You would be amazed at the number of people willing to pay the over-inflated premiums for health insurance. Even more amazing are the insurance companies who are turning away customers because they don't want the risk. The whole system is sick.

I guess you'd rather have me pay the cost of their healthcare? I pay about $250 a month for Kaiser Permanente. I could actually make this cheaper by paying more for doctor visits (I pay $25 for an office visit, $25 for tests, and I even paid $25 for an optometrist visit to get a prescrip for glasses). But, I have it mainly for catastrophic care coverage. Picking up after myself, you know?

For what seems like the millionth time, you're perpetuating the myth that uninsured people don't pay their medical bills. It simply ain't true, as I've posted 999,999 times already -- an unpaid medical bill is a debt, just like any other.

> Bob Herbert mourns the guy's
> death, but never mentions
> why he had no insurance

Alkon, you are a fuckin' libertarian Samurai. Either that or the NYT is all fucked up. To be fair, it's probably a little of both. I'd like to think that when a case gets this kind of attention in that kind of forum, some other reporter will take the time to find out where the chain of responsibility was broken.

Herbert wants to think that if policies are in order, no one will have to be responsible, because everyone will be responsible. This is bad math.

Actually, I spoke about this with a friend last night who writes politics. Take, for example, a person who is unemployed. This friend knows a woman who remains a "volunteer" worker on art films so she isn't employed, in case she has medical bills. Her husband makes $160,000 a year. They live in a very nice suburb of Los Angeles. When she gets sick, they go to the county hospital, and then, because she is "unemployed," her debts eventually get written off to a great degree.

Furthermore, it's a great deal costlier to pay medical bills than to pay for insurance -- in most cases, I'd guess. So, while people may be able to afford to put out for insurance, medical bills may be different and are going to be covered by the rest of us.

That comment just above was a response to Stu.

--Amy Alkon, libertarian Samurai!

Now, if you can't get insurance at all, yes, we should fix that.

Herein lies the rub: We don't want to just let poor people die for lack of money to pay for health insurance, and we don't want to pay for everybody out of (necessarily increased) tax revenues, and some people won't make good choices about buying health insurance when they could have, but we probably don't want to let them die for lack of health insurance either. Or do we?

Well, Justin, what if, instead of making it mandatory that we pay for people who make bad choices we have those who wish to pay for people who make bad choices do so voluntarily?

In short: Donation rather than taxation?

I guess I don't understand. If we're going to fix it so that anyone can get insurance regardless of their medical conditions, and if we're going to fix it so that even poor people can afford their insurance, then why not make insurance mandatory?

I don't think anyone wants to pay for someone else's expenses, but that's why it's called insurance. I don't want my house to burn down, and god knows, my insurance premiums will not pay for a new house, but my premiums plus your premiums plus crid's premiums plus good investing by the insurance company will pay for my house when it burns down, and you two will be the two that never have their house burn down.

Or, what is the difference between making health insurance mandatory and making everyone pay for the fire department?

(Note: I have health insurance, but I don't have a house. I do have paypal!)

I also think that making employers pay for insurance for employees is just dumb dumb dumb and makes no sense whatsoever.

In short: Donation rather than taxation?

I wasn't advocating taxation. The point that I was making, perhaps too indirectly, was that we face a real problem of where lines should be drawn between personal and public responsibility when it comes to health care. One the one hand, we want individuals who are able to keep their own houses in order; on the other, we don't want those who are not to suffer needlessly and die for want of basic medical care. The challenge is how to create strong incentives for personal responsibility without trashing a safety net for the truly desperate. I currently think that the direction suggested by Jerry's post - decoupling insurance from employment, mandating basic insurance coverage for all and providing some subsidization of insurance premiums for people who can't afford it - may be the best way to balance these competing interests.

I'm all for taking responsibility. How about doing it this way? Let's all pay taxes into a system that provides health care for all, the way ALL other industrialized nations do? That's more than just my taking responsibility for myself, it's all of us taking responsibility for all of us. No one claims that we should each individually take responsibility for defending the country, for building roads and bridges, etc. We each contribute to those things as part of a community and we get the benefits as part of a community. Why not health care?

> We each contribute to those
> things as part of a community
> and we get the benefits as
> part of a community. Why not
> health care?

Here are a couple reasons. There are others.

The first reason is that people do their best when they know that they'll enjoy the fruits of their own labor in proportion. When all your profits are shared with others, you just won't work as hard. We need people to work hard.

The small reason is there's no limit to the "contribution" we could be asked to make for the health of others. Robert Goulet was 73: Should he have been given an expensive, risky lung transplant?

I echo that, and double for education. Why make children suffer if they have idiot parents? We all win when everyone has access to quality basic literacy and health care. There's large room for personal responsibility in a free market democratic society that pursues sane, rational public policy goals via well-implemented social programs.

> via well-implemented
> social programs.

List five.

Broken record here:

Be thankful you live in a state where there is health insurance available.

The Insurance "Industry" is a horrid, nasty aberration in a modern world. A business that takes wagers to make profits based on the suffering of others is reprehensible. Insurance companies are in business to MAKE MONEY. They do so by denying claims. THAT's their business. In fact it's such an all-encompassing part of their business that they've outsourced it. There are companies staffed with phone jockey and pencil-pushers whose only job it is to deny medical claims.

Don't waste your time giving me heat about the munitians-makers. War-for-profit is another argument.

First, there's this.

The first reason is that people do their best when they know that they'll enjoy the fruits of their own labor in proportion. When all your profits are shared with others, you just won't work as hard. We need people to work hard.

And next, who has faith that government will provide good or even adequate health care, and why?

I'm certainly not the expert, but my understanding is we are still covering these people with taxpayer funded, government supplied health care, we just call it the emergency room. And I think studies have shown

A) Treating people preventively is cheaper than in the emergency room
B) Treating people preventively and for long term goals INSTEAD of trying to hold down costs is a strategy that leads to better health outcomes AND lower costs.

Apparently, the VA is able to hold down costs and provide better care than many private care facilities because they have the soldier and his family for life and they can pay not to prevent something from happening later on. When I have AETNA one year and CIGNA the next year what happens is that AETNA and CIGNA create policies to push care off.

This next part is even more hand waving. If you think the universal plan is not sufficient, you should be able to get a supplemental plan on top of that. If you think the universal plan is becoming too generous, well, uh, you vote for people that promise to gut it appropriately.

Wanna know the chief cause of Conservatism? It's when lefties say, 'Listen, we know what's best, so we're going to take all your money anyway, so you oughta just hand it over without a fight...'

Favorite example: http://www.youtube.com/watch?v=j1PfE9K8j0g

"The Democrats know what needs to be done...."

> her debts eventually get written off to a great degree.

*sigh* Here we go once more around the mulberry bush. Hospitals do not "write off" unpaid bills. In the USA, like any other business, they call in the collection agencies, who then use the exact same tactics as they use for ANY OTHER DEBT -- turning up at your workplace, making your phone ring every 5 minutes, trashing your credit record (or threatening to). Whatever. You MIGHT be able to prove that some percentage of the medical bills of uninsured clients never gets paid. And if you could, I would answer that bills sent to uninsured people are artificially inflated anyway -- quite possibly as a hedge against that very phenomenon.

Correct me if I'm wrong. But if I follow Stu, jerry, Tori and Dierdre's comments, a common thread might be this: The problem with our health care and insurance system is that it's generally run as a for-profit business. I think it would constructive here if someone would be willing to explain how it is why a market economy, which does a great job meeting other needs (like feeding and clothing us) doesn't work for medicine.

Hospitals do not "write off" unpaid bills.

They do when they determine, rightly or wrongly, that somebody isn't going to pay.

I wonder what kind of bills Ben Ehrenreich's girlfriend Ofelia Cuevas had to pay for her care at County USC? Can somebody else ask her, because I e-mailed her, and she didn't write back to me.

I'd like to see people who suck off the taxpayer hog have to give back in some way. Sweep up trash, clean graffiti, etc. I work very hard for my money. I'm taking a break from an all-day writing day now. Same as the other six days a week. Why should others (who are not utterly inacapable of caring for themselves -- ie, the homeless mentally ill, a tiny group) get to siphon the earnings of the rest of us?

The answer is obvious. Since the government can't provide decent health care or defense or border security or disaster recovery (note recent razor blade attacks costing billions, millions of illegal aliens, Katrina, and runaway acne rates), we should say no to government health care, defense, border security, and FEMA.

We'll save trillions in taxes.

What good has a poor person ever done for America? Or a lame person? Or someone fighting cancer?

It's a dog eat dog world and survival of the fittest should be our only law.

Anyone who thinks otherwise is simply a Communist or a pederast.

I am not against helping those who cannot help themselves. It's those who'd rather not help themselves I have an issue with.

Hey, same here, but as an 90-hour-a-week tech guy who came from the military, paid my own college, and lost everything when my job went overseas (and then came back with the H1-B visa holder it was given to), I'm just now pulling out of a financial nosedive that pushed me from six figures to financial ruin.

I know what it's like to be way past unemployment benefits with zero income, and in a bad age group, where insurance costs $600 a month and the co-pay is $50, where the Rx isn't $15 but $40, where there is no vision and no dental.

I sold every luxury I ever owned, cleaned out my retirement, savings, investments, and still had to choose between homelessness and healthcare.

Why? Who did I cheat? How did I squander? The answer is, I didn't, I just got caught in the whirlwind --- and it's time to stop pretending any of us are immune to that kind of financial disaster.

BTW, I don't think anyone is advocating the government provide the healthcare, but that a new insurance system is implemented instead.

My new sign --- "This Space For Rant"

90 hours? LOL meant to say 80. 90! That's ridiculous.

> I think it would [be] constructive here if someone would be willing to explain ... why a market economy, which does a great job [of] meeting other needs (like feeding and clothing us) doesn't work for medicine.

I'll take that on. It's because nobody in the system knows or cares what the true value of the goods and services being exchanged is. On the supply side, doctors and nurses have no idea of the dollar value of the medical services and procedures they prescribe and administer. Try asking one some time. And on the consumer side, of course, 99% of us don't give a shit, as long as we're assured that the insurance is picking it up. Therefore the normal "market forces" that make feeding and clothing us so efficient have no chance of working when it comes to patching up our poor battered bodies.

Why didn't health care have the widespread problems 20 or 30 years ago that it has today?

Obviously something changed, and not for the better.

> No one claims that we should each individually
> take responsibility for defending the country,
> for building roads and bridges, etc.

Not true, but I'm trying to stay focused here.

> > We each contribute to those
> > things as part of a community
> > and we get the benefits as
> > part of a community. Why not
> > health care?

> Here are a couple reasons. There are others.

Here's another reason, or just another way of putting Crid's first reason:

Military defense is a public good. I'm using "public good" as an economics term and not a casual phrase here. See http://en.wikipedia.org/wiki/Public_good . Also, see the link from that article for externalities.

General health care is not a public good. The only part of health care that is a public good is
preventing publicly communicable diseases.

> I echo that, and double for education.

There's a strong case that education is a public good in a democracy. The logic being that it takes a good education to be a good voter.

> I think it would constructive here if someone
> would be willing to explain how it is why a
> market economy... doesn't work for medicine.

Exactly, please do. And keep in mind that we currently have far from a market economy providing our health care.

> Hospitals do not "write off" unpaid bills.
> ...they call in the collection agencies

I don't know that this is true, but I believe it. And that would certainly put the rich, unemployed wife in Amy's story under pressure to pay.

You can't squeeze blood from a turnip, though. Unlike other businesses, hospitals are forced to extend credit to a significant percentage of their "customers" when they go to the emergency room. Those same people are going to be turned down by Crazy Dave's Discount Stereos. Also, please go to the bank, pretend you have no assets and no job, then let me know how much they loan you.

These people aren't going to pay, regardless of a collection agency. One way or another the rest of us will pay for them.

Also, the tort system is out of control. Your healthcare providers have to spend so much time, money and effort on avoiding lawsuits. That affects your cost, and more importantly, your care. For a great example, try having a baby. Also, as for the argument about paying for the healthcare of the uninsured, yes, we do. I don't know about other cities, but Dallas's 'free' hospital- Parkland-is paid for with tax money. They're always talking about billing the other counties for their residents who show up for treatment, claiming they're from Dallas. Care for illegals is absolutely burying them. Make insurance mandatory- how is that not socialism? Tell me the price won't go up when that happens. Paying into one big govenrment system? Next time you're sick, go to the DMV. Then pay 40% of your salary for the priveledge. Feel free to buy more coverage if you find the care inadequate. And lastly, for the folks who truly can't help themselves? Perhaps we should have a government program that covers poor peoples' medical care. Any ideas?

Make insurance mandatory- how is that not socialism?

Socialism is having the government provide basic services; it's not having laws telling you to do stuff. I think health insurance like I think about car insurance. You drive, you are mandated to have insurance, because you can fuck other people over if you don't. Because everybody gets treated as a last resort via emergency rooms at county hospitals on the taxpayer's dime, your failure to have insurance can end up fucking people over by taking their tax dollars for your problem.

I'll take that on. It's because nobody in the system knows or cares what the true value of the goods and services being exchanged is

Good post, Stu. Until we have a better sense of costs at an individual level, we'll not have much ability to make sensible decisions about costs and benefits of health care.

What Wayne said.

The less the government is involved in healthcare, the better I feel. I'm not aware of any program that the federal or state government isn't screwing up in some way.

Those people who advocate a nationalized health care system, not matter what side of the political spectrum they may be from, should consider this when you hand something over to the government to run as a monopoly: YOUR party may not be in power forever, and when the other party comes to power, they're going to add new rules, and ones you don't like.

Example - say, for the sake of argument, that you're somewhere closer to pro-choice than pro-life. Somehow, the pro-lifers add a line to a spending bill that every other senator wants, and suddenly, no matter where you live, or how much you're willing to pay, you no longer have that option. The opposite possibility - people who are appalled at the idea of abortion are now finding that they're forced to pay for other's promiscuity and lack of personal responsibility, with absolutely no way of not participating, because our government collects taxes at gunpoint.

Example 2: Someone spends a lot of money greasing palms, and suddenly, a new vaccine of questionable effectiveness and safety is now mandatory. Can't sue, later, cause you can't sue the government. Oops. Please consider how many bad programs related to military projects are rife with cost overruns and failed or failing results.

Example 3: When have you ever seen a government program run efficiently? There aren't any, because politics runs the process. It's all about the votes, baby, and selling access and influence.

Example 4: Now, since it's in the public interest, anything bad for you is now off limits or rationed. Welcome to the Nanny State. You only THOUGHT your SO was a controlling bitch. Mandatory exercise and weight control, so get your fat ass outside. If you think the sobriety checks are intrusive? Imagine getting stopped for a ticket, and having to do a pinch test, along with a breathalyzer and nicotine swab, with fines as a result. Hey, it's just business, after all. The justification for helmet laws, anti smoking laws and taxes, liquor taxes, etc., are all based on their perceived cost to the public at large, so the groundwork is already laid out.

Example 5: Brace yourselves for all new sin taxes, with the justification that it's only the 'true cost' of that cheezeburger, considering the heart bypass you'll need later. I've heard enough of this justification for sticking it to SUV owners, so why should fat-asses get a break? Be patriotic! Supersize me! There's a war on, and you need to do your part!

Example 6: Elective surgery? you must be joking. You don't NEED that eye surgery - glasses are just fine for you. Nose job - therapy would be cheaper, and besides, we can get you into therapy by january, while the nose job would have to wait until august, at the earliest. And personally, you're pretty fugly anyway, so you're really better of with counseling, or so says my report.

Example 7: Extreme sports are out. You f-ing skate boarders are killing the national budget with your head injuries and torn ligaments, and old people are eating catfood because of your selfishness.

Going to the mandated insurance - I live in Texas, a manadatory liability state. After that law went into effect, policies went up in cost, and you couldn't get anything done without it. Of course, if you're here illegally, you already don't give a shit, so the more popular coverage is uninsured motorist coverage, for when that yard crew fails to understand a traffic sign and plows the pickup truck into you. Really, the people who drop into the ER with no insurance and no intent (or ability) to pay, won't care about mandatory insurance either. Funny how you can't do anything in this state without proving you have car insurance, but GOD FORBID anyone ask if the tan guy who speaks in a funny accent is supposed to be here at all, because that would be racist.

amy, this topic comes up frequently, and you've clearly explained that what you object to are people who choose to risk living without health insurance. you do your homework, so i'm sure this perception isn't based solely this article and the Ehrenreich article. i'm of the opinion that the majority of uninsured people in this country actually cannot afford it; i work for an organization that operates several community health centers for people who are uninsured or uninsured. the people who come for care are low-income, often have a host of other issues, and at any rate are definitely not going to be able to pay $250.00 a month for insurance. it sounds like you agree we should have policies that help them get preventive care and stay out of emergency rooms, so my question is what information do you have that makes you think that most of the uninsured are choosing to be?

From the front lines:

"...If 'market-based' health care is so wonderful, how did it lead us to the miserable state of health care in this country today? Our leaders seem to have forgotten the fundamental truth of market systems: There are always 'winners' at the expense of 'losers.' Will we, as a nation, continue to accept our fellow citizens as health care losers in order for health insurance companies to be the big winners?

I, for one, cannot.

Greg Silver, M.D., Palm Harbor"

The rest of the letter: http://pqasb.pqarchiver.com/sptimes/access/1376828631.html?dids=1376828631:1376828631&FMT=FT&FMTS=ABS:FT&date=Nov+3%2C+2007&author=&pub=St.+Petersburg+Times&edition=&startpage=15.A&desc=FOR+THE+SAKE+OF+EQUITY%2C+GET+RID+OF+THE+PROPERTY+TAX

Socialism is no picnic. Be careful what you wish for:

http://reason.com/blog/show/123317.html

For example:

From the Daily Mail (11/01): "Banning a heart treatment on the grounds that it is too expensive could end up costing both lives and money, doctors warn. The Health Service's rationing watchdog saysdrugcoated stents used to treat around 30,000 patients a year are not cost-effective and should no longer be provided."

Wise words, Wayne.

As for this, ph:

what information do you have that makes you think that most of the uninsured are choosing to be?

I never said "most of the uninsured" are choosing to be, but here's the deal -- when you say you can't afford $250, that's what I pay as a 43-year-old woman. And I could get far cheaper insurance. But, when I was in my 20s, my insurance was around $100. And I paid for it myself, no employer kick-in. At the time, as I've mentioned before (and sorry to be tediously repetitive), I was struggling financially to get started as a freelancer, I couldn't afford a bed...I slept on a door on two milk crates and rode my bike or rollerskated all over Manhattan to save money on the subway. I had a black and white TV that I used to watch PeeWee Herman (fuzzy) on Saturdays. I went to $5 double features at Astor Place Cinema. And I worked as a mover, a bike messenger, and as a chicken, at my lowest of low points. But, I paid my health insurance so nobody would have to pick up for me if, say, I cracked my head open while rollerskating.

"... why a market economy, which does a great job [of] meeting other needs (like feeding and clothing us) doesn't work for medicine."

One problem is that medicine doesn't have much differentiation of its product. When I buy a car, I can go with a $500 used car, or a $50,000 Lexus. I can buy a one dollar McDonald's hamburger, or I can buy a $600 package of premium steaks from Donald Trump. Medicine, on the other hand, generally delivers its product only at the highest level of quality (and cost). As one person said, its like we always have to buy Madison Avenue strawberries.

Wayne wrote: "The less the government is involved in healthcare, the better I feel."

Me too. I live in Canada. My health care costs are paid for by me through taxes, but the government doesn't get a say in what doctor I see, whether I see one at all, or what procedures I consent to. It's only "socialist" in the sense that the province funds regional health organizations who are charged with running the system in their mandated regions. They have independent boards of directors who appoint the hospital administrations. Doctors operate their practices independently, like in the US; they just bill the provincial health plan rather than the patient directly, according to a scale they negotiate with the government. We do have premiums in my province that are about $150 per month for me and my daughter (and I probably pay more income tax than you, but I have an excellent quality of life. I have no real complaints).

You said: "YOUR party may not be in power forever, and when the other party comes to power, they're going to add new rules, and ones you don't like. Example - ... [abortion] suddenly, no matter where you live, or how much you're willing to pay, you no longer have that option. The opposite possibility - people who are appalled at the idea of abortion are now finding that they're forced to pay for other's promiscuity and lack of personal responsibility, with absolutely no way of not participating, because our government collects taxes at gunpoint."

YOUR states already do that. Canada's provinces cannot. Abortion has been legal here for decades, although access is spotty. It's illegal to refuse a woman an abortion or enact laws that would do so. I'd rather 'pay for someone's promiscuity' via birth control and publicly available abortions than extra costs associated with unwanted brats running around.

"Example 2: Someone spends a lot of money greasing palms, and suddenly, a new vaccine of questionable effectiveness and safety is now mandatory. Can't sue, later, cause you can't sue the government."

Real Examples please. In both our countries, parents are refusing vaccinations to the detriment of their children's health, and no one's putting them in jail or - for that matter - making them pay for the consequences of the horrible complications of measles and other preventable childhood diseases. And yes. You can sue the government. It has happened here.

"Example 3: When have you ever seen a government program run efficiently? There aren't any, because politics runs the process."

Yes. Government programs can be run efficiently, and they can be run off the rails. So can private sector programs. Our health care system here, for all its numerous faults, is run more efficiently than your U.S. semi-private patchwork system. It costs less - ever since since it started in 1962. It's much more efficient with less horror stories than Britain's. Other government programs run efficiently:

infrastructure. I drink my tap water without question. That's not always the case (google ontario drinking water scandal), but generally it is true.

I generally trust my government-built roads and bridges not to fall down. Anyone in Minneapolis care to take that one on vis a vis the U.S.?

"Example 4: Now, since it's in the public interest, anything bad for you is now off limits or rationed. Welcome to the Nanny State... Mandatory exercise and weight control, so get your fat ass outside. If you think the sobriety checks are intrusive? Imagine getting stopped for a ticket, and having to do a pinch test, along with a breathalyzer and nicotine swab ... "

Amy has an example of your country intruding into people's lives that way. Your spurious "nanny state" examples are canards that have nothing to do with health care. No one is forcing anyone to do anything in the industrial democratic countries that fund health care centrally.

Then you go on to the sin tax argument. that's a slippery slope argument that has nothing to to with the delivery of health care. Why not sin taxes? WHy not reward good behaviour, by having tax breaks for people who join and use a gym, or sign up their children for sports? (We have that here) Using the tax system to encourage healthy behaviour and tax undesireable ones is not a nanny state, it's using fiscal policy to encourage public policy goals. Besides, if you do something that is going to cost the rest of us (whether it's driving a gas guzzler or eating unhealthy food) then you should pay more for the costs of cleaning up after your choices.

Example 6: Elective surgery? you must be joking. You don't NEED that eye surgery - glasses are just fine for you.

What's your point? You mean unnecessary surgery like corrective eye surgery or plastic surgery. People have to pay out of their own pockets for that kind of surgery in Canada's system. Don't they in the U.S.? No-one here sees anything wrong with that.

Example 7: Extreme sports are out. You f-ing skate boarders are killing the national budget with your head injuries and torn ligaments, and old people are eating catfood because of your selfishness.

The government here has not tried to ban skateboarding, skiing or any other sport because of the health care costs. In fact no industrialized nation with centrally-funded health care systems has tried to do that. It's not inevitable with a state-funded health system.

One could argue that extreme sport enthusiasts should pick up more of the tab for their recklessness, and in many instances they do. I used to climb cliffs, for example, and I had to purchase extra life and health insurance just in case I had an accident. Plus I had rescue insurance to help cover the costs of the helicopter ride - just in case. Still has nothing to do with health care delivery models. Don't see your point.

Going to the mandated insurance - I live in Texas, a mandatory liability state.

Your entire rant about Texas makes the case for centrally-funded basic health care, rather than the idiotic expensive charlie foxtrot patchwork of insurance, HMOs, mandatory insurance, etc. your country has, and ours is heading towards.

Just for the record I would appreciate getting a statement at the end of the year for all the health care I've used. Every Canadian should. It would go a long way toward having us all wake up to how much we would have to pay if we lived with a US-style system, and encourage more personal responsibility.

I don't have all the answers, but think rationally about this. Amy made a point in a previous blog that it is more cost-effective to provide assisted housing for homeless drug addicts and mental cases. That's the idea behind centrally-funded health care and other social programs. If it is in the end cheaper and makes more sense to provide a service in order to prevent costly mistakes later, then that's good public policy and is worth paying taxes for.

What's not helpful is a knee-jerk reaction against a proposal because of one's ideology. We need more rational thinking and personal responsibility, not less.

> "The Health Service's rationing watchdog says drug-coated stents used to treat around 30,000 patients a year are not cost-effective and should no longer be provided."

Not to mention that their effectiveness is now widely questioned.

> your failure to have insurance can end up fucking people over by taking their tax dollars for your problem.

I don't think it's tax dollars, is it? Yes, the missing money has to come from somewhere (to pay the outrageous multi-million dollar salaries of US hospital administrators, don'cha know). But it turns up as generally elevated health service costs. So only the clients of health service pay, not the population at large.

Crid - You're not making sense. No one who wants a single-payer healthcare system wants "all profits" to be shared. Healthcare under single payer would come from tax money instead of insurance premiums. As such, they'd be subject to the democratic process like taxation and spending is today.

Of course we want people to work hard, but people in Germany, Canada, Japan, etc work hard, have flourishing economies and still get good healthcare from single-payer systems.

Your claim that there would be "no limit" to contributions is just not true. What would be paid for and reimbursement rates would be decided, as they are in most industrialized countries by law and administrative process.

The fact is that single-payer works everywhere it's used, and it works better than what we have in the U.S. It costs less and achieves better results. If big insurance, big pharma and the AMA didn't spend so much money to resist needed change, we'd have single-payer now. In fact, when it comes to Medicare, Medicaid and VA health benefits, we already have it, and it works well.

As such, they'd be subject to the democratic process like taxation and spending is today.

Like the government bureaucrats do such a good job with that now.

An American friend in France (married to a French woman) pays 65% of his income in taxes. And he makes, I'd guess, under $200,000 a year. But, he does have "free" healthcare!

> Since the government can't
> provide...

Taxpayers understand that government can do some things well, but other things not so well, so they carefully choose what's expected of it.

> Anyone who thinks otherwise
> is simply a Communist or
> a pederast.

Facetiousness in text is often difficult to decode. To be worthwhile it should amuse someone besides the writer.

> nobody in the system
> knows or cares what the
> true value of the goods
> and services being
> exchanged is.

That's an extremely important point. Nobody in the world --and stereotypes be damned, that includes the Israelis-- is as good at finding the correct price of things as Americans are.

But we go to the Doctor and he says "You need two of those, one of these, and six of the other thing." And he doesn't tell you the price of them so that you can consider the value. And not only that, you then hire a third party from outside "the system" to look over those prices and make some retroactive judgments.

> Why didn't health care
> have the widespread
> problems 20 or 30 years
> ago that it has today?
> Obviously something
> changed, and not for the
> better.

I see what you mean, but some things are better. Western medical care is the envy of human history. Whether you go in for a terrible cancer or a scraped knee, some of the most alert and thoroughly-trained people in your community are going to bring millennia of genius to bear on your complaint. And in either case, they know that if they fuck up, you're going to sue the clothes off the backs of their children. Medicine is better than ever. More concisely:

> Medicine, on the other
> hand, generally delivers
> its product only at the
> highest level of quality
> (and cost).

It's degrading to be poor. You get no respect from anybody. Employers grumble, bus drivers snarl, and creditors bite. But when you go to the hospital, you know you're getting some of the sweetest candy civilization has to offer, no matter who pays for it.

(In one important sense, it was better when I was a little boy, because nurses wore sextoy uniforms instead of mundane scrubs.)

> I have no real
> complaints

Others do. We hear that magistrates and legislators in the Great White North get to cut in line for health care. And it's often argued that Canadians rely on USA's healthcare system as a relief valve; two-thirds of Canadians live within an hour and a half's drive to the States.

> If it is in the end
> cheaper and makes more
> sense to provide a service
> in order to prevent costly
> mistakes later, then that's
> good public policy

It could be cheaper but not make more sense. Maybe it's worth the extra cost to encourage people to be responsible. Consider Wayne's point about abortion: Many taxpayers think it's murder. Maybe they're wrong, but they have a right to their judgment, and it's unspeakably cruel to make them take part in it just to save a few bucks.

> they'd be subject to the
> democratic process like
> taxation and spending is
> today.

Are you saying that like it's supposed to give us faith? Who do you think yer talkin' to?

> people in Germany, Canada,
> Japan, etc work hard

1.) Not as hard as Americans, whose productivity leads the globe. http://urltea.com/1zm4

2.) Germany, Canada, and Japan have many options for public spending that aren't available to us, because their stability and defense are underwritten by the United States. I'm not saying that to complain about it (yet). But to hear chirping along these lines is like Dad walking in the door after a hard day of work, only to find the teenage son (feet on coffee table) whining that he needs a new Playstation Seven or Scion TC. "A paper route would do much to buttress your argument, son...."

> What would be paid for and
> reimbursement rates would
> be decided, as they are in
> most industrialized
> countries by law and
> administrative process.

Yeah, sure, that's the ticket! We just need to get some technocrats involved! Because as we all know, no one's as wise as a government functionary spending tax dollars!

Fagan wrote many good lyrics, and this was a favorite:

A just machine to make big decisions
Programmed by fellows with compassion and vision
We'll be clean when their work is done
We'll be eternally free yes and eternally young

Ooooooooo.....

Medical care involves some of the most intimate moments of your life. If you think you can convince free-sprited Americans to trust a government panel with those encounters --especially after a visit to, say, the post office-- it will be fun to watch you make your case.

> it works better than what
> we have in the U.S.

Then why the fuck don't you live there?

(Earworm for Flynne: "So outrageous!")

":Taxpayers understand that government can do some things well, but other things not so well, so they carefully choose what's expected of it. "

Hence, Iraq, Katrina, and border security.

Carefully chosen, all of them, I'm sure.

It sounds like you agree with me: We should never let Hillary run our health care.

"We should never let Hillary run our health care."

As a former Democrat, I was appalled at Bill Clinton -- and I'd vote for Rush Limbaugh before I'd vote for Hllary.

Still, I think there has to be a way to improve our health insurance system, as good or as flawed as we each may consider it.

It's just a system. Its performance should bear up to continuous scrutiny and if it doesn't, it should be adjusted.

Also, I'm under no obligation to entertain anyone but myself with my writing. Personally I think you're forcing yourself not to baste me with kudos after each post.

I'm not in your life to baste you.

I have no problem with people dying who can afford health insurance and can't be bothered paying for it. (It's exactly what I'd expect to happen to me.)

I do have a problem with dishonest media types trying to spin it as some kind of catastrophe when people refuse to take precautions against risks that are completely predictable.

Rational Skeptic,

"Example 2: Someone spends a lot of money greasing palms, and suddenly, a new vaccine of questionable effectiveness and safety is now mandatory. Can't sue, later, cause you can't sue the government."

Real Examples please.

Gardasil- an HPV vaccine which, according to Merck, ...MAY (emphasis mine) help guard against diseases that are caused by human papillomavirus (HPV) Types 6, 11, 16, and 18. (www.gardasil.com)

From Wikipedia:

A group of Canadian public health professionals expressed concern about the vaccine in August, 2007, saying that many questions remain unanswered and a universal vaccination program in Canada "is premature and could have unintended negative consequences."

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

Apparently, despite professing a belief in evolution, our "betters" are doing everything they can to reverse it. If someone can't or won't purchase health insurance, the least we can do is encourage them not to reproduce. To do otherwise is to "play God" (or at least make it difficult for Darwin to do his necessary work). And somehow society will muddle through without them or their genes.

Actually, skepticism is called for on the need for Gardasil, vis a vis the price, the lack of research on it, and the fact that cancers can be caught through Pap smears:

http://www.healthyskepticism.org/library/ref.php?id=11938

When HPV strains, of which there are up to 200, do cause infections, they are usually slow to grow, which makes identifying them through Pap smears relatively easy. In a statement published in the February issue of the Canada Communicable Disease Report, the National Advisory Committee on Immunization explained that "In general ... the vast majority of precancerous lesions, which progress slowly, can easily be detected and treated." Even when the HPV infection is caused by one of the cervical-cancer-causing strains, reports the Canadian Women's Health Network, it takes about a decade for the disease to develop -- long enough for women to get their Pap test done (annually, and then every three years after smears come back clear twice in a row).

Here's more analysis:

http://www.scoop.co.nz/stories/HL0705/S00287.htm

in summary:

Summary

* Gardasil is a vaccine that may protect against a virus that may cause some but certainly not the majority of cases of cervical cancer

* Gardasil is a vaccine that may only confer protection for less than 5 years

* Gardasil is a vaccine that will require the spending of over five million dollars to possibly prevent one death

* Merck are laughing all the way to the bank

How to fix the polluted cafe (or theater or mall or...) environment for $50:
http://www.dealextreme.com/details.dx/sku.4355

"And to see the airspace in a café, for example, as shared airspace, not airspace one person gets to take over with their cell phone shouting."

Works like a charm. After the initial thrills of reclaiming fouled environments from rabid polluters, you realize that you aren't even inclined to use it much; just knowing you can if you really need to is what generates peace of mind.

I recently read a fascinating book relevant to this discussion, entitled "Life at the Bottom: The Worldview that Makes the Underclass," by Theodore Dalrymple. Dalrymple is a psychiatrist employed at a London hospital that serves an impoverished area of that city. Dalrymple's thesis is that by providing the necessities of life (housing, medical care, money to live on) for free, the state imbues the recipient with a set of values that trap the benificiaries in a life of chaos, squalor, and misery so that instead of improving the quality of the beneficiaries lives, the state prevents them from learning how to live, thereby destroying their lives.

This morning I had a fascinating discussion over breakfast at a bed and breakfast at Gettysburg, Pennsylvania with an emergency room physician and an ER nurse who were visiting the battlefield with their families. These folks work at a hospital in Wayne County (Detroit) Michigan - my home State. Their description of the situation in their ER tracked precisely with Dalrymple's description of his own patients. In each case, the picture given was one of human beings dependant upon the state for the necessities of life - medical care, monthly stipends, etc - and who have developed a profound and strident belief in their own entitlement to these benefits. In each case, the beneficiaries of the state's largess are physically, intellectually, morally, and spiritually degraded, doomed to lives of illness, chaos, violence, and addiction - in short, lives of tragedy.

Both of these stories resonate strongly with me because of personal experiences. I have three close relatives currently living on Supplemental Security Income (SSI). One of these is my father's younger brother. He has suffered from schizophrenia his entire life. SSI allows him to live as closely as a he can to a normal life with a modicum of dignity. Clearly, this is the type of person for whom the program was intended. As to my other two relatives, however, something else applies. My father's older brother is also on SSI. He, however, is not mentally ill - he is a lifetime alcoholic who has scarcely ever worked. SSI has enabled him, along with whatever he can grift from relatives, to live without work and feed his alcohol habit. He is now a broken man who really can't work and who requires massive medical assistance all due to his alcohol abuse - paid for by us.

The last case is my own brother, who was just awarded SSI a couple of months ago. My brother had a couple of psychiatric episodes triggered by his own drug abuse. These same episodes form the basis of his eligibility for SSI. When he received his first SSI check, he was on cloud nine, feeling like he had hit the jackpot. Before that he was making some progress, trying to live on his own and hold down a job. Now, he will never work a day again. The State has given him just enough money to get by along with what he can grift from relatives by manipulation and abuse. They have destroyed what little incentive he had to take responsibility for his own life and treat those around him with dignity. They have killed him with kindness. Of the three people in my life who are getting SSI, only one truly needs and benefits from it. For the other two, it is one more factor that keeps them mired in degradation and chaos.

The basic factor that all of these examples have in common is incentive: The manner in which the welfare state has been implemented has created perverse incentives - rather than incentivizing responsible behavior that would help the poor pull themselves out of poverty, they encourage dependancy and deprive these dependant people of dignity.

re: Rational Skeptic

For what it's worth, I'm a libertarian. Mostly, because it pisses people off, conservative and liberal. When I was a teen, I was a Democrat. Somewhere in my early 20's I became a Republican, and somewhere in my late 20's, I learned both parties consist of selfish hipocrite busybodies that have nothing better to do than run up my bills, congratulate themselves for it, and expect me to be greatful for the mess they left.

Yeah, yeah, yeah, I've heard how wonderful Canada's health care system is. I've also heard how frustrating it is from the end users who are looking for alternatives, and from more sources, I hear about how long it takes to see someone. I don't have the documentation to call on, since I don't use Canada's, and here in Texas, it's a bit far for medical tourism. I hear similar problems from the UK system as well, but you're telling me that you don't have the problem the UK does.

My point was that here in the states, with the political system that we have, that having a taxpayer funded, single payer system is inviting disaster. Obviously, you mentally superiour Canadians will be able to nudge each other and point while us silly Americans fuck something up again when we leave something up to politicians who are more interested in getting re-elected and their names on buildings and pork projects than they are at fixing things.

Case in point - as reviled as President Bush may be, and with the lowest approval in history, it's still better than our legislature's approval rating. Something sucks, and until that problem is fixed, giving them more to fuck up is not the answer.

The other problem is that we (americans) can't agree on what's screwed up about it. A good many people think that we're not making people do the right thing, and a good many people think that government is overbearing, controlling, wasteful and corrupt. Which side of the argument you're on tends to vary, depending on the issue, but by and large, we're better off when our Congress is at home, golfing, or out on a junket somewhere else than in DC.

Also adding to the problems here are the tort system, patent laws and other IP laws. Also screwing up the prices for things is that the government is both a major purchaser of supplies and services, including drugs, and like walmart, has either too much control, forcing us to pay the difference elsewhere, or not enough control, inviting corruption and fraud.

So, many of my points were directed twords how things work here in the states, rather than in Canada. Yes, some of them were to show a rediculous extreme, but to make people realize that we're on the crux of handing over a great deal of decision making to some people who are historically extremely bad at making good decisions.

Yes - a number of states have delved into legislating various aspects of reproduction, on what people can and can't do. Some will trust people with a gun, but not an abortion, and others are vice versa. All the more reason to leave these decisions and influences out of the hands of the government. Fund babies, fund abortions, fund adoptions, all in all, I would rather the government yank the rug out from under the people who think that being a couch mounted baby factory is a viable career, but I risk being labeled a mysoginist. Or a racist, depending. I would agree with you that faced with the choice of funding birth control or funding a parent to raise a child for 18 years, I'd pick the same as you, but my point is that if mom wasn't offered a subsidy every month, she'd likely make the same choice we would, as well, or figure out how to make ends meet, instead of sitting around helplessly. Stop paying women to be single moms, and we won't have so many.

I think that China, as a nation, has a few reproduction and sex laws that we would be uncomfortable with, Canadian and US alike. Lets just not go there.

Personally, I think that being forced to deal with the consequences of the risks that people are taking would get most of them to stop doing whatever it is. If you're knocked up, why should the rest of the country pay you child support? If you can't raise a baby because you lack the job skills to make it work, lets quit adding to the problem. Do those people with the 'darwin fish' stickers on their cars think that it doesn't apply to them?

It should be scary to be an adult. All the more reason to motivate the young skulls full of mush to do well in school and not sit around stoned all day, or obsessing about who's looking and talking to who, or whatever mania is possessing teenagers mental process throughout their waking hours.

I'm trying give examples to show that "free helth care" and other "entitlements" in the classification of "enabling", which is if you keep covering for people who screw up, they will continue to screw up.

Risk management, i.e., insurance, is something that costs money. It's a risk pool. It's a gamble. It's something that companies do for a profit, and if the odds and returns aren't good, they don't have to play. You're currently welcome to negotiate and pay for your healthcare, here, instead of having an insurance company do it for you. A single payor government system doesn't allow that.

I earn my healthcare, right along with my wages. I have a skill that someone is willing to offer a chunk of money for, and the company is successful enough that they offer a decent benefits package. I earned it, because instead of getting drunk and laid in my teens, I learned a marketable skill, and I found an employer willing to pay for it. (The singular benefit of being a socialy inept geek, I guess). I didn't win the lotto. My parents didn't die and bequeath it to me. I'm not keeping anyone else from repeating my success. I don't have a monopoly on being a geek, either, and I resent the fact that some people think they're entitled to the results of my hard work and sacrifice.

There's that whole Ant and the Grasshopper parable. I think it shows the problem nicely. The grasshopper never learns.

Really, tho - How much of my day do you think you're entitled to? We both have the same 24 hours. What's the upper limit on how much I should have to fork over?

I'm frugal with my health care usage, since I do have to pay a chunk of my expenses. My employer, who picks up the lions share of the expense, has a number of VOLUNTARY programs for preventing health problems. I can use them or skip them, but it doesn't effect my employment or my cost for my health plan. There are options, so I pay more for the plan to have a broader access to physicians, cheaper office visits. But, I think that when it's the government paying, or heavily subsidizing, that direct personal cost factor will be removed, and it will cause problems. Punishing people indirectly for not solve the issue, and really, those kinds of things just burden those people who's income is marginal at best. There will be someone advocating totaly free health care for everyone, or a significant subset of the population, here in the states, because it will be politically expedient to do so.

Years ago, I paid for my own Lasik surgery, since the health plan didn't cover it. One of the proposals is that the goverment pick up the tab for it. Following along the path that social security took -it was initially suposed to pay for only those who paid into it, then expanded to include all sorts of new people who have not paid into the system, plus the goverment 'borrows' against the social security that it's collected, and we have a real problem in that system. I don't want our health care system to face that sort of collapse.

Yes, I think vaccines are a good thing, I was speaking of political corruption. The example that I was thinking of: Texas Govenor Perry tried to make a new vaccine a requirement, recently, forcing every girl of a certain age to be vaccinated. The same company is spending a huge chunk of money promoting this vaccine on tv. I don't recall if it's for HPV or cervical cancer (or if they're one and the same), but I think there's something fishy about the process. I think until we have a better handle on some corruption, it's better if we don't hand too much over to the government in this area, and for one, I don't want my girls used as lab rats while someone pockets a campaign contribution.(Haliburton, Blackwater, Exxon, and a few notorious drug recalls should be enough).

Your argument about the Mineapolis bridge makes MY point. While I know that sometimes 'shit happens', human error and all, and hopefully we learn from our mistakes, there's not a whole lot of confidence here that the government does it's job well.

Here, yes, I drink my tap water, and it's ok. The other service the city offers, which is taking the water AWAY, didn't work so well last week, and I got a gift of an estimated 10 gallons of black water in the master bathroom at 3 am. Eww, to say the least. The city's response: "must be your fault that happened, because there's never a problem with our system", so I'm out more than $2000 for water damage. I can sue, but I have to fund an attorney, and I don't have a $4000 retainer lying around. Oh, and if I touch the exterior line, I have to pay for an upgrade to the city's pipe, along with any repairs to my own line, for an addition $1250. So much for putting in a check valve.

Yes, I'm aware that Amy doesn't like SUVs. She's entitled to her opinion, and welcome to dislike them all she wants. I dislike the people who operate them in a careless manner while yakking on the cell phone, park using 3 spaces, and their kids can't get out of the damn things without leaving me a new door ding on my roof. However, when an SUV owner pays to fill up his SUV at a cost of $140 or more, he's already paying more to move it the same distance as whatever morally superior uber-efficient daisy fart powered golf cart you'd prefer everyone had. He paid more to buy the extra metal, glass, plastic and fabric, all the extra features, he paid more in sales tax. He paid more in registration (assuming the state counts and taxes by weight and clasification). He pays more in tires. In exchange, he's got a large comfortable and safe vehicle. Personal responsibility - he chose transportation that meets his priorities, and pays the expenses as they come. He has the right to buy the same commodities as you or I, at the same market price as you or I. (Jacking up the gas tax doesn't effect him so much as it does the person who's struggling with a hand me down car who can't afford a new car with the newer technologies in efficiency.) You are allowed to prioritize your life the same way as the SUV owner, and the same should apply for health care. I'm risking a few problems on a steady diet of bad food, and I'm too busy with my kids to excercise, but for me, I think I'll be happier when I do kick off than some health nut who might outlives me a few years. I pursue my happiness my way, but that might be a foreign concept in Canada. It's been a while since my mother moved to the states and became a citizen, but I'll have to ask her why she chose Detroit over Hamilton.

The nanny state / fat check was one of those 'rediculous extremes' arguments, but in light of the helmet laws, smoking crusades, the new alcohol intolerance, and New York's new rules on fat in restaraunts, I don't think it's that far off the mark. You're advocating that people should be rewarded for taking care of themselves, and taxing unhealthy behaviour, so really, what's wrong with an annual tax on your body fat index?

Sin taxes - yes, someone decided there was good money in demonizing things that people wanted anyway. My point with sin taxes and rewarding/ punishing people for doing the right thing is that it's nobody's damn business what I do, and a national health care plan will suddenly make damn near everything I do someone else's business. I don't want anyone to clean up after my choices. They are, after all, MY CHOICES.

Elective surgery: My point was not against canada's system, but here, when people want it free, they want it all for free, and one of the major proposals is that the government has a monopoly on health care (Saint Hillary's statements from a few years back, Ira Magaziner, etc). When resources and funding are scarce, guess what's going to happen.

There's a few concepts here for doing things according to 'standard practice', 'reasonable and necessary', etc. When the government is the sole payor, there's only one way your treatment is going to be, and that's the government's way. One of the complaints of the Medicare system is that the care you get goes along with what the government pays the most for, so you end up with a one-size fits all treatment. It happens with the insurance industry, too, but nowhere near the extreme. Also, people end up with treatments they don't need, since the government is picking up the bill for it, and their review and oversight is shoddy.

Extreme sports - yes, for motorcyle users, there's been several concerted campaigns where "head trauma" was used to justify bad legislation. I anticipate this will be extended in to other areas. You chose to pick up extra life and health insurance, but that's when you asked someone to pick up the tab for your medical care. If I understand it, your health care system, miracle of the modern world, doesn't cover the sports injuries you were concerned with, so you had to manage the risk yourself, rather than burden others with the cost. I think that's been my point, all along: people should be treated as adults, and be left alone to manage their own risk and expense.

My point /rant about Texas had to do with our countries penchant about passing laws that only serve to cause problems for people who are not a problem in the first place, and don't really act as a deterant for the people who don't care what the law says, anyway. My point was that instead of mandating a system that seems only to make everyone (who does what they're supposed to do) miserable, try not enabling the screwups.

Yes, the US health care system has it's problems. Much of it has to do with the government's schizoprhenic involvement. I don't see it as a good resume for giving them more control.

See also - public schools, USPS, US Social Security Administration, Vetarans Administration (especially the health care part), congresses double standard on what the congressmen have for health care, and consider how many congressmen shell out the extra money to keep their kids out of the public school system, all the while keeping the monopoly in place. I think the same will happen for health care.

Now, I will grant you that in some cases, it's probably better to head off some of the problems by treating some things early. I'm sure that if we asked Americans that CAN contribute something to these issues, that people who have the means will probably chose to do so. But I don't see making the choice for people about where their hard earned money gets spent. I know best what my family needs, far better than some schmuck in DC who's trying to pander votes. Like I said, this nation collects taxes at gunpoint. Not paying taxes will result in asset forfeiture and incarceration.

My reactions are not knee jerk. I used to think that the government should do more. After seeing it in action for 43 years, I think I have enough experience with the government in several states and at the federal level to say that they're a bunch of screw ups. We have other problems to fix in OUR goverment, FIRST, before giving them more to do. Since your government doesn't have these problems, it isn't rife with corruption, doesn't suffer from ne'r-do-wells who think they're entitled to a free ride, your nation has found it possible to have a successful taxpayer funded health system. Congrats. Please realize that things are different in the states, and we don't have cold winters to clean out the pests like you do.

#@ly $h!t that got long. sorry about that.

Yes, I'm aware that Amy doesn't like SUVs. She's entitled to her opinion, and welcome to dislike them all she wants. I dislike the people who operate them in a careless manner while yakking on the cell phone, park using 3 spaces, and their kids can't get out of the damn things without leaving me a new door ding on my roof. However, when an SUV owner pays to fill up his SUV at a cost of $140 or more, he's already paying more to move it the same distance as whatever morally superior uber-efficient daisy fart powered golf cart you'd prefer everyone had. He paid more to buy the extra metal, glass, plastic and fabric, all the extra features, he paid more in sales tax. He paid more in registration (assuming the state counts and taxes by weight and clasification). He pays more in tires. In exchange, he's got a large comfortable and safe vehicle. Personal responsibility - he chose transportation that meets his priorities, and pays the expenses as they come.

He's actually driving a vehicle too heavy for the streets in my neighborhood, and unless he needs such a vast vehicle because he's hauling steel beams around -- not just for fashion -- he's unnecessarily polluting the air beyond what he needs to. And there's the libertarian principle, your right to punch me in the nose ends where my nose begins. The same goes for your right to shove particulate down my lungs. If you're carrying steel beams around, by all means, drive a vast vehicle. If you're moving your tiny blonde ass, a script and a latte around town, why should I be sucking your particulate?

The cellphone jammer is illegal and wrong to use. I'm completely against the jerks who shout into their phones in public places, who suck the peace and quiet of others the way many of the pigs in SUVs take more than their fair (or necessary) share of the roads and air. That said, there are people out there who must get calls, who are expecting calls for whatever reason -- emergency or just business -- and nobody has a right to disrupt them. If they disrupt you by shouting into their phone, say something. Or do as I've done: I've stopped going to the Rose Cafe -- haven't been there since last spring -- because they do nothing to stop the rudesters on cell phones (with a policy and/or a no cell phones sign), and I recently wrote them a letter telling them so. Another patron has as well. And a number of regular customers no longer go back there or go back there much.

Here'a another disincentive for having a government run health care system:

HIPPA laws, and the privacy that we take for granted will go right out the window. You may check in to see the doctor, and find a cop waiting outside the door to arrest you for testing positive for some controlled substance, or when the clerk ran your records, they noted that you've got an unpaid traffic ticket.

Oh, and I'm wondering how you feel about everyone getting a mandatory STD/HIV test, with the results in a government database, maintained by a third party contractor, and managed by someone's politically paid off contributor?

Granted, if the government is going to get up to speed on stopping AIDS, then we all need to do our part and roll up our sleeves for a blood test, but look how much righteous indignation and grief that suggestion got a few years ago, when someone suggested that those on the public dole got mandatory drug and HIV testing? Think of all of the cases that could have been prevented, with a harmless sacrifice? I'm not trying to be sarcastic, either. It's a tough call, and where does it stop?

oh yeah, and how about a national DNA database? Certainly would make that human genome project a little easier, and probably solve a few crimes as well. Work out a few of those "whos the daddy" problems, too. Probably help with that national ID card problem, too, except for those in the undocumented voting group.

People don't realize that with "free" (and it's not going to be free -- far from it) will likely come a loss of freedom and privacy.

(Earworm for Flynne: "So outrageous!")

I don't know this one, Crid, unless you want me to drink my Big Black Cow, and get out of here. o_O

The reason health care is being destroyed is the profit margin has been erased by the ins companies. they simply raise the premiums, then dispute EVERY claim, and actually reimburse the Dr,s less than Medicare for most procedures. That's correct, LESS THAN MEDICARE!!!.. Why aren't the Ins co's investigated for perpetrating the larges consumer fraud in American history. Bring on socialized medicine, at least they'll pay to medicare rates. Dr Mike

Actually, skepticism is called for on the need for Gardasil,

Amy- Yeah, I totally agree, and that's what I was trying to say, but on re-reading, I wasn't as clear as I thought. Gov. Perry here in Texas attempted to make that vaccine mandatory for 6th grade girls to attend school. Apparently, Merck made some campaign conributions to him. The vaccine hasn't really been tested yet- by use that is- and is suspected to have caused myriad problems and even several deaths. Merck can't even say it's effective- hence the quote that ...it 'may' prevent... Public outrage was enormous and several states backed down from mandating the stuff. A single-payer system would have made that much harder.

Heh. My daughters' pediatrician asked if I wanted to have them vaccinated with Gardasil. I asked her if it was safe. She hemmed and hawed a little bit, and I said, since my girls aren't sexually active anyway, let's take a pass on that for now. She actually looked releived, and then told me that she didn't think it would make much of a difference anyway, but that she was told she should make the option available. I'm glad we opted not to do it. I think that's something I'll leave up to them, once they hit the age of 18.

Flynne: That's the one.

Wayne:

Thank you for your thoughtful comments in response to my post.

In reading these comments, and Amy's blog in general, I have realized there is quite a cultural/political difference between our two countries. I greatly respect and admire America's people, her gregariousness, independent spirit, entrepreneurism and enthusiasm. Especially in Texas! (I have visited many US states).

I still don't understand your system of voting though - electoral college and whatnot. It seems complicated - much like your wonderful country itself.

By contrast Canadians are more reserved and conservative (small c there). In case you haven't noticed, we're also more apologetic - Maybe it's the climate :)

I in no way meant to imply that Canadians or Canada is wholly superior to the USA or Americans. And I didn't mean to say (as that a-hole Michael Moore does) that you folks need to adopt our system holus-bolus. I recognize that ours inherently creates longer line-ups and other problems.

Health care and social programs - it is a tough one, because you can't force people to become more self-reliant, but if you're decent and compassionate, you can't just leave the grasshopper out there to die either - can you? I can't.

I live in Calgary, Alberta, Canada. I called my regular family doctor on September 5 to book my annual check-up. The first available appointment? January 18. I wouldn't say we've got the whole health care thing all figured out up here.

...but if you're decent and compassionate, you can't just leave the grasshopper out there to die either - can you? I can't.

I think I can, if I've done my best to help the grasshopper understand that since I've feed him for 5 winters in a row, now he's got to learn to take care of himself. You can only do so much for people, until you burn yourself out with helping others beyond helping yourself. I'm all for helping someone out, but not over and over again until I've nothing left to give. I have a family to feed, too, you know. o_O

Hey Flynne,
I'm with you on that one, too. I don't think that many grasshoppers will have to die before the word gets out.

Rational Skeptic:

Sorry if I tarred you with the wrong brush. I run into too many people who, without any direct experience, think Canada is an liberal paridise, second only to France. (which, according to David Sedaris, is the hypochondriac's paradise). No need to apologize. Hope you can work the bugs out of your system. Like you said, I think more people in Canada are self reliant out of necessity, with that frozen grasshopper scenario being a real possibility.

After seeing so many bad government programs, all with really good intentions, I do everything I can to convince people that, here in the states at least, we need to fix what we're already doing, before we take on more problems.

I appreciate your insight into Canada's system. I'm sure the experience isn't universally good or bad, and has it's ups and downs, as a later post has shown.

It's tough to stop enabling people. It's even harder when its someone you don't know, because it's so hard to be specific, and I'm sure that there are some people in a genuine bind that just need a little push. Those people, I think, would best be served by their local community, who can choose to help, as they're able to help.

Me, I'm tired of the grasshoppers. They're starting to get damn pushy, and they seem to get what they want, before I get what's left of my paycheck. I think a frozen grasshopper or two will act as enough incentive to get the others off their asses.

Quentin Crisp - "My mother protected me from the world, and my father threatened me with it."

Amy - I had a longer response, but it's off topic. I cut it to this:

I'll bet that Al Gore's private jet puts out more harmful gasses and particulates in one trip than one jerk's SUV puts out in a year. Lets not forget the entourage of bullet proof armored cars, either. When Al Gore lives in a 1000 foot shitbox apartment in a noisy urban area, drives a Prius, rides the bus, lives with a handful of 13 watt CFL light bulbs, takes cold showers, and does his own composting and recycling, I'll take him seriously. Until then, that man thinks he's my better, and he's a hippocrite, just like anyone else in DC. Same for most of the hollywood environmentalists. I have yet to see Paris Hilton or any other hollywood train wreck taking any crap for driving a gas guzzling SUV. Nobody begrudges them their blinged out Escallades and high powered sports cars, but everyone fawns over them for whatever half baked 'cute animal/refugee' crusade they get on. They blow more energy in a weekend than I use in a month, and I don't have an LCD screen in the house.