New at Reason

June 22, 2007

Michael Moynihan files a review of Michael Moore's SiCKO—shortly before being rushed to the hospital.

Comments

|6.22.07 @ 3:18PM|#

"The online leaking of Sicko, his new documentary on the American health care system, was an "inside job," he said."

I believe him. I'm sure it was.

|6.22.07 @ 3:22PM|#

I can't wait to download it. Then delete it.

|6.22.07 @ 3:26PM|#

Sigh. Moore still exists? Why? I'm always disturbed when people buy his nonsense without reservation. I mean, even if you want to nationalize healthcare, the guy is still misrepresenting the facts and lying to a degree that should make you wonder whether he plans to join the Bush administration.

|6.22.07 @ 3:27PM|#

1, 2, 3, 4, I declare an Anecdote war!

thoreau|6.22.07 @ 3:29PM|#

5, 6, 7, 8, I'll put out some troll bait!

|6.22.07 @ 3:32PM|#

I can't even get past the first paragraph of this review -- the movie has been "leaked" to the internet, but Michael Moore stows the master copy in Canada to prevent the U.S. gov't from seizing it?

Good thinking....

D.A. Ridgely|6.22.07 @ 3:35PM|#

As I just mentioned elsewhere, Moore would make the perfect running mate for Cynthia McKinney on the Green ticket.

|6.22.07 @ 3:36PM|#

thoreau | June 22, 2007, 3:29pm | #

5, 6, 7, 8, I'll put out some troll bait!

From where will you pull it out, T?? Oh wait, I don't want to know... :/

|6.22.07 @ 3:38PM|#

Heh, I downloaded it and watched it the other day and I must say that though I totally disagree with him on everything he really made a good documentary this time. It is on par with Roger & Me which again I disagree with the message but feel it is very well put together. Columbine and 9/11 were really sloppy and I can't even bear to watch them again because they were so poorly put together. I think the reason that this one came out so nicely is that he really had his heart in it, much like Roger & Me.

UCrawford|6.22.07 @ 3:48PM|#

If Moore or his idiot followers think Britain have such a wonderful health care system, they should try living under it. I lived there for six years with the U.S. military and due to the dearth of military medical facilities in the region we had to use the NHS for routine medical care. The "free" public system generally consisted of long wait times (I knew Brits who were on the waiting list for two years for surgeries) and substandard care (one of my soldiers required an emergency appendectomy but the NHS simply gave him generic antibiotics and sent him home...we had to send him to a military hospital four hours away to get treated before his appendix burst. Another soldier almost died from internal bleeding because the doctors never checked for it after she miscarried). There are also hidden costs for patients and visitors (things like charging 5p per Kleenex, exorbitant parking costs in the hospital lots, charges for amenities like having a TV in the room). The condition and hygiene of the wards were also highly suspect and the Brits reportedly have a high level of infections (and deaths) from germs picked up inside the hospital. And that's not even considering the other effects of cost-cutting. Before the NHS turned dental care over to the private sector the NHS would often appoint one dentist to service 5 or 6 towns (resulting in a dearth of regular checkups). And there have been verified incidents where the NHS has refused to provide care for terminally ill patients on the grounds that there was no point in spending more money on them.

The military base where I was at eventually adopted the habit of sending all soldiers to the private health care system (which was substantially more expensive) because the quality of care in the NHS hospitals was so bad.

Here's a better link about the wonders of socialism and health care than anything Moore will provide: http://www.angelfire.com/pa/sergeman/issues/healthcare/socialized.html

thoreau|6.22.07 @ 3:51PM|#

You know, I'll probably go see it for entertainment. Moore is fundamentally a showman, even if he bills himself as a purveyor of truth. I can enjoy a good show full of humor and snark without agreeing with the intended message.

If I don't get around to seeing it in theaters, I'll definitely Netflix it.

|6.22.07 @ 3:56PM|#

As a favor to your neighbors, could you please revoke Michael Moore's passport?

Xanthippas|6.22.07 @ 4:00PM|#

Moynihan is completely wrong to think that Moore's film won't have any lasting effect. And I'll be back in a few months to remind you guys of that fact.

|6.22.07 @ 4:07PM|#

We're fucked. Seriously fucked

|6.22.07 @ 4:15PM|#

Why aren't there any major libertarian documentaries? Or are there, and I'm just missing them?

|6.22.07 @ 4:15PM|#

You guys are lax these days....a year ago there would have been 12 different ways of denouncing British health care due to their teeth alone by now.

Paul|6.22.07 @ 4:16PM|#

You know, I am getting increasingly tired of having to be subjected to crap like this "documentary" about healthcare systems, while I have first hand experience with an American emergency room with Canadian patients who are shipped down to the states by the Canadian government for real medical care. Add in the fact that the Canadian patients are expressing real and honest elation over the fact that they're getting American care instead of the downright shitty care they usually receive in Canada.

One account from a Canadian patient detailed how his pregnant wife had to sit in a waiting room until the moment she was ready to deliver, then was discharged from the hospital at 9:00 the next morning because they simply don't have the beds available.

Xanthippas:
Moynihan is completely wrong to think that Moore's film won't have any lasting effect.

It will have a lasting effect, which is why it scares me so much.

Paul|6.22.07 @ 4:20PM|#

a year ago there would have been 12 different ways of denouncing British health care due to their teeth alone by now.

Why do we have to do that when there are real and measurable ways our healthcare system is head-and-shoulders above their system?

ed|6.22.07 @ 4:20PM|#

The sight of Moore literally (yes literally!) makes me barf.

Xathras|6.22.07 @ 4:20PM|#

Man, I'm sure glad there are no long wait times here in the good ole USofA. Why, all you need is 40,000 in cash, and you can be seen whenever you want! Oh wait, you don't have good insurance? Well, no worries, we can pencil you in in a year. Wait, NO insurance? Then the queue time is infinity, unless of course you think to go to the ER, which is like 3 times more costly, with the cost coming right out of the pockets of everyone else that has insurance... after, of course, they take your house and car and you file for bankruptcy.

Yes, Moore is definitely the one not giving us all the facts, Mr. Moynihan.

|6.22.07 @ 4:22PM|#

We are ashamed to be from the same state as Michael Moore.

Paul|6.22.07 @ 4:33PM|#

Man, I'm sure glad there are no long wait times here in the good ole USofA. Why, all you need is 40,000 in cash, and you can be seen whenever you want!

Except in Canada, EVERYONE has a wait time, including those with insurance. Get it?

|6.22.07 @ 4:33PM|#

I can't stand the guy. Yes I disagree with him on almost everything. But I also disagree with his methodology. You can make anyone look like an ass when you are prepared to ambush them with a camera and they aren't ready for it.

I don't really like the tactic when Sasha Cohen uses it, but at least he is just trying to get a laugh. Moore is trying to Say Something, and he apparently can't do so without stacking the deck with selective editing and ambush tactics.

|6.22.07 @ 4:37PM|#

Reinmoose: You ask:
Why aren't there any major libertarian documentaries? Or are there, and I'm just missing them?

Well, it's not a documentary, but the Canadian flim The Barbarian Invasions offers an touching portrayal of a dying Marxist dad, his rich London banker son, and the thoroughly dysfunctional Canadian health care system. From one review:

...one of them is taken on a wild ride through the bowels of the worst hospital (socialized, of course) imaginable. Dead bodies in the halls share gurneys side by side with live sufferers, as depleted staff members bark orders amidst a proliferation of exposed heating and cooling ducts to a degree not seen on-screen since Terry Gilliam's "Brazil."

Rémy (Rémy Girard), last seen as an unreconstructed Marxist, is now a dying fatalist who submits to this faulty hospital system because he voted for hospital nationalization and he'll deny none of his early beliefs, political or emotional.

A seriously good movie.

|6.22.07 @ 4:38PM|#

Why aren't there any major libertarian documentaries? Or are there, and I'm just missing them?

Does Free to Choose count?

|6.22.07 @ 4:38PM|#

Right, Xathras. Some people don't have good insurance, and others don't have any at all. I see your point.. the whole system is screwed, so let's go ahead and turn it over to the government. They really know how to run an operation now, don't they???

|6.22.07 @ 4:42PM|#

Seriously, it boggles my mind that there are people out there who want their healthcare managed by the same people who run the post office and the TSA.

dhex|6.22.07 @ 4:44PM|#

i'm not so sure about the whole leaking thing. figure the whole "i sent the film to canada so it could not be seized" is good chaw for, uh, people who think the government was going to seize a film by michael moore. the idea that someone or something is actively trying to sabotage him is the web 2.0 version.

Paul|6.22.07 @ 4:49PM|#

with the cost coming right out of the pockets of everyone else that has insurance...

Like the Canadian system. The Canadian healthcare "syste" is the insurance, and it comes out of the pockets of everyone else. Who do you think pays for the healthcare in Canada?

after, of course, they take your house and car and you file for bankruptcy.

Two words: Charity writeoff.

Over my shoulder, sits the collections department for a major healthcare organiztion. All day long, I listen to collections calls to people who can't afford healthcare and don't have insurance. They get and got their healthcare, and if they qualify, the entire bill gets written off. Done.

Our healthcare system actually does a pretty damned good job of taking care of patients who are less fortunate. Oh, and it takes care of Canadian patients pretty well, too. Yes, I pay for it in higher insurance and healthcare costs. But I also know that there's a freaking bed waiting for me when I need it.

|6.22.07 @ 4:57PM|#

Reinmoose says: "Why aren't there any major libertarian documentaries? Or are there, and I'm just missing them?"

The Pursuit of Happyness -- A true story made into a movie, praising a multimillionaire Wall Street stockbroker who actually repaid money given to him by a welfare agency once he got even a little bit ahead, curses the IRS for taking money out of his bank account, etc.

steveintheknow|6.22.07 @ 4:58PM|#

Ron Bailey

Did you ever see the first movie,The Decline of the American Empire? Awsome as well.

|6.22.07 @ 5:00PM|#

Moore leaked it as a way to cover his fat ass opening weekend. If it tanks then it was a because of the conspiracy to subvert his message. If it is a hit then the message was to powerful to be subverted by The Man. A progressive Win/Win.

I ask, if his message is so important, why wouldn't Moore release it on the internet for free? It wouldn't be because he's a dirty capitalist who puts profits ahead of people would it?

|6.22.07 @ 5:01PM|#

I need some help. I got in an argument with my liberal brother that stemmed from a discussion about this movie. I tried to argue that US health care, with all it's faults, is still better than socialized health care, and that it's faults mainly stem from government regulation. His main argument was that one of the best ways to judge a health care system is infant mortality rates, which are better in Europe and Canada than they are in the US.
I realize that is grossly oversimplifies the argument, but how do you argue with that?

|6.22.07 @ 5:01PM|#

"Why do we have to do that when there are real and measurable ways our healthcare system is head-and-shoulders above their system?"

Such as...?

And no, "I knew this guy who said..." is neither measureable, nor is it usually real.

All of the cost/benefit analyses I've seen show much better outcomes from universal systems.

|6.22.07 @ 5:04PM|#

Pinette,

You theorize that infant mortality is counted differently in the US, and then pretend that the difference you discover is large enough to be not only statistically significant, but explain the entirety of the difference.

|6.22.07 @ 5:04PM|#

Why is it, that I am expected to entertain the fact that socialized medicine in other countries is better - when I have lived under both systems and all first hand experiences tell me the contrary?

I have health insurance in Canada, and I have even have supplemental health insurance in Canada in addition to the government insurance. I do not have any insurance in the United States. If I had any serious illness, I am going to the U.S. to get treatment.

I have a relative in the U.S., who has cancer. She has no money, and no insurance. She is a Canadian, and can go to Canada at any time for treatment. But she rather get treatment in the U.S..

This isn't some abstract choice. You can bet if my life is on the line, I would sell out any political ideals I had to save my life. If a loved ones life was on the line, I would abandon all political ideals to make sure they get the best treatment. The U.S. is the place to get medical treatment.

The only arguement that really matters is "what would you choose". Without a doubt, I would not choose the Euro model of government monopoly health care.

|6.22.07 @ 5:06PM|#

All of the cost/benefit analyses I've seen show much better outcomes from universal systems.

Have you ever lived under a "universal" system?

|6.22.07 @ 5:06PM|#

Pinette,

I would say that it's not the *only* way to judge a healthcare system. Why, you could merely look at the number of MRI machines per 1000 people. Or the wait time to get an MRI. Or the prevalence of level 1 trauma centers. Or the level of investment by medical centers in new equipment.

BTW, I would be surprised to see many states that rank above the US in any of those.

|6.22.07 @ 5:08PM|#

Pinette,

I know that one reason our rate is higher is that because of our abundance neonatal ICUs many more risky pregnancies are brought to term in the US. We have a lot of sickly/premature babies that never would have made it out of the womb in other countries.

|6.22.07 @ 5:10PM|#

A little late to this party but I have seen Barbarian Invasion and it is a quite good movie I would also recomend most of the work from on the fence films.
http://onthefencefilms.com/

|6.22.07 @ 5:12PM|#

I knew a guy who said all of the cost/benefit analyses he's seen show much better outcomes from universal systems.

|6.22.07 @ 5:14PM|#

Because, Rex, you haven't lived in the United States as someone who cannot afford decent health care.

As for hospitals being required to treat people who cannot pay, it's nice that liberals got those laws passed, but we'd really be better off if the dollars we spend to extend health care to the poor were spent more rationally. You know, like a system where they have regular medical care and their diseases are treated at an early stage.

FWIW, I've neither lived in the United States without reliable access to medical care, nor in any other country. I've always lived as one of the fortunate segment of Americans.

|6.22.07 @ 5:15PM|#

Rest assured we won't have universal health coverage any time in the near future. It's like immigration reform, everyone likes to talk about it, but it ain't gonna happen. The status quo still sucks though, get rid of employer provided health care and allow individuals to choose.

|6.22.07 @ 5:16PM|#

Matt J,

"because of our abundance neonatal ICUs many more risky pregnancies are brought to term in the US"

Um, neonatal ICUs only treat babies already brought to term.

But LoL at the quip.

|6.22.07 @ 5:19PM|#

thanks for a rational arguments guys.
except Joe - pretty sure he was mocking me.

Gilbert Martin|6.22.07 @ 5:23PM|#

"Except in Canada, EVERYONE has a wait time, including those with insurance. Get it?"

Oh he gets it all right.

That's what he wants - everyone to be dragged down to the same level, because it's just not FAIR that some have more than others here in the unequal US of A.

|6.22.07 @ 5:23PM|#

[i]Um, neonatal ICUs only treat babies already brought to term.[/i]

Really? They don't treat the ones that didn't make it?

Related question: Can anyone tell me what the rate of abortions are in countries with lower IMRs? You know, as compared to us?

|6.22.07 @ 5:23PM|#

Oops wrong tags. But you knew what I meant.

Paul|6.22.07 @ 5:24PM|#

Why do we have to do that when there are real and measurable ways our healthcare system is head-and-shoulders above their system?"

Such as...?

Canadian measurements. The Canadians have measured their own system and found it wanting. So wanting, in fact that the Canadian Supreme Court has struck the anti-private care laws down because of the very failure of the Canadian "universal" system to provide healthcare to all Canadians.

The court ruled that the waiting lists had become so long that they violated patients' "liberty, safety and security" under the Quebec charter, which covers about one-quarter of Canada's population.

And no, "I knew this guy who said..." is neither measureable, nor is it usually real.

Sounds like a Michael Moore "documentary" to me.

All of the cost/benefit analyses I've seen show much better outcomes from universal systems.

That's funny, because all the cost/benefit anayses I've seen show that universal healthcare systems are the worst.

anon|6.22.07 @ 5:30PM|#

@ Pinette

the infant mortality argument has already been debunked by Slate here: http://www.slate.com/id/2161899?nav=tap3

and covered by Reason here:
http://www.reason.com/blog/show/119199.html

good luck

|6.22.07 @ 5:32PM|#

I have a better idea for a movie: "ANECDOTE: How individual incidents ushered in government tyranny."

How about a new rule in Congressional Hearings: No anecdotal evidence allowed when debating whether to enact a new law.

Paul|6.22.07 @ 5:32PM|#

Um, neonatal ICUs only treat babies already brought to term.

Define brought to term, joe. Most definitions of "brought to term" are babies born at 9 months. Many babies in a NICU are there born extremely premature. Some weigh in at less than 600 grams. 600 grams!

There is an abundance of neonatal ICU's (known as NICU's) in the U.S., and a complete lack of them in Canada, which explains why Canadian patients increasingly fill U.S. NICU's. And often times, they're the poorest and highest need patients of Canadian citizens. I wonder what might be going on there?

Paul|6.22.07 @ 5:33PM|#

*last message should have read

"highest need patients from Canada"

Teach me to post while taking calls.

|6.22.07 @ 5:37PM|#

Um, neonatal ICUs only treat babies already brought to term.

Right. And because we have so many of them we deliver a lot of more babies that would otherwise have been miscarried or aborted to save the mother. More sickly/premi babies in the system are a contributing factor to our higher mortality rate. I say contributing because the Euros do have a leg up on us in prenatal care. At least the lower income levels.

Glad I gave you a laugh.

Paul|6.22.07 @ 5:50PM|#

How about a new rule in Congressional Hearings: No anecdotal evidence allowed when debating whether to enact a new law.

Anecdotes lie at the heart of all populist politics. Without anecdotes, populist politicians would be bereft of substance.

|6.22.07 @ 5:53PM|#

I meant to say at the lower income levels.

But who cares if you make it past infancy only to die of an untreated brain tumor in your teens because your in the back of the brain surgery line?

uncle sam|6.22.07 @ 5:58PM|#

I've got your sicko right here.

|6.22.07 @ 5:59PM|#

What amazes me about Moore is the number of people, like Sharon Stone, and Roger Ebert, who think the guy hung the moon. I look forward to Moore's next doc, Hollywood Brain Trust. Talk about your entertaining fairy tales...

|6.22.07 @ 6:01PM|#

Pinette,

I was mocking "Reason," not you.

Hmm, we seem to be using the phrase "brought to term" differently. I get it now.

shecky|6.22.07 @ 6:25PM|#

Ron Bailey:
I'm finding myself somewhat sympathetic to Moore's position, after dealing with my mom's hospital stay courtesy of Kaiser Permanente, which reminded me very much of the depiction in The Barbarian Invasions. It would have been worse had we not had access to a family member in the medical field in a position to crack the whip and find better solutions.

Granted just an anecdote, but there is clearly a serious problem with American health care, and I'm loathe to find a reasonable solution that relies on a completely private system, unless one is independently wealthy.

|6.22.07 @ 7:12PM|#

A great quote from Eric Hoffer that nicely sums up power-lusting "humanitarians" like Moore:

"The sick in soul insist that it is humanity that is sick, and they are the surgeons to operate on it. They want to turn the world into a sickroom. And once they get humanity strapped to the operating table, they operate on it with an ax."

LarryA|6.22.07 @ 7:15PM|#

Hollywood Brain Trust.

Wow. Three words that really don't belong together.

he stashed the master reel in Canada, lest the Bush administration try to seize it.

So Michael believes the U.S. government can plan and execute a fake 9/11, but can't retrieve a reel of film from Canada?

Wouldn't it make more sense to simply make fifty or so copies and spread them out? Or five hundred? I wonder if Michael backs up his computer.

I can compare the care my wife receives as an uninsured patient from our local private hospital with the care my cousin receives as a service-connected veteran dealing with the VA. It isn't the VA that comes out on top.

|6.22.07 @ 7:57PM|#

There is actually a great libertarian documentary about the health care system, called Hoxsey: How Healing Becomes a Crime.

Mind you, it was not written and directed by a libertarian, but by a scrupulous journalist who was honest and incisive enough to demonstrate the obvious, that government intervention has devastated the practice of medicine. The focus was on the treatment of cancer, but the point was obviously more general. Do rent it on Netflix.

jhn|6.22.07 @ 8:40PM|#

First off, I've actually seen the movie. I pirated the hell out of it. I've never liked Moore for the usual reasons. But this movie was pretty good.

I'm a libertarian but as I've grown older, it's more out of pragmatic concerns than ideological ones. High transaction costs, externalities, and lack of good information can all conspire to make markets fail. In such a circumstance, government action *is* needed. Either to fix the game (which it probably fouled up to begin with) so that the market can proceed as usual, or to step in and just provide the damn service itself at a loss.

Medical insurance has some curious traits. It will become less and less useful as medicine gets better and better. As doctors and actuaries are able to better predict what your actual medical costs will be, there will be much less of a "bet." Your premium will get closer to your actual cost of treatment. Imagine if we knew to a 90% certainty whether a *given* cargo shipment was going to sink to the bottom of the sea, and that there was no way to stop a shipment from proceeding based on this information. In a free market, would anyone provide insurance for a shipment 90% likely to sink at a cost much lower than the cost to replace the cargo and ship?

In short, insurance exists only because of ignorance. We spread out and average the risk. Yet actors in markets function best with more information. An efficient market in medical insurance will eventually exclude the sick and the poor. Employee and other group plans that spread costs around members are all that keeps the situation in the US from boiling over.

In the end, I think that it comes down to this: Should a person be given reasonable medical care, no matter what? I think the answer is yes. You shouldn't use the state apparatus to fund Shakespeare in the park. But it is a greater moral wrong to allow the poor sick to die than it is to tax people and take their money against their will.

The main flaw in Moore's film is that it fails to consider that the American system produces many benefits: we have the best medical technology, the best doctors, the best surgeons, etc. They're just not evenly distributed. A two-tiered system that provides a basic level of care, where decisions about what treatments are needed are never made by people with any financial stake in the matter (or maybe a voucher system), but where enhanced levels of care are available for those who pay, has a potential to get the best of both the French and the American models.

Out.

|6.22.07 @ 9:26PM|#

Hmm, we seem to be using the phrase "brought to term" differently. I get it now.

Geez, joe, which part of "brought-to-term" and thus died as "infants" and were "still-born" because they were never really ever "born" do you not not get?

Because that is really the difference between how birth statistics in most of Europe and those in the US are measured. Many European countries consider babies who died in their first hours as stillbirths rather than as live births that died.

Now if you want to write that off as excessive sentimentality about human life in America (as I do) then go ahead. But don't pretend that it's a meaningful number.

Gilbert Martin|6.22.07 @ 9:50PM|#

"But it is a greater moral wrong to allow the poor sick to die than it is to tax people and take their money against their will."

That is merely your personal opinion.

It's not something that you can prove.

jhn|6.22.07 @ 10:13PM|#

> That is merely your personal opinion.

> It's not something that you can prove.

No. No moral arguments can be "proved" in a scientific sense. You also cannot "prove" that it is immoral to just shoot people and take their money, or that you have some scientific, laboratory-demonstrated "right" to not pay taxes. Pointing out the subjective and contingent nature of moral reasoning does not seek to advance *any* point of view, yours or mine.

PJ O'Rourke once asked, "Would You Shoot Your Grandmother To Pave I-95?" No, of course not. But I would mug someone (after paying my own share) if that were the only way to ensure medical treatment for the poor.

wsdave|6.22.07 @ 10:17PM|#

Alvin,
"I have a better idea for a movie: "ANECDOTE: How individual incidents ushered in government tyranny."

Actually, that may not be a bad idea at all. We could do a documentary on the anecdotes that brought an end to slavery (if there were any), prohibition, seat belt laws, all kinds of stuff. I think it would rock.

wsdave|6.22.07 @ 10:19PM|#

jhn,
"But I would mug someone (after paying my own share) if that were the only way to ensure medical treatment for the poor."

And I wouldn't think twice about killing you for it.

Gilbert Martin|6.22.07 @ 10:21PM|#

"No. No moral arguments can be "proved" in a scientific sense."

It can't be proven in any other sense either.

What can be proven is that there is no ennumerated "right" to medical treatment in the Constitution.

There is also no ennumerated power delegated to the federal government in that document to mandate a socialized medicine system. And the 10th Amendment confines the federal government to ennumerated powers.

jhn|6.22.07 @ 10:22PM|#

wsdave: Ah, but we live in a world, and probably in a country, where most people agree with me and not you.

You are right to observe that it all comes down to force in the end. Unfortunately, you would be on the losing side. You wouldn't be resisting me, but the police, the army, etc.

jhn|6.22.07 @ 10:29PM|#

> What can be proven is that there is no ennumerated "right" to medical treatment in the Constitution.

> There is also no ennumerated power delegated to the federal government in that document to mandate a socialized medicine system. And the 10th Amendment confines the federal government to ennumerated powers.

Are you making a legal argument, or a moral one? If it is a legal one, I suppose you realize that states have plenary power, and are not limited by any enumerations. So, you win. We'll have 50 different socialized schemes, instead. (Might not be a bad idea.)

In any event, Congress would just tie it to an appropriation and mandate what the states have to do. (Not commandeering, "encouraging." Drinking age style.) Or add a sentence that the measure is "To regulate interstate commerce in medicine." Done. Constitutional muster passed. Or do you live in some alternate world of more prudent Supreme Court jurisprudence?

|6.22.07 @ 11:18PM|#

"There is also no ennumerated power delegated to the federal government in that document to mandate a socialized medicine system. And the 10th Amendment confines the federal government to ennumerated powers."

Tax and spend for general welfare clause. Not that I agree with the clause, or socialized or subsidized medicine, or that such a scheme is mandated. But you could squeeze a discretionary socialized medicine, or at least subsidized medicine, into an enumerated power.

Not that there is anything right with that.

|6.22.07 @ 11:21PM|#

You are right to observe that it all comes down to force in the end. Unfortunately, you would be on the losing side. You wouldn't be resisting me, but the police, the army, etc.

Good point. Thanks for reminding me that if I don't do what you want you'll have me killed.

Now, what, exactly, distinguishes you from any other common criminal?

|6.22.07 @ 11:36PM|#

joe | June 22, 2007, 5:01pm | #
"Why do we have to do that when there are real and measurable ways our healthcare system is head-and-shoulders above their system?"

Such as...?

And no, "I knew this guy who said..." is neither measureable, nor is it usually real.

All of the cost/benefit analyses I've seen show much better outcomes from universal systems.
joe,
I can say that all the prevenitive care already occurred before they hit the doctor's door.
Mainly, a big reason why Euros/Canadians are more healthy is that people in the US spend much of their lives with poor diets and sedentary life styles.
By age 40-50, a lot of Americans, and especially the less fortunate, ie poor, have hypertension, heart disease, hypercholestrolemia, diabetes, kidney disease, etc, etc, etc as a result of said lifestyle.

I've worked with a lot of those less fortunate, ie poor, since I am a med student at the LSUHSC/Charity hospital system (the socialized health system of Louisiana) and guess what, they're just like average joe blow American when Herr Doctor Professor asks them to stop eating all that junk food and get some exercise, they look at you like you are asking the impossible.
Hell, I bet a bunch of people in this forum are overweight, need a healthier diet, and could get more exercise (and I am guilty as any), and if someone lecturered them on the benifits of blah blah blah, it owuld go in one ear and out the other.
I know it would mine...

joe | June 22, 2007, 5:14pm | #
Because, Rex, you haven't lived in the United States as someone who cannot afford decent health care.

As for hospitals being required to treat people who cannot pay, it's nice that liberals got those laws passed, but we'd really be better off if the dollars we spend to extend health care to the poor were spent more rationally. You know, like a system where they have regular medical care and their diseases are treated at an early stage.

FWIW, I've neither lived in the United States without reliable access to medical care, nor in any other country. I've always lived as one of the fortunate segment of Americans.
I cannot reiterate how much lifestyle change would do so much and can be done even before someone hits the doctor's office...

Notice too that because of VATs in many countries, things like fast food are MUCH more expensive than here in the US, so while in say Norway people will make their own sandwiches for lunch, in the US people will go drive their car to McD's and get a Super sized Quarter pounder with that HUge-Ass ~500 calories of high-frucotse corn syrup flavored bevarage...
And people wonder why people in the US have so much damn diabetes...

|6.22.07 @ 11:38PM|#

You are right to observe that it all comes down to force in the end. Unfortunately, you would be on the losing side. You wouldn't be resisting me, but the police, the army, etc.

If enough of us resist, the army and the police won't be able to make us give up our liberty.

jhn|6.22.07 @ 11:40PM|#

> Good point. Thanks for reminding me that if I don't do what you want you'll have me killed.

> Now, what, exactly, distinguishes you from any other common criminal?

I *would* have the tax-dodger who tries to escape from jail shot while attempting to escape, yes. Since this is a very tough burden, I would only impose taxation for very important purposes. Like, you know, health care.

As a pragmatic libertarian, if I think that if the state should tax at all, it must be only for those programs that you can countenance the state killing for. (Jailing tax-dodgers, killing attempted escapers/resisters.) Unlike many libertarians, I think that there *are* such programs. (That's where the "pragmatic" comes in.)

Do you consider the actually existing coercive states that exist and have existed in every human culture to be indistinguishable from "common criminals?" Was Queen Victoria no better than a cutpurse or murderer? This is an intellectually consistent position, though I think at odds with human experience.

jhn|6.22.07 @ 11:53PM|#

An additional clarification. It is, in my judgment, more immoral to refuse to pay taxes to support the sick poor, than it is to jail the person who so refuses.

See discussion supra re: the contingent and subjective nature of all moral judgments, including this one as well as the common libertarian declaration that people somehow have a "right" to not be forced to do anything against their will.

(And yes, it should be possible to "opt out" and support some kind of charity instead, if the charity is more efficient. But whether to help at all should *not* be optional.)

jhn|6.22.07 @ 11:58PM|#

> If enough of us resist, the army and the police won't be able to make us give up our liberty.

Where will this "enough" come from?

From the NY Times: "A majority of Americans say the federal government should guarantee health insurance to every American, especially children, and are willing to pay higher taxes to do it, according to the latest New York Times/CBS News poll.

Nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the tax cuts of recent years; 18 percent said the tax cuts were more important."

Of course, the majority of people might want something which is a really, really bad idea. But moral and legalistic arguments will not defeat social health care. Better alternatives might, like the two-tiered system I outlined in my original post, or maybe Cato's medical savings accounts + federal catastrophic insurance or something.

|6.23.07 @ 12:26AM|#

Cost/benefit analysis might demonstrate that single payer systems provide better care than the U.S.'s messy dog's breakfast system but so what? Liberate insurance companies and hospitals from the state and in 20 years time I guarantee the libertarian oriented system would far outshine the creaking single payer systems, which undoubtedly, in years to come, will just gradually get worse: longer wait times/lines, aging/falling apart technology due to budget shortfalls, decreasing amounts of new and cheaper drugs available, etc. etc.

|6.23.07 @ 6:14AM|#

LOLOLOLOL The author uses a study financed by the family of Kaiser Permenente, the biggest HMO, as evidence that Americans are satisfied with HMOs.

John Simon Beverly|6.23.07 @ 6:35AM|#

Here in Sweden -the land of Mr. Moore's ill-considered dreams- the comparably few who is capable of exercising choice in matters of healthcare, faces the double financial burden of first having to pay the world's highest taxes for a healthcare that is notoriously inefficient, slow and even dangerous for patients with ailments requiring prompt intervention; then secondly, having to pay for private health care insurance with what little funds they have available after being hit with the world's highest taxes (which pays for the inefficent, "free" public health care they just opted out of, out of necessity).

I believe Mr. Moore's new movie is more targeted at European audiences, in a bid to position himself on the "Anti-American American"-lecturer circuit, this ever-more lucrative lifeline for American "intellectuals" such as Moore, Chomsky et al, serving European lefties with their knee-jerk Anti-American reactions whilst charging them top dollar for the pleasure.

A truly strange form of private enterprise.

|6.23.07 @ 11:05AM|#

Good post, John Simon Beverly.

...this ever-more lucrative lifeline for American "intellectuals" such as Moore, Chomsky et al, serving European lefties with their knee-jerk Anti-American reactions whilst charging them top dollar for the pleasure.

Exactly. And I bet they don't mind living and spending those top dollars stateside.

|6.23.07 @ 11:13AM|#

We know exactly how the U.S. government would run our healthcare system if given the chance. Think Walter Reed.

|6.23.07 @ 11:18AM|#

Here is an interesting link for those that want to compare the arguments on either side of this debate.

http://pnhp.org/facts/myths_memes.pdf

It is a pro-single payer article, but reviews some of the arguments being presented here (such as neonatal units, infant mortality, quality of care, cost, etc...).,

clearing the air|6.23.07 @ 11:49AM|#

I think a few things are missing in this debate. The most striking is a failure to recognize that there are separate and distinguishable issues at play.

There is (1) An /empirical/ question: Does our health care system work? Given the problems with information asymmetry and adverse selection and so forth, can a purely private enterprise insurance-based health care system /ever/ work to cover everyone?

Then, (2): If not, if government intervention therefore justified? Would private charity cover the market failure? Is it better, in the long run, to simply allow some people to slip through the cracks and not get care, than to decrease the average level of care for everyone? Is it too morally problematic (treating some people as means to an end) to impose a government system, regardless of what outcome may result?

|6.23.07 @ 12:18PM|#

No moral arguments can be "proved" in a scientific sense.
Actally, there is serious scientific research into the basis of moral reasoning. Neurochemistry/physics, evolutionary thinking on the subject, behavioural observation and experiments on primates etc. What fruit this will bear is completely unknown. Of course, that's why the research is being done, isnt it?

Perhaps, jhn, You should rephrase that as "No moral arguments have been proven in a scientific sense." Speculating on the limitations of science can leave you with a lot of egg on your face.

|6.23.07 @ 12:26PM|#

It is, in my judgment, more immoral to refuse to pay taxes to support the sick poor, than it is to jail the person who so refuses.

Is it immoral to refuse to give one of your kidneys to someone who needs one? Should you be jailed for refusing?

Just like my kidney, I'd rather have a choice as to who I give my hard-earned money to, thank you very much.

jhn|6.23.07 @ 12:26PM|#

J sub D:

You are confusing explanations of behavior with justifications of what is "right." An alien from space might be able to determine why people on Earth tend to think that certain things are moral or immoral. The explanation would lay in the brain and evolution and so on, as you say.

But, to someone who does not share those same human brain structures, you will not be able to ever prove their mystical "rightness." It would be like trying to say whether an ant colony was "justified" in its actions.

Morality can be explained and understood. Humans can engage in moral reasoning with one another. But morality can *never* be "scientific" or objective. It is not a property that has any existence outside of the human brain-- and not *all* moral beliefs are universal among humans. Particularly the one libertarians often hold about there being no "right" to force them to pay taxes.

jhn|6.23.07 @ 12:32PM|#

> Is it immoral to refuse to give one of your kidneys to someone who needs one? Should you be jailed for refusing?

Organ transplants are different than having to pay taxes. Giving up a kidney demonstrably decreases your health, paying a marginal fraction of your income does not.

I think a free market in organ transplants would take care of the problem in the real world, so we don't need to go down that route. The difference is that I don't think a free market works in the area of medical insurance.

|6.23.07 @ 12:38PM|#

"Of course, the majority of people might want something which is a really, really bad idea. But moral and legalistic arguments will not defeat social health care. Better alternatives might, like the two-tiered system I outlined in my original post, or maybe Cato's medical savings accounts + federal catastrophic insurance or something."
This is in essence the libertarians problem here, isnt it? They really don't, indeed in some way can't, have any solution to this problem. We've left it to the market, and many people go without care and many who think they have care actually don't when the chips are down, not to mention the inefficiency in our system (health care costs per capita, etc). But what can the docrinaire libertarian say to this, since we already have a private system? Make it MORE private (WTF?). I hear some talk about tort reform (but interestingly tort actions, along with contract actions, are quintessentially libertarian, individuals sue others for proven infractions of rights, government just mediates and insures payment). Face it kids, your fantasy date, the market, let ya down on this one. I realize you guys see the market as some kinda deity, but nobody's perfect, even the invisible hand...

dhex|6.23.07 @ 12:46PM|#

"Giving up a kidney demonstrably decreases your health, paying a marginal fraction of your income does not."

25 to 40% of your income is "marginal?"

jhn|6.23.07 @ 12:47PM|#

> I'd rather have a choice as to who I give my hard-earned money to, thank you very much.

The fact that you prefer something does not mean that others have to acknowledge that you have some "right" to that thing. I do not think there is a right to not be coerced. That does not mean that I think that all coercion is a good idea. I think that the libertarian argument is right when it comes to 90% of the issues, on a pragmatic basis. But for that remaining 10%, coerce away. Tax and spend. Jail the refusers.

Would you require me to pay taxes to support the police who defend your private property?

I am trying to demonstrate that the end point of many libertarian arguments-- that people will be jailed or shot if they refuse to cooperate with some socially-mandated program-- does not win the day. I'm fine with people being jailed or shot for refusing to pay taxes if the only way to achieve some valuable goal is through taxation. I am highly skeptical of any claims that the market cannot do X or Y. But I have become convinced, based on the evidence, that such a situation obtains in the field of health care.

|6.23.07 @ 1:40PM|#

"I am trying to demonstrate that the end point of many libertarian arguments-- that people will be jailed or shot if they refuse to cooperate with some socially-mandated program-- does not win the day. I'm fine with people being jailed or shot for refusing to pay taxes if the only way to achieve some valuable goal is through taxation. I am highly skeptical of any claims that the market cannot do X or Y. But I have become convinced, based on the evidence, that such a situation obtains in the field of health care."
jhn, your reasoned and objective comments are just never, never gonna get you into libertarian heaven (which most H&R'ers are working on doing).
Hey, there's Hayek dancing with Marx.
Marx:"For me this is hell, ya dig pally?"

|6.23.07 @ 1:45PM|#

My favorite libertarian "solution" to health care problems are the health savings accounts, which in English means "allow people to pay for health care." Of course, the fact that we already can do this (oh yeah, but the taxes are less, whoopee, what a bold policy iniative) and it ain't working shouldn't get in the idea of a policy which is in accord with out dogmas.
A much better tack for libs to take would be to just say "yeah, our free market health care system has problems, but intervention will create more and/or different problems that would outweigh any benefits." Or they could do just deny there are any problems (this is the global warming strategy). But I doubt those arguments will have much political pull as everyone knows their current health care is ineffecient, full of red tape (in a market system, say it ain't so!), and immoral to boot.

|6.23.07 @ 2:06PM|#

I find the ongoing efforts of progressives / liberals / democrats like Moore, Ken, and others on healthcare to be amusing.

They are spending an enormous amount of time, effort, and caterwauling to accomplish one goal.

Put George Bush in charge of their healthcare.

Good luck with that guys and hopefully your brainpan won't detonate from the cognitive dissonance.

Lurker Jack|6.23.07 @ 2:08PM|#

jhn and Ken,

Free Market in health care? In the US?

"...close to 60 percent of total U.S. health spending in 1999 - 7.7 percent of GDP - was financed through taxes"

I'm not trying to defend the current situation or even pretend to have a solution, but to your claims, I call Straw Man.

Lurker Jack|6.23.07 @ 2:20PM|#

Ken,
"yeah, our free market health care system has problems, but intervention will create more and/or different problems that would outweigh any benefits."

Isn't this exactly what we've seen since the inception of Medicare? As well as the fall in the percentage of the population covered by private insurance. And the full libertarian boilerplate, if you really want to get it right, is intervention leads to more intervention 'till the whole thing is socialized. I submit that this is exactly the trend we've seen with the continued growth in the percentage of health care spending by gov't at all levels.

jhn|6.23.07 @ 2:23PM|#

I agree, Ken.

The biggest problems with health insurance, which I have never seen a libertarian rebuttal to, is that insurance can only exist in a state of ignorance, and that insurance rewards those who take advantage of information asymmetry-- whether by insurance companies overcharging the inattentive and healthy, or by people lying to insurance companies in order to get cheaper coverage.

In short, health insurance isn't just another product that the market can efficiently allocate. It is a risk-spreading mechanism where every incentive pushes towards excluding the sick poor.

The incentives of insurance are good when they encourage people to not live in flood plains or to be safer drivers. But can you encourage people to not have a family history of diabetes, or to be genetically prone to cancer? All you can do is encourage people to try to be healthy, for what good that does. If you win the genetic lottery and are healthy as an ox, you shouldn't count that as a personal vindication of your achievement and merit and resent paying for those without such wonderful genes. (I, personally, haven't needed to see a doctor in 10 years.)

ps: Lurker Jack-- I don't think I ever said that we have a pure free market in the US in health insurance. I do believe that a pure free market could never cover everyone, for the reasons I've outlined. That said, we currently have the worst of both worlds and nearly *any* reform would be an improvement. Sometimes, the middle way of a regulated market is worse than both a social scheme as well as a totally unregulated market. I think a relatively unregulated market PLUS a guaranteed minimum of care for those it is not profitable to insure would go a long ways toward fixing our problem-- provided the healthy cannot "opt out" of subsidizing the sick, which is the entire basis of health insurance to begin with.

|6.23.07 @ 2:53PM|#

I can't really add anything to jhn. I'll sit back and watch him eat you guys lunches, all the fun and none of the calories. His advantage: he does not have to defend an ideology 100%. Ironically, folks like him (or her I guess I should not assume) are often the best friends markets and freedom have (markets are the natural choice of skeptics, unless of course they are plainly not working).

Lurker Jack|6.23.07 @ 3:20PM|#

jhn,

Indeed it was not you that claimed that the US has a free market in either health care or health insurance, that was Ken and he has bowed out of the discussion.

Like you, I lean toward pragmatic solutions. My preference is that these solutions do not violate liberty. Good Things usually don't follow sanctioned theft. My complaint in this discussion revolves around the notion that there is some empirical evidence to be found regarding the likely success or failure of market solutions to the health care/insurance issues. None has been offered here.

Regarding the nature of insurance in general, one of the patron saints of libertarianism, Ludwig Von Mises, says this...

"Insurance, whether conducted according to business principles or according to the principle of mutuality, requires the insurance of a whole class or what can reasonably be considered as such. Its basic idea is pooling and distribution of risks, not the calculus of probability."

http://mises.org/humanaction/chap6sec3.asp

Thus, I must agree with your statement that "... the healthy cannot "opt out" of subsidizing the sick, which is the entire basis of health insurance to begin with"

Additionally, I agree that the middle way is indeed the worst of all possible ways. I'm certain there is a Mises quote to back that up as well but you don't really need one for agreement do you? ;)

As for market allocation of insurance, even in the relatively successful auto insurance arena we can scarcely call gov't mandated insuance a free market but it is the model that holds the most attraction for me if Something Must Be Done.

Anyway, thanks for the thought provoking commentary jhn.

Gotta run, the wife calls...

|6.23.07 @ 3:32PM|#

I can't wait to download it. Then delete it.

I'll just wait until it comes on the Sundance channel. Then, I'll DVR it, then delete it.

|6.23.07 @ 8:55PM|#

jhn-

But can you encourage people to not have a family history of diabetes, or to be genetically prone to cancer?

Yes.

Just kill all their children... (See Margaret Sanger...)

(After all, if you would kill "tax resisters" that are a 'drain' on your government- why is this any different?)

|6.23.07 @ 8:59PM|#

Ken-

can't really add anything to jhn. I'll sit back and watch him eat you guys lunches

A ".edu" email? Tee hee!

I'll worry about you when mommy and daddy quit buying your lunches...

|6.23.07 @ 9:27PM|#

Me-I'm a professor jackanape, and at a private college. So don't worry about my mommy and daddy buying me lunches, as you and you're kids will be bringining mine and my kids lunches too us (hat tip to Good Will Hunting).

"Indeed it was not you that claimed that the US has a free market in either health care or health insurance, that was Ken and he has bowed out of the discussion." Sorry if I was simplistic, of course there are government dollars in our health care system. But my point holds: we of course have LESS government in our health care system than say Sweden, Norway or France, but we have more uninsured and inefficiency. If government is the problem that's hard to square.

|6.23.07 @ 9:58PM|#

"American students, Moore says, are saddled with debt and, thus, "won't cause [employers] any trouble"-he ignores a recent report from the British Medical Association suggesting that, by their fifth year of medical school, British students "have accumulated an average debt of" $39,000."

and what would the equivalent average for five years of medical school be in the US? i imagine an order of magnitude higher

|6.24.07 @ 12:15AM|#

"Me-I'm a professor jackanape, and at a private college. So don't worry about my mommy and daddy buying me lunches, as you and you're kids will be bringining mine and my kids lunches too us (hat tip to Good Will Hunting)."

Obviously not a professor of English.

"Sorry if I was simplistic, of course there are government dollars in our health care system. But my point holds: we of course have LESS government in our health care system than say Sweden, Norway or France, but we have more uninsured and inefficiency. If government is the problem that's hard to square."

Nor of economics. Maybe ethnomusicology?

One problem with some of these arguments is they fail to address long-term longitudinal issues. What direction are the single payer systems going? Start from their inception, and even before that - to the political economic conditions that made it possible for them to arise, and trace their trajectory. Is the system getting better or worse? Similarily, look at the U.S. system from this longitudinal viewpoint. As more controls have been added each year, has the system become more efficient or less efficient? That's the angle we need to take to understand whether government intervention is beneficial or not.

|6.24.07 @ 12:41AM|#

Me-I'm a professor jackanape...as you and you're kids will be bringining mine

Hey professor, it's your. I'll have ham on rye, k thanks.

|6.24.07 @ 1:39AM|#

As I've said before, health insurance falls in the class of those things where we're trying to cover EVERYONE.

And a lot of people, although they might be ok with charging more for results from one's own obviously self-endulgent behavior (smoking, gross obesity), there's less willingness to penalize people for things that are beyond their control (genetic history).

Libertarians would probably get better reception for their ideas if they figured out a way to fix the present messes in the system--such as the health insurance companies suddenly stopping coverage, or refusing to pay out on contracts already provided, or the incessant haggling as to whether treatment X is covered or not. Don't just say "oh, the market will take care of it", because to the average American the market HASN'T been taking care of it.

Unless the market fixes the problems associated with itself damn quick other people, i.e., government--will jump in and "fix it" for them.

And would all those of you who whine so much about paying taxes please move to a country where there ARE no taxes and shaddup already about it? Of course, these will be countries like Ethiopia, the Sudan, or Iraq, and you'll probably end up paying protection money to the local warlords, but AT LEAST YOU WON'T BE PAYING TAXES so you will be totally happy, right?

|6.24.07 @ 4:02AM|#

Traded anecdotes regarding health care with a group of Americans and Canadians over dinner tonight.

Results: Canadians were pretty satisfied, Americans weren't. Stories from occasionally Americans horrified Canadians. Canadians couldn't come up with any stories to horrify the Americans.

Just another random data point.

Mr. Blather|6.24.07 @ 4:38AM|#

shecky:
Your point about Kaiser Permanente is well taken, even by Michael Moore.

I've seen a copy of the film and if viewers pay careful attention during Sicko they will note that almost all of the most horrific cases of mistreatment and non-payment Moore describes are related to Kaiser Permanente.

The title could easily be changed from Sicko to "Sucko: The Kaiser Permanente Story."

|6.24.07 @ 9:22AM|#

Most professors in anything don't concentrate a lot on grammar and spelling, we have grad students to clean that crap up. Even if we did, we might not put a lot of concentration into message boards (though I would admit that for many on this board that may be the most intellectual thing they do all day, so spit and polish is called for I guess). But seriously, a great deal of wisdom is found both within and without academe, I was just responding to 'me's' snark.
I think this debate is not so hopeless for libertarians, I just enjoy poking fun at the more doctrinaire ones because many points run contrary to their dogma (government=bad, private=good) and the mental gymnastics that ensue are fun to watch.
There are several indicators that we can measure a health care system, and it is plain that on some, like innovation and quality, the US system, which is more market based than most 1st world nations, is excellent. This is no suprise, inequality and markets actually breed innovation and quality (at and for the top though) in most areas.
On other indicators we do poorly. If you think everyone should have basic care, or that a person who has genetic disease but is not well off should still get care, we suck. And this is no suprise either, markets don't seem ideal for things that we think everyone has a basic right to (even the most dogmatic libs usually don't advocate private police [poor people fend for youselves!]).
Popnjay's comments are neat, but not balanced out. We could also take as an indicator how many people are covered or get health care, and if we do that then increasing government is actually highly correlated to rising coverage. And he still has to explain, mighty economist that he is, why a system with LESS government controls and intervention (the US) has higher problems in many areas than comparable ones that have MORE controls (Europe). I don't have to explain that because I can admit that markets are neither magical nor mystical, but that they are beneficial yet at times flawed social arrangements.

|6.24.07 @ 11:21AM|#

I understand that your readers' Libertarian positions does not permit for any government programs such as universal healthcare but the fact is that Michael Moore (hate him or love him) is right that the system sucks and is much like FEMA was during Katrina and that the PRIVATE sector (that is Private Enterprise) in this case is ripping the american public off. One way or another to compete in the global economy healthcare will have to be paid by the government. Eventually the private sector will demand it to compete.

|6.24.07 @ 11:34AM|#

"The main flaw in Moore's film is that it fails to consider that the American system produces many benefits: we have the best medical technology, the best doctors, the best surgeons, etc."

That's because we pay by FAR the most money. And seem to get diminishing returns.

The reality is that no matter what you think, the insurance companies are way way too entrenched and powerful for them to ever go away. Whole towns are built on them, and you'd better believe that Senators and Congressman aren't going to let their local economies go into the sweet night over a national insurance plan.

This situation is a lot like education. There may or may not be some sound economic reasons for market failure. But the mere fact that you decide that the government should fund and regulate something is not the same as proving that the government should actually RUN the schools, or the insurance programs, etc. That's a huge and unwarranted leap of logic.

|6.24.07 @ 11:59AM|#

The argument that everybody deseves "affordabe" or government proveded health crae, presupposes that evrybody deserves something. I'm not a doctrinaire libertarian, but it IS obvious that any increase in personal security comes saddle with a commensurate loss of freedom. Is it the gov'ts responsibility to feed, clothe, house, and provide health care for all?
At what cost? In both dollars and loss of freedom.

|6.24.07 @ 12:01PM|#

Again, I'm not sure you can so easily say that we have market failure here. You can say so if you mean that a great deal of people have no or comparatively poor coverage. Markets don't bring equal results to everyone. But in some way the market in health care is working, providing innovative techniques and top doctors and many services that the public demands but would never be funded in a nationalized system (cosmetic surgery or viagra come to mind). We just have to decide, should health care be like police protection (where we feel everybody should get equal access and levels of protection) or like housing (where we accept inequality and the fact that some go without). I also agree with plunge that jumping from funding/regulating to running may not be warranted, though I am unsure what that implies (I'm guessing something like block grants to many different systems?).

|6.24.07 @ 1:54PM|#

I suppose one could also throw the "chickenhawk" argument back at Moore and ask him to forego paying for a fancy insurance plan or otherwise paying for health care out of his own pocket, become a British, Canadian or French citizen, and, should he or any of his children need an operation, they can wait in line like everyone else.

|6.24.07 @ 1:56PM|#

If something has to be done, I would much rather have the various states do various programs (or not) for a few years before anything is done at the federal level, so we can all see what works best.

|6.24.07 @ 1:58PM|#

I am with Cesar on this one.

Seems like a state level responsibility rather than federal even if you believe in single payer. The feds should only be involved in setting minimal standards of care or other goal setting activities. No direct involvement.

|6.24.07 @ 3:14PM|#

Part of me agrees with Cesar and Neu Mejican, but then I think of Mississippi and what they'd force on their citizens, and I'm unsure. If part of the whole push is to create more equality of opportunity in health care, having 50 plans may not do that.

|6.24.07 @ 5:11PM|#

Ken, don't you really think the federal government has enough on its plate (and in its budget) to take on health care? Again, do you really want George W. Bush or one of his appointees running our healthcare system?

|6.24.07 @ 5:22PM|#

A better alternative to either socialized medicine, and crony corporate medicine exists. And using the free market. Simply abolish the patent system for drugs and medical devices. This might seem impossible, but there are alternative ways to fund medical research. A $200 bottle of pills for example probably costs only two bucks to make. Government granted monopolies (i.e. patents) for medical research allow this. There are other ideas to. I recommend checking out the book "The Conservative Nanny State" at www.conservativenannystate.com .You can read it for free online.

|6.24.07 @ 5:56PM|#

Jost-Won't eliminating patents reduce the incentives of firms to engage in r and d and develop new drugs?
Cesar-I agree that the feds, especially under Bush, are pretty incompetent (see Iraq and Katrina). But more incompetent than Mississippi? That state is positively medieval! It's a tough issue, state expermintation will virtually mean some people will have excellent competent systems, others terrible ones, and then we will still have the problem of unequal access and quality of care. Of course, if one sees no problem with that (as I mentioned, we think that way with say, housing) then a state system may be fine.

|6.24.07 @ 6:16PM|#

Ken-

I believe the states will want to compete with one another to have the best healthcare systems possible to attract the best people and businesses to their states. If single-payer healthcare really raises health stats, then lets see if it does that at the state level.

Another reason for doing it at the state level is the way the federal government usually pays for things. How long do you think it will be until the federal government uses the funds marked for national healthcare on the Iraq War or for a new bridge in Alaska, and borrows endlessly to make up the difference? I would give it about two years.

Single Issue Voter|6.24.07 @ 6:56PM|#

"But more incompetent than Mississippi? That state is positively medieval!"

Wll does that make Louisiana the "dark ages"?

And is Mexico populated with savages or barbarians?

libertreee|6.24.07 @ 6:59PM|#

And this is no suprise either, markets don't seem ideal for things that we think everyone has a basic right to (even the most dogmatic libs usually don't advocate private police [poor people fend for youselves!]).-Ken

I advocate private police. Anyone who has read Radly Balko on this website lately should know that the police do not provide equal protection to the poor. In fact, the police are not required to protect anyone! Numerous court cites for that.

You seem to be nuanced in that you say you are reluctant to admit market failure. Good. But you are locked, it would seem, into the Nirvana fallacy. That is, if the market cannot provide what you think it should, the answer is more government.

Why not more markets, instead? You believe you work in a private university, but there is only one private university, Hillsdale College. All others are semi public, and accept federal funds and regulations to some degree. Yet, since you feel that your university accepts somewhat less federal funds than others, it is private. You compare it to the more regulated, not to Hillsdale.

Simalar fallacy with health care. Because health care is less public in America than Canada and Europe, but not really private, you prefer to compare it to the more public systems, which you claim therefore by comparison are superior, rather than seriously examine how the state has distorted American markets. Despite your denial, you do believe in market failure, and that government must step in to "cure" it the way you think it could, in a Nirvana sort of way.

|6.24.07 @ 7:59PM|#

I liked Moore better when he had a TV show. He seems quite apt at exposing broken policies (Fahrenheit 9/11, Downsize This, and Sicko, according to Moynihan's review) but fails at explaining them (all of the above) or creating a quality proposal. In the TV setting, he didn't have enough time to put forth his cockamamie theories. I respect Moore for his uncanny ability to expose malfeasance. I just wish he'd let the explanations and solutions come from somebody less asinine than himself.

jhn|6.24.07 @ 8:16PM|#

> In fact, the police are not required to protect anyone! Numerous court cites for that.

Courts don't want to get involved in deciding whether enforcement levels are sufficient. If something is against the law, and the police fail to prevent it but theoretically *could* have prevented it, a court isn't going to second-guess a police agency's allocation of its scare resources.

That's what the law is, and why it is. I wouldn't have it be different. The law isn't "the police are not required to protect anyone," it's that the police (and any executive branch agency) gets substantial deference in its decisions.

|6.24.07 @ 8:37PM|#

As far as I read those cases jhn is right. The courts cannot recognize an overall right each individual possesses for police protection because then they would be liable anytime their discretion to have more cops in area x left area y open to more crimes. It would be quite the mess...
Libertree-I'm not sure what you mean by fighting market failure with more markets.
As to Hilsdale, yes they are the only college that refuses federal funds (but many 'private companies' take federal contracts, does that make them 'public' entities?). But Hilsdale is also a bit, well, nutty. Not sure they are a good role model...I agree the police are not to be too trusted, Balko is the man on this. But private police are and would be quite the mess (they would be responsible to the highest bidder and totally neglectful of poor victims).
Lamar-I quite agree with you. Moore is good at provoking questions. I show Bowling for Columbine to my classes and we are amazed at how Moore refutes his owne thesis, that the amount of guns causes the high murder rate in teh US (he shows that it is not too difficult to get one in Canada for example). He casts doubt on other easy answers such as a 'culture of violence', music lyrics, poverty. But then he cops out and adopts an easy answer! In my opinion he's no Morgan Spurlock, who has much more tightly argued, balanced and fun to watch documentaries.
SIV-I'm not sure that Mississipians are necessarily medieval (it was kinda of a joke y'know?), but that state is behind every other state (except yes, maybe LA) in just about every indicator. Mexico makes Mississippi look like a utopia if the same indicators are examined. I guess your point is to threadjack and bring up immigration issues. My answer is that MS and LA have lower levels of social pathology and for all their faults there is a shared history and culture there. Every family has a nutty uncle. You don't get rid of them, but you don't advertise for more in the paper.

jhn|6.24.07 @ 8:42PM|#

libertree- Insurance is a different beast than other "products." It is, as I've already said, not a *thing* but a risk-spreading mechanism. It only works correctly when the healthy subsidize the sick.

Health care is a thing-- I pay you three goats to saw off my son's leg. Health insurance is a gamble.

The incentives of insurance usually work great. It's plumb wonderful that bad drivers with 5 DUIs have to pay more in car insurance than safe drivers. Keeps 'em off the road or keeps everyone else's rates lower: Great.

Not so great when "risky"(i.e. sickness-prone) *people* find that the cost of their "insurance" asymptotically approaches what the cost of their care actually will be. As insurance companies become more sophisticated in being able to predict how likely someone is to contract an illness, this will happen more and more frequently.

Health insurance in the US only creaks along because so many employers buy group plans whereby the healthy employees underwrite the sick ones. Young healthy employees, if they just got cash instead of coverage, might be able to find cheaper coverage elsewhere. Old employees would not be able to find cheaper individual care. I think this setup is pretty awful, frankly. It gives employees a reason to stick with big organizations, and disadvantages small companies and free-lancers.

The very crux of the health-care crisis is that it is just not profitable to insure some people, and never can be-- unless you provide the kind of phony-balony "coverage" which isn't actually there when you need it, which Sicko highlights.

ps: Even with other kinds of insurance, some government oversight is needed just to get the companies to pay out on their contracts. Insurance companies have shown a willingness to shred their reputations in order to avoid paying large claims-- look at the post-9-11 and post-Katrina suits. Management tends to be short-sighted. Hell, sometimes an insurance company can literally have to dissolve itself in order to pay claims. It should have to. How would you make it? In situations where literally billions of dollars are at stake, I fail to see how a system of private law enforcement would function to force the cash out of rackets like Farmer's.

|6.24.07 @ 9:50PM|#

A funny story in the documentary is when Moore tells us how the creator (forgot his name) of the most anti Moore website had to shut it down because of medical cost due to Insurance company not covering much needed medical services. So Moore who believes in the right to criticize sent him a $12,000 check anonymously so he could get the care he needed. The site quickly went back up. So as you can see this has nothing to do with politics as usual, this is about how we have let pure profit take advantage of people who are unable to afford medical care and about how insurance companies will turn you down at will (especially when it cost them too much). The film does not even suggest our doctors are not the best, etc. It is not what the documentary is about. It is about the insurance companies ripping the American public and our fear of universal healthcare. My advise go see the movie and shut up about it until then.

|6.24.07 @ 11:37PM|#

You know, here we are on a libertarian message board, and the support for the private insurance system is pretty tepid and the actual majority of posters seem to favor some kind of governmental response. Now that is evidence that, despite the relentless efforts of several major lobbies, people just are not buying the idea that we have the best health care system in the world. I have no doubt that the checks will get a little larger and the paid punidts whose job it is to spin will pull a Boxer in Animal Farm and dedicate themselves to "work harder" convincing the people. The shrillness will rise as it always does when vested interests must defend the virtually indefensible...But it almost renews my faith in the people I tell ya. You can only deny reality so long I geuss...Now I just hope they don't make the system even 'sicker' which is a real possibility...

|6.25.07 @ 1:46AM|#

"But private police are and would be quite the mess (they would be responsible to the highest bidder and totally neglectful of poor victims)."

That's an assumption, hardly proven. Mall police go after theft in stores as well as police the hoodlums who would prey on innocent victims. Various cities and neighborhoods, from time to tim, have hired private police who also serve this function. I think there was even a movie, called "Cuffs" with Christian Slater that featured these private police - in that case it was San Francisco (unless I have my C.S. movies mixed up..:). While they protect the businesses on the block they also have been shown to break up violence and criminal activity affecting everyone, including the poor. A general, rather than merely selective police force, not only provides security to all but is also just good business as people want to live and shop in areas that are safe.

On another of your points, it doesn't follow that because a majority of people favor some form of government response to health care that this is derived from the view that the U.S. is not the best system in the world. I also am not convinced the U.S. system, as it currently stands, is the best - I think we have the worst of both worlds. But that doesn't mean I think we should go the direction of Europe. I agree with some earlier posters that we have to do more than look at cross-sectional comparisons; we must look towards longitudinal studies to determine the best direction to go. If every indicator is that the European single payer system has gradually gotten worse over the last 20 to 30 years, then it would be a mistake to go in that pyramid scheme direction. If it is gradually getting worse than we should adopt something that at least has some market based incentives built-in, like Cato's plan.

factbased|6.25.07 @ 2:36AM|#

I saw a preview of Sicko last night and this seems to be a rather unreasonable review.

So 89% of Americans are satisfied with the quality of their own care. First, consider that one of the sources is Kaiser Family Health. Second, what happens to the percentage if you separate those with recent non-routine claims and those just getting a yearly checkup? Third, why not also include the next point in that pdf, about the majority of Americans having concerns about being able to continue their own insurance?

Did Moore imply that "such horror stories are de rigueur"? Perhaps. There was a line about people not "falling through the cracks" but "being swept toward the cracks" by greedy insurance companies. The implication is that insurance companies have an incentive to not provide care. Does Moynihan think a few cases that came out alright should have been included, for fairness? I don't recall Moore making any claims about how often those cases happened, just that they do happen and why.

Moynihan next discusses the alternative "according to Sicko" but instead of focusing on Sicko sets up his Scandinavian argument based on a (presumably hyperbolic) statement by Moore about Norway and then exaggerates with the phrase "squadron of munificent bureaucrats."

I, as a viewer, was not left wondering who will pay. Moore asked it himself in the movie and there were statements about it being paid from taxes, as if that was not obvious. Maybe Moynihan's point is that the tax burden would be too high. Of course, anecdotal evidence such as the French middle class couple (family?) is not so convincing, but were there not also statements about the U.S. spending more per person and getting worse results?

The Dillner anecdote in Sweden is first of all a straw man, since Moore did not even cover Sweden. Second, the end result was never even stated - did Elias wait a week, a month? Has he been waiting 3 years now? Third, another straw man is the statement by the Swedish legislator. Moore did not make that statement and who knows what he thinks of co-existent private options.

The Szmyt anecdote is also from Sweden. Why another straw man? Could he not find even anecdotal evidence of this sort of thing in Canada, the U.K. and France? Surely every system must have people falling through the cracks. Also, what exactly was the waiting period the government considered reasonable?

Certainly a fix for America's problems is more complicated than presented. And if other systems have problems, what is the effect of the problems? How do their results compare with our results? At no point does Moore suggest we can only do as well as Cuba. It was presented as an example of what a "small island with few resources" can do, with the clear implication (if not explicit statement) that the U.S. can do better.

Moynihan seems to imply that Hammersmith Hospital has gone downhill, but did Moore film at Hammersmith before or after the cuts reported on in 2005? Were the cuts realized? Was care impacted? Were the linked problems due to these cuts? Would that not be a good argument for more NHS funding? Did the per capital expenditure drop since 2003, when the U.K. spent $2,317 and the U.S. spent $5,711? What sort of services would they be getting if they doubled their expenditure and still paid around 81% of what the U.S. pays? Certainly it would solve the "NHS cash crisis." In perhaps the most laughable part of the piece, a $20,000 bonus is seemingly presented as evidence of waste. But it is simply called "small beer by American standards", without mentioning the United Health Group CEO's $1,600,000,000 windfall. If Moynihan is pointing out that $39,000 of debt is bad for a British medical student, he should be forthright and state a similar figure for the average American medical student, which the American Medical Student Association puts at $120,000 at graduation in 2004.

The statement that only 4% of Britons think the NHS "has enough money and the money is spent well" is not only a straw man, but also misleading. Moore does not claim that the NHS has all the money it should get nor that its waste is minimal. Most respondents to the poll think the NHS is under-funded (29%) or is wasting too much money (64%). How do you think the responses would change if they were spending nearly 2.5 times as much money, like we are?

In the end, we learn that Moynihan does not like Moore's voice, the soundtrack, Dennis Kucinich, Moore's jokes or the lack of specific policy details. Then we get the standard fear of letting "the government run the damn thing" as if faith in the free market was the only point the author really had all along. Socialized health care may indeed be more expensive for Moynihan, O'Rourke and Moore, since its funding would presumably be from a progressive tax. But for most people, and the system as a whole, it may be much cheaper, even if we can't do it any better than those other countries.

Mr. Blather|6.25.07 @ 7:22AM|#

factbased:
I, as a viewer, was not left wondering who will pay. Moore asked it himself in the movie and there were statements about it being paid from taxes, as if that was not obvious.
Moore then downplays the taxes by showing us an "average middle class French family" who take home $8,000 dollars. He never once asks them how much they pay in taxes or if the 8,000 is before or after taxes. He just shows that at least one French family lives well. He also ignores the comments of the French doctor who said that patients "pay according to their means." In other words, it's not only taxes that pay for it, it's also patients themselves.

He does a similar thing with Hammersmith. The trip to England was to show how cheap prescriptions are (he skipped this in Canada, where it's a bit more complex than just six pounds fifty). He then counters the argument that doctors will suffer by showing a well off doctor (he drives an AUDI!). There's no context to show if this is typical or not. He never mentions taxes.

I'm surprised Moynihan didn't mention the trip to Canada where Moore ducks the closest he gets to an actual criticism of socialized medicine. First he shows random newsreels of what appear to be American pundits trashing Canadian health for long waits for things like cancer treatment, hip replacements and cancer screening. He then says sarcastically "let's see what Canadians think about their health care" and interviews his own relatives who trash the American system. He also interviews a "conservative" and then talks about how good Canadian emergency care is by showing the man who got five fingers put back on for free. The viewer, I guess, is supposed to have forgotten that the complaints were about waits for non-emergent care, not care in emergent cases. Finally, he interviews people in a small clinic in London, Ontario who don't mind waiting.

He reports only bad things that happen to Kaiser Permanente patients in the USA and never intervies Americans who LIKE their health care. He reports only positive things about Canada, England, France and Cuba. Talk about straw men.

|6.25.07 @ 8:26AM|#

left-pondian-we actually don't have to speculate as to how private police would perform, it's happened throughout history, for example with the Pinkerton Agency:
http://en.wikipedia.org/wiki/Pinkertons
As a private agency they enforced the "law" as understood by whoever paid them. You also had private police back in the old west when whoever could hired gunhands to enforce the "law" and "protect" their employers (think Shane, or the Lincoln County War for a real life example of that mess).

|6.25.07 @ 8:56AM|#

Ken, I wasn't speculating. I was providing other real life examples in more contemporary times. Also, the "Wild West" might have been wild but in truth was it much wilder than today's world where the police are often corrupt or are forced to abuse their power at the bidding of public officials: see the drug war. A purely private police force would not work protect us all perfectly of course, and would have problems of its own - but I don't think one can assume there would necessarily be more problems than what we have now - and this is especially true for people who currently live in the contemporary wild west zones of the inner cities.

|6.25.07 @ 8:59AM|#

Ken, see the current story on the drug war and Corey Booker at the top of Hit and Run. Talk about the Wild West! What we have is the Wild East, West, North, and South, outside of your safe little suburbs at least.

Gilbert Martin|6.25.07 @ 9:12AM|#

"Would you require me to pay taxes to support the police who defend your private property?"

That's not what you're paying for - you paying taxes to support the police to defend your own private property - and thats' what everyone else is doing as well.

There is a fundamental difference between paying for services that are being provided to you - whether it's government or the private sector doing it - and being forced to pay for services being provided to someone else.

McDonalds cannot force customer #1 to pay for the Big Mac eaten by customer #2. There's no reason why government should be able to do the functional equivalent of that either.

|6.25.07 @ 12:34PM|#

"the "Wild West" might have been wild but in truth was it much wilder than today's world where the police are often corrupt or are forced to abuse their power at the bidding of public officials: see the drug war."
I reiterate, see Shane, its one of the most famous movies of all time (deservedly so) and completes this though experiment. Why would a private police have ANY interest in enforcing the law in an across the board, fair fashion? They would be hired guns, plain and simple. We'd go from enforcing the majority will to enforcing the minority wealthy will, and I think it's plain which is worse...

|6.25.07 @ 1:11PM|#

Some observations:

I suspect that Michael Moynihan's use of Swedish examples is due to the fact that he has lived and worked in Sweden and thus is familiar with how to get this information.

Another thing worth knowing is that not all "single-payer" systems are alike. In fact very few are actually "single-payer" systems in a strict sense.

Australia, France and Germany use a mix of private and public insurance with the State providing a floor or safety net as well as cash assistance for either insurance or direct payment for services. There is also no prohibition on paying for services at private facilities.

To the best of my knowledge Canada is the only place in the free world that prohibits private medical care and has made healthcare a total state monoploly. Interestingly though doctors in Canada are still considered private practitioners they must still accept paymant from one source.

None of the foregoing is intended to express any opinion on the relative merits of said systems, merely to caution those who advocate for (or for that matter oppose) more government involvement in healthcare that there are significant differences in the way different countries approach the matter.

I have no idea how New Zealand (possibly the country in which most American libertarians would feel at home) handles it, though I do know they do have a universal plan.

|6.25.07 @ 1:13PM|#

I had a painful bout with kidney stones and was rushed to the hospital and my health insurance paid for it. A couple of months later, I got kidney stones again (it's genetic for my family) and this time the doctors at the hospital said they couldn't treat it (I needed several days while they melted it with medicine) because my health insurance company declared it a "pre-condition" and refused to pay. I ended up going home, buying the "melting" drugs myself (super-expensive) and some pain-killers and felt like dying while trying to get the stone out while urine was piling up in my kidneys.

Mr. Moynihan, for the majority of Americans who are denied care all the time, your article does a great disservice. Basically all you want is to stay with the status quo, which is, only the rich deserve good health care, the middle-class and poor can eat sh#t and die.

|6.25.07 @ 1:21PM|#

Now, C, MM's efforts are probably aimed at getting him a regular paycheck. In the US there are many "think tanks" funded by vested interests that constantly need intellectual hired guns, and hey, hired guns need a living, integrity be damned!

Gilbert Martin|6.25.07 @ 1:36PM|#

"Mr. Moynihan, for the majority of Americans who are denied care all the time..."

The "vast majority" are "denied care all the time"?

Do you have anything that remotely resembles proof of that?


"Basically all you want is to stay with the status quo, which is, only the rich deserve good health care, the middle-class and poor can eat sh#t and die."

No one "deserves" anything.

All individual rights are negative rights and all individual responsibilities are negative responsibilities as well.

No one has a "right" to receive anything from anybody - no one has an obligation to do anything for anybody.

|6.25.07 @ 1:39PM|#

Walter Reed became worse when they started giving to PRIVATE COMPANIES the duties that used to be done by government personnel.

|6.25.07 @ 1:42PM|#

Gilbert said, "No one has a "right" to receive anything from anybody - no one has an obligation to do anything for anybody."

Oh. So you don't have a "right" to have the police stop someone from murdering you? You don't have a "right" to have the fire department save your house? You don't have a "right" to send your kids to public school? you don't have a "right" to borrow books from the public library? you don't have a right to expect the "FDA" to make sure the food you eat at restaurants won't make you sick or kill you?

All these services are "socialized". Everyone gets them through taxes everyone pays. So why can't we do the same thing as life-and-death as health care?

|6.25.07 @ 1:47PM|#

Oh, C, that is SO reasonable, but will SO not get you into Libertarain heaven! Keep up the good work, sooner of late these libs will realize their relgious views are simply in service of vested interests in the name of "liberty" (though i will not hold my breath)

Gilbert Martin|6.25.07 @ 1:49PM|#

"Oh. So you don't have a "right" to have the police stop someone from murdering you? You don't have a "right" to have the fire department save your house? You don't have a "right" to send your kids to public school? you don't have a "right" to borrow books from the public library? you don't have a right to expect the "FDA" to make sure the food you eat at restaurants won't make you sick or kill you?"

That's exactly correct - no one has a "right" to any of those things. Try suing the police department if they fail to prevent someone from murdering one of your relatives and see how far you get.

|6.25.07 @ 1:55PM|#

To anyone who agrees with Moynihan's criticism, I ask these questions: when you get sick through no fault of your own (maybe you were mugged or like the 9/11 volunteers who got respiratory ailments), and can't go to work and so can't pay for health insurance, do you deserve help or should people just say, "Tough luck!" and leave you to die?

Is that the kind of society we want: where as long as you are well, you can work and afford to get better. But if you have a prolonged illness and lose all your money, you might as well give up?

Given that, Americans would be perpetually anxious and worried should they ever get sick. They'll know with certainty no one's going to help them because guys like Moynihan want things to be that way: no helping the not-rich (it's their fault they don't have enough dough). Wow. What a wonderful society we'll have then: just Paris Hiltons and Dick Cheneys and Bill Gates. We'll just import servants and the minute they get sick, we'll just ship them out again. It'll be that simple.

|6.25.07 @ 1:58PM|#

ken, and Gilbert, in your dream society, I sure you hope you never get sick (if your illness is prolonged and wipes you out, just stay at home with the pain and die), never are in a fire (hey, you need to pay the fireman before they'll hose down your house), or ever need to have your kids educated (bring them to work, they'll assimilate something or the other). Good luck!

Gilbert Martin|6.25.07 @ 2:04PM|#

Spare me the sanctimony, C.

You just want a guarantee that you can sponge off of other people - that's all.

|6.25.07 @ 2:06PM|#

Gilbert said, "Do you have anything that remotely resembles proof of that?"

Here's one study:
"Conclusion: Denials and downgrades are frequent, with marked variation by health plan. More profitable plans had higher denial and discount rates."

Check these out:

http://www.plunkettresearch.com/AboutUs/News/tabid/328/default.aspx

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4DKV7JV-1&_user=10&_coverDate=11%2F01%2F2004&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1413eb11ed7fbcbfd0527b80131159e0

|6.25.07 @ 2:09PM|#

gilbert says, "You just want a guarantee that you can sponge off of other people - that's all."

Man, I make a good living, thank you. I tend to give to charity and I've never had to receive it myself since I make a lot of moolah from the tech industry. Still, since I pay for my own health insurance, I've personally experienced how crappy it is. I want a better system for my money.

As for you Gilbert, I guess you don't care about anyone but yourself.

Gilbert Martin|6.25.07 @ 2:37PM|#

"As for you Gilbert, I guess you don't care about anyone but yourself."

What I don't care about is self rightous moralzing from other people about what all our obligations to each other are - since there has never been so much as one single person who has ever drawn breath on this earth in the entire span of human history who has ever accomplished a single thing in his or her entire life that proves they are one iota wiser than me as to what those things should be.

|6.25.07 @ 2:52PM|#

For all against universal health care. Watch this and see if it doesn't change your mind (she's pretty too):

http://youtube.com/watch?v=x9jPvPMVfn4

|6.25.07 @ 3:41PM|#

Something to do: support Conyers' bill on health care: HR 676

factbased|6.25.07 @ 3:58PM|#

Mr. Blather:
As I said before, anecdotal evidence of a middle class family doing alright is not convincing. You say Moore downplayed the taxes, but was it not clear that the money came from taxes, that the overall cost was less in that system and that the outcomes were better? Is your point that he should have stated the tax rate on that family? Since that funds much more than just health care, it would be misleading unless he then went on to discuss the French government's revenue from all sources and what share goes toward health care. You state that Moore ignores the French doctor's statement, but did he not edit that clip into th
e film?

Maybe it's too obvious, but perhaps he showed the U.K.'s prescription service because he thinks that is a better model than Canada's. Certainly the Audi-driving doctor was implied to be typical. If you think it's misleading though, perhaps you should check some statistics on U.K. doctors' incomes. I believe the one in the film said he made around 100,000 GBP.

Regarding Canada, I agree that the anecdotes are not very convincing. I don't remember him citing statistics on how many (if any) Canadians would want to change to a private insurance model. Were there no surveys of that question, or is it just so overwhelming that nobody has bothered to do a survey. You, I guess, would have preferred that he acknowledge the faults (long queues, outlawing of private care) and then make the point that they still prefer it to be socialized. That's fair. But I think you should acknowledge that given the large gap in per capita expenditures, Canada could virtually eliminate queues and still
spend less than the U.S.

You criticize Moore for only reporting the bad things in the U.S. But what is wrong with focusing attention on the problems? He sees problems and proposes ways to reduce those problems. Could anyone really get the impression that nobody is satisfied with their insurance and care in the U.S.? The positive anecdotes outside the U.S. are appropriate when they illustrate not exception, but general policies (your prescription will cost X, you can get your teeth fixed, preventive care for diabetes is encouraged, etc.) As the anecdotes get more specific to the individual, they aren't so useful except on an emotional level. Yes, he shows only his side of the case, but what straw man does he construct only to knock it down?

jhn|6.25.07 @ 4:46PM|#

>> "Would you require me to pay taxes to support the police who defend your private property?"

> That's not what you're paying for - you paying taxes to support the police to defend your own private property - and thats' what everyone else is doing as well.

> There is a fundamental difference between paying for services that are being provided to you - whether it's government or the private sector doing it - and being forced to pay for services being provided to someone else.

You're making a distinction without a difference. Paying for police protection is insurance, just like health care. Some people pay more than they get out of it, some get more out of it than they put into it.

In both cases, you get "protection." One from marauders, the other from unexpected illness.

Why can't I just decide that I don't want anything to do with your little "police" scheme, thank you very much. I decide that I can defend my own property cheaper. Would you still require that I pay into the public police?

>> All individual rights are negative rights and all individual responsibilities are negative responsibilities as well.

>> No one has a "right" to receive anything from anybody - no one has an obligation to do anything for anybody.

Nonsense, unless you're a strict anarchist. The kinds of arguments you're making defeat much of the platform of the libertarian party, if swallowed.

If I have to pay taxes for *anything*, it means that every "negative" right implies a positive obligation on others to enforce that right. It's a reciprocal obligation, to be sure. But it is not merely an obligation not to act. The right to (say) private property means more than my having to refrain from trespass.

If there is no obligation to act to enforce a "negative right" against third parties, then why call it a "right" at all? You would just have a series of reciprocal agreements. A right is something you don't have to say "thank you" for, and something you don't have to negotiate over.

"Rights" aren't properties that exist outside of the societies that decide they exist. The right to free speech wasn't discovered, it was invented.

Just flat declaring that one kind of right exists and another doesn't is not a good argumentative technique. You need to provide reasons why I should accept one framework and not another.

Jill|6.25.07 @ 4:57PM|#

Gist so far:

Against Universal Health Care:
- I don't want to pay for someone else's inability to take care of themselves
- I don't want to pay for someone who doesn't contribute as much as me
- I want the choice to determine what kind of health care I get
- Socialized medicine is inefficient

Pro Universal Health Care:
- I don't want to worry about going bankrupt or dying if I get really ill
- It's fair to pay for someonelse's health care since I or my daughter or someone I love will also benefit, maybe not now, but some day
- Private health care, motivated by profit, is in cross-purpose with providing the best health care: because providing the best health care usually costs more

Livid|6.25.07 @ 5:00PM|#

Link to guy Michael Moore saved by pressuring health care provider Humana to "un-deny" a pancreas operation via a funeral stunt in front of Humana headquarters:

http://youtube.com/watch?v=cm4sNMKp0Mw

Namesake|6.25.07 @ 5:08PM|#

Gilbert wrote: "What I don't care about is self rightous moralzing from other people about what all our obligations to each other are - since there has never been so much as one single person who has ever drawn breath on this earth in the entire span of human history who has ever accomplished a single thing in his or her entire life that proves they are one iota wiser than me as to what those things should be."

Man, if you haven't figured out what your basic obligations are, I'd hate to be your neighbor. You probably throw the trash everywhere, play your music up so loud at 3 am and wake up all your neighbors, spit and urinate anywhere, steal other people's newspapers, litter, and punch little kids till they cry.

Nurse maid|6.25.07 @ 5:47PM|#

I hope Maria Shriver will divorce Arnold if he vetoes again the California single-payer health bill.

factbased|6.25.07 @ 6:30PM|#

Jill - nice summary of the arguments for and against universal socialized medecine.

Regarding the arguments against:
- There's nothing factually wrong with the "you're on your own" argument, but I disagree with the morality of it.
- Almost the same as the above.
- The choice argument is not a rational argument against socialized health care per se, but against one possible implementation of it.
- Socialized medecine may in fact be inefficient compared to some theoretical ideal, but it seems to be much more efficient than the U.S. system.

Regarding the arguments for:
- How much money would you need to be reasonably safe from bankruptcy or dying from medical bills? Certainly bills can run into the millions. Note that bankruptcy has become more difficult; you may need to pay it off the rest of your life.
- This may appeal to those able to handle their own costs but not those of all the people they care about.
- The current system has monetary incentives for refusing coverage to those most in need of insurance and for denying claims whenever possible.

I would add a few items to the for list:
- Socialized health care will likely do better with long term health goals than someone's temporary private insurer will.
- Another benefit is the removal of a mountain of time-wasting paperwork and bureaucracy.
- And of course, depending on how much we want to improve the care, we will likely save an awful lot of money.

|6.25.07 @ 10:12PM|#

Man, if you haven't figured out what your basic obligations are...

My basic obligation is to leave you alone. Your basic obligation is to leave me alone.

You probably throw the trash everywhere, play your music up so loud at 3 am and wake up all your neighbors, spit and urinate anywhere, steal other people's newspapers, litter, and punch little kids till they cry.

If you cannot tell the difference between those things and leaving people alone then we hardly have a basis to discuss anything else.

But please feel free to tell us all the other things we need to to do.

Mike Reason|6.25.07 @ 10:16PM|#

Michael Moore is the most dishonest sophist in history. In Roger & Me, he pretends that he isn't able to get an interview with the CEO Roger what'shisname. In reality, he did get an interview with Roger and Roger's company filmed it. In Farenheit 9/11, he shows video of president Bush playing golf after 9/11. In reality, that footage was taken before 9/11. Now that socialist pig is calling socialized healthcare, "free." What he neglects to mention is that it is free in the same sense that the government takes a disproportionate amount of your income in exchange for subpar healthcare that they have no choice with. Only an unethical demagogue like Big M would believe that the insurgents fighting to destroy Iraq's democratic government are freedom fighters, and that people would live better under an all-powerful state that sees it's citizens as mere pawns that exist to serve them.

|6.25.07 @ 10:48PM|#

I am British and living in New York. I am also uninsured. Last year I had skin cancer, and everyone fully expected me to go home to get it done free on the NHS, and yet knowing what I know about that system, I chose to stay in New York and have treatment at NYU and Bellevue. I am self employed and don't make a great deal, and even though I couldn't show them proof of income, they gave me a huge low-income discount nonetheless. Service was swift, facilities were top-notch and the medical staff I came into contact with were incredibly professional and nice - a whole different atmosphere to back home, where everyone's overworked and underpaid and doctors don't have a lot of time for you.

US hospitals have such a nice feel to them in comparison! Many if not most of the NHS hospitals are desperately old and outdated in their look, which give them a spooky, authoritarian feel guaranteed to frighten children. I had two spells in British hospitals as a kid and I hated the old creepiness of them.

Gilbert Martin|6.25.07 @ 10:54PM|#

"You're making a distinction without a difference."

Not on your say so.


" Paying for police protection is insurance, just like health care. Some people pay more than they get out of it, some get more out of it than they put into it."

No it isn't. The police force is not in the least bit analogous to a socialized medicine program. The police force is not "insurance" nor is it an "entitlement".

The main function of the police force is to maintain overall public order and prevent anarchy. The police have no obligation to protect any particular individual's life or property and no one has any standing to sue the government for the police failing to do so.

Nor will the police reimburse anyone for the value of property that has been stolen or damaged by criminals. You have to buy property casualty insurance from a private insurance company and pay for that yourself.

That isn't anything like a socialized medicine "entitlement" program.


"If I have to pay taxes for *anything*, it means that every "negative" right implies a positive obligation on others to enforce that right. It's a reciprocal obligation, to be sure. But it is not merely an obligation not to act. The right to (say) private property means more than my having to refrain from trespass."

Nope - that's just your characterization of it.
Paying taxes for the administration of the law does not constitute an "affirmative obligation" to any other individual citizen.

"Just flat declaring that one kind of right exists and another doesn't is not a good argumentative technique. You need to provide reasons why I should accept one framework and not another."

LOL - you're no authority on argumentative technique nor does it matter to me what you do or don't accept.

I can flat out declare that affirmative rights don't exist because they aren't ennumerated in the Constitution. The rights specified in the Bill of Rights - freedom of speech and religion, the right to keep and bear arms, private property rights - they are all negative rights.

Furthermore my views on the matter are in sync with the man who pricipcally authored the Constitution in the first place:

"I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents."

James Madison

And since it's an absolute physical impossibilty that any 20th century liberal alive on this earth could ever possibly be any wiser than James Madision about the role of government - I'll go with him on it.

Gilbert Martin|6.25.07 @ 11:06PM|#

" Socialized medecine may in fact be inefficient compared to some theoretical ideal, but it seems to be much more efficient than the U.S. system."

Says you.

We already have a socialized medicine system for old folks - it's called Medicare. When the program was started in 1965, the official government projections for what the spending would be for hospital insurance in 1990 was $9 billion. The actual amount in 1990 was $66 billion. The Medicare payroll taxes are now nearly double what the original supporters promised would be needed to fund the program.

The unfunded liability to pay for future Medicare benefits (on an actuarially determined net present value basis) is about $75 TRILLION dollars.

Social Security and Medicare are projected to take more than 50% of federal income tax dollars by the year 2030 - and that's on top of the dedicated payroll taxes for those programs.

There is no way that those programs can be sustained on that basis. The government cannot afford to sustain the entitlement programs that have already been created. The politicians are not only refusing to address the problem they are now tryng to create an even bigger entitlement of socialized medicine for all.

|6.26.07 @ 12:42AM|#

I have never waited longer than fifteen minutes for any health care in Canada. No one in my family has ever waited for or been refused care. Your anecdotal evidence would suggest otherwise. Government can do many things better than the private sector. War for instance. Yours seems proficient at that. No I lied, not proficient at war, just profiting from it. They can always find the money for killing.

|6.26.07 @ 2:39AM|#

As defintions of 'good' health evolve how will a completely politicized system cope? Afterall all goods and services have limits and have to be rationed in some way - either through markets or through political decisions. So, how will the mandarins of the politically based systems decide what will be defined as a 'need' and what will be defined as a luxury, a 'want' as they definitions of 'good' health evolve. And who will get to decide that?

I smell a falling giant, creaking under the weight of increasing demands, more lilaputians pulling on him for better and more services, more ropes of an increasingly tax strapped citizenry thrown around his neck, dragging him to the ground.

Comment|6.26.07 @ 3:07AM|#

The poor are poor because they deserve it. People who can't afford quality health care are in their rut because of their fault. We shouldn't do anything for them or to help them. Let every person sink or swim on their own. That's the American way. You'll end up with only the fittest. Like have crippled people, sick people, deaf people, blind people ever contributed anything to our society? Are we what we are because of anything these people have done? Do away with them if need be.

We need to be a country of the strong, the beautiful. Those who can't hack it because of bad genetics or bad luck need to leave our borders--we don't have space for you (well maybe to clean our garbage, pick our fruits, and clean our latrines--but please leave soon after, you shouldn't waste our resources by staying on).

And if ever I encounter bad luck myself and no longer be one of the chosen, then I should just commit suicide.

Like these arguments--these are the ones against universal health care.

Reallynow|6.26.07 @ 3:15AM|#

"There is no way that those programs can be sustained on that basis."

If we can sustain a hundred-billion-a-year war for several years (Iraq) we can sustain a hundred billion a year for health care.

|6.26.07 @ 8:15AM|#

Comment,
Have you ever considered that someone might oppose universal health care not because of the ad hominem and straw man arguments you mudsling around but because they worry that universal care systems are based on pyramid scheme types of economics and so will ultimately crack and crumble, resulting in worse care - less availability of services, longer and longer wait times, less money for r and d and research, for everyone including the poor, in the years to come? No? I guess it's just easier to sling mud around then try to understand your opponents. I really wish some of you could have an econ 101 textbook dropped on your heads to at least understand notions of scarce resources, rationing under alternative systems, etc.

Gilbert Martin|6.26.07 @ 8:17AM|#

"The poor are poor because they deserve it. People who can't afford quality health care are in their rut because of their fault. We shouldn't do anything for them or to help them."

You and everyone else are perfectly free to help anyone you wish to - to the extent of your own finances.

Government has no authority to mandate charity. Other people's money isn't yours to give.

Gilbert Martin|6.26.07 @ 8:20AM|#

"Government can do many things better than the private sector. War for instance. Yours seems proficient at that. No I lied, not proficient at war, just profiting from it. They can always find the money for killing."

You'd better be glad we have the military that we do, since the US military is the ONLY reason that Canada still exists an independent nation today.

Reallynow|6.26.07 @ 10:24AM|#

Grannykiller: "I really wish some of you could have an econ 101 textbook dropped on your heads to at least understand notions of scarce resources, rationing under alternative systems, etc."

Okay--explain how a system where the private health care provider, by providing quality health care ups their costs and lowers their profit? Economics 101 says they should then try to lower costs and maximize porfits by denying care, kicking people off coverage. Umm, I wonder what kind of care such a system would provide?

Another Economics argument: why would pharma firms come up with cures and vaccines? cures would stop pharma firms from selling medicine for the disease. Vaccines would stop the disease themselves so is also a no no. Which is why, according to recent stats, the number of U.S. pharma firms working on cures and vaccines has gone down from 25 to 5.

Gilbert Martin|6.26.07 @ 11:27AM|#

"If we can sustain a hundred-billion-a-year war for several years (Iraq) we can sustain a hundred billion a year for health care."

One - entitlement programs go on forever - not several years.

Two - Medical hospital insurance alone was $66 billion a year back in 1990. I don't know without researching it what it is today but I'll bet it's over $100 billion now.

The unfunded liability for Medicare is $75 trillion. As I said before, the government can't afford to sustain the entitlement programs that already exist - much less create new ones.

Gilbert Martin|6.26.07 @ 11:29AM|#

Make that Medicare hospital insurance - not Medical.

Namesake|6.26.07 @ 11:40AM|#

Social security has gone on for years. It costs billions. You think Americans can't handle it?

Just cutting the defense/CIA budget by a third will be enough to pay for universal health care.

|6.26.07 @ 11:51AM|#

I just moved to the UK in February from the US. Prior to taking my current position, I was in London for interviews when I had a kidney stone attack. I forge the name of the hospital I was at, but it was very close to Heathrow, I believe it was called Hillingdon. I received the worst care I ever received in my life. I arrived around 10pm to the filthiest ER I had ever seen. The bed they put me in had dried blood on it, and the gown they wanted me to wear was dirty and had holes. Very early in the next morning, around 2am, I was moved to a room where a surgeon looked after me. I asked for more pain killers as the does they gave me had no effect. He looked at my chart and quickly ordered an additional dose. He said that the ER only gave me half a dose, a standard practice there to see how little the patients can deal with. Other than the surgeon who saw me at 2am, I did not see a doctor for the entire day. The following day a doctor finally came and saw me. He said that they would not be able to do a CT scan for at least 2 weeks and that it would be best if I just went back to the US to get treated. He gave me enough pain killers for the flight back to DC. I returned home just in time for Christmas. The day after Christmas, I found a doctor through my insurance company and had an appointment for that day. He got me in for a CT scan on the same day.

When I started my current job, I had a selection of benefits to choose from, including private health insurance. So, despite the wonderful and "free" NHS, every single co-worker said that I needed the private insurance. And for dentists, if you don't have private insurance, it's almost impossible to get an appointment with an NHS dentist if you are a new patient. Most of them are not accpeting any new NHS patients.

Namesake|6.26.07 @ 11:53AM|#

Speaking of the defense/CIA budget, how many more nuclear missiles, torture prisons, overpriced no-bid Halliburton contracts do we need?

Do we really need all our arsenal? Are we like waiting for Galactus or something to strike the Earth? We can probably do with half of all our defense/spy spending (even less if we actually were efficient). Then we'd have less taxes to pay and universal health care to boot.

C|6.26.07 @ 12:11PM|#

Jorge Del Rio, what you went through is nothing compared to what this US college student went through because there's no universal health care in the US:

http://youtube.com/watch?v=x9jPvPMVfn4

Gilbert Martin|6.26.07 @ 12:35PM|#

"Social security has gone on for years. It costs billions. You think Americans can't handle it?"

As a matter of fact they can't handle it - or Medicare either. Both are headed for serious cutbacks or collapse.



"Just cutting the defense/CIA budget by a third will be enough to pay for universal health care."

Bullshit - you have no idea what you're talking about.

Namesake|6.26.07 @ 12:44PM|#

If you want to know how big the defense budget is, check this out...

http://www.benjerry.com/americanpie/

as for the intelligence (CIA, etc.) budget...

http://www.fas.org/irp/budget/index.html

Gilbert Martin|6.26.07 @ 1:04PM|#

Military spending is about 20% of federal outlays.

Social Security and Medicare alone are 37%

As I said, you don't know what you're talking about.

Namesake|6.26.07 @ 1:40PM|#

Actually "20%" is currently not correct. Thanks to Iraq:

http://www.warresisters.org/piechart.htm

Gilbert Martin|6.26.07 @ 2:27PM|#

Whatever is currently "correct" is not going to be defined by any group called "warresisters".

I go by the pie chart of federal outlays the IRS puts out in the 1040 tax instruction book.

Whatever the "current" percentange is for the military - it's still less than the percent for social security and medicare. And social security has been going on since 1935 and medicare since 1965 - far longer than the spending for any war.

C|6.26.07 @ 4:31PM|#

I don't see Gilbert or any anti-universal health-care person answering the crucial questions posed earlier:

1. Okay--explain how a system where the private health care provider, by providing quality health care ups their costs and lowers their profit? Economics 101 says they should then try to lower costs and maximize porfits by denying care, kicking people off coverage. Umm, I wonder what kind of care such a system would provide?

2. Another Economics argument: why would pharma firms come up with cures and vaccines? cures would stop pharma firms from selling medicine for the disease. Vaccines would stop the disease themselves so is also a no no. Which is why, according to recent stats, the number of U.S. pharma firms working on cures and vaccines has gone down from 25 to 5.

|6.26.07 @ 4:34PM|#

For those whining about the length and costs of the war in Iraq, they sure are quiet about the length and costs of the war on poverty.

C|6.26.07 @ 4:35PM|#

For profit makes sense when building computers, shoes, movies, not for deciding whether to treat someone's illness or not.

Imagine your doctor asking himself, "Hmm, I won't get my bonus if I give the care this guy requires--it'll cost our company too much money...so should I? I so want to take that trip to Barbados so I really need that bonus..."

|6.26.07 @ 4:40PM|#

C,

1. You have no clue about the invisible hand. No one would pay for a service that gives them no service. Therefore, profits would dry up due to the *lack of income* regardless of cost cutting measures. Your universal system you advocate is a monopoly. It needn't worry about cutting service to cut costs because there would be no backlash.

2. Treating the disease is easier than finding a cure. You mitigate the risk of a losing cause in finding a cure. Why swing for the fences when a three singles would drive in the same run?

|6.26.07 @ 4:42PM|#

C, forcing people into a system where they have no choice is facsism.

|6.26.07 @ 5:02PM|#

How come when reacting to arguments for government run health care we always get the "government will be just as bad if not worse than the private sector" argument? When are you going to explain how capitalism provides adequate care for everybody who needs it? Moore give anecdotes about private insurers being mean, you give anecdotes about government bureaucrats being mean? Can't you spend some time discussing how awesome and amazing private insurers are? Instead it's like, you're admitting we live in a shitty system but any attempt to change things would make things even shittier. Sounds like the same "debate" we have about Iraq. Can I get some solutions please? Otherwise stop wasting my time.

|6.26.07 @ 5:08PM|#

mishu:

The war in Iraq kills and maims thousands of people. When I see social workers with missing limbs rehabbing at Walter Reed I'll totally join you at that War on Poverty protest.

|6.26.07 @ 5:47PM|#

I guess you forgot to mention that Elias Dillner and his sister Agnes got their hearing back by the Swedish hospital for free, apparently less than a week after complaining.

Source:
http://www.expressen.se/nyheter/1.87394

Gilbert Martin|6.26.07 @ 5:47PM|#

"I don't see Gilbert or any anti-universal health-care person answering the crucial questions posed earlier:"

Sorry but I don't accept you as the arbiter as to what the "crucial questions" are.

As far as I'm concerned, the crucial question is why should any individual ever be required to pay for medical treatment of another individual in the first place?

C|6.26.07 @ 6:01PM|#

mishu, you do have a choice. Even in Canada, France, etc., you can opt for getting extra, private health care. But at least you won't have any worries when you get sick whether you'll get a doctor to take care of you.

Forcing people to follow rules which keeps everyone safe and healthy is not fascism. It's being a good citizen and being wise.

You say, "1. You have no clue about the invisible hand. No one would pay for a service that gives them no service." This is exactly why there's a clamor to change current health care--people are not getting proper service for their money. People are starting to realize, to get the best health care for their buck, they should go universal/single-payer/not-for-profit style.

Again, your arguments are merely this: private health care will just do enough so people will keep paying. But private health care cannot give great service or their profits will dry up. What kind of free-market system is that? Where a mediocre product ensures the most profit? It's screwed. Everyone's realized this (except maybe you) and so people are demanding change.

In a couple of years, when you and your children are enjoying free health care set up by Liberals, just remember all your arguments against it.

You guys seem to forget all the Liberal benefits such as the lemon law, clean air act, clean water, school sports for both your son and daughter, national parks, the Internet, protection from illegal search and seizure, etc.

C|6.26.07 @ 6:04PM|#

Gilbert, "As far as I'm concerned, the crucial question is why should any individual ever be required to pay for medical treatment of another individual in the first place?"

Question is, why should any individual pay for crappy medical treatment? And you'll definitely get that because you don't face the plain fact that for-profit health care cannot provide good treatment because it hurts their profit motive.

Io|6.26.07 @ 6:07PM|#

Hey mishu, gilbert, try this: call any U.S. private health care provider, tell them you were born with diabetes and ask if you can get full coverage. If they agree, ask how much.

Paul|6.26.07 @ 6:18PM|#

Mishu and Gilbert should go live in a cave or join a monastery. The way they talk about not being co-dependent on other people is plain silly. Hey you two, who made your clothes, who taught you at school, who made your food, who made the ingredients for your food? Answer: other people. You can't exist by yourselves so you need to co-exist. To do that, you have to we all have to agree on ground rules. Most people don't want to go bankrupt when they get ill. The only solution is paying for universal health care via our taxes. If you guys don't like this solution, then you can migrate to a third-world country.

ACD|6.26.07 @ 8:00PM|#

Failure is the motive for success. We strive to be right than wrong. People rise to the occasion and get lazy when one is absent. The Nanny State promotes laziness, lack of ambition and ultimately innovation and entrepreneurship disappear, plunging the state into collapse.

Social Programs are the training wheels of society, and we all know it takes a kid twice as long to be confident on a bicycle with training wheels than when nerves push him to master his balance. People take risks and get brilliant under stress. So why are all these utopian liberals about peace-on-earth, everyone living under the same social status free from peer criticism and competition other than to assuage their own white-guilt?

Health Care is a privilege, not a right. If you care so much about the welfare of the poor, tithe to charity, but don't force me to pay for your idealism through taxes, an inefficient government and a nanny program that reduces my way of life.

|6.26.07 @ 8:43PM|#

enjoying free health care

It is not free! It is paid for through exorbitant taxes. A middle class person would have to give up over half his income to taxes to fund socialized medicine. That's how much it costs in Canada and Germany. At least in Germany you can opt out for a private company however, you still have much less take home pay. Remember this is for middle class people. The socialists here think they are finally taxing the rich for their "fair share". Nothing could be further through the truth. The rich can afford to move their money to tax havens. Look at that famous "philanthropist" Bono. He spends his time nagging heads of state to commit more tax money to African aid. Meanwhile, he changes residency to the Netherlands to dodge Irish taxes. Socialism has always crapped on the middle class while making no difference to the rich. Everyone suffers the same.

Hey you two, who made your clothes, who taught you at school, who made your food, who made the ingredients for your food? Answer: other people.

Other people who voluntarily enter into contracts to exchange their materials, labor and/or capital for like rewards based on negotiation. They didn't do it under duress like the Stalinists around here would impose.

Gilbert Martin|6.26.07 @ 10:26PM|#

"Question is, why should any individual pay for crappy medical treatment? And you'll definitely get that because you don't face the plain fact that for-profit health care cannot provide good treatment because it hurts their profit motive."

LOL

That's not even remotely close to being a "plain fact" - it's merely your claim.

Every business has a profit motive. The "profit motive" doesn't prevent Toyota from building good cars.

You aren't the least bit capable of proving that all for profit medical treatment is "crappy" or that all non-profit medical treatment is terrific.

Being forced to pay for somebody else's medical treatment is far crappier than just paying for your own - regardless of the quality of care you're paying for - which is your own responsibilty to shop for by the way, just as it is for shopping for anything else you buy - like a car.

Gilbert Martin|6.26.07 @ 10:34PM|#

"The way they talk about not being co-dependent on other people is plain silly. Hey you two, who made your clothes, who taught you at school, who made your food, who made the ingredients for your food? Answer: other people."

Blah, blah blah - I've heard all that talk before and it's still nonsense every time I hear it.

Other people are in the business of providing food, clothing, etc. to others because that is how they've chosen to make their living. They're doing it to make money - not as some altruistic act. And I oblige them by giving them money in exchange for the things they've provided to me. As the language of contract law goes, consideration was given by both parties and the deal is done.

Nothing further is owed to anybody else who wasn't a party to the deal.

Gilbert Martin|6.26.07 @ 10:37PM|#

"The only solution is paying for universal health care via our taxes. If you guys don't like this solution, then you can migrate to a third-world country."

No if you don't like private healthcare, you can migrate to one of the socialist countries.

I'll stay right here and work to make sure socialized medicine schemes are defeated - just like Hillarycare was the last time around.

jhn|6.26.07 @ 11:27PM|#

> The main function of the police force is to maintain overall public order and prevent anarchy. The police have no obligation to protect any particular individual's life or property and no one has any standing to sue the government for the police failing to do so.

> ...

> That isn't anything like a socialized medicine "entitlement" program.

Please answer the original stated question: Under your view of the distinction between positive and negative rights, what claim does society at large have on my pocketbook to pay into the general fund to pay for, inter alia, the police? I'm not a troublemaker, so I never violate anyone's rights directly. I am in no need of state protection. Why do I have to pay? What are you going to do if I refuse?

> Paying taxes for the administration of the law does not constitute an "affirmative obligation" to any other individual citizen.

You are glibly calling the maintenance of a police force, which maintenance necessarily provides unequal benefits, the "administration of the law." This is a verbal trick. I could just as well call socialized medicine "the administration of health care."

There is nothing magical about "law" (defined here as the keeping of the peace, etc) which distinguishes it from any other good which government may or may not provide. You might call it a public good with positive externalities-- but once you go down the "public goods" path there's really no stopping until you end up at Sweden.

Unless, of course, you make *pragmatic* and not *ideological* distinctions between public policies.

> LOL - you're no authority on argumentative technique nor does it matter to me what you do or don't accept.

Nor, then, does it matter to me what you say your rights are or aren't.

This may come as a shock to you, but "rights" are not an objective property of matter or of the human mind. They exist only through messy social processes and rough consensus. They have no being, no reality, apart from this. If you want people to accept that a certain right does or does not exist, you have to convince them that it should or should not. Convince enough people and *poof* a right appears. Once it's created it's as real as Mickey Mouse.

> I can flat out declare that affirmative rights don't exist because they aren't ennumerated[sic] in the Constitution. The rights specified in the Bill of Rights - freedom of speech and religion, the right to keep and bear arms, private property rights - they are all negative rights.

The Constitution enumerates *powers of government* not personal rights or liberties, which the Constitution does not try to list or limit.

Hint: Check the Tenth Amendment.

> Furthermore my views on the matter are in sync with the man who pricipcally[sic] authored the Constitution in the first place:

My views on the matter are in sync with Mr. Edmund Burke, who outlined a theory of rights as an entailed inheritance. My view of the necessity of government is in sync with Hobbes. My view of the necessity of some government involvement with health care is based on opening my fucking eyes.

> "I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents." James Madison

Oh, zing! I guess we'll just have the states do it, then. What with their plenary power and all. Would Madison have objected to Virginia allocating money for those French refugees, or was his argument strictly constitutional?

Why are you citing a legal argument to make a policy point? Is policy X good or not good only in America and only because of the Constitution? Should there be free speech in China? If so, why? Please note that in China they don't give a fig about James Madison.

> And since it's an absolute physical impossibilty[sic] that any 20th century liberal alive on this earth could ever possibly be any wiser than James Madision[sic] about the role of government - I'll go with him on it.

The "role of government" isn't some property that can be determined like the weight of a feather. Like all else in human affairs, it just depends. In the case at hand, it depends on the specific nature of modern health care and the peculiar properties of insurance in a time of increasing medical sophistication, how those relate to the legal structure of corporate governance, and specific problems I've already detailed like gamesmanship and adverse selection.

Gilbert Martin|6.26.07 @ 11:59PM|#

I'm tired of your long winded bullshit, jhn.

Not on your say so - is an entirely sufficient response to each and everything you have said - period.

jhn|6.27.07 @ 12:17AM|#

Gilbert Martin,

Nothing's on anyone's say so. It's just that you make statements, contradict yourself, and back yourself into indefensible positions. I offer arguments. Say it ain't so!

What I'm tired of is know-it-alls like you who have figured out all the mysteries of political economy before the age of 25. But I try to keep it civil, you know. Sorry about the long-windedness. "LOL," as you would say.

Still anxious to hear from you re: "What are you going to do if I refuse to pay taxes?" I'll be happy with a response to that one quick point.

jhn|6.27.07 @ 12:37AM|#

My mistake, Gilbert. You write with such confidence I thought you were a teenaged boy-- a younger version of myself, perhaps. In fact, you appear to be a grumpy-looking, middle-aged accountant based in the American south.

We fellow Hit-and-Runners are glad to accept your say so!

Io|6.27.07 @ 1:58AM|#

Basically Gilbert, mishu, etc. all work for the Health Care industry and are worried their days of billion dollar profits at the expense of people's health and lives are coming to a close.

Gilbert Martin|6.27.07 @ 8:38AM|#

"It's just that you make statements, contradict yourself, and back yourself into indefensible positions."

And that is also not on your say so.


"Please answer the original stated question: Under your view of the distinction between positive and negative rights, what claim does society at large have on my pocketbook to pay into the general fund to pay for, inter alia, the police? I'm not a troublemaker, so I never violate anyone's rights directly. I am in no need of state protection. Why do I have to pay? What are you going to do if I refuse?"

Paying taxes for the police has nothing to do with creating any "rights" at all - either positive or negative. The police are part of the law enforcement mechanism that holds people accountable who break the law and violate the rights of others. You claim you never violate anyone else's rights but you could be a liar. You have to contribute toward keeping yourself and everyone else in line.
None of that creates any "affirmative right". It only makes sure you are held accountable if you violate somebody else's negative rights.

None of that is in any way comparable to an entitlement program.


"What I'm tired of is know-it-alls like you who have figured out all the mysteries of political economy before the age of 25"

What I'm tired of is liberals trotting out nonsense like claiming the police force and the fire department are "socialized" and therefore creating a socialized medicine system is just following the same principal.

Oh and there's no such thing as a "political economy".

jhn|6.27.07 @ 9:38AM|#

> What I'm tired of is liberals trotting out nonsense like claiming the police force and the fire department are "socialized" and therefore creating a socialized medicine system is just following the same principal.

I'm not a liberal. There need to be very good reasons for me to support government intervention in any field. Such reasons exist with regard to medical care for the poor.

I don't think that the fact of socialized law enforcement is reason by itself to support socializing anything else. There need to be reasons that are examined in each case. In each case, you ask: Is there market failure? Is it a public good? Is it morally justifiable to coerce taxes from people to pay for it? What's the cost/benefit analysis?

You have to answer these kinds of questions with particularity, and your attempt to distinguish the two on a priori grounds is pathetic. So, pay taxes or go to jail-- but that's not an "affirmative obligation."

Oh, and what of the fire department, by the way? Why can't private fire insurance handle that?

> Oh and there's no such thing as a "political economy".

Google it.

Gilbert Martin|6.27.07 @ 10:44AM|#

"You have to answer these kinds of questions with particularity, and your attempt to distinguish the two on a priori grounds is pathetic."

I don't have to do anything - including going along with your attempt to set yourself up as the judge of what counts as being "socialized" or being the authority on what is or isn't a valid argument.


"There need to be very good reasons for me to support government intervention in any field. Such reasons exist with regard to medical care for the poor."

And that's something else you cannot prove.

"Google it."

No reason to. All that would prove is that someoone has used the term "poltical economy" - not that it actually exists.

jhn|6.27.07 @ 11:52AM|#

> I don't have to do anything - including going along with your attempt to set yourself up as the judge of what counts as being "socialized" or being the authority on what is or isn't a valid argument.

I'm not setting up myself as a "judge." I'm just offering arguments, backed up by reasons why I believe what I do-- reasons which I have obtained from my study of "authorities" much smarter than you or I are. You're countering my arguments by deciding not to engage with them because I am no "authority." What does that even mean? Are *you* an authority? Wanna compare degrees?

My libertarian beliefs are pretty strong, my friend. But they're based on empirical observation of the world and an open mind, not semi-religious delusion.

>> There need to be very good reasons for me to support government intervention in any field. Such reasons exist with regard to medical care for the poor."

> And that's something else you cannot prove.

Thing is, it can be proved. And has been, to the extent that anything human can be "proved." To a moral certainty if not a mathematical one.

Even if it hadn't been, it's the kind of thing which is *susceptible* to proof-- not before-the-fact ideological declarations of what does and does not constitute valid government action.

> No reason to. All that would prove is that someoone[sic] has used the term "poltical[sic] economy" - not that it actually exists.

My, you're quite the intellect. A whole field of study doesn't exist? Does physics exist? The moon? How about laughter? As in, I'm laughing at what a fool you're making of yourself?

Gilbert Martin|6.27.07 @ 12:21PM|#

"Thing is, it can be proved. And has been, to the extent that anything human can be "proved." To a moral certainty if not a mathematical one."

It hasn't been proven in either sphere. There isn't anything that CAN be proven as a "moral certainty". Morality is strictly a matter of personal opinion. Certain consensus opinions of morality have been codified into laws that we are obligated to abide by. But even that doesn't prove any of those things is a "moral certainty".



"Even if it hadn't been, it's the kind of thing which is *susceptible* to proof-- not before-the-fact ideological declarations of what does and does not constitute valid government action."

No it is not the kind of thing that is "susceptible" to proof. There are no "facts" that can prove that government should require one person to pay for medical treatment of another. That is opinion - not fact.

jhn|6.27.07 @ 2:08PM|#

Hey, Gilbert, I actually agree with your last post. I totally, 100% agree that concepts of morality and rights can't be proved in a scientific or mathematic sense. I have argued that very point earlier in this thread.

But (1) People with common values (arbitrary "opinions" they may be) can still have meaningful discussions on what ways to to promote those values-- or try to at least provide *reasons* (not "proofs") as to why one should move from one value framework to another, and (2) There being no objective, in-the-sky "morality," I don't see why you are so insistent that only "negative rights" exist. Whatever rights society determines exist, exist.

If you think that there should *not* be government-subsidized health insurance for the poor, you need to give us reasons, based on our common values, why this should be the case. Right now, there is government involvement in health care and by far the majority of Americans think this is a good thing.

Argue however you want. I know you don't like being told what to do. But all you've done so far is go on and on about what rights you have and others have, trying to draw what I (and many more people) think are unsupportable distinctions between different kinds of rights in order to support a minarchist state you have decided in advance is preferable. You're going in circles.

Vermont Gun Owner|6.27.07 @ 3:42PM|#

C and jhn seem to have some trouble making their arguments work together...

Right now, there is government involvement in health care and by far the majority of Americans think this is a good thing.

and earlier:

Again, your arguments are merely this: private health care will just do enough so people will keep paying. But private health care cannot give great service or their profits will dry up. What kind of free-market system is that? Where a mediocre product ensures the most profit? It's screwed. Everyone's realized this (except maybe you) and so people are demanding change.

So, people like that the government is involved with health care, but dislike the health care that results? Good argument.

jhn|6.27.07 @ 5:17PM|#

> So, people like that the government is involved with health care, but dislike the health care that results? Good argument.

I think it's true, though. People want government involvement (which satisfies the need for consensus to establish that there is a "right" to this or that), but the way it's been done doesn't work.

Like I said earlier, right now we have a worst of both worlds, regulated trade environment. The middle way is often the worst.

The government, should it get involved, should limit its involvement to making sure that the people who can't afford their own decent care are covered, and not be concerned with micro-regulating and distorting the market.

This is an idea similar to some with pedigreed libertarian history, by the way. It reminds me of school vouchers and the negative income tax-- Milton Freedman-style government involvement.

Gilbert Martin|6.27.07 @ 6:01PM|#

"But (1) People with common values (arbitrary "opinions" they may be) can still have meaningful discussions on what ways to to promote those values-- or try to at least provide *reasons* (not "proofs") as to why one should move from one value framework to another"

Who says we have "common values" in the first place or that we are coming from the same "value framework"?

That is the crux of the arguement in the first place. You seem to be claiming that government mandated socialized medicine is included in or an extension of some "common values" we have now by invoking the old "for the common good" phrase.

The founding fathers had a view of values and rights and the role of the federal government that animated how they drafted the Constitution. There is no evidence that they considered there to be any such thing as an individual "right" to healthcare financed by other taxpayers. Contrary to what you said earlier, there is indeed an ennumeration of individual rights in the Constitution. That's why the Bill of Rights is called what it is. And while it is true that the ennumerated list was not intended to be an all inclusive one, it is significant that all the ones they thought of as being significant enough to specifically ennumerate are indeed negative rights - not affirmative ones. Freedom of speech, religion, the right to keep and bear arms, private property rights - negative rights one and all.

If a "right" to healthcare is supposedly included in our "common values", then I'd like to know exactly when it got added to the list and exactly who it is who has the authority to declare something as a "common value" that has not been specifically codified into law as such by the Constitution.

|6.27.07 @ 6:48PM|#

Basically Gilbert, mishu, etc. all work for the Health Care industry

Nope. Not even close. I lived in Canada and thought the medical system sucked for the amount of money you kick in.

|6.27.07 @ 7:04PM|#

The government, should it get involved, should limit its involvement to making sure that the people who can't afford their own decent care are covered, and not be concerned with micro-regulating and distorting the market.

This is an idea similar to some with pedigreed libertarian history, by the way. It reminds me of school vouchers and the negative income tax-- Milton Freedman-style government involvement.

Bing! Bing! Bing! Bing!

Finally through a tapestry of circular logic, jhn gets it. My criticisms of socialized medicine, be it NHS, OHIP or whatever, did not mean that I was endorsing the status quo in the U.S. There are many problems with the current system. Ironically, when lefties criticize HMOs for crap service it's *because* it's a government entity and you would only get *more* of the same if you involve more government. Nowhere did I ever criticize a possible solution that jhn mentions above. This is how it is done in Switzerland. It allows free choice and allows the disadvantaged to get insurance.

If you only brought that up earlier jhn, you would have saved Reason a lot of disk space.

jhn|6.27.07 @ 7:56PM|#

> Contrary to what you said earlier, there is indeed an ennumeration of individual rights in the Constitution.

The government gets its power from the people, not the other way around.

The bill of rights is a list of limitations on government power. The government may not abridge, for example, freedom of speech. But the government doesn't grant us this freedom. The government simply promises to not violate your already-existing freedom-- assuming it even would have otherwise had the power to do so (which is one of the main reasons the bill or rights was opposed-- why should the government promise not to do what it already may not do?).

But I understand where you're going: That all the limitations that the government imposes on itself are limitations that can be seen as promises not to violate individual rights of free action, and that any non-enumerated rights would at least take the same form. But I do not think that levying taxes to fund health care for the poor would violate your individual rights any more than paying taxes for fire departments would, because I think the attempt to distinguish these kinds of programs a priori is flawed.

I don't necessarily think there is or should be a "right" to health care-- I just think that the government needs to step in to fund health insurance for those who can't afford it. This rights talk is a distraction. A program can be a good idea whether or not there is a "right" to it.

But I certainly do think that if such a right comes to be recognized, it would have nothing to do with the Constitution. I don't think that a right to privacy exists in the Constitution-- but I still think that such a right exists and that the government ought not to violate it. There's no bright line way to tell when such a right comes to exist. We now have a right to marry members of other races-- no founding father would have recognized such a right, and the Constitutional text (the civil war amendments) that gave cover to the Court in Loving v. VA had been around for a 100 years before they suddenly "realized" what it had been saying all along. (And this "right" can be framed either positively or negatively, by the way. The right to be left alone in your marriage partners, or the right to get state recognition for your marriage?) The Court found a way to read the present into the Constitution; this right did not originate there.

Since the founding of the nation we have come to want the government-- even the federal government-- to do or allow things the founding fathers would never have thought of. Sometimes-- usually-- this is a bad thing. But it's just hero worship to think that it's always the case.

@mishu

My only beefs are with people who think that the free market can provide services it is unprofitable to provide, and those like Gilbert, who see no justification for using government money for health care at all, regardless of the facts on the ground. The latter particularly irk me, as a strict application of their ideas would rule out even a system of means-tested medical vouchers.

Gilbert Martin|6.27.07 @ 10:07PM|#

"But the government doesn't grant us this freedom. The government simply promises to not violate your already-existing freedom-- But the government doesn't grant us this freedom. The government simply promises to not violate your already-existing freedom--"

I didn't say the government created the rights - I said the Constitution ennumerated some of them. And that is correct. The word "right" is explicitly used in the text.
You were partially incorrect when you said this:


"The Constitution enumerates *powers of government* not personal rights or liberties, which the Constitution does not try to list or limit."

" But I do not think that levying taxes to fund health care for the poor would violate your individual rights any more than paying taxes for fire departments would, because I think the attempt to distinguish these kinds of programs a priori is flawed."

Well that's just your opinion. I don't agree. Furthermore you're comparing functions done by different levels of government. And the federal government is constrained to ennumerated powers as per the 10th Amendment. It cannot levy taxes to fund an activity not contained within it's ennumerated powers. And mandating a socialized medicine system isn't contained therein.


"Since the founding of the nation we have come to want the government-- even the federal government-- to do or allow things the founding fathers would never have thought of."

And if those things are not pursuant to an ennumerated power of the federal government as udnerstood by the founding fathers, there needs to enough of "we" who want it to happen to actually go through the formal Constitional amendment process and explicitly change the Constitution to allow it in order for it to be legitimate.

I am still waiting, by the way for you to elaborate on exactly what these "common values" are that you claim we all have.

"those like Gilbert, who see no justification for using government money for health care at all, regardless of the facts on the ground."

And just what would those "facts" be?. Healthcare for the "poor" is no worse today than it was 100 years ago. If there was no necessity for government to do anything about it then, there's no necessity for it do so now.

The only difference between then and now is an increase in "entitlement" mentality that began with FDR's so-called "New Deal". And ALL any of that is REALLY about is increasing the power of politicians by making as many people as possible dependent on government and buying votes by promising their targeted constituency groups some sort of handout of other people's money.

|6.28.07 @ 10:02AM|#

Hi Guys,

Please let me know what you think of "the poor" in our society. Is it their fault so the society does not have responsibility to take care of them or should there be some responsibility from society or even from myself that I should do anything for them?

Some people say that we will be judged by how we treat the marginalized people in the society. What do you guys think about it?

confused from INDY

Needingsolutions|6.28.07 @ 1:45PM|#

I make around $3,000 net a month. Half goes to my rent, the other half to living expenses. I'm on retainer, and because I have a genetic disposition to gout, am unable to get health affordable health insurance. If I get sick and can't produce (I'm an illustrator), I'm dead. There is currently no system for people like me. Rather than just saying Michael Moore is promoting socialism, what other solution do you propose for the millions in the same boat as me?

|6.28.07 @ 9:29PM|#

What nobody ever mentions is how little Moore's films effect ANYONE. Have any of his films made any difference? The man is completely ineffectual, he simply preaches to the choir and his haters just hate him. Personally, I can't stand the guy.

|6.28.07 @ 9:35PM|#

Needing, well I think that the biggest misconception is that our health care system is "free market". It absolutely is not, by limiting supply and by hiding the true cost of health care from individuals, this has driven the costs up. Free market reforms can drive the prices down, so that not having insurance will not sting as much. Personally, I think that a much more free market system, with health insurance untethered from employment, will drive prices down. Then we can have a subsidy for the very poor and charity can cover the rest. There's some interesting websites out there on free market reforms for our health care system.

Actually|6.29.07 @ 3:21AM|#

Rotten: "Have any of his films made any difference?"

Actually, Michael Moore saved a guy's life: he pestered health care company Humana to grant a pancreas operaton to a guy who was dying:

http://youtube.com/watch?v=LXkpxV7mnqY

He also saved a couple's house--threat of Mr. Moore led to insurance company reversing their finding. He also saved a daughter's ear: threat of Mr. Moore led to changing denial of cochlear transplant.

So Rotten, this guy has made a big difference in people's lives--for the better. Which is more than I can say for people who bad-mouth him.

|6.29.07 @ 8:07AM|#

What about that soldier that is suing him?

I was looking for changes in policy, none of his films have any impact on discourses. His films simply either preach to the choir while he makes no attempt to gain any converts from the other side of the aisle. I consider him a propagandist and an opportunist.

C|6.29.07 @ 1:02PM|#

I consider Michael Moore the best example we have of a humane human being: someone who cares so much for the weak, the oppressed, those hurting, that he wants to do everything he can to help them. We are all lucky to get to know individuals like that, we are even luckier if we were actually one of them at some point in our lives.

|6.29.07 @ 5:06PM|#

Germany: Universal Coverage, but NOT single payer!

I wish everyone would stop assuming that universal health care is equal to single payer health care. It is not!

In Germany, there is a two-and-a-half tier system of health care delivery. There is first the distinction between private health insurance and non-private health insurance. Private health insurance is basically the same as here in the U.S. The insurer is free to charge what he wishes and the purchaser can choose his coverage as he likes. The caveat is that in order to purchase private health insurance, you must have a certain minimum yearly income, the level of which is set by the government. When I was there a few years ago, the minimum was approximately €80,000 per year. If you earn more than that - you may purchase private insurance, if you earn less than that, you may not. Private health insurance in Germany is better than non-private in almost every way: front-of-the-line treatment by doctors, private hospital rooms, better coverage, etc. The downside is once you move into private insurance, you have to stick with it forever - even if your health deteriorates or you get old - either of which will send your premiums skyrocketing of course. As a privately insured individual, you may return to the non-private insurance system only if you are broke.

Most Germans don't earn enough to purchase private insurance, so they are in what I call the "non-private" system. I don't call it public insurance, because it isn't. Non-private insurers in Germany operate like credit unions in the U.S. They are medical co-operatives that pool health-related risk. There are many hundreds of these organizations. Any given individual will qualify for several of these medical co-operatives based on their profession, home address, religious affilation, etc., in much the same way that people qualify to join various credit unions here. You pick an insurance provider from among the co-operatives for which you qualify. You can choose based on coverage, rates (which may vary within certain boundaries), perceived "goodness" (usually related to how much they pay doctors - and therefore how much doctors like people covered by that co-operative), etc. Premiums in these medical co-operatives are based on a percentage of your salary, and deducted like payroll taxes - but they are not taxes: the money goes to your provider, not to the government. The higher your salary, the higher percentage you pay as your insurance premium - up until the above mentioned private health insurance minimum. When you earn more than that, the percentage of salary charged as a premium stays constant. This is to encourage people to stay in the non-private system even though they could afford private insurance.

With non-private insurance your medical experience will not be as nice as with private insurance - all the basics are covered well, but you will share a hospital room, and you will not be bumped to the front of the line, or have access to special appointment times. I was in this system and I found it entirely satisfactory. It didn't bother me that someone with private insurance could come to the doctor's office at 8 when appointments for the rest of us began at 9. But then again, I'm not a bitter jealous person.

Medical services for non-privately insured people are basically "free" at the point of service, but there is a co-pay of €10 to discourage frivolous doctor visits encouraged by completely "free" health care.

German health care provides universal coverage by making membership in the local government's medical co-operative available to people who don't have jobs, income, etc. Their premiums are paid by the government as a social welfare benefit.

Oh, and paying cash for medical services is entirely legal. I did it myself before I entered the German health insurance system.

By introducing a measure of market economics to their health care system, Germany provides universal care without the typical waiting lists and rationing that are a common feature of all socialist economic systems. In fact, German newspapers often run articles on the horrors of medical care in the British NHS - the awful stories that Michael Moore doesn't want to talk about, but that are all too common in Britain, but almost completely unknown in Germany.

In short, Universal Coverage: YES! Single Payer: NO!

Michael Moope|6.30.07 @ 12:24AM|#

I Am Not An Asshole

George Boob|7.1.07 @ 3:08AM|#

I Am An Asshole

|7.4.07 @ 2:33AM|#

Well, it is always to work anecdotical and come up with horrifying stories. Moore this, and so does the author. The interesting facts are that:

- American health care is almost twice as expensive as European health care
- Americans have a significant shorter life expectation
- The average health of the Americans is worse than Europeans
- 47 Million people have no insurance at all
- Almost 2x as many babies die in the US per 1000 births
- (Too) Many Americans ruin their family by becoming sick

Despite its flaws, the European health systems seem to provide a much better bang for the buck than the American system, implicitly making Moore's point. Lets face it, even Fahrenheit 9/11 was more on the dot about Bush then I thought at the time.

|7.5.07 @ 12:21PM|#

Yes, let's all have a good time bashing Moore, and defending the status quo. That's what we're supposed to do, right sheeple? We're not capable of fixing the problem, so let's not even address it, right? What problem? What were we talking about? Oh yeah, did you watch American Idol the other night?

pissed reason|7.6.07 @ 1:33AM|#

This article was crap.

The whole point of the movie was not to build up some strawman so it could be knocked down.

THE POINT OF THE FILM WAS TO HIGHLIGHT HOW DEEPLY AND HOW OFTEN WE ARE GETTING SCREWED.

We can get healthcare for everyone. We can let some pay and some not. We have a lot of choices as to HOW WE IMPROVE OUR LOT, and that too is the point.

Way do dodge the real issue; namely, our health care system sucks.