I was responding to OoerictoO’s comment about Republicans in power already being rich and their supporters thinking they can get there too.  The reality is, virtually none of them will ever get there, or even close.

I agree with you that there are many, many ways in which Republican party policies are dangerous to the middle and working classes (to say nothing of the poorest of our citizenry).

Here’s the URL for the Yglesias article indicating 75% of Americans are satisfied with their personal health-care: http://www.slate.com/blogs/moneybox/2012/06/27/americans_health_care_complacency.html

It also adds a 52% unfavorable impression of the new health-care law!  It might be a no-brainer improvement as far as you or I are concerned, but it’s got a ways to go before a strong majority of Americans approve (38% approval ?!?)

However, let me state that this is a blog.  Of course it’s about vague philosophical ramblings.  This particular topic is not packed with references by anyone, and I don’t think it would be greatly improved with twice the statistics and one fifth the comments.

Unless one’s idea of a good thread is 150 “ditto” remarks :-(.

I’m constantly amazed by (1) how low the uninsured figures are and (2) how most Americans are satisfied with their personal level of care.

You should be amazed because you’re living in an anomaly. Fifteen comments in this thread and not a single citation to back up your claims. That relegates your commentary to vague philosophical ramblings.

The assumption of good-faith on the part one’s political opponents is a fundamental requirement for democracy.  Once that is lost, the only logical choice is authoritarianism with you at the top.

I HATE the attitude that anyone who disagrees with me is stupid, evil, or both. It essentially declares that a huge swathe (even majority) of people are unfit to rule themselves, either because they’re too ignorant, or too malignant.

Just because you hate it, doesn’t make it false.

If a party’s policy is to seize all the belongings of people whose last names start with A-M and give it all to people whose last names start with W, am I voting against my interests, even though it would leave me rich?

I am not a fan of the Republican platform, but the idea that *personal* economic gain is the only standard by which ones interests are defined seems pretty odd.

The lines intersect in every system.

(The main advantage of the Canadian system is that you are lied to.  When they say “there’s nothing that can be done”, it feels much better that “there’s nothing we’re willing to do”, even though the second is actually the truth.

Even better, by being denied the truth, you don’t face the personal choice of personally deciding how much your child’s life is worth.  You *can’t* mortgage the future of you and your family’s life, no matter how much you might want to, which means you also don’t have to live with the consequence of choosing *not* to do so.

Sometimes freedom’s a burden, and in this case (for me at least), the burden is not worth the truth.

Still, the government health-care spending level is a tribute to the fact that the Americans are far more generous to their poor than they are given credit for.

It’s just a pity that the cost of economic health-care freedom is so enormous.

Lastly, I will say that I do find a lot of Americans strangely allergic to the one very Canadian-like aspect of their system: HMOs.  These did significantly cut costs by rejecting treatments that had to low a cost-benefit ratio, reducing choices in primary care and specialists, etc.  All things that Canadians automatically accept, yet caused Americans conniptions (if the media was any judge).

I had to wonder, how did the Americans think that costs get brought down?  The cost-saving fairy?

Honestly, I think it slightly demeans the Canadian choice of universal coverage by pretending that Canadians aren’t making any sacrifices at all to achieve that goal.

I still don’t think the improvements are worth twice the cost (and yes, my mother did have to wait several months), but given most Americans seem to be happy with the personal level of care, it’s not alienating everyone.

(2) I have to say that the drug companies behavior belies that.  They won’t develop much for diseases that aren’t big markets, which indicates to me that the development DOES depend on a rich marker that’s willing to pay for extraordinary development costs.  If everywhere was Canada, I don’t think that most companies would continue to do much development.

Honestly, as a Canadian, I’m willing to acknowledge the debt we owe to Americans for funding development of stuff we can use on the cheap (and providing a just-accessible-enough second tier for wealthy Canadians).

(3) Supplemental insurance covers a few odd knick-knacks like private rooms as well as, more importantly, drug coverage.  Note that you can’t usually get private rooms in hospitals even with the supplement because it’s not cost-effective to provide them.  We get cheaper health-care, but you DO make trade-offs.  You want choice, go southward.

(4) Car insurance is for the other guy.  You don’t have to buycar insurance to protect yourself.  Your point about covering people who don’t have insurance anyway is a good one.  However, I think the stories of being harassed to pay a huge bill for the rest of your life is supposed to mean that you are on the hook for any expenses anyway.

It’s all part of the traditional American mores that freedom means the freedom to do stupid, self-destructive things like not buying health insurance.  I don’t value freedom that highly, but I’m not American either.  And I’m not going to hold those who do in contempt, even if I disagree with them.

However, I have to take raw statistics over my personal impression.

Aninous: That statement might be credible if there were a citation attached to it.

First, let me clarify – I am talking about health-care outcomes based on medical care received.  I don’t dispute that American health measures are generally lower, but that’s pretty much due to other social factors. and not the medical care that Americans receive (when they receive it).

I will still claim that Americans do get something for their extra money – marginally better health-care outcomes for medical procedures for much larger bills. 

I, of course, think Americans would be better off spending 3/4′s as much, getting slightly lower outcomes, but now be able to cover the uncovered, who would get much *better* outcomes.  HOWEVER, I don’t dispute the the majority of Americans would be slightly worse of (medical-wise) to make the minority of Americans much better off.  That trade-off is apparently not acceptable to the majority of Americans.  I’ll do my best to persuade them otherwise, but not by pretending that the trade-off doesn’t exist.

As for the reference, I searched the CBC site in vain.  The article was about a year ago when the health-care debate south of the border was in full swing.  It was a study done by 4 hospitals looking for best practices on the outcomes of 5 major procedures (treating heart-attack, breast cancer, etc.)  In the end, the Americans came out ahead on one, slightly ahead on one, tied on two, and the Canadian recovery rates were slightly better on one.  Analysis indicated some procedural changes for both sides, and some cases where the higher spending on the American side afforded slightly better diagnosis (and thus outcomes).

The total difference, in my opinion, was not worth the nearly double costs south of the border, but the health outcomes *were* slightly better.  i.e. individual Americans were getting something for the extra money.

My favourite line in an interview of a hospital staff worker interviewed when asked the difference between the two health-care systems:  “We’re here to improve patient care on both sides of the border, not provide fodder for politician’s debate.”

Yes, of *course* single payer healthcare is more efficient, but that is not the only criteria a lot of people use to measure the system.  Having single payer clothing would also be a lot more efficient (and would be fine with me), but most people feel the loss of freedom to pay more or less for different clothing is not worth the extra efficiency.

I HATE the attitude that anyone who disagrees with me is stupid, evil, or both.  It essentially declares that a huge swathe (even majority) of people are unfit to rule themselves, either because they’re too ignorant, or too malignant.

The idea that the majority of Americans value their economic freedom higher than they value covering their fellow Americans does not make them unreasonable (and by implication, unworthy of franchise), even though I find the attitude at strong variance from my own.  If there’s only one reasonable course of action, why bother with democracy?

In the long run however, it will have to come to terms with its one dimensional, shrinking white, aging, uneducated followers and attempt to make nice with so many groups that it has demonized. And again, oh, let’s not forget the huge gobs of new cash due to SCOTUS’ Citizens United ruling…

And finally, oh, let’s not forget the huge gobs of new cash due to SCOTUS’ Citizens United ruling…

Healthcare reform isn’t about common infections; it’s about the big diseases that kill thousands every year, chronic diseases like cancer and heart disease.

A: the president says it’s not a tax, but his lawyers, using a legal fiction, say it is, and the court will go along with that pretense.

B: Roberts says, translated into plain english, this doesn’t look much like a tax, but there’s a presumption of constitutionality, so we will -interpret- it here as a tax, in order to uphold the statute.

C: Now I personally think Roberts believed what he wrote, but stategically it’s brilliant. Marbury v Madison may have gotten the facts wrong about which papers were on whose desk, but strategically the case gave the court an important new power. Roberts gives the liberals a minor win by upholding Obamacare (less the state medicare aspect based on federalism), but scores a victory by finding 5 votes to limit the commerce clause, changing the dynamic between court and congress.

That assumption of power would have been called activist and partisan, if he hadn’t conceded on the tax issue. He comes off as a statesman not a hack.

The next point I want to address is Rand Paul and who gets to decide what is constitutional. The government has three coequal branches. Each of them has a role as a protector of the constitution. Rand can vote to repeal unconstitutional statutes. Obama can veto unconstitutional bills, and maybe choose not to enforce unconstitutional statutes. The court can declare statutes unconstitutioanal, if they get a case or controversy, although unfortunately they have made up a rule about presumptions of constitutionality. The health of the republic depends on all three branches doing their job well. Rand is correct to have his own views. There is a similarity here with the protestant v roman catholic worldview. For protestants, jesus speaks to them through prayer and the bible, not just through a pope. When I swore to uphold the constitution, as a state employee and as a lawyer, my oath was to what the constitution means, not just what this court today says it means.

(Also, Roberts has a history of thinking that anything the Executive Branch wants to do is Constitutional, whether it’s torturing prisoners, holding American citizens without habeas corpus based on accusations of terrorism, or whatever.  Obamacare should be a piece of cake to excuse Constitutionally compared to those.)

2) That’s true.  In the U.S. medical research is well funded.  That’s due to the government subsidizing research more than people paying for it through their insurance, though.

3) I know people in Canada who have supplemental insurance, though maybe that’s not what you mean.  When I lived in Canada we paid for upgrades at the hospital, though, and it worked out.  

4) Nobody plans to be injured or get a disease.  The point of insurance is to cover for accidents.  Good drivers still need car insurance.  Younger healthier people get much better rates if they buy private insurance, and need insurance just as much as anyone else, even if they don’t like paying for it.  Uninsured people drive up costs of care at hospitals which raise the expense for everyone else.

The quest is to be liberated from the negative, which is really our own will to nothingness. And once having said yes to the instant, the affirmation is contagious. It bursts into a chain of affirmations that knows no limit. To say yes to one instant is to say yes to all of existence.

Actually, if you compare health-care outcomes in cross-border studies

That statement might be credible if there were a citation attached to it.

Yes OoreictoO, single payer would be much better, if you can get that through congress I will wash your car and buy you a pony.

Agreed.  But then, living away from a river is no guarantee of a flood-free future (as people find out in micro-bursts that flood a house in an hour.

Anyway, it’s basically a question of whether you feel its ethical to make young and healthy people subsidize the old and sickly (which means the young and healthy forego things they might prefer like education, better housing, or more beer.)  Personally, I’m okay with it, although I think taking from tax revenue is generally fairer (and also means that people can point to something that their taxes are used for that they approve of), but I think this is the best compromise the American culture and electorate will allow.

Actually, if you compare health-care outcomes in cross-border studies, the advantage is slightly to the Americans.  On the other hand, they pay literally twice as much, so I don’t think they’re necessarily getting better value for their money.

this is no longer true, most medical technologies and techniques come out of europe (read: socialized insurance), SOME pharm being the exception

The idea of waiting for an MRI is almost unknown to most Americans who have decent health insurance (which is the majority).  You can wait a long time in Canada, if it’s non-urgent (but still quality of life harming).  We also save money by not using expensive technology (that produces lightly better outcomes).

Canada saves money by not having MRIs on every corner.  Do you think Canadians waved a magic wand?  You want to save money, you make trade-offs.  Personally, I think the trade-offs are worth it. 

I’d rather have a Corolla health-care system for all than a Lexus health-care system for the majority, but don’t pretend that there’s no difference between a Corolla and a Lexus.

there are some countries you can live in where you don’t have to pay for roads or clean water if you don’t want them.  no one thinks this is a good idea in modern society.

I’d agree.  But, I don’t a majority of Americans are stupid or evil for disagreeing with me (at least on healthcare).  The American culture is much more about each person pulling themselves up by their own bootstraps.  Seems odd to me, but I’m not going to criticize how Americans choose to rule themselves – merely try to point out the advantages (and costs) of my own preferred policies.

Essentially so (you can’t be “partially in”, so it’s like private schools – you pay the *entire* cost, not just what isn’t covered. – thus there’s essentially no meaningful private system).  It’s a point of contention, but it prevents a parallel system from eroding our current system with the death of a thousand minor cuts.

However, it does mean that USA provides a needed safety net for Canadians who can afford better coverage and would use their influence to establish a second tier within our borders.

As for mandates, the *whole point* is for young, healthy people to pay more to subsidize the older, sicker people.  This is how it won’t break the government bank.  The flood insurance analogy is apt.  If you want to give people who live in the flood plain insurance, even if they can’t afford it, you *must* make somebody else pay for it.  Hence me up on the hill is buying not-especially-cheap flood insurance.  I have no problem with this as a cost of universal coverage – BUT THERE IS NO FREE LUNCH.

In Canada, because it’s tax based, it’s the wealthy, not the healthy that do the subsidization.  I’m decently paid, so my family probably pays 2-3 times what the province spends on us in health-care. 

For somebody in the gainfully employed middle-class, the Canadian system is actually a net loss on a personal level.  However, I (and most Canadians) think it’s a net benefit on the society level.

(Sorry, it’s my hobby horse – I want people who support what I support to know exactly what the costs are for their choice.)