I think that Obama, being the politician he is, sees things largely though a lens of power. In the information age, celebrity preachers and TV doctor personalities hold a great deal of weight, especially for ceremonial roles (like giving an inaugural invocation or being surgeon general), so he picks those kinds of people.

  50. #50 Matt
    January 6, 2009

    “Matt, might it be that the effectiveness of the health care system of a country correlates with the life expectancy therein?”

    You could try to argue that, but remember their are other factors contributing to life expectancy then health care:

    http://images.google.com/images?hl=en&q=mcdonalds+kid&btnG=Search+Images&gbv=2

    I don’t really think it is the health care systems fault that we eat McDonalds and Burger King all the time, now is it?

  51. #51 cw
    January 6, 2009

    Oh Sanjay!!! I got scared, I thought he said Sanjaya.

  52. #52 AaronF
    January 6, 2009

    @John Morales:

    “Matt, might it be that the effectiveness of the health care system of a country correlates with the life expectancy therein?”

    Not necessarily. We need to take into account the lifestyle of the people within a country such as the diet, percentage of people who smoke or drink alcohol, percentage of people who exercise regularly. There are various factors that attribute to life expectancy. I don’t think the studies that are being cited as evidence of the supposed poor quality of the US health care system address any of those factors.

  53. #53 Jadehawk
    January 6, 2009

    also, no doctor is required to treat me. the ER is required to treat me, but by the time i get to the ER with whatever is the problem, it’ll be possibly a bit late to fix it.

    there’s a reason 22000 people die every year in the U.S. as the direct result of lack of insurance

    and it’s bullshit that you have to wait long for urgent operations. nonurgent ones of course take a waiting-list, because they’re NON-URGENT, and there’s a lot of people.

  54. #54 'Tis Himself
    January 6, 2009

    Matt writes:

    Again, switching insurance companies is a phone call away. Where do I call to switch my government? Or I could just tell both to go to hell and work out a price directly with the doctor, which is becoming more popular here. That is what happened before the government passed the HMO act of 1973.

    If you want to switch your government, you move to another city, country, state or country, depending on which government you want. Most Americans with health insurance get it from their employer. It’s a take it or leave it system (and I’ve never heard of any employer giving the money otherwise spent on health insurance to the employee). So while governments can be changed, it’s more difficult to change insurance providers.

    If you see a doctor without any kind of insurance, they generally want all the money up front. Obviously you don’t have a clue about what a visit to a doctor costs. Hint: It’s a noticeable number of dollars per minute.

    Doesn’t quite work that way with the government. They will send men in costumes to fetch my money for them if I don’t pay into that system.

    The old libertarian “men with guns” gambit. I should have known I was trying to discuss real life with a libertarian wacko.

  55. #55 joeyess
    January 6, 2009

    That’s odd, considering the WHO listed the US as #1 in wait times out of everyone else. Canada’s average wait time for major conditions is about 18 weeks, not including the wait times to get to your GP in the first place.

    Number one in wait times If you can afford it, right Matt?

  56. #56 Jadehawk
    January 6, 2009

    shit, when i was still insured with my mom, i used to fly to germany for my dentist appointments, because it was cheaper than getting my teeth fixed here. it’s an absolutely pathetic system unless you’re lucky enough to make enough, in the right spot, at the right time, with the right employer. and never lose your job. COBRA is a fucking ripoff.

  57. #57 Matt
    January 6, 2009

    @#44

    “god you’re stupid. ”

    :rolleyes: Democrats are the party of hate, republicans are the party of fear.
    http://www.youtube.com/watch?v=tG6JYsm1GmM

    “health insurance would cost me a minimum of $150, and that only covers the worst emergencies, not preventive care. ”

    Have you tried shopping around?

    “and that only for as long as i work 40 hours at some crappy job (and most jobs here give only 38 hours a week); since my primary income is from being self-employed, i’m doubly fucked.”

    Get an individual plan. Everyone gets their employers plan and forgets about it, but they rip you off on those things. I shopped around for an individual plan and found a really good one with no catches. I’ll be dumping my employer plan within the month and picking up my shiny new, $120 a month with $2500 annual deductible (everything over $2500 spent in 1 year covered) plan.

    Not that I’m saying insurance is great, but hey the government created this system, now you want them to fix it?

  58. #58 person living in the real world
    January 6, 2009

    “Again, switching insurance companies is a phone call away.”

    HA HA HA HA HA AHAHAH HA HA HA.

    good one. maybe youve never ever heard of anyone being rejected coverage of existing conditions. i wish i lived in your fairy tale world and not in the real one.

    also tell me matt, since the utopia of of hospital emergency rooms are so great and cant reject me even though i’d probably have to wait hours upon hours to see anyone with fox news blaring on the TV the entire time (true story), is that treatment free? what if i happen to need an MRI, chemotherapy, or an operation. do i go to the emergency room?

  59. #59 Bill Dauphin
    January 6, 2009

    Matt:

    If you have a joint that needs replacing, go into a hospital in Canada and demand they replace it. They won’t, the surgery needs to be scheduled, surgery and step down beds need to be booked, the surgeon needs to be booked, etc. If any part of that chain gets interrupted, you are back on the waiting list.

    [cough]Idiot![/cough]

    AFAIK, joint replacement is almost always elective (at least in terms of timing). What makes you think you could get it instantly, on demand, here in the U.S.? I just had to wait several weeks to get in for a simple hernia repair. A colleague of mine had hip replacement surgery (and I have good insurance), and he scheduled it months in advance. What part of the country do you live in where fully staffed operating rooms are just sitting empty, just waiting for you to wander by with a yen to get somethin’ worked on?

    BTW, even if you could get joint replacement surgery on a moment’s notice, you wouldn’t… because it takes time to organize your life to accommodate the long, inconvenient (at best) recovery.

    Also, you cannot “opt-out” of the system, so there’s no issue of “whether you are paying into the system or not.”

    Well gee that’s kind of the whole point, isn’t it. That you pay whether you get treatment or not.

    Yeah… just like you pay (through taxes) for roads and bridges whether you own a car or not… and just like other people’s taxes pay for some damn thing you use and they don’t. The fact that everybody shares the burden regardless of actual usage is what makes shit like… y’know, infrastructure… and shared services… affordable for everyone. BTW, that’s the way health insurance works, too… except that in our system, part of the burden everybody (well, everbody who’s lucky enough to be able to get insurance, that is) has to share is somebody else’s profit, not to mention somebody else’s wasteful corporate overhead.

    ‘Splain me again why that’s a good thing?

  60. #60 joeyess
    January 6, 2009

    Hey Matt. I urge you to move to Canada and reform their healthcare system in your image.

    You would be chased out of the country with pitchforks and torches.

  61. #61 'Tis Himself
    January 6, 2009

    I missed this bit before:

    I pay about $120 a month for a mid-deductible plan, and I’m in a really expensive state.

    I doubt you’re paying $120/month for health insurance. That may be your co-pay with your employer picking up the rest, but there isn’t any way you’re paying that little for insurance that covers more than catastrophic care.

  62. #62 Bill Dauphin
    January 6, 2009

    since my primary income is from being self-employed, i’m doubly fucked.

    Well, geez, Jadehawk, you need to cut out that “doubly fucked” stuff: You might get pregnant… and I don’t mean to alarm you, but I’ve heard you don’t have health insurance!

  63. #63 Jadehawk
    January 6, 2009

    matt, you are really clueless. i have shopped around. what i quoted was a fact, not a wild guess.

    and i’m not even that badly off. my boyfriend has never had insurance in his whole life, and would be uninsurable if he tried. and he can’t “go home” in case of serious illness. he’s stuck with being stuck outside your stupid system.

  64. #64 joeyess
    January 6, 2009

    Not that I’m saying insurance is great, but hey the government created this system, now you want them to fix it?

    This has won the internets for the day. File this under “Insurance Industry Shill Out Of Talking Points And Just Wingin’ It”.

  65. #65 AaronF
    January 6, 2009

    Government sponsored health care is great if you want Pat Robertson specifying what kind of health care you will be able to receive. If you don’t think that’s going to happen, you haven’t been paying attention for the last 8 years. And maybe Obama won’t let it happen, but you cannot guarantee that the next President won’t.

    Witnessing how the federal government has handled things so poorly throughout my lifetime, particularly in the past 8 years, I’m not convinced at all that health care is the one thing they are capable of managing. I’m not saying what we have now is acceptable, but just by going off the government’s track record, I don’t see how anyone could say they believe that government control will make health care better.

  66. #66 Jadehawk
    January 6, 2009

    Well, geez, Jadehawk, you need to cut out that “doubly fucked” stuff: You might get pregnant… and I don’t mean to alarm you, but I’ve heard you don’t have health insurance!

    smartass. :-p

  67. #67 mayhempix
    January 6, 2009

    What Matt doesn’t seem to understand is that market driven forces and fair affordable healthcare are mutually exclusive events.

    He’s clueless to the fact that he is paying more because hospital emergency rooms are jammed with people without insurance. He’s also completely full of shit about how free he is to change at any time because if he was sick with something serious insurance companies wouldn’t take him unless compelled to by law. Looking at the price he pays it’s also clear he doesn’t have to pay family rates which approach $600 a month with huge deductables.

    As long as we have multiple carriers whose masters are profit and the bottom line instead of the health and welfare of the patient, the poor (read women and children) will continue to be screwed so the affluent don’t have to wait a few weeks longer for elective surgeries. And as far as his videos go? They are purely anecdotal and do not represent a true view of the bigger picture. All institutions have their fuck ups and problems and unfortunaely there will always be sad cases of people falling through the cracks. Right now it’s more like people being pushed of the edge of a cliff to squeeze out a few more bucks and a higher stock price.

    Matt has to be a Free Market God worshipping Libertarian.

  68. #68 Matt
    January 6, 2009

    “Number one in wait times If you can afford it, right Matt?”
    “If you see a doctor without any kind of insurance, they generally want all the money up front. ”

    I’ll say it again. It is ILLEGAL to deny care to anyone who comes within 250 feet of the hospital, regardless of their willingness or ability to pay.

    “The old libertarian “men with guns” gambit. I should have known I was trying to discuss real life with a libertarian wacko. ”

    Are you saying that violence does not come into this system at all? I mean, corporations might be bad and evil, but I’ve never seen a corporation do what our government does (though maybe they might use the government for their own ends).

    “Yeah… just like you pay (through taxes) for roads and bridges whether you own a car or not… and just like other people’s taxes pay for some damn thing you use and they don’t. The fact that everybody shares the burden regardless of actual usage is what makes shit like… y’know, infrastructure… and shared services… affordable for everyone.”

    Well, maybe we shouldn’t give money for those things. I’m sure as hell never going to use a $250 million bridge to nowhere in Alaska, but the government still feels my dollars should go there. That is just as unfair as paying for health services you don’t want to use (actually the government already does this as well).

  69. #69 Astraea
    January 6, 2009

    Everyone knows no one in America ever suffers from waiting for treatment!

    Excuse me, I have to go to a hospital and get an instant joint replacement. Here in America where surgeries don’t have to be scheduled, rooms don’t have to be reserved, and doctors are just waiting for my order like a McDonald’s drive-through.

  70. #70 joeyess
    January 6, 2009

    Witnessing how the federal government has handled things so poorly throughout my lifetime, particularly in the past 8 years, I’m not convinced at all that health care is the one thing they are capable of managing.

    I don’t want them to manage it. I just want it paid for. Preferably, in total, by Richard Mellon Scaife.

  71. #71 John Morales
    January 6, 2009

    Matt, AaronF, I don’t deny lifestyle choices are highly-significant, but I would think that, say, Canada and Australia are comparable to the USA in terms of affluence and lifestyle. Can you point to any salient factors that differ between these countries and affect mortality that would render the difference of health care effectiveness insignificant?

  72. #72 SC, OM
    January 6, 2009

    I don’t really think it is the health care systems fault that we eat McDonalds and Burger King all the time, now is it?

    Well, it’s in very significant part the government’s fault, for caving to the fast food / industrial agriculture complex that determines the options and their availability. (This is in addition to the abominable system that leaves millions without adequate health care.)

    Anyone in government who doesn’t recognize the importance of food policy to public health policy or who is unwilling to take on these powerful interests in promoting public health is incompetent or corrupt or both.

    Here’s one group trying to address this:

    http://www.fooddemocracynow.org/about-us/

    In contrast, government programs place pressure on kids to “make healthy choices”

    http://www.surgeongeneral.gov/obesityprevention/index.html

    all the while supporting corporate agriculture that is destructive to the environment and human health.

    Gupta won’t be radically different in this regard, I’m sure.

  73. #73 Kemist
    January 6, 2009

    Matt @ 8

    I happen to live in a single-payer system (north of you). I have seen a bunch of people get sick around me, and get excellent care. Among them is my best friend, diagnosed with ovarian cancer. Operated on, in the same week as her diagnosis, by a world-reknown gyneco-oncologist surgeon.

    My uncle, diagnosed with prostate cancer, thanks to the PSA test (developped in the very same institute I happen to work in by Dr. Fernand Labrie) and to his very zealous doctor. Put on hormone treatment (also broadly developped in my institute), which included several 1600$ lupron injections (which were paid for by our health care system), in the same week .

    Another friend, diagnosed with several brain tumors while on a trip in Brazil. Has had MRIs done regularly to check progression and effectiveness of chemotherapy regimen. Is still around thanks to an experimental chemotherapy regimen dispensed by the Sherbrooke University Hospital.

    The only people I hear complaining around here are those who are stupid enough to crowd an emergency room for common colds. Single-payer system, at least here, means that your priority is given according the actual emergency of your complaints, rather than the amount of money you’ve got in your pockets (and/or the quality of the insurance you can afford). I think it makes sense. You’re free to disagree.

  74. #74 Kel
    January 6, 2009

    Government sponsored health care is great if you want Pat Robertson specifying what kind of health care you will be able to receive.

    Are there any countries that have universal healthcare where the only treatments that are available are decided by fundamentalist Christians?

  75. #75 Matt
    January 6, 2009

    “I doubt you’re paying $120/month for health insurance. That may be your co-pay with your employer picking up the rest, but there isn’t any way you’re paying that little for insurance that covers more than catastrophic care.”

    Nope. I have employer sponsored insurance at the moment, but I thought they were ripping me off so I switched to an individual plan. The catch with that particular plan is that I pay everything up to $2500 a month, then the insurance company steps in and handles the rest. Based on what I was paying before (and getting a piece of the employer deductible transferred from the insurance company into my pocked), I’ll be at least $500 in the black every year, even if I have to spend all $2500 of my deductible.

  76. #76 Jadehawk
    January 6, 2009

    omfg, it’s a libtard. why am i even bothering talking to someone who believes that the Law of the Jungle is the best system there is. and we’re the ones who are accused of worshipping Darwin (survival of the fittest) *headdesk*

    and before you talk to me about charities, i’d like to point out that there was a scandal last year with charities being accused of being finnicky for refusing donations of lead-poisoned meat. standard response of those “good people” whose donations were thrown out: “well, i’m not buying marginally more expensive bullets, i’d rather just not donate. so there.”

    aaah, the love

  77. #77 AaronF
    January 6, 2009

    @joeyess:

    “I don’t want them to manage it. I just want it paid for. Preferably, in total, by Richard Mellon Scaife.”

    Sorry, you can’t have one without the other. In paying for it, the government will have the final say as to what is going to be covered. Just like insurance companies do now. I think most people think that government run health care is going to mean that everyone is going to get a blank check when they go to the hospital or doctor’s office. In a country of 300 million people, that will surely not be the case.

  78. #78 Jadehawk
    January 6, 2009

    The catch with that particular plan is that I pay everything up to $2500 a month

    case in point. i don’t even make that much a month, so a plan like that would be completely and utterly pointless to me.

    deductibles are the devil. they’re half the reason people don’t go to their regular checkups even if they have insurance. which is half the reason a lot of stuff goes to develop into nastiness before it’s caught.

  79. #79 Rebecca Skloot
    January 6, 2009

    Seriously. Huge surprise!!

  80. #80 AaronF
    January 6, 2009

    @#74:

    “Are there any countries that have universal healthcare where the only treatments that are available are decided by fundamentalist Christians?”

    Are there any countries that have universal healthcare where the government is run almost entirely by Christians, and bends over backwards to please conservative Christian constituencies?

  81. #81 Azkyroth
    January 6, 2009
    The catch with that particular plan is that I pay everything up to $2500 a month

    case in point. i don’t even make that much a month, so a plan like that would be completely and utterly pointless to me.

    deductibles are the devil. they’re half the reason people don’t go to their regular checkups even if they have insurance. which is half the reason a lot of stuff goes to develop into nastiness before it’s caught.

    But, like a typical libertarian Deregulation Cultist, Matt isn’t talking about someone who can’t afford to pay $2500 a month out of pocket, he’s talking about PEOPLE.

  82. #82 Bill Dauphin
    January 6, 2009

    Well, maybe we shouldn’t give money for those things [i.e., public infrastructure].

    OK, fine. I see that the conversation has reached the point of clearly exposing your absolute, impenetrable ideological bias, so I won’t trouble you any longer, except to wish you a Very Happy Water-Main Break, since you obviously shouldn’t be asked to contribute to, you know, fixing shit.

  83. #83 Matt
    January 6, 2009

    Trying to keep up here, its coming thick and fast!

    “Well, it’s in very significant part the government’s fault, for caving to the fast food / industrial agriculture complex that determines the options and their availability.”

    Agreed. Big agribusiness is wrecking the country, popular fast food is a symptom of that.

    @#71

    Fatness.

    @#67
    What Matt doesn’t seem to understand is that market driven forces and fair affordable healthcare are mutually exclusive events.

    Healthcare was affordable until the government got into it in a big way in with the Great Society and Richard Nixon’s fuckups. Combining Medicare and Social Security gives us an unfunded liability of something like $60 trillion?

    Where is that going to go if we start a “medicare for all” plan which I’m sure most of you support? Where is the money going to come from? I’m all ears.

  84. #84 SC, OM
    January 6, 2009

    Blech. All we need now is for Randolph and SfO to show up.

    Another thread derailed by the libertrollians. Fucking ideologues.

  85. #85 Jackie
    January 6, 2009
  86. #86 Kel
    January 6, 2009

    Are there any countries that have universal healthcare where the government is run almost entirely by Christians, and bends over backwards to please conservative Christian constituencies?

    England has it’s head of state as the head of the official church.

    Just saying that universal healthcare does work in other countries, and provides a huge array of treatments even when the populations and political leaders are staunch conservatives. “Universal healthcare” that doesn’t offer proper treatment will inevitably lead to a free market enterprise where those treatments are still offered. We have a system of public and private healthcare in Australia, we have a choice between either. The public system doesn’t include everybody, but it does include those who can’t afford to get private healthcare and it still does a decent job… though we have nothing on some of those European countries.

  87. #87 Matt
    January 6, 2009

    @#81

    Oops, I meant $2500 a year, not a month. I said it better in another post.

  88. #88 frog
    January 6, 2009

    Mike: When a congresscritter’s daughter gets told she will wait 6 months for an MRI on a brain tumor, they might figure out their mistake.

    Who’s “they” in this sentence? Are you implying that non-Congressional Americans will be upset to discover that Congressfolk are being treated just as badly as they currently are? Yes, I’ve known scientists at medical schools (not the bottom of the barrel by any means) who’ve almost been killed by a cancer because of delayed treatment of that kind.

    Or is “they” the Congresspeople? Why should we care about their feelings when we’re being killed by the current system? Are you a “congresscritter” and therefore have a special sympathy for the species?

    Or is it simply that you can’t write a sentence that isn’t implicitly self-contradictory? Why is it that it’s been years since I’ve heard a right-winger make a lick of sense? I feel like this a conversation in the old Soviet Union where the proper platitudes for the political officers will inevitably be trotted out, even if (or especially because) they make no damn sense.

  89. #89 Kristinmh
    January 6, 2009

    I killfiled Matt after his second post – did he say anything interesting? Judging from the quotes I saw, I’m guessing no.

    From my own anecdotal experience, when I was 19 (almost exactly nine years ago) a random cyst I didn’t know I had in my neck got infected and abcessed. I spent two weeks in the hospital, was given the best of care, was moved to a private room when they realized how ill I was, had emergency surgery when the IV antibiotics didn’t do the trick.

    Did I mention I live in Canada?

    No single member of my large extended family and wide circle of friends and aquaintances has ever had to wait for essential care, suregery, or tests. BTW, my father is a cancer survivor and 9 of his 11 siblings are still alive – a few of them have diabetes and other chronic illnesses, one has osteoperosis and Addison’s disease – even though the oldest one is in her nineties.

    The canards thrown out by US conservatives – “blah blah blah can’t pick your doctor blah blah blah six months wait for cancer treatment blah blah blah omg GOVERNMENT decides you can’t have treatment” are, in my experience, bullshit.

  90. #90 DaveB
    January 6, 2009

    We don’t need a single-payer scheme to fix the problems with health care in the U.S. (or at least the problems that can be fixed).

    Expand Medicaid to include the people who currently don’t qualify but otherwise can’t afford health insurance. Having been on Medicaid, I was grateful that I had it, and even more grateful when I could afford to buy my own insurance.

    Make health insurance mandatory the same way car insurance is mandatory. Some legitimately can’t afford health insurance, but the millions of families and individuals that risk bankruptcy to save on insurance premiums put a strain on the entire health care system. Many of the people who default on medical bills could’ve avoided it by being more responsible about their health care costs.

    Pass a “patients bill of rights,” that gives patients legal recourse against potential abuses by insurers and guarantees coverage regardless of preexisting conditions..

    Promote a healthier lifestyle for all Americans. Reduce tobacco use, encourage more Americans to exercise regularly, educate the public about the dangers of an unhealthy diet the same way we educate the public about the dangers of smoking, etc…

    That’s it. A lot of work to be done, but the problem is solved without sacrificing the advantages of a free market for insurance.

  91. #91 cookiegirl
    January 6, 2009

    Like a few others commenting here, I am Canadian, and I came to the States for my PhD. I can’t wait to move back. As a Canadian I find it abhorrent that someone should go bankrupt because they are sick, and many of those have insurance. I am personally slightly shocked every time I go to the doctor and have to fork over just ten dollars. The first time I was ever told which doctor or hospital I can visit was when I got here. Yes, occasionally in Canada you have to wait for care, but 99% of cases are for elective or non-urgent treatments. Also, waiting times are much more reflective of supply of doctors and equipment than the inherent insurance system, although it is true that in many parts of Canada the number of med students at any one time is dependent on government funding for public universities.
    Matt, like other Americans, are deeply mistrustful of anything ‘socialist’, and have accepted as fact many biased reports of single-payer systems. Of course there are drawbacks, but to the citizens of just about every other industrialized country it is simply a moral imperative that everyone should have equal access to health care, and a single payer system is the most economical way to do it.

  92. #92 Kristinmh
    January 6, 2009

    DaveB:

    Or just have single-payer like the rest of the civilized world and stop paying 13% of your GDP for something a tenth of you aren’t getting.

  93. #93 frog
    January 6, 2009

    Morales: Matt, AaronF, I don’t deny lifestyle choices are highly-significant, but I would think that, say, Canada and Australia are comparable to the USA in terms of affluence and lifestyle. Can you point to any salient factors that differ between these countries and affect mortality that would render the difference of health care effectiveness insignificant?

    Last year there was a paper out (JAMA? Lancet?) comparing health outcomes in Britain and the US. Britain has very poor “lifestyle” choices, being fat cigarette smoking drunks as bad if not worse than Americans. Yet somehow they were healthier than Americans.

    It’s particularly surprising, given that the British system is commonly thought as the worst example of a national health care system, highly centralized and micromanaged, as opposed to the rest of Western Europe.

    But then again, once someone starts reducing systematic interactions to simple one-off interactions, you know that they’re not seriously thinking about the situation at all — they’d declare phonons as non-existent.

  94. #94 Nerd of Redhead
    January 6, 2009

    DaveB, if health care insurers and their required profit are removed from the health care system, the cost of benefits could drop significantly without effecting extent of coverage. It doesn’t take a genius to figure that out, only someone who balances their checkbook regularly.

  95. #95 AaronF
    January 6, 2009

    @#86:

    “England has it’s head of state as the head of the official church.”

    Irrelevent. England’s government still does not bend over backwards to please radical conservative Christians like we do here in the US. We are the only western country that shapes government policy based on conservative religious ideologies. I’ll be damned if I am going to let those buffoons influence my health care options.

    “Just saying that universal healthcare does work in other countries, and provides a huge array of treatments even when the populations and political leaders are staunch conservatives”

    Herein lies the problem. We can’t always say “x works over there, therefore it will work here”. Believe me, I’d like inexpensive and efficient health care just as much as everyone else. But I also tend to live in reality where what we want and what we end up with are not always the same thing. When it comes to the Federal Government, what we want and what we get are almost never the same thing.

  96. #96 Chayanov
    January 6, 2009

    I suppose someone who can afford a $2500 deductible could also afford their own roads, sanitation, water treatment, and fire and police services. There are simply some services that make more sense to have the government provide.

  97. #97 John Morales
    January 6, 2009

    Matt @83, I grant the USA seems to have the highest obesity rates, and it is of significance. Whether it’s significant enough to lower life expectancy below countries having “other systems [which] are way worse.”, such as Australia’s and Canada’s is, however, not obvious to me.
    Because it still seems odd that you claim “way worse” health systems yield higher life expectancies overall.

    (I’ll note in passing that Australia’s Government does take this issue seriously, though.)

  98. #98 frog
    January 6, 2009

    AaronF: We are the only western country that shapes government policy based on conservative religious ideologies. I’ll be damned if I am going to let those buffoons influence my health care options.

    You’ve got cause and effect reversed. Those buffoons rule us because we have such a crappy safety net. When people are terrified (at least subconsciously) constantly about becoming sick or losing their homes, they tend to become reactionary and religious, which then of course acts as a positive feedback.

    We have to break that loop. Why do you think that the leaders of the buffoons are so strongly against any safety net? Why they’re always mouthing libertarian platitudes? They know that they can run people into the churches hat in hand if they can only leave them leading lives of very high risk. It’s not primarily the poverty, but the constant fear from unbuffered risk that makes one unable to think clearly.

    So, your position is to strengthen the buffoons and clowns, add to their armies, and let them dominate your entire life in the fallacious hope that you can make a private fortress against them.

  99. #99 Bill Dauphin
    January 6, 2009

    Irrelevent. England’s government still does not bend over backwards to please radical conservative Christians like we do here in the US.

    The concern that a U.S. single-payer system would be dominated by “radical conservative Christians” is what my sainted mother would call a baroque worry: It’s impossible to imagine a U.S. government dominated by the Christian right instituting single-payer in the first place.

    We can have one or the other, but not both. I know which I choose!

  100. #100 Azkyroth
    January 6, 2009

    That’s it. A lot of work to be done, but the problem is solved without sacrificing the advantages of a free market for insurance.

    Which are…what, exactly?

  101. #101 AaronF
    January 6, 2009

    @#99:

    “It’s impossible to imagine a U.S. government dominated by the Christian right instituting single-payer in the first place.”

    We most certainly can have both. That is because the pendulum is always swinging. The single-payer system could be put in place under a Democrat congress and President. However, we are eventually going to have a Republican president and Congress. Do you really think they are going to ignore the opportunity to enforce their “values” on the entire country by eliminating coverage for health care they deem to be in conflict with their moral convictions?

  102. #102 mk
    January 6, 2009

    Matt’s a good American. All things American.. good! All things foreign… Bad!

  103. #103 MikeM
    January 6, 2009

    I am still so encouraged by the selection of Steven Chu that it’s going to take a lot more than Gupta to upset me.

    Bringing in someone like Chu is a complete reversal of the Bush years. And this is bad… Oh, wait, here I am trolling again. I think it’s positive.

    More than positive. I think it’s about as positive as you can get.

  104. #104 The Science Pundit
    January 6, 2009

    DaveB (#90)

    Make health insurance mandatory the same way car insurance is mandatory.

    There are thousands of people who don’t drive, not because they can’t afford a car, but because they can’t afford insurance. There are thousands of others who simply drive without insurance (driving up everybody’s premiums when they get into accidents).

    1. Somehow I don’t think that will work for health care. This can be done with car insurance because–as I was repeatedly told when I was a teenager–“Driving is NOT a right. It’s a privilege!” Are you saying that health care is not a right?

    2. A single payer system eliminates the problems mentioned above.

  105. #105 Cylux
    January 6, 2009

    As a UK resident I’d like to point out that an unfortunate number of the problems with the NHS stem from successive governments attempts to baby step it into privatisation. For example privately run ITCs (independent treatment centres) are hoisted onto trusts and are contracted to perform a number of operations, say 500 hip replacement a year and are paid for the full 500 rather than say the 160 that they actually did. Also the after-care from ITCs tends to be, well, non-existent so if there’s a complication they usual end up back in the local trust run hospital anyway. So not only are many hospital trusts forced to pay private med care companies for treatments that often do not occur but they then have to pay to sort out the mess that the ITCs did for the operations that were performed.
    And I don’t think there’s anyone in the UK who doesn’t know that one of the main driving forces behind the rise in MRSA is the fact that many hospitals are forced to contract out for cleaning. I’m not even going to bother touching the farce that is ‘Foundation Hospitals’, or Richard Granger’s choice of regional monopolies to provide the Connecting for health IT program.
    In other words the NHS’s hands have been firmly tied by both the last governments so that privatised health care doesn’t quite have such good and well loved competition any longer.

  106. #106 gypsytag
    January 6, 2009

    Matt @

    As a canadian i can honestly say that you’re full of shit.
    My father had two knee replacements and didn’t have to wait. Yes he had to schedule his surgury like everyone else. I have had other surgeries and didn’t have to wait. my mother had cancer treatment and didn’t have to wait.

    You’re full of crap. You need to stop parroting the neocon scaring-points. They’re lies, they always are.

  107. #107 Bill Dauphin
    January 6, 2009

    The single-payer system could be put in place under a Democrat congress and President. However, we are eventually going to have a Republican president and Congress.

    Maybe not: If we have single-payer, folks might get the mental health care they need! ;^)

    But seriously, I actually don’t think the people, having once gotten a sane healthcare system, will ever vote for a government that would take it away from them. In particular…

    Do you really think they are going to ignore the opportunity to enforce their “values” on the entire country by eliminating coverage for health care they deem to be in conflict with their moral convictions?

    So you imagine some future Minister of Health trying to take away family planning, contraception, fertility care, abortion, etc., from women (and their partners) who’ve come to see it as a right in fact as well as in principle? Can you say riot? I knew you could!

    Once full healthcare services become the norm in our society, they’ll become the same sort of political “third rail” that Social Security is today.

  108. #108 DaveB
    January 6, 2009

    I’m really heartbroken no one likes my health insurance plan. FYI, my proposal is basically a synthesis of Secretary Clinton’s and President Obama’s proposals.

    To generally respond to any objections –

    The media makes our health care system sound worse than it is. “Area man gets quality health care from his insurance provider” doesn’t make for an arresting headline.

    Obviously any system we choose will force us to make trade-offs, that’s the iron law of scarcity at work. These are the biggest problems (imo) with a single-payer scheme (we all know too well the problems with a purely market-driven scheme):

    -Tens of millions of Americans would be forced to accept inferior health care to what they currently buy for themselves.

    -Health care would be even more vulnerable to political considerations, some of which will be contrary to best medical practices. Put it this way – do you think we’ve seen the last of the Christian right, and how do you feel about them potentially making insurance decisions for you?

    I’m not going to get into a tedious back and forth; I’ve derailed the thread enough already. Thanks if you’ve read what I have to say, I hope you’ll at least consider that there are problems with a single-payer system, which can be avoided with an appropriate compromise.

    Also, Sanjay sounds like a good, competent pick, but… Deepak Chopra? How does this guy fool so many smart people?

  109. #109 Kel
    January 6, 2009

    Herein lies the problem. We can’t always say “x works over there, therefore it will work here”.

    Of course you can’t. But by the same token when you see different systems all amounting to the same thing across the world that you would come to a conclusion that has not been seen in any other country. It would be far more honest to just come out and say “I’d prefer to pay for my own” than to say that it would lead to a system ruled by people who would stop many treatments on religious grounds. Surely you can see the difference between what was said and what the reality of the situation is.

  110. #110 The Science Pundit
    January 6, 2009

    The media makes our health care system sound worse than it is. “Area man gets quality health care from his insurance provider” doesn’t make for an arresting headline.

    Actually I think I did see that headline on FOX News (I’m lying; I don’t watch FAUX News). Another headline I’ve never seen is “Swedish family loses their home because of crippling health care costs” or “Record number of bankruptcies in England due to rising health care costs.”

  111. #111 'Tis Himself
    January 6, 2009

    Jackie #85

    City Journal is as unbiased about single payer health as the Cato Institute or Sarah Palin are.

  112. #112 Steve_C
    January 6, 2009

    I don’t think it’s a bad pick. It’s more of a face and voice to government health policies than it is for policy making. He’s articulate and maybe he’ll put a friendly face on responsible sex education, healthier eating and exercise.

    I don’t want to hear anything from him on Healthcare insurance and national healthcare though.

  113. #113 frog
    January 6, 2009

    AaronF: Do you really think they are going to ignore the opportunity to enforce their “values” on the entire country by eliminating coverage for health care they deem to be in conflict with their moral convictions?

    For Jeebus’s sake — they tried to kill Social Security! They did not try to “use it to enforce their morality” (it is a huge fund), but simply kill it. If they were strong enough to use health care to enforce their morality, they would be strong enough to at least try to kill it, which would likely lead to a massive reversal in their political fortunes.

    What they “want” is to drive us into their churches; everything else is secondary. Just look at the US South, and its political structures. Counties and towns are filled with red-light districts, strip joints and meth that are, at minimum, winked at by those very religious organizations. They don’t want to enforce their morality, they want to keep folks poor and helpless so they wander in some Sunday hat in hand.

    So yes, they would give up a wonderful opportunity to enforce their moral strictures, if in exchange they could beggar us. Otherwise, wouldn’t one expect that the religious right would be the proponents of single-payer and not rabid opponents? Shouldn’t one test natural hypotheses against natural history?

  114. #114 Obeah
    January 6, 2009

    Another Canadian.
    I meet your anecdotal with my anecdotal.
    I went to the emergency room in the morning with dizziness and language issues.
    Had an MRI in the afternoon.

    It’s not a perfect system but my uncle would be bankrupt right now if he lived in the states.

  115. #115 Quiet_Desperation
    January 6, 2009

    When a congresscritter’s daughter gets told she will wait 6 months for an MRI on a brain tumor, they might figure out their mistake.

    Maybe. I’m not yet sold on single payer for *this* country in particular, and I have non-ideological reasons for thinking that way while remaining open minded, but your argument has a flaw.

    The daughter (or son) of a congresscritter will *NEVER* wait for any procedure under *ANY* system. You savvy?

  116. #116 Solo
    January 6, 2009

    The fact of the matter is that Matt is at least trying to discuss the issue while many others just name call. Seriously, I disagree with him on several points, but some of you regulars who claim an intellectual high ground sound like hatemongering little twerps. Just part of the Greater Internet Fuckwad Theory, I suppose.

    http://fishbowl.pastiche.org/archives/pictures/greater_internet_fuckwad_theory.jpg

  117. #117 Azkyroth
    January 6, 2009

    The fact of the matter is that Matt is at least trying to discuss the issue while many others just name call. Seriously, I disagree with him on several points, but some of you regulars who claim an intellectual high ground sound like hatemongering little twerps. Just part of the Greater Internet Fuckwad Theory, I suppose.

    No, it’s part of the “We’ve Already HAD This Argument, Damnit” theory, 879th revision.

  118. #118 mayhempix
    January 6, 2009

    ” Healthcare was affordable until the government got into it in a big way in with the Great Society and Richard Nixon’s fuckups.”

    Matt: you are a fucking liar and will eat anything the redbaiters feed you.

    You also completely dodged the fact that once you’re sick you have no options in shopping for “a better deal.” No insurance company will take you. They only want healthy members so they can take their money and never have to use it to pay for healthcare. Plus healthcare isn’t like going to Best Buy to find a better price on that new TV. People with cancer, MS, serious injuries, etc don’t have the luxury to shop around to save a few bucks… they just want to stay alive with some quality of life.

    When you have kids you can’t have large deductibles because doctor visits are a fact of life. Single males in their 20s and 30s think that everyone is like them: “What? Me Worry”. Time to grow up little matty and face the realities of the rest of the world.

    And your whiny “Who’s going to pay for it all !!!” is just more dogmatic ignorant crap. Every study done shows that single payer like they have in Canada, Hawaii, etc has significantly lower overhead so the fact is that we would pay less for healthcare than we do now and everyone would be covered. The money is already there asshole.

    AaronF is even more clueless and programmed than Matt which is saying something.
    Ever notice how Libertarians are usually single males with no responsibilities except to themselves?

  119. #119 frog
    January 6, 2009

    Solo:

    What kind of fuckwad comes to Pharyngula expecting politeness? One can immediately diagnose terminal stupidity in anyone who does — like going to a snake-handling church and being Shocked, Shocked I Say! at the speaking in tongues.

    Particularly when they fail to cite particular examples, counter-pose the elements of the debates and then adds the obligatory “I don’t have a dog in this fight — I’m offended for someone else” concern-trolling.

    Greater fuckwad, indeed.

    Now we return to our regularly scheduled orgy to complain about the lack of personal space.

  120. #120 CalGeorge
    January 6, 2009

    Obama seems to be developing some serious blind spots.

    GUPTA on CHOPRA:

    “I always smile when I see you. You make people feel cared about.”

    http://forums.randi.org/archive/index.php/t-96559.html

    Barf.

  121. #121 John C. Randolph
    January 6, 2009

    Meh.

    He is a neurosurgeon, and the job of the surgeon general is largely a PR gig. It’s not like he’s going to run the CDC or the NIH.

    -jcr

  122. #122 AaronF
    January 6, 2009

    @#118:

    “AaronF is even more clueless and programmed than Matt which is saying something.”

    So using the federal government’s own track record to make the assumption they will fuck up universal health care is being “programmed and clueless”. But, believing the magic Obama fairy will swoop into the white house, wave his magic wand, and fix the ailing health care system is the highly intelligent and well informed route.

    Wow. Raving liberal == always informed and correct. Anyone who disagrees == clueless and programmed.

    Got it.

  123. #123 inkadu
    January 6, 2009

    I’m glad that this discussion is turning into a discussion about universal health care; I think instituting universal health care will save more lives than an PR talking head could.

    If Gupta just going to chastise Americans for being too fat, then he’s welcome to the Surgeon General’s position. If he’s going to have any say in public health policy, we might have a problem. Being a doctor to an individual is much, much different than public health.

    As for Matt, anyone who can follow the sentence

    Well why don’t you take a look at that stupid lying video I posted earlier detailing what a family had to go through to cure the husband’s brain cancer.

    with

    Great, but that is anecdotal evidence. Lets see some statistics on the quality of our systems to back it up.

    is clearly a waste of time.

    Matt — go to FrontLine’s website (the public tv show, not the anti-tic drops) and watch “Sick Around the World.” It’s an exploration of other forms of national health, all of which are zealously beloved by its citizens. It’s not going to change your mind, but at least you may seem like less of an idiot about the many options for universal coverage (including a private-insurance friendly option like in Germany).

  124. #124 John C. Randolph
    January 6, 2009

    some of you regulars who claim an intellectual high ground sound like hatemongering little twerps.

    It wasn’t always this way on Pharyngula. A couple of years ago, (when it was still at phrayngula.com instead of on scienceblogs.com) this was a forum where civilized discussion was the norm. Lately though, PZ doesn’t seem to care much about the tone of the conversation here.

    -jcr

  125. #125 John C. Randolph
    January 6, 2009

    So using the federal government’s own track record to make the assumption they will fuck up universal health care is being “programmed and clueless”.

    Shh! Don’t mention the quality of service at VA hospitals. You might be injured in the explosions when all their fantasies explode.

    -jcr

  126. #126 mayhempix
    January 6, 2009

    “But, believing the magic Obama fairy will swoop into the white house, wave his magic wand, and fix the ailing health care system is the highly intelligent and well informed route.”

    Please show me where I expressed any of the above.

    Also please show me how a market based healthcare system run by corporate interests is more efficient and does a better job at providing good healthcare to all citizens than a government run one. You can’t.

    You are an idiot.

  127. #127 PZ Myers
    January 6, 2009

    No, the tone matters. But it also matters that I don’t act like a petty tyrant and dictate what and how people converse.

  128. #128 frog
    January 6, 2009

    AaronF: So using the federal government’s own track record to make the assumption they will fuck up universal health care is being “programmed and clueless”

    No, failing to distinguish between the federal governments bad track record and it’s good track record, where it worked and were it failed, is “programmed and clueless”. It’s at about the same intellectual level as a Stalinbot railing about the inevitable failure of capitalism.

    For example, Social Security has a 3% administrative load I believe, has functioned effectively for over 70 years now, and appears to be functional for several generation with a few tweaks, while attempts by some countries to privatize their systems has ended in administrative loads of 25% and the inevitable risk of failure associated with private risk management.

    “Government is Bad” == uninformed trogledyte with an undifferentiated tumor between its ears.
    “Government is Good” == uninformed trogledyte with an undifferentiated tumor between its ears.

  129. #129 costanza
    January 6, 2009

    Obama’s choices continue to baffle me. Hillary Clinton (what was he smoking)? Rahm Emanuel I can see, same for Steven Chu. Gupta? Leon Panetta? Director of CIA is the wrong position for an inexperienced political hack. Who’s up next and who’s on deck? I may start a betting pool.

  130. #130 John C. Randolph
    January 6, 2009

    But it also matters that I don’t act like a petty tyrant and dictate what and how people converse.

    Well, I understand that it’s a difficult balance to strike. I’ve moderated mailing lists with thousands of participants, and it was pretty rare that I had to ban anyone. Nevertheless, Pharyngula is certainly a far more hostile environment than it was a couple of years ago.

    -jcr

  131. #131 Jeb, FCD
    January 6, 2009

    Orac should be surgeon general.

  132. #132 John C. Randolph
    January 6, 2009

    Obama’s choices continue to baffle me.

    They make far more sense when you accept that he’s a politician, and people’s hopes for him to be more than that are merely wishful thinking.

    -jcr

  133. #133 Emmanuel C.
    January 6, 2009

    Normally I agree with most of PZ’s opinions, but I sense a rather odd case of judgment on this. Al Franken is applauded for having reached a seat in the Senate, and he doens´t have any former experience in politics. What makes him different from this man, apart that he is an outspoken atheist?

    I am not commenting on the religious views of either men, just on what makes someone elligible or not. Why the attack on Gupta but an easy hand for Franken?

  134. #134 Scott from Oregon
    January 6, 2009

    The problem with single payer in America is half the country doesn’t want it.

    Whether it is the best system or not is a good debate, sure…(which system over-all has produced the most innovations in medicine, the best equipment for hospitals, etc…? Canada is a fine place for skiing, but it benefits greatly by being joined at America’s innovative hip…) but the fact still remains- Americans don’t want government in their business. Call it “tradition”, or whatever you like. Maybe “heritage” is a better word? Why would you want to enforce your wants on 150 million people without their approval?

    That’s a form of ugly fascism, if you ask me.

    Why not start an “I voted for Obama health care co-op instead? Surely 67 million people is a sufficient pool to give yourselves ample coverage!! You could buy-out failing hospitals and convert them to your “I voted for Obama” health care needs?

    It would add competition to all the other private health care providers and you could do it all privately, electing your own board of trustees… and all of that.

    Bill Lauphin could put it together as he seems to enjoy joining things, and you could import that Socialist dude from Scotland to show you how best to run a co-op…

    Problem solved for everybody, and the name calling can go back in the sand box where it belongs…

  135. #135 mayhempix
    January 6, 2009

    “…Pharyngula is certainly a far more hostile environment than it was a couple of years ago.”

    I blame it all on the Free Market God worshipping Libertarians.

    (And yes jcr, that is meant as humor, no matter how true it might actually be…)

  136. #136 amphiox
    January 6, 2009

    I don’t give a care about how many payers there are or might be. But any system that does not have equitable universal access is unethical.

  137. #137 frog
    January 6, 2009

    jcr: Shh! Don’t mention the quality of service at VA hospitals. You might be injured in the explosions when all their fantasies explode.

    Wow — talk about fantastic self-delusion. VA care is actually preferred by many now. Have you been in a private (or public) hospital lately? The whole system is rapidly imploding, and has gotten so bad that the VA is an examplar of efficiency compared to the standard route — even for the wealthy and well-connected!

    I recently had a relative who was an MD with plenty ‘o cash, good insurance and all the connections one could expect from inside the system in a hospital for a few weeks. She left with minimal lung function, risking death, rather than deal with that clusterfuck of incompetent nursing, clock-watching doctors, bureaucratic wrangling and general stupidity. They couldn’t manage to get their hands on a respirator even — and this was at a well-respected, fully private hospital!

    I mean — it was really nasty, with patients screaming for hours, shitting and pissing on themselves, medications confused, … It looked like the VA at it’s nadir in the 70s, or your worst nightmare of uninsured public hospital. You had to pray you got sick enough to go the the ICU, so you could get better.

    The VA has at least a good patient and medication tracking system. That’s how bad it’s gotten — the VA is being used as a good example!

    Really, the brain-dead ideologues who can’t see the catastrophic conditions in our current system are amazing. Unless you need the latest, cutting edge treatments, you are better off, rich or poor, in many South American countries.

  138. #138 John Morales
    January 6, 2009

    SfO,

    but the fact still remains- Americans don’t want government in their business.

    They say they don’t.
    Apparently, it’s different when the business needs subsidies/bailing out.

  139. #139 'Tis Himself
    January 6, 2009

    I don’t give a care about how many payers there are or might be. But any system that does not have equitable universal access is unethical.

    I worry that my self-employed daughter is one major surgery away from bankruptcy. I worry that if I get laid off, my wife with multiple sclerosis won’t have access to a neurologist. And I worry about 48 million uninsured Americans. I realize that libertarians like Matt and Randolph make a point of not caring about their fellow citizens (hell, they don’t even care about the concept of citizens), but some of us are concerned about other Americans.

    I know Randolph will say “I do care about other Americans.” Of course he does, he cares about them not being a burden on him by making him pay taxes and obey laws.

  140. #140 frog
    January 6, 2009

    SFO:

    First sensible comment I’ve seen from you — short of overlooking the basic function of both capitalism and taxation (other than stealing, for both): the raising of investment capital.

    You’ve heard of these things called “barriers to market entry”, correct? And how most aren’t regulatory, but are questions of raising sufficient capital to compete with pre-capitalized entities, correct?

    Now, clearly capital will not flock to anything that hasn’t promised massive growth — which makes a coop a no-go on the market. And banks don’t capitalize anything that isn’t already capitalized. And if most people had the spare wealth to capitalize such a venture with a return on investment over a 70 year period, we would already have such self-funding entities, right? Of some scale larger than grocers, right?

    You are trying, I’ll give you that. But you seem to not understand the very basics of why we have markets and governments in the first place. And no, it’s not to move product.

  141. #141 Longtime Lurker
    January 6, 2009

    Wow, gotta love the thread derailment.

    Yeah, neither Obama nor Gupta are perfect, but we should give them a chance, and oppose any bad moves they may make as they arise.

    On a lighter note, maybe Barack Hussein Obama and Sanjay Gupta can get together on national television and sing a duet:

    http://www.youtube.com/watch?v=03OfDbsT68U

  142. #142 The Science Pundit
    January 6, 2009

    Emmanuel C. (#133)

    Normally I agree with most of PZ’s opinions, but I sense a rather odd case of judgment on this. Al Franken is applauded for having reached a seat in the Senate, and he doens´t have any former experience in politics. What makes him different from this man, apart that he is an outspoken atheist?
    I am not commenting on the religious views of either men, just on what makes someone elligible or not. Why the attack on Gupta but an easy hand for Franken?

    Why don’t we just look at the post?

    He seems a bit of a lightweight, to me — he’s mainly known as a congenial talking head on television news. He’s also an apologist for US health care, which does not give me any confidence that we can expect the slightest effort towards health care reform.

    (emphasis mine)

    Scott from Oregon (#134)

    The problem with single payer in America is half the country doesn’t want it.

    And the problem with teaching evolution instead of creationism in America is that half the country doesn’t want it. Do you think it might (just might) be a framing problem? Perhaps most of those people who oppose a single payer system have been sold on a lie. I’m just sayin’ …

  143. #143 Stephen B. -- Math Teacher
    January 6, 2009

    Thought I remembered Gupta pandering to the Antivaxxers. From Pure Pedantry, he talks a bit about this when CNN cut the sci/tech from their programming.

    http://scienceblogs.com/purepedantry/2008/12/boo_on_you_cnn.php#comments

    I’m worried if they get an antivaxxer as SG.

  144. #144 Feynmaniac
    January 6, 2009

    Orac should be surgeon general.

    Seconded!

  145. #145 Traces
    January 6, 2009

    I am amazed at the profound ignorance of these supposedly educated netizens WRT insurance: Matt, I’m talking to you.

    My wife has minor depression and my son has chronic asthma; neither of which are particularly unusual or life-threatening ailments. Nonetheless, we are uninsurable via an individual plan. I am currently unemployed, and so the only way we can get insurance is through my wife’s work. She’s parttime, so we have to pay $1200 a month for insurance. Out of pocket, after taxes. While I’m unemployed.

    Please, Matt, describe to me HOW a government plan, EVEN if care is rationed, could be any worse than our current situation.

    I’m waiting…

  146. #146 Kevpod
    January 6, 2009

    PZ,

    I wonder what you have to support your contention that Gupta is a “lightweight.” From what I see, he’s a practicing neurosurgeon and, like you, a leading media professional.

  147. #147 frog
    January 6, 2009

    Traces: Please, Matt, describe to me HOW a government plan, EVEN if care is rationed, could be any worse than our current situation.

    A bad premise — care is already rationed. That’s what redistributive economies do — whether they are feudal, market-driven or centrally planned, they ration on some principle the goods that are available.

    So the question is whether the rationing by some single-payer system could be any worse and less equitable than our current scheme for rationing these resources, and whether they would lead to a decrease in these available resources.

    All I know is that folks are less interested in becoming doctors now, doctors are retiring early now, and massive economic resources are being put into administration instead of into healthcare, while most people are in the position of being denied decent care — not just 10% of the population, or 50% of the population but the 99% of the population being pilled up, no history worth a damn taken in the 15 minutes allocated per patient, and pawned off on bitter, angry nurses — and that’s for those with health insurance. On top of that, patient decisions are now routinely being made by non-medically-trained bureaucrats at call centers.

    Yup, mighty fine system of rationing we got there. Mighty, mighty fine — all the disadvantages of central planning, with none of the cost savings plus destruction of the feedback mechanisms that are supposed to pipe information to decision makers, and the inequities that are unavoidable in market based approaches. Might as well live in Cuba — as some health results indicate! Ain’t that crazy???

  148. #148 mayhempix
    January 6, 2009

    PalMD over at Denialsim is pleased with Gupta pick.
    http://scienceblogs.com/denialism/2009/01/gupta_for_surgeon_general_cool.php

    I’ll be curious to see Orac’s reaction.

  149. #149 A
    January 6, 2009

    - On the original topic, the Gupta appointment, Paul Krugman points out Gupta’s “mugging .. Michael Moore over Sicko. … Gupta … claimed that Moore ‘fudged his facts’, when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong.” see
    http://krugman.blogs.nytimes.com/2009/01/06/the-trouble-with-sanjay-gupta/
    (detailed in a reference in Comment # 9 to Schwitzer’s health news blog:
    https://blog.lib.umn.edu/cgi-bin/mt-search.cgi?IncludeBlogs=704&search=sanjay+gupta ).

    - On the Universal health care/insurance discussion apparently occuring here: -see my comment at
    http://scienceblogs.com/mikethemadbiologist/2007/11/doing_everything_right.php#comment-632461
    which concludes: “So, if you hear someone saying that a government insurance scheme is an inefficient bureaucracy, this person hasn’t had to call his private insurance yet. And he wants you not to know about the [close to 30%] overhead cost.”

    - Matt (#19), with the cheap insurance deal you’ve got, don’t get sick! (nor get old, probably once over 40, your rate will go up) Only then you’ll find out that your copay is enormous!
    (And your insurance doesn’t actually pay out money, it just gets a rebate from the hospital or health care provider, your copay is the only actual money your doctor sees [as I observed for the well-child visits for my children]).
    And btw, the cheapest insurance in my area (SF bay) is ~$1250.- per month (for family coverage) before employer subsidy.

    - Matt #19,32 “switching insurance companies is a phone call away.”
    No, it is linked to my employment, and you can change insurance only during one 4-week period in a year. Perhaps the sales offices of insurance companies answer the phones faster than the office you call to complain about them not paying your doctor.

    - And then, eli #39 repeats the mythical “$70+/hour figure for US autoworker labor” debunked, e.g. in
    http://www.dailykos.com/story/2008/11/19/04636/389/733/663386

  150. #150 CanadianChick
    January 6, 2009

    Matt – you’re obviously reading some biased and/or painfully inaccurate sources of information based on your opinions of the health care systems in places like Canada…and then using your chosen anecdotal claim to try to counter the anecdotal claims of Canadians. Way to shoot logic in the ass.

    Yes, the Canadian system is not perfect. However, the problems with the system are not about access – they are about resources, and I generally do not mean capital, but HUMAN resources.

    Canada is a big country. A LOT bigger than the US. With a tenth of the population. Lots of that population lives in or near the major urban centres, but most of it doesn’t.

    So, access can be a problem. If you live 250 km from the nearest (insert obscure specialist here), it doesn’t matter if you’re in Canada or the US – you’re gonna have trouble with access. PLENTY of Americans are on long waiting lists too – because of access issues.

    There also just aren’t enough doctors. That’s a flaw in the education system, IMO – and in the system that doesn’t grant foreign-trained doctors appropriate credits, or doesn’t help them find ways to get their credits evaluated.

    The US also suffers from this problem, I note…insufficient GPs, nurses (or why else would they come HERE to recruit doctors and nurses and other medical technicians?).

    Here’s my anecdote: I HAD a friend in the US. She had only just started with her new employer. The old one didn’t offer medical insurance, and she had some past medical issues that meant private coverage was financially out of reach. Her insurance at the new job wouldn’t kick in until she’d been there six months.

    She developed breathing problems. Something just wasn’t right. But, she couldn’t afford to see a doctor, and was afraid to see one, because if she saw one before the insurance kicked in, whatever was wrong might be treated as a “pre-existing condition” thus reducing or eliminating payment. The problems had first started when she was at her previous job – the one with no insurance. She didn’t qualify for Medicaid because even with her crappy job, she made too much money.

    Finally, she went to a hospital in her US (Texas) city – not the one she would have liked, but the one that would take people without insurance. Waited over 12 hours to be seen.

    She was dead within a week of the diagnosis. Lung cancer. In a lifelong non-smoker.

    You’re right – they were obligated to treat her. Too little too late.

    Had she been able to afford to see a doctor when the symptoms first manifested, she might have lived. Had she been able to afford regular medical visits, she might have had it detected BEFORE it became problematic. She might still be alive.

    Yup, that health insurance system you’ve got there Matt, sure is a good one…dying is SO much more preferable than having to wait 4 months for a knee replacement because there aren’t enough surgeons in your town.

  151. #151 Scott from Oregon
    January 6, 2009

    “”Now, clearly capital will not flock to anything that hasn’t promised massive growth — which makes a coop a no-go on the market.”"”

    So what you are saying is liberals don’t want the system either, unless they can get money from rich people who don’t need the system to pay for it?

    The hypocrisy in this is boundless…

  152. #152 Dave
    January 6, 2009

    Canada is a big country. A LOT bigger than the US.

    Im not sure that 9.9 million sq km is “A LOT bigger” than 9.8 million sq km. Although Ill grant you that the difference in population densities is large, which is the point.

  153. #153 Dave
    January 6, 2009

    So what you are saying is liberals don’t want the system either, unless they can get money from rich people who don’t need the system to pay for it?

    No, what he is saying is that hospitals are a capital-intensive business, and inequal access to capital is one of the things generally ignored in market-fetishists fantasies of free-markets.

  154. #154 cookiegirl
    January 6, 2009

    traces – I would seriously recommend looking into moving to Canada. There are areas that need workers, although they are generally less desirable. The country, like the US, needs all kinds of healthcare workers, some places need teachers, the oilfields in Alberta and the surrounding cities are usually desperate for workers (but houses are scarce), you can even get bonuses for those willing to live in the far north in almost any job. Immigration or resident info is available online.
    I recommend the same solution for gay couples wishing to marry.
    Plus in Canada, the conservative politicians work furiously to keep their secret super-right christian agendas secret, so as to avoid the blatant laughing/anger from the rest of the country.

  155. #155 Scott from Oregon
    January 6, 2009

    “”No, what he is saying is that hospitals are a capital-intensive business, and inequal access to capital is one of the things generally ignored in market-fetishists fantasies of free-markets.”"

    So you are saying 67 million democrats can’t outspend the existing market?

    I’m getting embarrassed for Democrats.

    Are you all that poor?

    Lordy lordy lordy…

  156. #156 AlisonS
    January 6, 2009

    Yet another Canadian who thinks Matt is an idiot. I have had multiple surgeries in Quebec and Ontario. My care has always been great and I choose my own doctor. The only elective surgery I had was for varicose veins. There is normally a wait for this surgery, but my ankle was almost in an abcess situation, so I was moved to the front of the queue. The second leg was done later, at my convenience. Futhermore I had the surgery in a small French hospital in Montreal and my French is very sketchy, nonetheless my experience was fantastic. The hospital was very efficiently run and the staff were incredibly caring. I was even wrapped in hot blankets as I waited to be wheeled into surgery. I could go on and on with my experiences, but that would be boring. The biggest problem here is one you have in the States too, and that is a lack of GP’s. Get your facts straight Matt before you spout off more drivel.

  157. #157 PTJ
    January 6, 2009

    Single-payer seems like an abuse of government power to me, exactly where in Article 1 Section 8 of the Constitution is Congress given the power to create something like that? Or have the Dems decided that the Reps abused power so much they want their chance to do it too?

  158. #158 Azkyroth
    January 6, 2009

    So you are saying 67 million democrats can’t outspend the existing market?

    I’m getting embarrassed for Democrats.

    Are you all that poor?

    Lordy lordy lordy…

    Yes, actually.

  159. #159 Azkyroth
    January 6, 2009

    Single-payer seems like an abuse of government power to me, exactly where in Article 1 Section 8 of the Constitution is Congress given the power to create something like that? Or have the Dems decided that the Reps abused power so much they want their chance to do it too?

    Glad you asked…

    Section 8 – Powers of Congress

    The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

    To borrow money on the credit of the United States;

    To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

    To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;

    To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

    To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;

    To establish Post Offices and Post Roads;

    To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;

    To constitute Tribunals inferior to the supreme Court;

    To define and punish Piracies and Felonies committed on the high Seas, and Offenses against the Law of Nations;

    To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;

    To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

    To provide and maintain a Navy;

    To make Rules for the Government and Regulation of the land and naval Forces;

    To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

    To provide for organizing, arming, and disciplining the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;

    To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings; And

    To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

  160. #160 dave
    January 6, 2009

    “”No, what he is saying is that hospitals are a capital-intensive business, and inequal access to capital is one of the things generally ignored in market-fetishists fantasies of free-markets.”"

    So you are saying 67 million democrats can’t outspend the existing market?

    No, but I am beginning to believe that you have reading comprehension issues.

  161. #161 John C. Randolph
    January 6, 2009

    #137 Frog:

    That sounds like a hospital that should go out of business. The trouble with government-operated services like the VA hospitals, is that there are rarely any negative consequences to fucking up. In fact, horror stories of badly-managed organizations like that typically come with demands for increasing their funding, while the people who have demonstrated their incompetence keep their jobs.

    -jcr

  162. #162 Monado
    January 6, 2009

    In the 1930s, people in Canada could be bankrupted by an illness in the family. The radical left-wing party, the CCF, later the NDP, documented the problem and how it affected ordinary people. We didn’t like it. We changed it. Now, we can get checkups, tests, preventive medicine, nutritional counselling, physical therapy, X-rays… and when someone spends a year dying of cancer, their family doesn’t lose the house.

    Matt, your infant mortality stats are the pretty well the worst in industrialized nations, because people can’t afford prenatal care and advice or follow-up visits.

    There are glitches in our health system — but no system is perfect. But Americans pay as much or more per capita and still leave tens of millions without health care. What kind of bargain is that? And people who have insurance spend hours arguing with their insurance companies or trying to figure out coverage options. We present our health card and never have to think about it again. We can spend our energy getting better or visiting our sick relatives.

    My doctor moved to the states because she was tired of dealing with governments and their glacial bureaucracy to get paid. Guess what? She came back. One government was better than a slew of insurance companies.

  163. #163 Monado
    January 6, 2009

    I’d say that the welfare of states includes health care if the states want it. We don’t have federal health care. Each province administers its own provincial health care. Doctors are provincially licensed. Canada sets federal standards for health care with the Canada Health Act.

  164. #164 RickD
    January 6, 2009

    Posted by: Matt | January 6, 2009 4:10 PM

    I can’t wait till a Single-payer system comes to America. Not because I think its a good idea, but because I don’t think Americans have been exposed to the problems inherent in single-payer systems. When a congresscritter’s daughter gets told she will wait 6 months for an MRI on a brain tumor, they might figure out their mistake.

    Congressmen already have their health insurance paid for by the government, you ignorant twit.

    And the 6-month scare number is just something you pulled out of your ass.

  165. #165 Chayanov
    January 6, 2009

    I wonder how many U.S. Senators complain about the poor quality of their government-provided healthcare?

  166. #166 Tom
    January 7, 2009

    Actually, he’s a good choice for what the surgeon general is supposed to be. You want someone who will be out there convincing people to exercise more and get their blood pressure checked, blah blah blah. You don’t need the surgeon general to be a big advocate for health care reform. You need politicians for that job.

  167. #167 Monado
    January 7, 2009

    So far I think Pres.-elect Obama is making reasonable choices. He picked a genuine working and researching doctor, who was an advisor to Hilary Clinton in health issues. And you’ll remember that when people were speculating about what she should to, Health & Welfare was mentioned because she’s thought to be good at that.

    He also picked a moderately civilized evangelist to perform a traditional role at his inauguration. It’s a way to tell the religious half of the country that he’s not rejecting nor demonizing them. It doesn’t set policy or put Warren into a position of power. Expect, as the man compromises and “reaches across the aisle”, that he’ll make some choices you don’t like. I always think that if both sides grumble a little at a settlement, it’s probably pretty fair.

  168. #168 Tom
    January 7, 2009

    Not to say the American system as it stands is great. It is actually pretty awful. But those other systems are way worse.

    Yeah, I can tell because life spans in the US are so much longer than those countries with single payer systems. Wait… you mean the US doesn’t have longer life spans? You mean the US actually has shorter expected life spans? Never mind.

  169. #169 Nico
    January 7, 2009

    Count me in as another Canadian who loves the system, warts and all. A visit to an ER for a mild asthma issue, in, and out in 90 minutes.

    Friends in the US with persistent pain issue in his leg: can’t get pre auth to visit a doctor. Another, misdiagnosed with cancer, is paying that bill. Gimme universal care, where we can spend our time being well, not being afraid of disaster.

    ( i might be mistaken but due to preventative and maintenance care, we’re healthier for it.)

  170. #170 Azkyroth
    January 7, 2009

    Yeah, I can tell because life spans in the US are so much longer than those countries with single payer systems. Wait… you mean the US doesn’t have longer life spans? You mean the US actually has shorter expected life spans? Never mind.

    The resident Deregulation Cultists take the position that those life expectancy differences have to do with diet, or exercise, or something other than poor health care.

    An attitude which sounds familiar, somehow…

  171. #171 Tom
    January 7, 2009

    The resident Deregulation Cultists take the position that those life expectancy differences have to do with diet, or exercise, or something other than poor health care.

    Maybe. But if those people with bad diets and lack of exercise had a regular physician who nagged them about the importance of those things, perhaps it would help.

  172. #172 Jake
    January 7, 2009

    Monado,

    I totally agree with you there, I personally can’t understand how people are getting so angry about him for having Rick Warren do his inauguration speech dealy. Sure, Rick Warren is an arse of the worst calibre, but he’s performing a once off ceremony and won’t have any say over anything whatsoever other than a single speech. The people he HAS put into power are the ones that people should be looking at, and from what I saw of his science board, they’re fantastic choices.

  173. #173 Scott from Oregon
    January 7, 2009

    “”The resident Deregulation Cultists take the position that those life expectancy differences have to do with diet, or exercise, or something other than poor health care.”"

    “Deregulation Cultists?”

    Teehee. To think a website promoting rational thought lets this kind of nonsense fly in its midst…

    The mind boggles…

    So now the mantra is “diet and exercise have nothing to do with longeveity and health?”

    Lordy lordy lordy…

    America is losing its grip…

  174. #174 Azkyroth
    January 7, 2009

    So now the mantra is “diet and exercise have nothing to do with longeveity and health?”

    That’s not my point and you know it, you dishonest little shit.

  175. #175 Jadehawk
    January 7, 2009

    So now the mantra is “diet and exercise have nothing to do with longeveity and health?”

    i suppose i could mention WHY people are less obese in europe, but that would just get us into a debate on the evils of public transportation and biking infrastructure… :-p

  176. #176 AaronF
    January 7, 2009

    @126:

    “Also please show me how a market based healthcare system run by corporate interests is more efficient and does a better job at providing good healthcare to all citizens than a government run one. You can’t.”

    I haven’t advocated a market based healthcare system run by corporate interests. In fact, I haven’t advocated anything at all. I want a better health care system just like everyone else. However, I don’t believe that our government in it’s current state of ineptitude is capable of delivering that. Plus, it’s funny you mention that the current healthcare system is run by corporate interests. Isn’t the federal government currently being run by corporate interests also?

  177. #177 Scott from Oregon
    January 7, 2009

    “i suppose i could mention WHY people are less obese in europe, but that would just get us into a debate on the evils of public transportation and biking infrastructure… :-p ”

    And you would be fairly accurate. Americans don’t walk a mile a day. That’s why they die at an earlier age than others statistically. And they eat crap food and stuff too.

    So… no liberal big government promo guy or gal is going to unabashedly tackle a giant health care co-op made up of liberal big government promo guys and gals?

    What’s the problem again? You need money from successful people to pay for it?

    I see…

    You need people with business skills to organize it? Ahhh….

    You need people to actually want health care when they are healthy and pay for the obese sugar squatters and two pack a day smokers who will consume most of the health care dollars you put into the system and ruin it for you and your donut eating professor?

    Gee…

    67 million people voted Democrat for prez. One should be able to get 67 million people signed up for health care co-op style…

    Why wait for the rest of the country to agree with you. Do it and show them it works.

  178. #178 cm
    January 7, 2009

    Matt and others who want to get the government out of our hair:

    For me, a big part of why I want single-payer health care in the U.S. is not even about typical medical problems: it’s about money and truly unbelievable irritation.

    First, money. Yes, you’re right, people have to be treated in hospitals in the U.S…bu then they are billed. Yes, some small few can claim true indigancy/hardship and the hospital eats it, but many of us are in that vulnerable middle, where we might make $30k a year, but live one car accident away from a $350,000 medical bill and the collection agency goons who make the Nazgul look like cub scouts, who come after you and will hunt you down until you drop. Destroying one’s financial life is a truly terrible and ruinous thing, because it destroys your future…and I believe we do have a right to expect all of us to pay taxes such that none of us have to live with that stomach-churning threat.

    Now, truly unbelievable irritation. Dealing with insurance companies when they make mistakes is nightmarish even when one is completely healthy. I spent at least 20-30 calls, faxes, repeating and re-repeating my simple request to just pay what I was entitled to under my plan–for 10 months–getting one screw-up finally fixed. I have heard this same type of story from at least 2 other friends (who are a Canadian and a German living in the U.S.) and my sisters. Dealing with this sort of thing when you or a loved one is sick or gravely sick is a tragedy, but one which is common in the U.S. My sister had to spend hours on the phone with her insurance over her husband’s cancer, when he only had a limited time left to live. That is simply not right.

    In Spain, where I have received treatment as has my wife and in-laws for 50+ years, the story is always the same: you get sick, you present your ID card, you get treated. That’s it. No phone calls. No faxes to the home office in Eden Prairie, MN–oh, but you forgot to put the special code on it so it didn’t “get picked up in our system, try again.” No pre-authorizations (just think of how freakin’ insulting that concept is?). Certainly no preexisting conditions. Sure, the clinic was a little dingy, and we had to wait for an hour. Big deal. When we left we knew were done–cleanly. When I leave a doctor’s office in the U.S. I’m always waiting for the other shoe to drop in the form of a bill for services that was supposed to be paid by my insurance but got “mis-coded”. Sometimes they come 6 months later, too. Fun, fun.

    Freedom? You want freedom? I want to not have to become a part-time claims administrator for my own life. I’ll gladly joyfully pay more taxes for it, and I’ll pay it whether I get sick or not for every shlub in this country.

  179. #179 John Morales
    January 7, 2009

    We’ll have to see how that ol’ conservative, Orac, reacts to this news.

    Now we can.

  180. #180 bastion of sass
    January 7, 2009

    At #48 Matt wrote:

    I’ll say it again. It is ILLEGAL to deny care to anyone who comes within 250 feet of the hospital, regardless of their willingness or ability to pay.

    A hospital may treat you, but that doesn’t mean the treatment is free. Someone has to pay for the treatment. It could be other patients. It could be taxpayers. Or, if you were able, but simply unwilling, to pay it will be you.

    If the hospital believes you have the ability to pay even part of your bill, they will come after you. Most will sue you if necessary, then when they get a judgment against you (the typical result), the hospital will slap your assets with liens, attachments, garnishments.

    And your assessment of whether you are able to pay may not be the same as the hospital’s. (Heh. Kinda like when you apply for financial aid, and a university decides what you are able to pay out-of-pocket.)

    From a recent series of articles in The Baltimore Sun on the subject of hospitals suing low income patients:

    A charity care application can also be affected if a person owns property, has a job, or has a bank account. And in some instances, hospitals sue and obtain judgments against patients before offering charity care.

    Carroll Hospital Center said it considered the existence of a mortgage “an indicator for suit.” Garrett County Memorial Hospital said it might sue if it found that a patient owned two cell phones or was saving to buy a lawn tractor.

    For those interested: the article from which those quotes came, Loose Rules, is the third in a three part series.

  181. #181 Matt Heath
    January 7, 2009

    omfg, it’s a libtard.

    I thought that was usually an insult aimed at liberals (in the American sense). I think you meant “libertardian”

  182. #182 Liberal Atheist
    January 7, 2009

    I haven’t had any problems at all with our health care system in Sweden, and I know that while it’s not perfect, it does work well. We all pay for it, so we all get the benefits of it. No one is ever denied based on their financial situation, or whether they have some private insurance. I often see Americans claim how horrible this system is, but they never seem to bring me any evidence of that, other than parroting the scare propaganda by the rightwingers. How weird.

  183. #183 Leigh Williams
    January 7, 2009

    Just in case Matt or another of our libertarian friends might be interested in some, like, actual FACTS, instead of anecdotes (though I’ve got a boatload of those, too), here is an extensive analysis of how much Americans pay for medical care in comparison with other developed countries (way too much, quelle surprise) and what our outcomes are (not so great, given what we’re paying for it). It’s a five-part series; this is part 1:

    http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/

    What’s even more astounding to me is how some people are okay with the fact that 18% of the American population under 65 has no health insurance. None. The single largest cause of personal bankruptcy is medical bills, which also doesn’t set off any alarm bells amongst the ideologues.

    It’s really obvious that Matt is a young, single male. When he has a few kids to worry about, and discovers that health insurance for a family costs between $1000 and $1500 a month, he’ll sing a different tune.

    Not to mention how he’ll squawk when he’s fifty, laid off from work, paying COBRA of $1350/month (for the few remaining months his savings hold out), and finds a tumor in his thyroid. When he has to choose between bankrupting his family or dying, ideology won’t matter so much to him, and he’ll wonder how in the hell we came to this pass in the richest country on earth.

    And yes, that last is anecdotal. Amazing how viewing this stuff up close and personal can change the plural of anecdote to TRUTH.

  184. #184 Robert W
    January 7, 2009

    Horrible horrible horrible. Once again I am wondering, “What is Obama thinking?”

    Alienated Progressive,

    -me

  185. #185 Ashutosh
    January 7, 2009

    I think he is a pretty smart and knowledgeable guy who usually tries to be unbiased. It’s not his fault that the lazy buffoons at CNN have to have him spew out 1.Trite nonsense 2.Sensationalist claims. I don’t think he would be a bad choice if he can take on high-profile decision making cases and handle the bureaucracy well.

  186. #186 Naked Bunny with a Whip
    January 7, 2009

    @Jackie #85: If Moonbattery.com praises the story, it must be true!

  187. #187 Naked Bunny with a Whip
    January 7, 2009

    @AaronF: Have you looked at what the existing Federal programs like Medicare cover? It seems like those would be an indicator in this case. They actually cover a broad range of procedures. My girlfriend has SS disability insurance, and it’s pretty comparable to the stuff I get through work in its breadth (though the limits are lower, naturally, and I don’t see any ideological biases.

    The government can already prevent people from getting some treatments through legal mandates. A single-payer system wouldn’t change that at all.

  188. #188 Bill Dauphin
    January 7, 2009

    CanadianChick (@150):

    Sorry to reach so far back into the thread, but I wanted to comment on your story…

    Here’s my anecdote: I HAD a friend in the US. She had only just started with her new employer. The old one didn’t offer medical insurance, and she had some past medical issues that meant private coverage was financially out of reach. Her insurance at the new job wouldn’t kick in until she’d been there six months.

    ….

    Finally, she went to a hospital in her US (Texas) city -….

    She was dead within a week of the diagnosis. Lung cancer. In a lifelong non-smoker….

    Too little too late.

    I have the happy flipside of your anecdote, but even though the outcome was different, it illustrates (IMHO) the same key point:

    In the Spring of 2001, my then 10 year old daughter started having severe headaches. A flu had gone around her school just before that, so at first we checked for that. Then for a chronic sinus infection. Then to see whether her eyeglass prescription was wrong. Then… then… then…. We spent the whole Spring and into the Summer chasing the problem from doctor to doctor and test to test, while her headaches got worse and worse, to the point where she couldn’t eat or drink and we began to worry about dehydration and malnourishment. Finally, she was diagnosed with migraine and given a prescription, and we left on a family vacation. When we returned, though, her neurologist was concerned that she hadn’t gotten more relief from the medication, and referred her to an ophthamologist to check on a tiny abnormality he’d noticed on her retina weeks before. By this time (August 31, about 3 1/2 months after the first headache), the abnormality was no longer tiny. She had full-blown edema of both optic nerves, and we had our diagnosis: brain tumor. Within a week, she’d had 3 surgeries, including a 14-hour resection of the tumor (I remember calling the hospital room where she was recovering on 9/11 to warn them not to watch the news), and on September 12 we got the news that it was cancer.

    Now, I said this was a happy anecdote: After that marathon surgery, more than a year of chemo, five weeks of radiotherapy, and an awful lot of excellent professional care both at the local (wonderful!) children’s hospital and at home, she’s now happy and healthy (cancer-free for 7 years), and looking forward to going back to Yale in a few days for the second semester of her freshman year.

    The reason this is relevant to the argument over universal healthcare has less to do with the treatment she got than with the process of getting to her diagnosis. You see, the reason it took so long, and required so many different doctors and tests, to get the diagnosis is not that anyone was incompetent, but that her condition was extremely rare (in children, anyway). Those hoofbeats were coming from zebras, after all, and not from any of the sorts of horses we were looking for.

    We didn’t realize until late in the game that her condition was life threatening… but because I had good insurance through my employer, we were able to keep looking for an answer for as long as it took, without fear of financial ruin in the process. I’m personally convinced that if we’d been uninsured, or even underinsured, her cancer wouldn’t have been discovered until it was much more advanced, and she might well be dead now. And my wife and I would likely have bankrupted ourselves fighting her disease even so.

    So I’m unalterably convinced that my daughter’s life depended entirely on the lucky happenstance (from her point of view) that I had that insurance. Had I been unemployed, or self-employed, or even well employed in another sort of job that didn’t provide coverage, a purely innocent 10 year old would have died for my “failings.”

    When I look back on our story, and then think of all the families have no insurance at all (is it 40+ million people? How many households is that? How many children?), it makes my blood run cold. This is a great country in many ways; that we allow the lives of our children to depend on the luck of the parental-employment draw is a horrifying sin, and one for which we all share responsibility. Anyone who’s unwilling to pay a few dollars more in taxes to correct this evil situation can, as far as I’m concerned, get the hell out of my country.

  189. #189 frog
    January 7, 2009

    jcr: That sounds like a hospital that should go out of business. The trouble with government-operated services like the VA hospitals, is that there are rarely any negative consequences to fucking up. In fact, horror stories of badly-managed organizations like that typically come with demands for increasing their funding, while the people who have demonstrated their incompetence keep their jobs.

    JCR, you are simply a nincompoop. Of course the hospital should go out of business, just as in a badly managed public hospital, the voters should remove the top administrators via election of their government representatives.

    But those of us who don’t live in la-la-land recognize that, in the actual world of hard-facts, neither happens. When you have an emergency, you have little choice in the matter. When you don’t have an emergency, you have little information about the matter, and most of us aren’t repeat customers.

    So the market relationship with the insurance companies drive care, rather than any relationship with the patient. The individual is not the customer. The customer is the insurance company, and the patient is merely a consumer. That distinction is so often lost on the unhinged right. What you get is that there is, in practice, no choice for the consumer — the hospital I was talking about is actually well-regarded in certain specialties, it’s just that every hospital in the region is just as bad.

    We can tell that’s the case, because in one of the rare specialties where you have ample planning time and ability to collect information, where the consumer is the customer in practice, you see actual market differentiation in consumer treatment: childbirth. I’ve been a consumer on that front as well, and that market actually functions because it is essentially different from almost all other non-elective specialties, where you are both a likely repeat customer and have quite a bit of time to make decisions while you aren’t actually frightened out of your wits about impeding death.

    The only ones with sufficient information are the MDs — but they no longer have the power. The best system is one where the relationship between doctor and patient is strengthened, including a market oriented approach, while the large-scale organization is stripped down to a national administration with congressional oversight. Remove the worst from both system. In short, subsidized small practices — a world of small business that are protected from mega-businesses, so that the market can actually function.

    That’s the insanity of the right — by following a “government is always bad” ideology, in practice they strengthen large-scale, blind and bumbling bureaucracies because they are nominally “private”. They create Soviet-style central planning because they are so moronically attached to the form but not the function.

  190. #190 Robert Byers
    January 8, 2009

    From Canada
    I responded to this in Orac on Gupta.
    I say its legitimate to accuse Obama of picking this Indian because he’s not white or Jewish and there was no credible black.
    this is racism and rejection of ‘white” voters in the democratic party.
    Obama can pick anyone he wants but not pick just any motivation . Its illegal to pick against americans of original British stock pre revolution and illegal anyways to pick against any identity based on race/ethnicity/sex.
    While possible its a sincere pick on merits the climate allows the expressed suspicion and accusation that its not on merits but on identity.

  191. #191 Janine, Bitter Friend
    January 8, 2009

    Its illegal to pick against americans of original British stock pre revolution and illegal anyways to pick against any identity based on race/ethnicity/sex.

    You are a gibbering idiot.

  192. #192 Joe
    January 8, 2009

    I say its legitimate to accuse Obama of picking this Indian because he’s not white or Jewish and there was no credible black.

    Not racist even a little. >__>

    In all seriousness, I snorted some beer when I read this. Tingly.

    Joe

  193. #193 Falyne
    January 8, 2009

    ……….why did I read all the way through this thread? Why? Libertarians, up to and including SfO, are bad enough, but then Byers just has to show up to put the shit-soaked cherry on this shit sundae with whipped douche cream…

    I’m going to bed. :-P

  194. #194 Azkyroth
    January 8, 2009

    I thought that was usually an insult aimed at liberals (in the American sense). I think you meant “libertardian”

    We mean “Deregulation Cultist” since libertarian implies a concern for freedom whereas the priorities of SfO, JCR, Matt, and their ilk begin and end with “never being told you have to share.”

  195. #195 Ian Gould
    January 11, 2009

    In the unlikely event that anyway is foolihs enough to give Robert Byers comments any credence:

    http://en.wikipedia.org/wiki/Presidential_transition_of_Barack_Obama#Cabinet_and_top_advisors

    26 senior Obama appointments are listed. A 27th appointment – Bill Richardson – has been withdrawn.

    Assuming Gupta is appointed and counting in Richardson, we have two African-Americans; two Hispanics two three Asian-Americans.

    Shocking isn’t it – only 75% of Obama’s appointments are whites! That’s only roughly 50% higher than their percentage of the general population.

    and as Byers’ points out at least one of them isn’t a REAL white person, he’s a Jew.

    This is the sort of vicious assault on the human rights of white Americans that will be unleashed now that a darkie’s been elected President.

    No white woman will be safe.

  196. #196 Ian Gould
    January 11, 2009

    Oh and add me to one of the brainwashed craven serfs who believes the lying evidence of my own eyes rather than the eternal and self-evident truth of libertarian ideology.

    Australia’s medical insurance system differs quite significantly to that in Canada and the UK. Generally speaking we have a more market-driven and competitive system – but the government still operates as the single payer and ensures universal coverage.

    In total we psend abotu half as much as the US per person on health care and live longer. (So do Puerto Ricans BTW)

    But this is all irrelevant.

    The real point is America is the greatyest country in the world and every aspect of America is infinitely superior ot any other country. Anyone who says different is a dirty com-symp/pinko-fag/Eurotrash freedom hater.

    And to the extent that any aspect of the US appears NOT to be superior to the foreign equivalent we need only invoke the magic formula “America’s different”.

    Or blame government, those damn liberals and the ethic minorities.

    The interesting thing abotu the “America’s different!” argument is that essentially every other highly developed country – including Japan and South Korea – and many developing countries *including Brazil, Jordan and Costa Rica) deliver universal coverage at lower cost than the US and have longer life expectancy.

    But of course, all those countries are more similar to each other than any of them are to the US in one important regard: we’re all scum.

  197. #197 Ian Gould
    January 11, 2009

    http://en.wikipedia.org/wiki/Health_care

    The US currently spends US$5700 per person on health care.

    Australia spends US$2,500.

    The Australian government actually spends a lower proportion of its total budget on health care than does the US.

    In dollar terms, the Australian government spends roughly USD$1600 per person on health care. The balance is paid by individuals and through private insurance.

    In dollar terms, the US spends roughly $2400 per person on health care – despite the fact that millions of Americans receive no non-emergency care.

    But remember – defending the system that means the government pays 50% more means you’re opposed to big government and high taxes.

    If this seems odd, just repeat “Government is Evil” “Foreigners hate freedom” and “America is the greatest country in the world” and all will become clear.

  198. #198 negentropyeater
    January 11, 2009

    France ranks #1 according to the WHO and spends 10% of its GDP on health, 80% from public, 20% from private.

    US ranks #37 according to the WHO and spends 15% of its GDP on health, 40% from public, 60% from private.

    Both countries have large pharmaceutical corporations, perform worldclass medical research, and can even get Nobel prizes in Medicine.

    Conclusion : public funding of health care works better, is cheaper and is more equitable.

    But as usual, Americans will have to reinvent the wheel so that the wheel makers can make some profit and cause more debt.
    Afterall, that’s the only thing American free-market ideology has been really, really good at doing : accumulating the most monumental debt in history, $54 trillion and counting. A big chunk of it in unfunded liabilities for public medical and retirement programs that have already been voted for, but not funded for. Otherwise, if they had funded them, like France did with the sécurité sociale, the share of GDP would have been 20% instead of 15% for healthcare costs. But that would have caused an increase in taxes, and Americans don’t want more taxes, as this might have caused growth to be lower. So they just didn’t fund it. But voted for it, leaving the problem to future generations. It’s what’s called irresponsible management, I’d even call it lunacy.

    When are americans going to wake up ? YOU CANNOT AFFORD THE SYSTEM YOU HAVE NOW ! Change it fast before your country implodes.

    And Obama’s appointment ? The same as all the other ones. He’s already been pulled over to the dark side by the institutional machine. Like his appointments of Volcker, Geithner, Summers at key economic posts (the main architects of the mess we’re in), we now know he’s not going to change a thing.

    Stop hoping for real change, demand it !

  199. #199 africangenesis
    January 11, 2009

    #198, The unfunded debt you describe is not the fault of the capitalist system but of a corrupt form of campaign financing using public funds. Politicians are purchasing votes with promises of public funds, just on a larger scale than even the earmarks McCain is trying to bring under control. The reason the Republican base was so unforgiving of McCain/Feingold was that it attempt to restrict private campaign financing leaving small government conservatives and libertarians at a disadvantage against this corrupt purchasing of votes.

    The capitalist system is responsible for the surpluses that allow the financing of luxuries like research and health care and the jobs, that have undocumented workers coming here for improvements in more basic needs such as food and shelter.

  200. #200 negentropyeater
    January 11, 2009

    africangenesis,

    I don’t know what is the capitalist system anymore. What I know is that the free-market ideology that dominated in the USA parked all kinds of externalities (environmental, societal, unfunded liabilities) outside of the real costs and pretended to ignore them advitam eternam. This has been the dominant policy of republicans AND democrats since Reagan, Federal and State Government AND private corporations, the institutional machine has been moving to the dark side for the last 25 years.

    But what were they thinking ? That future generations would never find out ? That the debt could keep growing like this eternally at a rate of 10% per annum, doubling every 7 years ? We’re there now, the shit has hit the fan, the debt has reached its Minsky moment, it can’t grow no more.

    This leadership model is dead, we need to see ego-less servants build a new resilient network economy where each region of the world is autonomous, resilient, and networked with each other. Within each region a resilient network of small private enterprises that own the network will manage the economy.

    We need to build out of this institutional machine that has ruined us, this is not a recession, not a depression, this is the end of an era. We will need a transition time, but if we know where we want to go, there is no way back.
    What will come out of this will be a fundamentally better world.

  201. #201 africangenesis
    January 11, 2009

    negentropyeater@200,

    How can you claim the free market ideology has dominated when it has faced counterproductive class warfare rhetoric and every turn? Reagan backed down from eliminating the double tax on dividends when shouts of “tax breaks for the rich” rang out. Evidently the Democrats thought that single taxing interest favoring debt and leverage benefited their constituencies. GW stuck to his guns despite the daemonization, but still only got minor reductions in the double taxes on dividends and capital gains.

    The deficit financing and unfunded mandates have more to do with our incumbant advantaged two party system than with capitalism which produces the wealth that allows us to be concerned with such luxuries as the environment and scientific research. Yes there are externalies, but they could have been addressed with a much less intrusive and parasitic ruling elite. The record of central planners such as the Soviet Union was much worse. Reduction in air pollution these days now costs an estimated $15 million per life saved, when lives can be saved for $15 thousand by better prenatal care, and for much less through vaccination and curing nutritional deficiencies elsewhere in the world. True international socialists won’t have much patience with pollution concerns or precautionary principle nuclear safety standards.

  202. #202 negentropyeater
    January 11, 2009

    Africangenesis,

    btw, which surpluses are you talking about ?

    Over the last quarter century the GDP of the USA has been growing at an average rate of 3.5% per annum, whereas the debt has been growing at a 3 times faster rate of 10% per annum. The debt is no high, so ruinous, that to produce 1$ of goods and services, it is necessary to have $3.5 of debt.

    Surpluses ? You gotta be kidding me. You most probably mean illusions of surpluses, of course if you ignore the debt, it’s all surpluses. The debt is for us now.

    If the debt had been growing at the same rate as the GDP, which any sound management rule would have suggested, the completely artificial growth rate of 3.5% of the GDP would never have been seen. But the USA, like other countries, would not have been building this fake prosperity from which many have gorged themselves and left us with the shit to scrape now.

  203. #203 negentropyeater
    January 11, 2009

    Africangenesis,

    free-market ideology dominated way more in the USA than it did in the more prudent mixed economies of Western Europe (Germany/France/Scandinavia/Benelux).

    Sure, they didn’t grow as fast, but their debt is at 70% of GDP at tolerable levels. They do not have unfunded labilities. They are the only advanced economies that have kept their savings rate more or less constant at 10% throughout this last quarter century.

    The USA publishes a “National Debt” of roughly $11 trillion so it says it’s on par with those other countries at 67% of GDP. But : it parked outside unfunded liabilities, state and municipal debt, corporate debts, and households have a monumental debt, with quasi zero savings rate (it was actually for the first time negative in 2007 untl the recession started). So in total, it’s not 70% of GDP, but 350% of GDP. That’s the slight problem America has now.

    Think about it this way, every American household has now an average debt hanging over his shoulders of more than $500,000. A bit much, wouldn’t you say ?

  204. #204 africangenesis
    January 11, 2009

    102 and 103,

    The debt and low savings rate are artifacts not of the free market as a system but of the way money is created in the fiat money system. It is dependent on creating credit through the fractional reserve banking system with the benefits going to the banks and stimulous being applied with lower interest rates. This, in addition to the tax favoring of debt, creates a highly leveraged economy, prone to deeper business cycles, and the low interest rates and expections for inflation decrease the incentives to save. During the period you are discussing there was nearly continuous concerns about a savings glut, searching desparately for higher returns. The competition of capital for better returns, of course, bid down those returns. The deleveraging that occurs during a credit crisis and collapse of commidity prices, destroys money in a fractional reserve fiat money system. It is estimated that 4 to 7 trillion dollars have disappeared, and the federal reserve has no way to replace it, because the banks don’t want to lend to businesses and consumers in a bad economy and consumers don’t want to borrow when they might get laid off. In other words, this government is so stupid it doesn’t know how to print money, and has let the financial crisis spread from wall street to main street. Totally unnecessary!

    If the federal reserve actually created the money directly rather than through credit and managed the money supply to a 2 to 3 percent inflation rate, it could stimulate the economy without decreasing the incentive to save and without incentivising leverage in the economy. A simple way to do it would be with special debit card accounts for every person in the US, and the fed would just deposit money into them on an egalitarian per capita basis. The consumers would then pick the winners and losers rather than the government, and Obama could continue with the tax and spend plans he originally had in mind.

    Are you sure your characterization of Europe was correct? I understood that they their pensions and old age medical care were not actuarially sound either, and that they were actually encountering their demographic crisis earlier, since a lower birth rate means fewer workers per retiree.

  205. #205 'Tis Himself
    January 11, 2009

    In a gesture of bipartisanship, I’ll show that the Clinton Budget Surplus? was a myth, a fabrication propagated by those who don’t understand how the federal budget is accounted.

    Data from the Treasury Department show the federal budget under the Clinton years operated at a deficit of $100-200 billion for most years, reaching a low point of $18 billion during 2000, but leaving a deficit budget of $130 billion in 2001.

    By definition, there could not have been a budget surplus; deficit spending defies the idea of the existence of a budget surplus or balanced budget. However, the lie isn’t so obvious that Clinton wasn’t able to use political maneuvering and clever accounting to sell the surplus idea. So where did the surplus myth come from?

    While government spending was in a deficit, the U.S. public debt, better known as the national debt, was being paid off. The national debt accounts for money that the federal government owes to states, corporations, individuals, and foreign governments but not what is owed to intragovernment obligations, such as the Social Security trust fund.

    So while the public debt was being paid off, the debt from intragovernment holdings skyrocketed while general federal spending was relatively unchanged. Clinton pointed to the national debt as being paid off, but neglected to mention that the source of this money was debt owed to Social Security.

    The dot-com bubble provided a temporary economic stimulus during the Clinton era, which allowed the Social Security Administration (SSA) to increase revenue through Social Security taxes, leaving Social Security with a surplus.

    SSA is legally required to purchase government securities with surplus funds. This results in a transfer of funds from Social Security, intragovernment holdings, to the Treasury Department, which was used to pay down the national debt.

    There is a difference between debt and surplus, no matter where the funds are coming from. The government doesn’t have unique sources of production, and must rely on external sources from which to extract capital. Therefore, a true surplus can only arise by reducing spending or increasing taxes or both.

    Even by raising taxes, this only represents debt owed to the public. The government relied on the dot-com bubble by funneling funds through SSA, which allowed it to mimic a surplus by obscuring the source of funds. This is a clever accounting game, but it is not a surplus.

    So when the dot-com bubble burst, and Social Security was left in debt, the federal government couldn’t give SSA its surplus back. The money had been put towards the public debt already. By that time, Clinton was already out of office, so the effects of the dot-com crash could be blamed on George W. Bush anyway.

    The bubble itself, which was caused by over-speculation in Internet-based start-up companies, was, in itself, funded by low interest rates set by the Federal Reserve, giving investors a surplus of capital which to invest in the overvalued Internet companies. Government policy contributed to the unsustainable dot-com bubble which the government took advantage of to temporarily reshuffle its debt to give the appearance of a budget surplus to win political favor.

  206. #206 negentropyeater
    January 11, 2009

    Africangenesis,

    The debt and low savings rate are artifacts not of the free market as a system but of the way money is created in the fiat money system.

    Absolute nonsense. The Euro is as much a fiat currency as the dollar. Within the Eurozone, some countries, Spain, Ireland, Italy, have very low savings rate and high total debt (public+private), whereas others, Germany, France, Scandinavia have much lower total debt and much higher savings rate.

    You’re just repeating the nonsense of the Austrian Trade Cycle. It’s about as much backed by evidence as intelligent design.

  207. #207 africangenesis
    January 11, 2009

    n@206, I thought the Austrian’s were gold standard, hard currency types. What I proposed was nothing like that.

    Yes, many people saved, there couldn’t have been a savings glut otherwise. But that must have been cultural, not based upon great returns. Where are those savings now! All the market incentives were in favor of borrowing and spending now, paying back in cheaper inflated dollars. Maybe you want to save at one or two percent interest rates, but I’ve got better things to do with my dollars.

  208. #208 'Tis Himself
    January 11, 2009

    Why is it that libertarians insist that they prove they’re economic illiterates? africangenesis is Exhibit A.

    The deleveraging that occurs during a credit crisis and collapse of commidity prices, destroys money in a fractional reserve fiat money system. It is estimated that 4 to 7 trillion dollars have disappeared, and the federal reserve has no way to replace it, because the banks don’t want to lend to businesses and consumers in a bad economy and consumers don’t want to borrow when they might get laid off. In other words, this government is so stupid it doesn’t know how to print money, and has let the financial crisis spread from wall street to main street. Totally unnecessary! [emphasis added]

    Do you know what happened in Germany after World War I? An interesting phenomenon known as hyperinflation.

    The main cause of hyperinflation is a massive increase in the amount of money, which is not supported by growth in the output of goods and services. This results in an imbalance between the supply and demand for the money (including currency and bank deposits), accompanied by a complete loss of confidence in the money, similar to a bank run. If the entity responsible for printing a currency promotes excessive money printing, with other factors contributing a reinforcing effect, hyperinflation usually continues. Often the body responsible for printing the currency cannot physically print paper currency faster than the rate at which it is devaluing, thus neutralizing their attempts to stimulate the economy.

    Hyperinflation is generally associated with paper money because this can easily be used to increase the money supply: add more zeros to the plates and print, or even stamp old notes with new numbers. Historically there have been numerous episodes of hyperinflation in various countries, followed by a return to “hard money”. Older economies would revert to hard currency and barter when the circulating medium became excessively devalued, generally following a “run” on the store of value*.

    Hyperinflation effectively wipes out the purchasing power of private and public savings, distorts the economy in favor of extreme consumption and hoarding of real assets, causes the monetary base, whether specie or hard currency, to flee the country, and makes the afflicted area anathema to investment. Hyperinflation is met with drastic remedies, such as slashing government expenditures or altering the currency basis. An example of the latter occurred in Bosnia-Herzegovina in 2005, when the central bank was only allowed to print as much money as it had in foreign currency reserves. Another example was the dollarization in Ecuador, initiated in response to a massive loss of value of the sucre in early 2000. Dollarization is the use of a foreign currency (not necessarily the U.S. dollar) as a national unit of currency.

    The aftermath of hyperinflation is equally complex. As hyperinflation has always been a traumatic experience for the area which suffers it, the next policy regime almost always enacts policies to prevent its recurrence. Often this means making the central bank very aggressive about maintaining price stability or moving to some hard basis of currency such as a currency board. Many governments have enacted extremely stiff wage and price controls in the wake of hyperinflation, which is, in effect, a form of forced savings, but does not prevent further inflating of the money supply by its central bank, and always leads to widespread shortages of consumer goods if the controls are rigidly enforced.

    *To act as a store of value, a commodity, a form of money, or financial capital must be able to be reliably saved, stored, retrieved, and be predictably useful when it is so retrieved. Anything can be a store of value: gold, gems, real estate, grain and other agricultural products capable of long-term storage, etc.

  209. #209 africangenesis
    January 11, 2009

    Tis@208. This is hardly a libertarian position, they are hard currency types too.

    Yes I am familiar with hyperinflation both in Gernmany and currently in Zimbawe.

    The Federal reserve already prints money, using the credit dependent, fractional reserve banking method.

    Now that we’ve addressed that.

    Do you know of any reason that the debit card method couldn’t be managed to same targets. Keep in mind that it just creates an extra tool, and allows the interest rates to be kept higher.

  210. #210 negentropyeater
    January 11, 2009

    Africangenesis,

    sorry didn’t understand you well, but those days the main advocates of the theory “that-it’s-all-fiat-currency’s-fault” have been Austrian economists.

    It’s true that there aren’t that many radical monetarists left. Friedman’s ideas of fixing inflation at a constant rate has been tried in the past and doesn’t work. That’s already one thing we can be sure of. I mean it’s quite obvious to understand that inherently there’s going to be periods when the economy is going to be more creative and innovative than others and there’s no way a constant rate of inflation is going to work in an uncertan world. Humans aren’t machines, they don’t have constant innovation or productivity rates.

    Anyway, they’re both equally intellectually bankrupt 100%ideology / 0% evidence.

  211. #211 africangenesis
    January 11, 2009

    negentropyeater,

    The major central banks have actually be pretty good at sticking to target inflation rates for a couple of decades. But I think this credit creation mechanism for printing money, has just demonstrated a huge vulnerability. The central bank efforts to create money in Europe, Japan and America have been likened to pushing on a string. The mechanism seems to create these structural instabilities, and in the US which has a growth as well as anti-inflation mandate, when targeting growth it has lowered interest rates, reducing the incentives to save.

    It should be possible to have a mechanism to print money which doesn’t increase risky leverage and which doesn’t discourage saving. Helicopter Ben Bernanke had the idea but not the mechanism. He would probably get pilloried by the right if he proposed this.

  212. #212 negentropyeater
    January 11, 2009

    Africangenesis,

    the problem of USA’s gigantic debt has nothing to do with fiat currency.

    It has all to do with the fact that too many (not only in Govt but everwhere) believe in illusions (of surpluses), magic (that the debt can keep on growing forever) and miracles (that if it becomes a problem, a miracle will save the USA).

    It’s becuase of this general irresponsibility and complete lack of consideration for future generations that the problem of the debt is so gigantic.

  213. #213 clinteas
    January 11, 2009

    Hi Neg,

    wb,where have you been mate?

  214. #214 negentropyeater
    January 11, 2009

    Been travelling, you know, family, friends, eating and drinking a lot. Back in Barcelona now.
    Thx for asking.

  215. #215 africangenesis
    January 11, 2009

    Simply replacing the money destroyed in the credit crisis would avoid the 1.3 to 1.7 trillion dollars of deficit spending being budgeted as a fiscal stimulous. I do think this is misguided. The debt mechanism is completely contrived. There is no reason to obligate future generations for this particular artificial crisis.

    Just $1 trillion, about $4000 in everyone’s debit account immediately reduces concerns of credit defaults and demand contraction. Considering that another $4 to $7 trillion were destroyed, there is considerable room for judicious correction, another $12000 to $24000 per capita. The consumers and savers would pick the winners and losers as the economy is gradually reflated. China and India and OPEC would love to honor these dollars to restore their prior growth rates. At bottom this spread as a monetary crisis, not any kind of “necessary” or “cleansing” “correction”. The subprime housing component was a bubble, so the reflation should be judiciously short of “complete”, since imbalances existed that don’t need to be restored.

    The other aspects of the debt concerns should be kept in perspective. The US is the third most populous nation in the world, and before this latest fiasco, could easily manage its debt obligations. Raising the Social Security retirement age in out years brings the system back into balance.

  216. #216 'Tis Himself
    January 11, 2009

    Because it allows them to hide their spending and avoid an obvious tax increase, governments have frequently resorted to printing money (or in the modern computer age by adding credits to the entire banking system via their central bank) to meet their expenses. Inflation is merely another tax on the citizens but subtly hidden and is therefore harder to understand by ordinary citizens. Inflation obscures who is to blame for the cause since the general price indexes may increase only months or years later. This is why monetary inflating has historically been the favorite form of taxation by governments since ancient times.

    The causes of inflation are debatable. You can find a decent discussion of various theories in the wikipedia article on inflation. What to do about inflation is more difficult. Some inflation is inevitable, in my view it’s built into capitalism. The central bank adjusting the interest rate (called the discount rate in the U.S.) and open market operations (the central bank buying or selling bonds for hard currency) are the traditional means of dealing with inflation.

    The so-called debit card method can be implemented by changing the proportion of total assets that banks must hold in reserve with the central bank. Banks only maintain a small portion of their assets as cash available for immediate withdrawal; the rest is invested in illiquid assets like mortgages, loans and other financial paper. By changing the proportion of total assets to be held as liquid cash, the Federal Reserve changes the availability of loanable funds. This acts as a change in the money supply. The monetary base can be expanded or contracted using an expansionary policy or a contractionary policy, but not without risk.

    In order to achieve a low level of inflation, the Federal Reserve or other central banks must have credible policy so private agents (corporations and consumers) can believe that these policies will reflect actual future events. If a policy about low-level inflation targets is promulgated but not believed by private agents, wage-setting will anticipate high-level inflation and so wages will be higher and inflation will rise. A high wage will increase a consumer’s demand (demand pull inflation) and a corporation’s costs (cost push inflation), so inflation rises. Hence, if a central bank’s policies regarding inflation and monetary supply are not credible, the policies will not have the desired effect.

  217. #217 negentropyeater
    January 11, 2009

    ‘Tis Himself,

    Hence, if a central bank’s policies regarding inflation and monetary supply are not credible, the policies will not have the desired effect.

    On this note, have you seen this piece by Willem Buiter ?

    Can the US economy afford a Keynesian stimulus?

    Would like to hear your views on it.

    Particularly this part :

    The US Federal government has taken on massive additional contingent liabilities through its bail out/underwriting of the US financial system (and possibly other bits of the US economic system that are too politically connected to fail). Together will the foreseeable increase in actual Federal government liabilities because of vastly increased future Federal deficits, this implies the need for a future private to public sector resource transfer that is most unlikely to be politically feasible without recourse to inflation. The only alternative is default on the Federal debt. There is little doubt, in my view, that the Federal authorities will choose the inflation and currency depreciation route over the default route.

    If I can figure this out, so can anyone in the US or abroad who follows recent economic developments. The dawning of the realisation will lead to the dumping of the assets.

    Does this mean Weimar scenario to immediately follow deep recession / defation in 2009 ?

    If he’s right, it’s scary. For the whole world scary.

  218. #218 africangenesis
    January 11, 2009

    Tis@216,

    Changing the fractional reserve level is not working, the banks aren’t lending enough to restore the monetary supply, and it is not equivilent to the debit card, because it still relies upon increase the level of debt in the economy. The debit card balances are owned by the people. I think some of the political opposition to this will come from the left. Empowering the people with the semi-entitlement to whatever money is created, does not increase their dependency on the government and doesn’t depend upon the take over of industries.

    The people will have to be educated that this will not be a dependable supply of money but will be entirely conditioned upon the Feds management of the money supply.

    It is obviously a social issue whether the benefits of the money creation should go to the banks and government as it does currently, or to the people. It is probably good to have the discipline that the government must tax or borrow to get its money.