PERSONAL RESPONSIBILITY

Americans spent more time talking about our nation's healthcare system in 2010 than in the last few decades combined, which is good. Unfortunately most of what they know and believe about it is false, retarded, or both. Which is bad. We learned mostly that there is a powerful noise machine in our society that can make anything, no matter how ridiculous, plausible to dullards through sheer force of repetition. We learned that 'mericans don't like Socialism and Government Takeovers and Death Panels and Rationing Care and lots of other straw men. We learned that people will argue passionately to defend a system from which they derive no benefit and, in many cases, actively fucks them.

What we did not do – indeed, what we never do, because it is hard and requires more than 15 seconds of attention – is question the fundamental premise of our, uh, "unique" approach to healthcare in this country. Think for a moment about the way we do things here. Not about the bureaucracy, the inefficiency, the clusterfuck of third-party payers, or the all-encompassing atmosphere of inaccessibility. Consider how this system works on the most basic level: you have to pay for getting sick or injured.

You slip on a patch of ice and break your hip, and then next thing you know you're out $10,000 if you happen to be uninsured or poorly insured. You develop breast cancer and a hospital (and eventually a collection agency) sends you a bill for $25,000 because you got cancer. You get tagged for $100-200/month in prescription drug copays for making the mistake of having allergies or some other congenital medical problem. You pay several hundred dollars in fines and penalties for catching some weird virus from a stranger at the airport. No matter the reason, and no matter whether you are insured or uninsured, being sick and getting injured cost a lot of money in this country.

Is that not a little fucked up? I'm sorry to tell you that you have leukemia, Mr. Jones. Just give us tens of thousands of dollars and we can do some chemo, or maybe think about a bone marrow transplant. If you can't afford it, you can either go home and die or get the treatment anyway and we'll take your house.

The American attitude toward the healthcare system represents our national obsession with Personal Responsibility taken to its ludicrous extreme. We feel that people should have to pay for any services they receive because A) we're proud capitalists, and thus everything of value must have a price attached to it and B) we blame individuals who end up in the hospital, just as we blame the ones you end up poor, in prison, on drugs, or unemployed. Everything that happens to you up to and including getting cancer is your own damn fault.

Our system is the way it is because we generally believe that illness and injury are preventable, thus in the classic Reaganite mindset you should have been smart enough to prevent it. Admittedly this outlook has some appeal and anecdotal supporting evidence. It is often hard to generate sympathy for someone who drunk drives into a tree or smokes for 50 years and develops lung cancer. Sometimes the trip to the hospital is indeed a consequence of our own actions. It raises the larger question of where the line between personal responsibility and bad luck should be drawn – which is a red herring for the even bigger question of why, in a wealthy, industrialized, and allegedly civilized nation, that should matter when it comes to something as fundamental as access to a doctor.

Our culture (and especially our media) would have you believe that an obese person who has diabetes or heart problems is undeserving of sympathy, and certainly undeserving of free access to medical care. He did it to himself, we are encouraged to tell ourselves. Probably sat around all day stuffing his face with KFC. This personal responsibility fetish relies upon a number of important assumptions – namely that the consequences of every action can be known or predicted in advance and that prevention is usually (if not always) possible. More importantly, it keeps us from questioning the idea that is the cornerstone of a for-profit healthcare system: that access to medical care, the need for which may be driven by our own actions or random chance, is not a human right but a privilege reserved for those who can afford it.

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56 Responses to “PERSONAL RESPONSIBILITY”

  1. Natalie Says:

    You pretty much boiled that down. I've been saying all year that the basic issue is that the health of the public shouldn't be a for profit institution like selling clothes or cars or something. It's much more fundamentally important than that. Which is why healthcare is one of the first things that gets socialized when you move down the slider bar even the littlest bit from "Total Capitalism". Seems that only pinko commies want their fellow citizens to be in good health. Bah!

  2. ladiesbane Says:

    I think we're on the same side, and yet your argument is incomplete. Should doctors work for minimum wage? Of course not. Should they charge a million dollars to set a broken arm? Of course not. Setting a price between those two extremes is up to…whom? The market? An anonymous government committee? The doctor who wants a million bucks, or the patient who has fifty? I wouldn't put a roofing job up for the lowest bidder, much less a broken limb, but med school isn't cheap, and if I can't find a doc who will do it for fifty, should I try to do it myself?

    And should med school only be available to the children of the already-rich, or those who might have to take out loans? I'm afraid there aren't enough Dr. Kildares out there, with a true vocation and indifference to the almighty dollar. What are my provider choices? Especially since I'm not independently wealthy and must rely on insurance to pay most of the bill.

    This matter is incompletely pondered here, and answered not at all. Whenever someone says "Suit yourself" I hear "Suture self" and worry that it may be an option.

    And I'll remind anyone who hasn't heard my five-dollar rant: I'm a licensed insurance agent who is pro-single-payer. It is too damned expensive, and it is worth every penny.

  3. kathequa Says:

    "The American attitude toward the healthcare system represents our national obsession with Personal Responsibility taken to its ludicrous extreme. We feel that people should have to pay for any services they receive because A) we're proud capitalists, and thus everything of value must have a price attached to it and B) we blame individuals who end up in the hospital, just as we blame the ones you end up poor, in prison, on drugs, or unemployed. Everything that happens to you up to and including getting cancer is your own damn fault."
    Amen Brother!

  4. J. Dryden Says:

    It's too easy to blame the Puritans, but…yeah, fuck it, I'm gonna: When your culture originates from a simultaneous notion of radical personal independence/self-sufficiency and of 'Total Crapulence' as the human condition (re-read your "Sinners In The Hands of an Angry God"), there's always going be an underlying belief that sick people Had It Coming. Heart attacks aren't genetic–they're preventable proof that you were Having a Sinfully Good Time. Cancer isn't bad luck–it's because you're somehow a Bad Person, and God caught wise.

    I've said it before, but the Protestant notion of illness as a moral failure is pervasive in this country. We flat-out (though rarely out-loud) believe that if people were just a little more *sturdy* of character, they'd walk it off.

    There's something *almost* endearing about this, though–about the American notion that you are entitled to NOTHING. Not food, not shelter, not health, not safety. You get NOTHING for free. If you want any of these things, you will *earn* them–just like the rest of us. If you're gonna consume, you're gonna produce. Period. Seen as a kind of glum, jaw-clenched notion of universal responsibility, there's a perverse kind of nobility to it.

    But where the "almost" becomes "not at all" is the fact that if you're going to have such a system, you have to make it possible for everyone to be able to *buy* their necessities. If I'm not entitled, fine–but fairness demands that I have equal access to earning my way. Alas, corporate capitalism hears that claim and giggles while stroking a white Persian cat. We will pay "what the market will bear" for necessities, say the neo-cons–because the system is self-correcting! Right. Because when the banks say no to my needs, and I go to the loan sharks, I'm not going to just pick *any* old shark, who'll break my legs when I so much as whimper about the vig! The system wouldn't allow such an individual to stay in business with such unappealing practices!

    Personal experience offered in support: I'm staggeringly lucky–a week ago, I was in the Emergency Room with what I was informed was a "moderate" case of pneumonia. (I would not, for the record, care to experience a "severe" case.) I could not breathe. I coughed up unmentionable stuff tinged with blood. I was in a head-swimming amount of pain. And their first question to me was (you can all see this coming): "Do you have insurance?" I did. Treatment was swift, the drugs were ridiculously subsidized, and I'm now on the mend, still able to afford rent and light and heat.

    But I think of what would have happened if my answer to their question had been "No," and I get cold all over. Should those who can afford health insurance get it? Yes. But if we demand that they should (and we do, by making the consequences of not having it so dire), then we have to make sure it's actually *affordable*. And if those who don't have it get sick, God damn us if we victimize those who are literally at their most vunerable, just because we can. (Come to think of it, maybe the Puritans were right about that 'Total Crapulence' thing…)

  5. Maren Says:

    It's a rationalization born of fear. We all do it, even those who of us who actually want socialized medicine. You hear about something bad happening to someone else, from health problems to unemployment to stubbing a toe, and your first thought is to analyze what they did *wrong* so you won't end up in the same place. "I eat gallons of fish oil a day, so I'll never get cancer." "See, I told him not to take that job." "I always turn on a light when I'm walking in the dark!" Rather than deal with the fact that we are all very likely to end up with moderate to severe health problems at some point, if only because we live so damn long nowadays, we preemptively come up with reasons that *those* people got sick and don't deserve a dime out of *our* pockets. Combine that with the extra rationalization that everything that happens is a result of God meting out punishment or rewards and you've got yourself a nice little worldview to keep away the bogeyman at night.

  6. Ben Says:

    I was set to be all "healthcare is one of those hideously complex things, like global warming, that humans can barely understand but not solve, and we all have to deal with the consequences while groping toward a solution".

    Then Reality penetrated my American skull and reminded me: hey fuckwad, every other industrialized nation on Earth has figured out healthcare.

    There really are certain American notions that other countries don't have that bring heavy costs.

  7. kathequa Says:

    @ladiesbane – I had the pleasure of hearing T.R. Reid speak in one of my classes last year. He wrote of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," comparing the different types of healthcare systems around the world and also did a Frontline special on the same topic.
    You should check this out: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/notebook.html and this:
    http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html
    The one thing that I remember so clearly, and that I agreed with was that we needed to state the intended outcome (healthcare for all) and work backwards to find the solution. In other words, it is our moral obligation as a society to provide healthcare to all of our citizens. THAT is the starting point. That is what Germany, Switzerland and I believe Taiwan did. While no system is perfect, the priority in all of these systems is that everyone is covered. Yes, with this type of change in our country, doctors would have to take somewhat of a cut in income, but is maintaining a doctor's income more important than a person receiving healthcare? It's all about priorities, and as Ed points out, it seems in the USA, the priority is making a profit. And profit should not be a priority when it comes to health and well-being.

  8. Sarah Says:

    What's even more deliciously ironic is that those who are trying the Personal Responsibility approach to healthcare (e.g. Michelle Obama's "Let's Move" campaign) are getting slammed for their OMG socialism!!!!1!!!one!!! by the right (Sarah Palin recently took a jibe at Michelle Obama on her TV show with a snide remark about eating s'mores in honor of her, because she "says that we shouldn't eat dessert").

  9. Bette Noir Says:

    Part and parcel of our American Exceptionalism fairy tale, which is far more lethal than any other form of terrorism and right on schedule to be our ultimate undoing.

    Right on, Ed.

  10. Southern Beale Says:

    What we did not do – indeed, what we never do, because it is hard and requires more than 15 seconds of attention – is question the fundamental premise of our, uh, "unique" approach to healthcare in this country.

    This is true, and this is why I was so frustrated that we never got to have the single payer debate, even though our opposition was using anti-single payer arguments. All of this "government takeover of healthcare" and "death panels" and "socialized medicine" rhetoric from the right was pure lies but the pro-reformers never really adequately countered the lies because they were't arguing FOR single payer, they were arguing for this crappy reform that basically kept our private for-profit healthcare system in place. So the lies about single payer ("rationed care," "there is no medical innovation in Canada," etc.) were never countered.

    I said from day one (notably here) that I don't want a choice of healthcare plans. What a fucking hassle. Who wants to shop around for that? I just want to go to my doctor of choice and not get reamed in the wallet in the process. How fucking hard is that?

  11. sluggo Says:

    Profiting off Health Care is Blood Money. There is special section of Hell waiting for these people.

    I wish I could articulate this more eloquently, but I can't get past the concept of someone withholding medical treatment to make profit.

  12. grumpygradstudent Says:

    Yes…the American faith in meritocracy (as both description and prescription) is probably the single most important politically-relevant aspect of our culture. It's one of those articles of faith that are so fundamental that most Americans don't even realize they have it.

    Americans don't like to think of themselves as being subject to forces that are larger and more powerful than themselves. We're raised to think of ourselves as heroes or messiahs or geniuses. I grew up in a rural area in the midwest, and it took me years and years of intellectual development and study before I was able to really see American individualism as the strange cultural mythos that it is. As a child and young man, it simply didn't occur to me to question it.

    I see the same thing with my students today. No matter how much I try to explain that racialized poverty is the result of years of systematic policy choices, they will always gravitate toward the explanations that maximize emphasis on personal resposibility.

  13. Hazy Davy Says:

    What a wacky, weird argument. I'm with ladiesbane which, despite what the comment says, means I think we're in disagreement.

    Personal responsibility? No, I'm pretty sure that it has more to do with personal authority.

  14. comrade x Says:

    I had an argument with a National Guardsman about this topic. He was on a VA plan but against a socialized healthcare plan. His opinion was that the government can't run it efficiently enough- for evidence he cited the delays he had encountered with the VA getting him his GI Bill money. What does that have to do with his VA health plan? Nothing he admitted. But having government run healthcare would be a terrible idea, he insisted.
    " Then I suggest you drop the VA as your provider and start shopping for a private health insurance plan."
    " I can't afford that."
    Face palm.

  15. keith Says:

    That we deliver health care using an insurance model, and that we tie the availability (or affordability) of that insurance to where we happen to work, is completely asinine. I buy an insurance policy to cover catastrophic losses to expensive assets I own (i.e. my house). The routine maintenance stuff I can (usually) handle without insurance.

    Health care is qualitatively different, and its availability and affordability should not be tied to our personal wealth or good fortune, or which corporation we happen to work for. Government is the only entity capable of ensuring health care delivery everyone, and I would happily pay extra taxes for this service. I have yet to hear of any country that has socialized its health care delivery system express any desire to emulate the U.S. model.

  16. bb in GA Says:

    The fundamental question for me is:

    As part of YOUR unalienable rights, do you have a claim, at law, on MY life/property for your own purposes?

    If yes, then where we are heading is justified. If not, we need to rethink it.

    I realize this is supra Constitutional as we already have a court decision that allows for the military draft [Jan 07, 1908 - The Seven Cases Decision] – the taking of my life, in the worst case and involuntary servitude in the best.

    Also, the Kelo decision seems to ice it for Private Property rights on the Federal level.

    BTW I believe there are moral claims to be made on my time and wealth. I am not asking this question to shield my stuff from your needs, what you would call a Randian Pig.

    Our family has given 10 – 15% of our gross income away for the last 30 + years. To gauge this in wealth terms, our SS benefits (which are owed by my estimate for the next 22 years before break even at below market interest rates during my work life and now) are a significant portion of our current income.

    P.S. – to solve OUR problems, I am willing to take a cut in the return of my own money and am willing either to die sooner, or take my chances w/ my faith and my 'root' medicines. I prefer that to shooting at some of y'all…

    //bb

  17. ladiesbane Says:

    Thanks, Kathequa — I enjoyed the Reid piece especially, since it discusses some common models for national health. My ex lived in Japan and had great experiences with their system. There are issues we face as Americans that might make a new model a better fit (or doom us if we choose the wrong existing plan) and we should be thinking about our unique challenges.

    One of them is the idea that doctors should work for a standard pay scale, presumably lower than what they earn now. Subsidized medical school or loan forgiveness for national providers might provide an incentive. Another problem is that many hotshots will still go into private practice, and there will be a quality gap between private care for the rich and public care for those who can't afford to pay up front. (Ancient gag of wisdom: What do they call the guy who graduated last in his class at med school? "Doctor".)

    You may ask if "maintaining a doctor's income" should be more important than care for the poor (or the many), but that choice is up to the doctor, not the state. A good hairstylist or plumber or architect can charge what he or she will, but a good orthopedic surgeon should make a limited wage? The doctors may not stand for it — and I have a hard time telling a doctor to take a pay cut because I want a person's effort, education, and expertise to be free at my demand. I try to imagine having this conversation with the specialists I know, and when you know them as individuals, it's not so neat a package.

  18. John Says:

    @kathequa, "In other words, it is our moral obligation as a society to provide healthcare to all of our citizens."

    Therein lies the problem. There is a substantial chunk of this country that subscribes to a belief system where the above statement is not true. Their belief is that they have a moral obligation to better themselves, full stop. No further obligation to anyone other than themselves.

    This is also the source of the wild and, quite frankly, insane disparities in income for jobs both essential and non. Your average pro sports player makes at LEAST tens of times more money than your average garbage and sewage collector/processor, if not hundreds of times more. But I ask you this: If the garbage/sewage handlers and the sports players both disappeared tomorrow, which would society miss more? Which loss would harm society more greatly? When there's literally shit piling up in the streets, and no baseball game on the television, which problem is more dire?

    Yet we, as Americans, have decided that it's alright for the people that keep us from wallowing in our own refuse to be compensated orders of magnitude less than the people that hit and chase balls for our amusement. The ball chasers are hailed as marvelous "producers" while the people that actually make society function are denigrated as "parasites" or "welfare queens".

  19. Jimcat Says:

    bb: The nation does have a lawful claim to some of your wealth, as per Amendment 16 to the Constitution.

  20. John Says:

    @ladiesbane, "A good hairstylist or plumber or architect can charge what he or she will, but a good orthopedic surgeon should make a limited wage?"

    The problem is that if a nation goes without hair styles, everyone looks a little less suave, but life continues. If a nation goes without healthcare, that nation crumbles and dies.

    The issue is that healthcare is a problem that affects the basic stability of a society. It is a necessity that transcends the profit motive, and our country is one that has decided that the profit motive supersedes all other considerations. We frame the question as "What right do we have to demand services for free" instead of "What right do we have to watch society fail because we feel we're not being compensated enough".

    Both questions are valid. In both cases, one is negatively affecting the other. Our society has developed such that the first question is the natural one, whereas other societies have developed such that the second question is the natural. Ultimately, the healthcare problem comes down to a more basic, universal question:

    Which is more important: the individual, or the society?

    Your answer to that question determines your solution to the healthcare problem. If you believe the individual is more important, then healthcare becomes a question of what right the society has to demand the service of the individual. If you believe the society is more important, then healthcare becomes a question of what right the individual has to hold the society hostage by denying service.

    As bb pointed out earlier, the existence of the draft shows that, in some areas at least, we acknowledge the second option. The individual has no right to deny service in the armed forces if society deems it necessary. Is this always the case, though? That question has yet to be answered.

  21. bb in GA Says:

    Jimcat:

    I stated that my question is supra Constitutional.

    I am appealing to the language of the DOI. Just what are your unalienable rights and do they extend to your having a legal (natural law) claim on my life and stuff in order for you to exercise them?

    If yes, all that followed (16th amendment, 1908 draft decision, Kelo, personal mandate in Obama Care) is jes' Jim Dandy – as my Daddy used to say…

    //bb

  22. Da Moose Says:

    The for profit healthcare situation in this country is perhaps the most stark example of the judeo-christian hypocrisy that has essentially eviscerated the American middle class.

  23. xynzee Says:

    I have no idea where to start or finish this one, so I'm apologising at the start.

    Had a long chat with my brother who's opposed to the idea of a national health care system. He just couldn't seem to get his head 'round the idea that he's saying this as he sucks away greedily at the teet of the government (he's got .mil in he email) why is it that they're the most opposed to government largess.
    Our dad's wife has type-1 diabetes, and thinks that it would encourage her to *not* take care of herself. WT…!!! As if getting access to subsidised insulin will prolong the life of a diabetic who neglects their health. She recently had a quad bi-pass, not because she's been neglecting her health, but just 'cause she has diabetes! Because she was taking care of herself the docs gave her a good prognosis, but still it shows even diabetics who *are* responsible are just going to fall apart.

    Australians and the rest of the Industrialised world look in wonder at how the U.S. doesn't offer national health care. Granted *no* system is perfect, and the one we have here limps along, but it beats the crap out of not having it. I probably wouldn't be here today if it wasn't for Medicare. Because of the coverage I've been able to access psychiatric care for my depression, and affordable co-pay for my meds. A couple of years ago, I was under a particular amount of stress, haven't kept myself in as good a shape as I could and I'm starting to hit an age when the heart starts to have issues. I had really bad heartburn after dinner and started thinking that it's better to be safe than sorry so took myself to casualty. A full night of observation, chest x-rays, the works… direct cost to me? $0! Man I love paying taxes and getting something that I can really benefit from :)

    Add that to the list of it's your faults: you're just no longer 23 anymore!

    There are limitations of course, sure you may have to wait to have a knee operation, but if you have the money and/or insurance you can see a private surgeon. I also think you need to get insurance to pay for obstetrics and paediatricians. BTW – I'm pretty sure that **that** procedure, the one that nearly skuttled the U.S. version *isn't* covered by medicare. Though I believe that in general it's reasonably affordable.

    One of my bro's issues is why should he pay for some fat-arse who smokes n drinks? Well the answer to that is make them pay more for their life style choices. It's called a tax? Wooo! Novel idea, or if you want to give it a more user friendly term call it user pays. The idea being that a smoker and a heavy drinker will be making less wise health choices and therefore need more health care correct? Well we get them to pay more to use the system. How do you figure out who these individuals are in the system? Well make 'em pay for it with each pack of ciggies, or bottle of beer. WOW!!! So smokes are something like A$18/pack – about US$35 at current exchange rates ;-) – and about A$15/6-pack. Now if only they would do the same for KFC and McDs we'd be set.

    At ladiesbane:
    The system here has a few different ways of handling things. There's what's called Bulk Billed, show up present card, sign see doc. (for an illness or medical need ie stitches or broken arm) off you go. Then there's pay per visit, you take a receipt to the Medicare Office and get re-imbursed up to a certain amount of the bill. Then there's fully private where you still get a certain portion back, but the rest is up to you. So if you need knee surgery, you'll get faster treatment though the private system, as opposed to waiting up to 2-3months through public. One may argue one gets a little bit more thorough consult through private, but for basic I'm feeling really under the weather, it works well. The private system allows for those docs who want to be the doctor to the stars, to set their fees accordingly.
    Also one can reduce one's tax exposure by taking out health insurance. If one is over x age and earns above $x, then one is liable for a Medicare levy if one doesn't have private health insurance.

    Med-school here is based on merit, as you need to have the grades to be accepted into a medical degree. Granted one can go the back door route, study a science degree to start and then after graduating apply to study medicine. They have a user friendly form of student loan, where one doesn't have to start paying off their uni fees until after one starts earning above $X. This is then collected out of one's tax return. However, it does continue to accrue interest until one pays it off.

    Something to be aware of though, is that there is some legislation that comes with this. I remember coming to Aus for a visit as an 8yo, and getting into the car I was told I had to put on my seat belt. I was like, WT..!!! That is the stupidest thing I'd ever heard. Why? Because, it's the law! Man what a dumb law, taking away my freedom like that! And that was an 8yo, thinking this.

    Years later, after emigrating I made the cognitive leap myself to what the point of said law was. *Prevention!*

    It's fare cheaper to legislate and enforce prevention of someone's head going through a windscreen than to clean up the mess of: surgery, recover, rehab, loss of a skilled worker to the GDP, possibly never working again and being a drain on the government etc.

    Something that seems to be overlooked is that a *healthy* work force is a much more *productive* work force.

    @J.Dryden: The Puritans get a lot of bad press, and as a Christian I'm usually not very impressed with Edward's theology (Sinner at the Hands fame). I don't think either they or enlightened contemporary Evangelical theology preaches that "God gives you what you deserve cause you're a sinner!" Cancer, HIV/AIDS, Hepatitis, Whooping Cough, even abortion, are symptoms of what's wrong with the world – however, as many of those are preventible, unprotected sex, with multiple partners? Now you have an STD, what were you thinking?? If you live in Uganda we could understand your not knowing, but in NYC?? So yeah, you could say you got what you had coming. The name for that brokeness is Sin (or missing the mark). Yes, a man who can work has a responsibility and duty to work! But there's a Christian duty to care for those who are not able or in a position to take care of themselves. In the Old Testament, the vulnerable were "commanded" to go to the fields to gather (ie work) their portion of the harvest rather than depend on handouts.

    I'm not sure at what point the Protestant Work ethic, got co-opted into Capitalism, but I really don't think the Puritans would approve of the greed and consumerism that they would see that calls itself Christian. Much of the Biblical verses that get trotted out are really a very pointed finger being shoved into one's own chest telling one to take stock of their own failings like the "Remove the plank of wood from your eye, before going after the speck in your neighbour's eye", and therefore cannot be used as a command for others.

    For those that would really like to challenge themselves and step out of their normal comfort zone I highly recommend reading, "The Jubilee Manifesto" edited by Schluter and Ashcroft. They try to explore how society could have looked as laid out in Deuteronomy. If nothing else you will learn that not all Christians think that unrestrained capitalism is a wonderful gift from God.

    What's really obnoxious about the system that you got is it's like an 80s GM diesel engine. Americans have this way of doing things where if they don't want to do something they'll do such a hatchet job of it that everyone will regret ever going there. Take GM's diesel. At the time diesels seemed a God send to the high price of gas. As GM couldn't make a competitive engine compared to the German diesels, they made an engine that was so crap that it effectively killed the entire market.

  24. Georgia Jeff Says:

    A reasonable person knows that neither capitalism or socialism are panacea's to anything, 'health-care' included. I like to point out as economist Thomas Sowell has said that 'health-care' is a misnomer for 'medical care'. No matter how compassionate or non-compassionate a person is for the ill, medical care has a cost associated with it. Especially American medical care. If you do not know where the money comes from, you are not providing a solution, you are only pointing out the obvious.

    I have been around long enough to know that there is no good endeavor that government, any form of government, can fuck up to the highest level of inefficiency. And there is a gun at the end of their management model. And they will kill you.

    What if medical care was privately managed as a 'not-for-profit' industry? I mean, wouldn't all of the well-intentioned people pitch in and pay something for the ill? RIGHT!

    I watched a special on NATGEO this weekend about Vanderbilt Medical center. They provide over $300 million dollars a year in unfunded medical care to meth addicts who manage to blow themselves up or find some other way to destroy their own lives and the lives of everyone they touch. Who will ante up for them?

    I know who does. The evil corporations who pay 71% of all health care premiums in the U.S. And then there are the remaining people who actually are foolish enough to pay their own health care premiums.SIlly me.

    And Jimcat, re: the 16th amendment…you are correct. And it is a really fucked up mess. What is the tax code now?

    http://www.cato.org/pub_display.php?pub_id=3063

    SO lets turn medical care over to government…my best fucking friends who always has my best interest at heart.

    The government of the United States, at this time, is evil. They have no business in the medical business.

  25. anotherbozo Says:

    "…we blame individuals who end up in the hospital, just as we blame the ones you end up poor, in prison, on drugs, or unemployed."

    Great post, Ed, and Dryden's Puritanism is part answer to the above. So is a lot of the self-congratulatory bootstrap values ("I did it the hard way; so should everybody else") of successive waves of achieving immigrants. But it strikes me that there will be a lot more readiness for national healthcare if more people examine the assumptions you've encapsulated above. They are the sort of assumptions that will evaporate if scrutinized, at least with thinking people. Blame, indeed. I imagine a television special called something like, "Why Do We Blame the Poor and Sick for Being Poor and Sick?" and goes on to examine other questions, such as "Are the Wealthy Necessarily More Deserving?" But an examination of fundamental American values, on national TV? I dream, surely.

  26. mojidoji Says:

    Self-reliance: How North Korean of us.

    Juche!

  27. Strangepork Says:

    I like to point out as economist Thomas Sowell has said that 'health-care' is a misnomer for 'medical care'.

    And that's where I stopped reading.

  28. Southern Beale Says:

    I had an argument with a National Guardsman about this topic. He was on a VA plan but against a socialized healthcare plan.

    Steaming cup of STFU for those people. Sorry but put your money where your mouth is or quit reciting Frank Luntz-approved RNC talking points.

    I will say this: when it came time to put my Parkinson's-afflicted father in law in nursing care, we were extremely grateful for the VA facility. The privately-run nursing homes in the area were Dickensian.

  29. 16shellsfroma30aught6 Says:

    Our culture (and especially our media) would have you believe that an obese person who has diabetes or heart problems is undeserving of sympathy, and certainly undeserving of free access to medical care. He did it to himself, we are encouraged to tell ourselves. Probably sat around all day stuffing his face with KFC.

    If people left their door unlocked when they left the house and they get robbed, they don't deserve access to police.

  30. Jimcat Says:

    bb: OK, I understand what you are saying. At the supra-constitutional level, it has always been part of the social contract that the society has some claim on the lives, property, and wealth of the citizens. Taxes are as old as civilization. And the claims that the United States makes today are less burdensome than many throughout history. For all your bitching about "giving away" part of your income, you are still a citizen and not a serf.

    What has that 15-30% of your nominal wages bought you? Rule of law. Reliable physical infrastructure. An abundance of both basic necessities and consumer goods. The confidence that someone with more money and firepower isn't going to be able to push you around just because they feel like it.

    Justice and safety for all citizens, not just a privileged few, cost money and are worth paying for. In my opinion, so is health.

  31. Bette Noir Says:

    @anotherbozo You're right about Dryden — and I also detect a soupcon of Calvin. As the Creationists are fond of pointing out, evolution just takes so darn long . . .

  32. wellnab Says:

    @bb:
    Yes, there is a natural-law claim on your private resources, if you live in this society. You benefit from (among other things) a vast network of federal interstate highways that facilitate cheap per-unit commerce so that you can buy ridiculously inexpensive consumer goods; electricity and minimally clean water brought straight to your home, the latter of which is probably subsidized by federal dollars and the former of which is regulated that way, and, not least, the internet… brought to you by your federal government, and the tax dollars of others.

    Unless you live at the end of a dirt track that you made yourself, in a house that you made with lumber you personally harvested, put together with nails that you made from iron you dug out of the ground on your own property, only consume food that you grow, have no electricity or telephone or internet service, and don't own a car, then you have received benefits from society of a scale that you personally cannot possibly have reciprocated, and you owe. How much is a different question, but I don't think that there's any quid pro quo that is rationally calculable. How do you put a price on being able to drive from state to state if you want to? How do you figure the cost of consumer goods in the absence of highways? How much would it cost for everyone to lack access to electricity?

    Also, more to the original point, the federal government already pays for private health care in that private insurance is mostly paid for in pre-tax dollars. Has anyone seen a calculation of the amount of lost tax revenue vs. the cost of single payer? I doubt if they would match, but it's something to consider – the fiscal burden of individuals need not necessarily change. Additionally, every labor dispute that I can recall has gotten stuck on the cost of insurance/health care or level of benefits provided, or both. Seems like businesses would leap at the chance to have workers' health care paid for by someone else, or at least to not have to hash out the gory details with workers individually.

  33. wellnab Says:

    Ha. Jimcat beat me to it, and said it in fewer words.

  34. Robert Says:

    I worked for a government-run health care system my entire career (the VA).
    We were understaffed and underfunded for the last few years – thanks,
    Grover Norquist, and say hi to Roy Cohn for me when you get to Hell – and as the son of a
    WWII veteran, I am proud of the service we provided.

  35. sluggo Says:

    @Georgia Jeff

    The Free Market will fix everything blah blah blah. Government is evil, corporations are blessed by God. I've heard this same tired line for more years than I care to count.

    Just remember, on 9/11 government employees ran UP the stairs and the stockbrokers ran DOWN the stairs.

    Some things can't be fixed by the market.

  36. jazzbumpa Says:

    A cuppula thotts:

    1) We are become Erewhon. "Erewhon satirizes various aspects of Victorian society, including criminal punishment, religion and anthropocentrism. For example, according to Erewhonian law, offenders are treated as if they were ill whilst ill people are looked upon as criminals. "

    http://en.wikipedia.org/wiki/Erewhon#Content

    2) Ed: We learned that people will argue passionately to defend a system from which they derive no benefit and, in many cases, actively fucks them.

    J.M. Keynes (The Economic Consequences Of The Peace) : Thus this remarkable system depended for its growth on a double bluff or deception. On the one hand the laboring classes accepted from ignorance or powerlessness, or were compelled, perusade or cajoled by custom, convention, authority, and the well-established order of Society into accepting a situation in which they could call their own very little of the cake that they and Nature and the capitalists were co-operating to produce. And on the other hand the capitalist classes were allowed to call the best part of the cake theirs and were theoretically free to consume it, on the tacit underlying condition that they consumed very little of it in practice.

    http://economistsview.typepad.com/economistsview/2010/12/keynes-on-the-psychology-of-society.html

    WASF,
    JzB

  37. sluggo Says:

    Ed,

    Another great post. This is the best political writing I have read since Mike Royko passed away.
    Happy New Year.

  38. mojidoji Says:

    It's always a clue to the quality of someone's argument about government when they start treating it as an accounting exercise.

  39. Tim H. Says:

    The healthcare system has become an eyesore, an embarrassment and an economic handicap.

  40. Baffs Says:

    I could not agree with you more, if you robbed, raped, attacked a fellow citizen I'm sure it's society's fault. If you do drugs it certainly isn't because of your free will. Let me guess, the average age of your readership is under 30, has no savings in the bank, and think I'm a Capitalist Pig because I strive to do better in life. Did you forget to mention that the Top Ten Capitalists in this country have decided to donate their wealth to better mankind? Gates, Buffet, ect, ect. Why do I know 20 former Britain's who totally shit on their system and think were the last Bastion of Capitalism and Democracy left. 2 Trillion in additional debt this yr alone. A story regarding a puppy thrown from a car has gotten hundreds of press clips this yr and people cant fathom the cruelty to an animal. Tribune reports 100's of children attacked, molested, abducted where 90% aren't even prosecuted, where's the outrage? Is your next piece on Man Made Global Warming? Who bought the computer your using, probably your employer!

  41. leon Says:

    Is healthcare a right or a privilege? How can it not be a right if our three fundamental (American) rights are life, liberty, and the pursuit of happiness? None of those can be acheived without access to healthcare. It's that simple.

    If you start a discussion on healthcare with the question above, and the person with whom you are discussing says that healthcare is and should be a privilege, move on. Nothing can be gained from arguing with someone with such a selfish view on life. We all get sick, and buying insurance from for-profit companies is not the most efficient way of providing healthcare devised. As flawed as the Healthcare Bill was, at least it put additional controls on the profit motive uber alles.

  42. bb in GA Says:

    Jimcat:

    "For all your bitching about "giving away" part of your income, you are still a citizen and not a serf."

    I wasn't bitching. I am talking about literal charity here (10 – 15%) of my gross income for the last 30+ years. I am blessed and happy to do it.

    I wasn't talking about taxes – that is in addition.

    //bb

  43. Xynzee Says:

    @Baffs: capitalism in and of itself isn't bad, and ppl should be encouraged to do better. It's when it's been taken to the n-th degree that it falls apart. As Dryden points out, it's one thing to tell people to earn it, it's something else when it's made so far beyond reasonable reach that it becomes skewed and evil.

    @Georgia Jeff: why is it that the mythological meth addict gets trotted out (does that qualify as a strawman?) Of the 330 mill. ppl in the US, what percentage are meth addicts? Let's get real and talk about *real* Americans. You'll find that the average person is more like your parents, neighbour, the sales girl at Meier & Frank/May Co. or the counter person in the corner deli. Those are the great unwashed bulk of the masses we're discussing.

    Now there's a group that can use help. Think about the small mom n pop operation that would like to take on staff but can't because they're not big enough to offer health coverage, as they can't get the bulk rates that something the size of Exxon gets. To offer it, makes the business especially at start up virtually impossible.

    Something that my brother pointed out is getting rid of the artificial skewing and effects on the Market. The medical market has something unique that others don't eg. plumbers and hairstylists. Insurance. Medical insurance does allow for a severe distortion of the market when one thinks about it. Some maybe the real solution to making health care affordable is to actually get rid of insurance companies. If you can only pay what you've got, and there's no huge amorphous pool of money for the medical industry to tap, then prices will fall. Thereby making it accessible to more.

  44. Goytotheworld Says:

    Baffs:

    So, have you ever actually read anything Ed wrote before this, or is it more important for you to act like a self righteous shithead and get a hard on over the feeling that not only did you just insult him, you also showed him what for.

    Aw why the hell am I even bothering, you probably couldn't see another point of view if we cut your legs off and forced you to stand on the bloody stumps.

    "Let me guess, the average age of your readership is under 30, has no savings in the bank, and think I'm a Capitalist Pig because I strive to do better in life."

    I'm 30, I have a savings account and a retirement plan that's been donated into for five years, I don't think your a capitalist pig, I think your callous and willingly choose to blind yourself to how reality can affect the things we don't see immediately. I can make up as much crap as I want about my minor good fortune all being the capitalist dream and the bootstrap myth, but most of it was luck and being in the right place at the right time.

    Our health care system is fucked and we need some real change to happen, but the new batch of assholes moving in would rather set fire to the bridge while we're still on it.

    Question for you, a man is in his home dead asleep when a drunk driver comes down the street and doesn't hit his brakes. He runs through the house, injuring the man. He spends two weeks in the hospital, including the amputation of his left arm, bilateral rib fractures, chest tube placement for one week to drain and repair the massive hemathorax he suffered, and the ORIF repair of his left femur. In the end, without health insurance, all of this cost him well into the 100k range of costs. The loss of his arm forces him to lose his job as a construction worker. He also is unable to work due to the fucking horrific pain in his body that will take another month or so to turn into just plain agony. No health insurance because his work doesn't provide it, and it costs too damn much for him to even think of paying for it once utilities and food is covered.

    So, how was it his fucking fault for any of that to happen to him? Because he was a construction worker? How do you know he wasn't trying to save up so he could go back to school for something better than this? He could afford health insurance if he didn't have to pay for the house? What if the house was inherited after the death of his parents ten years ago, and he only covers the taxes on it once a year? What more will you look for to be able to say this guy was entirely at fault for this happening?

    What about drunky going down the road before he ran into his house? What about the people who saw him swerving down the roads, but never reported him? What about the folks at the bar who saw him stumbling towards his car, and didn't nothing to stop him or call a cop when he got into the vehicle? Kind of sounds like society didn't do it's job there.

    As members of society, we have responsibilities. As part of society, if even just half of the population would do one thing that could benefit society, even something as simple as dropping off a can of vegetables or a pair of pants at the homeless shelter when it's not Christmas Eve would have an impact that frankly could be amazing. But hey, fuck you I've got mine, that's all that matters in this world, right?

  45. jjack Says:

    Getting cancer is your fault.

    Haven't you seen "The Secret"?

  46. Jimcat Says:

    bb: I guess I owe you an apology for the misconception in that case. But the rest of the concept still stands. Yes, the individual does owe something to society. But debate over how much is certainly legitimate.

  47. bb in GA Says:

    Jimcat:

    My fault for not being clearer. Be Blessed.

    And, in the spirit of the season, we agree – only the most extreme libertarian or know nothing would claim no financial allegiance to the flag.

    The eternal musical question is "How Much and for What?"

    //bb

  48. kathequa Says:

    A look at how those dirty, lazy socialists view us…
    http://www.alternet.org/story/149324/america_in_decline:_why_germans_think_we're_insane?page=1
    Simply embarrassing that our country does not take care of its own.

  49. Georgia Jeff Says:

    @sluggo – I began my post by asserting that neither capitalism nor socialism has a solution. I would hope that decency means that anyone who needs medical care, and wants to live, should get medical care. Unless you can refute a fact, that corporations pay 70% of medical care premiums in the U.S. then you should have the intellectual integrity to deal with the fact. I am not a fan of unfettered corporate pillage. I simply stated what was posted as a fact by the Cato Institute. Please let me know if this an incorrect number. Otherwise, deal with it.

    @Xynzee – Basically I agree with you. But the meth addict was no myth. He was wrapped from head to toe in gauze, in a burn unit. The meth addicts were 'trotted out' by the trauma doctor who provided the medical care. If it means anything toward your premise about 'mom and pop', it means that a person who is contributing WAY LESS to society (if anything) than 'mom and pop' is using up a disproportionate amount of limited resources, that could allow 'mom and pop' to hire their employees. My wife and I are small business owners. I think medical insurance is a racket. All insider stuff. Corps pay the politicians (both sides about equally) to put laws in place that rig the game toward their interests (pols, corps, insurers).

    The point, my main point, is that the only solution that ANYONE ever seems to come up with, is to fuck the socioeconomic class to which I may belong at the time. I started life as a lower middle class of a WWII vet and union worker. A boomer. I am a 30% disabled Vietnam vet. I got a degree in music and worked as a performing artist, then as a teacher and school, administrator. Then I needed to support my two kids-through college. It took more filthy lucre than teaching provided. And they needed medical care. So I sold my soul to the corporate satan. Then I became an independent software consultant because I hate corporate bullshit. No matter where my position in life, someone was always 'entitled' to their cut. Notice that I did in fact 'give back' to society.

    As soon as socialistic thinkers come up with programs that have a TRUE factor of equality in it, then I will give it more consideration. In other words, EVERYONE has a responsibility to society, including the individuals who are net negative contributors. Net negatives that are the result of their own choices must have a consequence or you are stealing form everyone. This may mean MANDATORY incarceration in a treatment center (not a prison). I exclude folks who are in need because of circumstances beyond the control of their adult decision making choices. Of course they should be helped.

    @any mindless socialist, paternalistic fuck head…

    Just because someone doesn't agree with you does not make them a heartless capitalist pig..blah, blah, blah…power to the people…blah blah blah…we are so compassionate…blah, blah, blah…It just means that you haven't provided a solution that isn't centered around YOU deciding what is best for them. 'Pure" socialism is an enemy of the human race just as sure as a mindless, faceless capitalist multi-national corporation is. In fact, it is nothing more than a corporation on steroids and with the power of government (read life-or-death).

    You're gonna have to come up with a better solution than anything I have read here. And it will ultimately require FORCE. And if you don't have the stomach for it…suck on it.

  50. Turok Says:

    If everyone stopped stuffing their face with gin and tacos, we'd be a much healthier nation. Obesity is at an all time high, and drug use is rampant. Of course we don't focus on something unpreventable because that's in the minority of health care issues.

  51. Tosh Says:

    @GeorgiaJef: We're gonna need a link for that son. As a healthcare professional for well over thirty years, I will unequivocally state the GOV is, singularly, the largest provider in the US, bar none, without question.

    One FINAL thought:

    EACH AND EVERYONE IS GOING TO
    GET SICK AND DIE…

    There is one way out.

  52. Georgia Jeff Says:

    Thanks for calling me out on this Tosh. It made me look more closely. To my point…there is a distinction between paying medical insurance PREMIUMS and paying for MEDICAL CARE. First, I'm sure you are correct that government pays the majority of medical care costs. But they do not pay medical insurance premiums. None, that I could identify. And I think that is the rub. The government is not contributing premiums. And, it seems that it is EMPLOYEES not employers, who are now paying the bulk of medical insurance PREMIUMS. On that I stand corrected.

    http://www.scpr.org/programs/patt-morrison/2010/09/07/employer-v-employee-who-pays-more-for-health-care/

    http://www.kff.org/insurance/upload/7670_02.pdf

    In addition to paying those premiums, employees then pay for the medical care of others in the form of taxes taken by the government. The government earns nothing. It pays nothing. It simply take's the money of one person, takes it's cut (adding cost), and pays it out to another, and I would find it questionable as to adding an value. Government is no one's friend. Caring individuals make the most (positive) difference, I think.

    That's the part that irriates me. Politicians spin that they can 'save' people from spiraling heath care costs. They cannot. They are simply doing what politicians always seem to do these days. (At least as a group.) Fuck the tax payer. No grease. No reach-around. Then take the credt for great progress. Bullshit.

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