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Health care costs cause 42% of bankruptcies in the US (the next largest cause is job loss at 22%). The rest of the developed world is starting to point, shake their heads, and seriously wonder about our sanity.

If I were king I'd sign up everyone to some kind of health care insurance stat and figure out how to pay for it after the fact. If it weren't for Canada right next door putting us to shame on a variety of social issues I don't think any real reform would be possible here. People might try vacationing there to get a different perspective on things if they can't afford a trip abroad.

Ummm.. pretty sure our "king" just did that..
And next time you are sick and need to wait
6 hours in a crowded waiting room full of
sick people and screaming kids to see a second
rate hack-quck......

Plinky: You're right on the money with that. My neighbor is from Canada. Her mother still lives there ... and she travels to New York for medical care. The wait for medical care in Canada just doesn't suit. In the US, you get served quickly, and it's worth the drive over the border.

Dave Horne: Our social security tax is 6.15% to the employee, and another 6.15% to the employer. That's 12.3% of the first 90 or 100 thousand of income. I'd rather put that in my 401k (or in other investments) ... ones that produce a return on my money. But the government says NO! We know what's good for you! (Sorry, guv, you don't.)

Also, I can understand the requirement to carry auto liability insurance. If I (or anyone) has significant potential to cause harm and loss, then insurance (or a bond) should be required.

What I don't understand is a government that demands I obtain insurance for situation where I can incur no liability at all. But the current government doesn't agree. Our freedom is vanishing bit by bit, all the time.

Socialists here in the states are fond of telling me what to do, how and when to do it, without leaving me any choice. I think it's outside government's role to do so. I can make my own choices, but they won't let me.

All you need to know:

Plinky: You're right on the money with that. My neighbor is from Canada. Her mother still lives there ... and she travels to New York for medical care. The wait for medical care in Canada just doesn't suit. In the US, you get served quickly, and it's worth the drive over the border.

This wasn't addressed to me, but it wasn't stated what type of surgery it was, whether it was an urgent operation such as an organ transplant or heart operation, or a less serious procedure such as a hernia operation or cosmetic surgery.

I just look at longevity rates (and infant mortality rates) to judge the overall health and effectiveness of a country's health care system.

Longevity rates - Life expectancy at birth, years > Total population (most recent) by country


Also, I can understand the requirement to carry auto liability insurance. If I (or anyone) has significant potential to cause harm and loss, then insurance (or a bond) should be required.

What I don't understand is a government that demands I obtain insurance for situation where I can incur no liability at all. But the current government doesn't agree. Our freedom is vanishing bit by bit, all the time.

I don't have a degree in economics but I'll go out on a limb here and state that whether it is car insurance or health care insurance, the individuals who are covered are subsidizing (paying more for their insurance) to cover those who are not paying for insurance.


Socialists here in the states are fond of telling me what to do, how and when to do it, without leaving me any choice. I think it's outside government's role to do so. I can make my own choices, but they won't let me.

We live in a society and there are taxes to be paid and some agreed upon rules.

The speed limit in my neighborhood is 30 km per hour. I think that's too slow. I don't have to follow it but if I get caught speeding I am fined. I suppose if I felt very strongly about this infringement on my right to speed, I could either change the system from within, speed and pay the fine, or move to a country that has less restrictions on my driving.

I hear from my conservatives friends about freedoms being lost usually when the conversation is regarding universal health care. Having lived in Europe for the last 18 years and investigated health care costs, the US pays more than all countries (except the Marshall Islands ) as a percentage of GDP for their health care. Health expenditure, total (% of GDP) per country

I place common sense and practicality above ideology in this instance. I don't look at universal health care as a loss of freedom.

I'm curious to learn what freedoms you have that I don't have here in Europe. I have a conservative relative in the US who always mentions 'freedoms' but he's never specific enough for me.

If the loss of your perceived freedom is participating in universal health care, the various models already in place in Europe, Scandinavia, Australia, Japan, and Canada are all less costly ... with measurable and tangible results - greater longevity and lower infant mortality rates.

Longevity and mortality are also related to lifestyle, diet, and cultural/genetic factors.

Example: We have too many crack addicts and smokers and fast-food-eating fatties. I don't recall seeing many such when I visited Amsterdam two summers ago. Perhaps that makes a difference between these two nations.

The news media have been reporting for decades on such lifestyle factors. Don't these life choices bear heavily upon health and longevity?

If you judge longevity solely on health care, that's akin to this: The sun is hot and the sun is yellow. Therefore bananas must be hot because they're yellow.Quite likely. But let's dig deeper:

Auto insurance is required for reasons I think we'd agree upon. Those who don't carry insurance surely cause an increase in what the rest of us pay in premiums. The only holes in this system are that the uninsured are generally not caught, and when they are they are generally not held accountable.

But how does that apply to health insurance, or to any other personal choice? If a person chooses not to insure, how does that affect the rest of us? I can think of only one way: Social policy that forces you and me to pay for the foolish choices of others. The solution: cut the social policy and educate people about important life choices. After that, people can be accountable for (and responsible for) themselves.

Speed limits are meant to protect us from the misdeeds of others. In such cases, laws are appropriate.

When someone can harm others (by committing a crime, or by simple accident), there ought to be laws to protect the victims and hold the perpetrator accountable. But when someone makes a personal choice that does not harm others, the law ought not intervene.

That's the very principle invoked in gay rights. The American left insists that gays cause no harm to others, so let them be. I agree.

Yet they ignore that very 'live-and-let-live' approach when then trample on my rights to choose. Example: My religious beliefs are cast aside in all public affairs. Religion cannot even be mentioned in schools anymore.

To compensate, Bush-era legislation made monetary allowance for those who wished to send children to private schools rather than public ones ... and the left strongly objected.

"We can't let people make their own choices!" and "They're taking money away from public schools!"

Health care is just the latest government intrusion. See above for the public school problem.

In principle I understand what you are saying here Mac. I've been following the debate with interest. But this area is just one of those where someone has to play God - and there is no fair or equitable way around this problem.

Eating fatty food? Generally agreed to be bad for you. For some there is a relatively early and devastating effect on their health (diabetes, hard disease, some cancers). For others an almost negligible effect FROM EXACTLY THE SAME BEHAVIOUR. These things are not clear cut. Lifestyle is an important factor in health and wellbeing, but arguably genetics and hereditary factors are even more significant.

Public health policy encourages exercise and sports. Sports injuries cost billions per year to treat. The habitual runner will quite likely require joint replacement surgery and that costs thousand and thousands. In fact, skeletal/joint deterioration is very common among keen athletes. But the public message remains: it is a good thing to partake in these activities.

So who's going to play God when it comes to choosing who will get treated and who won't in an assessment of "lifestyle choices"? Each human being is a complex organism and the effects of lifestyle cannot be predicted for each individual. We all know people who have smoked for decades and enjoyed a relatively healthy, long life.

The problem with adopting a system that just assesses risk and charges an appropriate premium to an insurance purchaser (ie, patient), is that is is a very unsophisticated way of doing things and fails to take account of all the other variables.

In terms of health care I really think we have it better in the UK - yes, public health should be subject to benign manipulation. An example is that public policy has encouraged the consumption of at least five portions of fruit and/or vegetables a day. The result is that the British consume more fruit/vegetables than almost any other European country. That kind of encouragement to good health is positive but to withhold or restrict health care to others is playing God.

If we were to rely solely on an insurance company's assessment of risk then those who just happened to be born to parents/families with histories of any number of health problems would be discriminated against - you can't control who you are born to and what family medical history you have so why be held accountable by insurance companies? It's immoral in my opinion.

There is no perfect healthcare system. They are all expensive. And I take your point from several pages back about the cost of treatments having escalated over the decades. The medical profession is placed on a pedestal to an unreasonable degree by the general population, and as result doctors in particular are vastly over paid. A general practitioner in the UK, working solely for the National Health Service, can be earning up to £250,000 per year. That is completely ridiculous. That is double what our Chief Constable is paid and he is responsible for a very large geographical area and the peace and community safety of over 600,000 people and heads an organisation with over 2000 officers and staff and is controlling a budget of around £100,000,000. There are countless other examples that would underline the disparity between what doctors do (and get paid for doing), compared with other professions. I'm not anti-doctor by the way, I'm just illustrating one of the reasons health care costs so much!

But even with the faults and inefficiencies of a public health care system like we have in the UK I can't see a better model out there.

Yes, you cannot choose to not pay taxes. But the lack of choice happens long before the government becomes involved in your affairs.

First, the company you work for may profit immensely from your work and ideas. Your salary may not even remotely reflect that. So you are already taxed by the company you work for before even the gevernment taxes you. Could you choose to work for a different company? Perhaps, but they may be too far away from where you wish to live, or just not hire you, especially when jobs are scarce, or rip you off even more.

If you are privately employed, you still have to pay for materials and services provided by companies whose prices are inflated by the need to make profits and pay the CEO millions.

Then as a consumer, you again pay for huge profits (think of Apple) and CEO millions.
The market is not infinitely efficient - otherwise there would be an ipad clone just as good and costing a lot less from some start-up company with razor thin profits and a CEO on a modest salary.

So even in the private sector you pay the equivalent of tax without much real choice. But this is just fine - communism was terrible, so we need some sort of market economy.

Living in the UK, I pay approximately 40% of my salary in income tax, national insurance, property (council) tax, and VAT. But then I benefit from police, fire, health, national defence, street cleaning, flower beds in the parks, etc. In addition, an advanced society would not exist without universal education.

I figure half of my salary should be for me to spend as I choose, and half for society as a whole to choose. I am getting a very good deal by only paying 40% !

As I don't make it a habit to nap near body snatching pods from outer space, I can only speculate that they're talking about the freedom to go bankrupt and leave the rest of society holding the tab when they fancy themselves individualists so rugged that they rashly decide not to purchase health care insurance, and develop a mild cough and can't afford the medical bills. Regardless, freedom isn't free, something, something, I forget.

The waiting period issue is a red herring IMO. My personal experience is that I'm "free" to schedule an appointment to see my "gateway" GP (which can take upwards of a week) and "free" to convince said non-specialist that I need access to a specialist, then "free" to schedule an appointment with the specialist (which can take upwards of a month, if indeed they are in my plan and accepting new patients) and if all goes well an operation is scheduled (which can easily be months out if the issue isn't life threatening). After which, over the period of a year or so, I "freely" receive random bills in the mail from the anesthetist's cat's vet and the like that threaten to put me in the poor house, whereupon I'm "free" to spend literally days on the phone trying to get my for-profit insurance company to talk to my for-profit hospital and vice-versa because they can't seem to manage to do so on their own. It can be one long excruciatingly frustrating exercise in foot dragging and non-payment, one people rationally tend to avoid, so it's no wonder our life expectancy stats are in the toilet.

For some reason Obama is the new Hitler for making a weak, half-hearted, industry friendly, and extremely protracted attempt at improving this. I tells ya, it's a full-time job just batting down the FUD emanating from certain think tanks and media outlets, and trying to keep people from voting against their self-interests, much less pushing things forward around here.

I had a lengthy response prepared to address many of the issues raised in the last few posts. I did a CTRL A and deleted it.

I can't think of a better way to measure the health of any nation than to look at longevity rates and infant mortality rates.

How would you measure and compare the health of nations? This is not a rhetorical question. Some folks measure wealth by the number of cars or number of TV sets, I look first to health issues.

Europe tends to be more proactive regarding health care. Women over 50 here in the Netherlands are invited to have breast cancer screening done every two years provided by the government. I'm sure my conservative American friends would label that an intrusion into their personal lives by the nanny state.

I look at this as proactive, saving money and lives in the long run.

I'm reminded of a FaceBook friend in the US who is retired US Army (USMA Band). He collects a military pension, will collect Social Security when the time comes, has the privilege of shopping in government stores (PX and Commissary), pays nothing or very little for government health care ... and was going on and on about how he wants a smaller government all the while benefiting from that same government.

I could go on and on and on but to be honest, I'm tired of this discussion.

Nice posts, Virgo Cluster, Dewster

It is a widespread illusion in all societies that we are owing all of our well-beeing and fortune solely to our own strengths, competences and assertiveness. We rely heavily on the performance on the public, our personal achievements are relative to that of the others, but rely on the national and global efforts and achievements of the present and of all of that past generations.

A Ferrari is no use if you don't have smooth roads (but both are the product of others skills and efforts).

We are more rich, than the richest Pharaohs was in ancient Aegypt. (They had no access to modern medicine, they had no televisions and internet and airplanes and....)

Just another but similar cultural and behavioral difference seems gun legislation. To bear a weapon I regard here as not a real contribution to my own security (at least here in Europe not where situations of personal threats when a proper response is only with a gun are negligible rare). The US must be either a much more insecure place to live or there must be much more people susceptible to symbolism: having a gun as the main source of ones invulnerability.

It is a highly deceptive feeling of freedom and security: the many guns in others hands are much more a threat than the response to them with a weapon protects against them. I prefer the freedom and comfort of not having to bear a gun.

Unlike in the US in European countries the right to possess a gun was never even a political issue - men who are require these freedom are mostly regarded as belonging to a split subculture ("macho", ending up in the French Legion or just infantile personalities).

For whatever reason many middle class people here who are firmly and undeniably on the dole seem to be the most vocal about the evils of socialism and government assistance. If nothing else this demands a level of hypocrisy that one wouldn't think humanly possible.

+100!!!

K.

No one would be against the government assisting people in various ways if there no costs to doing so. But the costs are terribly high. They take people who would otherwise be well into the middle class and push them into poverty. Just because someone isn't starving or unable to own a car as a result of paying their taxes doesn't mean the government hasn't harmed them greatly by taking that money.

People pay a lot of attention to the relatively small number of people that the top whose lifestyle isn't affected even if they pay tons of taxes and to people at the bottom who don't pay any. But most of the story is about the guys in the middle who work hard experience great stress as they try and make their way through this world (put a decent roof over their kids, pay for their education, etc.), but nevertheless are not so poor that the government cuts them any slack. These hard working folk bear almost the entire cost of the various government programs. Taking money from someone who can barely afford it and must make great sacrifices to give it up and then giving it (or a small percentage of it, after all the waste) to someone else who isn't making sacrifices or working hard is offensive to a large percentage of Americans, even if the first group doesn't starve.

And we should remember throughout this discussion that the argument is about a marginal change from the way things are now, not a complete change. No one advocates eliminating all social programs or the entirety of the safety net. No one in America seriously advocates total government control of healthcare. Obama has shifted power to insurance companies and employers away from the individual. This means the individual has less control over who provides insurance. There is less competition, the insurance companies can charge more, and losing your job will be yet a bigger deal. Actually it's a mixed bag. There are many good things in his health care bill, but the thing is absolutely huge, unbelievably complex, in some cases not even feasible to implement (at any cost), and full of little pieces of unrelated pork stuck in by one politician or another.

If everyone paid their own health insurance, the way people pay their own auto insurance, insurance companies would compete much harder and offer a much greater variety of plans and better service. Auto insurance (which is mandatory) is one of the industries with the highest satisfaction rate there is. If companies provided auto insurance, auto insurance would cost far more and treat you much worse.

The health care bill in question didn't actually make that large of changes to the system, but it ignored the most broken parts of the system and made others worse than they are now. If his health care bill was for socialization like in Europe or Canada this would be a different discussion.

Examples of things ignored in Obama's health care bill:

1. The AMA artificially restricting the number of doctors, causing acute shortages and high incomes. In some specialties (dermatology, anesthesiology, radiology, orthopedic surgery, etc.) the shortage and wages are absolutely unbelievable.

2. A government committee that has been lobbied hard into paying certain doctors millions of dollars per year instead of something like a market wage. Normally when there's an easy job that pays a ton, lots of people enter the profession and drive prices down, but they can't do it here because of #1.

3. Company sponsorship of heathcare plans instead of individual choice prevents insurance companies from needing to treat people well and also insulates people from realizing how much of their wealth is paying for medical care. This does affect the life choices they make and their expectations.

4. Doctors can be sued for millions in malpractice, but can buy insurance against this. This means they charge much more than they would (in order to pay for the insurance) but if they do bad things and harm their patients, they can continue to practice without hindrance. In other words the lawsuits are not about punishing the doctors or making sure malpractice is avoided, but just about dumping huge sums of money on victims (or people pretending to be victims) and their lawyers.

5. Hospitals charge individuals, small insurance companies, and medicare far, far less than they charge big insurance companies and medicaid for the same services. The difference is so large that it's basically not feasible to pay for even routine treatments yourself. As a result, people without insurance just don't pay at all, which passes the costs on and leads the hospitals to mark up prices for individuals even more in order to write it off on their taxes.

6. Hospitals are compelled by law to provite for lots of things for people who will not pay. My brother is a doctor and tells me that he sees people all day who either are trying to get drugs from their doctors (many doctors just prescribe them...it doesn't cost them anything and it gets these people out the door faster) or taking advantage of the fact that the hospital can't kick them out easily to treat a very expensive hospital bed like it was cheap housing. There are many stories of people who couldn't afford treatment they needed, but for the most part these are people who have not learned how to cheat the system.

These are all things a bill could have changed, which would have helped us far more than what was done without socializing the whole thing (I am not a doctor, so I don't know all the others). In my opinion, total government takeover makes more sense than what was done, and I hate government takeovers.

The vehement anti-Obama sentiment about Obamacare stems mostly from partisanship, not good cause--that's true of almost all vehement sentiment. The bill does hurt things and for the most part doesn't help, but it's nowhere near changing the US healthcare system in a fundamental way.

There was no surgery, just routine care from a physician. Lucky for her that she lives right across the border, just a short drive. Q: What would she do if she lived farther north? A: Suffer.

Nope. My objection is in being forced to accept government choices. If you're satisfied with government running your life, feel free to be so ensnared. But I choose otherwise.

I'll say it again: I don't mind that other get what they want. But I object when they force me to get what I don't want.

It's hypocrisy. Suppose government forced my religion upon you. (It's been done before, yes?) Would you object? Why must you accept personal choices made by others? Why must I?

Suppose government forbade gay people certain rights. (Oops. "Suppose" is inappropriate. It's being done right now.) Wouldn't they object? (Oops. That's a rhetorical question. They do object!) Why must one lifestyle be accepted and another rejected. Why must someone accept personal choices made by others?

In sum: You do it your way, I'll do it mine. And government need have NO say in the matter.

Quite true. But both the Ferrari drivers and the Corolla drivers like to have roads, so we willingly pay for them. Yes, the roads are the product of others. But those people are being paid for it? I don't see a problem.

I'm not sure what you mean. Which people "here" are vocal and on the dole? People here on the board? People in your home location?

Anyway, that might be a true anecdote. But don't make it a general conclusion. I am in the middle-class. I am vocal about the harm socialist government inflicts. And I have NEVER been on the dole. (And I await criticism for being "successful", the cardinal sin of American socialism.)

Perhaps some people advocate complete elimination, but I don't. But I DO wish to eliminate programs that benefit special interest groups at the expense of others.

Correct. That drives to the heart of the problem: government control.