The Horrors of Free Health Care

by publius

It's heartening to see Britain rallying around its health care system in the face of egregiously dishonest attacks and accusations.  Of course, as this NYT essay explains, the British system has its problems.  But the general British complaints about their health care system are being misinterpreted on this side of the pond.

It's basically a question of baseline assumptions.  Think about our free education system.  We complain about it a lot.  It has its problems for sure.  But discussions of those problems take place within a widely (almost universally) shared consensus that free primary education is a good thing.  To criticize education policy isn't to call for its abolition -- just like criticizing your family doesn't mean you want your family to be disbanded.

That's why the American attacks have been dishonest.  They've been citing complaints from people who fundamentally believe in the system to justify attacking the very premise of the system.  It's like citing complaints about teacher pay to justify abolishing public education.

The new British enthusiasm to defend its system stems from the recognition that the American attacks are aimed at the foundation of the system, and that Americans are trying to exploit everyday criticisms in a fundamentally dishonest way.

And just on an aside, is free health care really so terrible?  I mean, American seniors don't seem to mind their free, socialized, single payer system that much.

Comments

[sara]

But many right-wing Americans DO believe in abolishing public education.

I wonder how many of them also want to do away with municipal water and sewer systems. They would be more free of hypocrisy if they lived on farms with private wells and septic systems and grew their own food. But they have an inchoate conviction that all public institutions sap their precious body fluids.

[GoodOleBoy]

Why do you use an expression like 'free health care' in a post essentially about dishonesty by those in opposition to many of the recently developed legislative proposals? Many of the points used by the opponents of what is being 'proposed' don't really grab my attention, but I will join the contest when the discussion is about the costs as well as about where control of the structure of the the system of medical services delivery is exercised. For the American people, there is plenty of substance within these two areas to carry the argument without resort to results of approaches used in other countries.

Your comparison to public education is also disingenuous. Although I abhor the level of involvement and influence of the federal government in our educational process, nowhere yet has that involvement shown the potential to eliminate an individual's choices in obtaining an education, notwithstanding the unintended consequences of that involvement. And certainly that public education is not free. The issue of individual choice regarding medical care is one that many opponents feel is in jeopardy. What is your idea of honesty on this issue of costs?

[Yarrow]

GoodOleBoy, try googling for "free, compulsory public education". Then let's talk.

[Brett Bellmore]

"Think about our free education system."

We don't have one to think about. We have a "pay an amount unrelated to your use of it" system.

So now you want a health care system where payments are equally unrelated to your use of it, and you're again going to pretend that's "free". Which is going to be a real shock to the people footing the bill. Fat lot of right you have to complain about dishonesty.

[GoodOleBoy]

'GoodOleBoy, try googling for "free, compulsory public education". Then let's talk.'

Once again, someone jumps on a side issue in order to detract from the principal point.

[Crawford Kilian]

Speaking as a Canadian retiree, I know it's not "free"--I pay about $100 a month for it to cover my wife and me. It's insurance, not health care, and just as with car insurance or house insurance, it's to cover emergencies. I'm delighted to spend $100 a month to keep my wife and me healthy, and on those rare occasions when we do need to see a doctor or have a medical procedure, the costs are covered.

And while we spend far less on health care than the US does, Canadians actually live longer than Americans...thanks in large part to a universal, single-payer insurance system.

[Yarrow]

Once again, someone jumps on a side issue in order to detract from the principal point.

Glad you've seen the error of your ways, G.O.B.!

[GoodOleBoy]

I have no problem with compulsory public education, where public means the costs are covered by state revenues. As a US citizen, I do have a problem when that funding is at the federal level. I would be happy if Washington would stick to protecting individual rights guaranteed in the Constitution and stop taking over functions where there is no constitutional basis.

[John Thullen]

"pay an amount unrelated to your use of it"

There's all of those nuclear weapons laying around that I never get to use.

I've got to get out on I-80 a little more often because I have a feeling Brett is hogging my allotment of the passing lane.

The Hubble Telescope -- when do I get to use it to look at stuff I want to look at --and go ahead and think I'm a sort of interplanetary pervert?

Why do old people get all of the chemotherapy and radiation for their tumors? I want a piece of that action.

Fallujah -- I don't remember having property there that required defending.

Hurricances, tornados, earthquakes, and pestilence never hit my area of the country .. I feel cheated.

Swine flu -- Brett's got it and I don't and I paid just as much to get it as he did.

[Ben Alpers]

Crawford Kilian,

The post is about the British system, not the Canadian one. The two are quite different from each other.

[John Thullen]

Yes, Ben, but the point is that if Americans are not free to have the choice of shorter life spans, it kind of ruins the prospect of having longer life spans for them.

In American, living to 90 is very fine and good, but what really makes it worth the wait is that so many other suckers croaked a lot earlier.

[Phil]

I have no problem with compulsory public education, where public means the costs are covered by state revenues. As a US citizen, I do have a problem when that funding is at the federal level.

What school districts in the US are funded by federal tax revenues rather than from state tax revenues or local property taxes? Because I surely don't know of any.

Which is not to say that I'd have a real problem with it in theory. Because the current system means that children in poorer districts are punished with an inferior education based on nothing more than where their parents buy or rent a home. Which kind of trips over that whole "equal protection" thing.

As to Brett Bellmore, well, you'll forgive me if I decline vocabulary advice from someone who throws around words like "sociopath," "extortion," "bribery" and "mafia" so blithely.

[D'd'd'dave]

Publius

"The Horrors of Free Health Care"

IT IS NOT FREE! The british pay for it. We will pay for it if it comes here. And you're talking about egregiously dishonesty. Look at yourself.

[John Miller]

dave, we already do pay for it, and far more than we need to. GOB, since, particulalrly with the public option, people would have more choice and control under any reformed bill currently under consideration, why is there the concern?

The irony about all this debate is that people are runnin nscared about greater government intervention in their lives, when virtually none is being proposed, but appear to actually want greater corporate intervention.

[John Thullen]

"We will pay for it if it comes here."

Do you mean to tell me I paid for PBS' "Masterpiece Theater" and "Fawlty Towers" when they sneaked ashore like rats off the mystery ship?

Wait a minute! Are you telling me the Iraq War was NOT free? I paid for waterboarding? And furthermore, I didn't get to waterboard anyone or to be waterboarded my own self?

Lyndie England (where did SHE come from, with a name like that?) is a socialist leech.

Gosh, if I'd known that, I wouldn't have merely imagined violence, I'd have gone out and done something about it.

Grab your balls, boys, and follow me.

[Porcupine_Pal]

Gosh, give a guy a wallet full of credit cards and he thinks he's Davey Crockett.

[Uncle Kvetch]

Oh mercy--you've clearly hit a nerve with the I-Got-Mine-Jack Brigade, Publius.

Pass the popcorn. This is gonna be good.

[GoodOleBoy]

Thullen has been known to be humorous and incisive but not here this time. You'll have to do better, John Thullen.

Uncle Kvetch, always on the same theme. Have you noticed how Barry always informs us that 'it's not about me'? He is the first POTUS who in my memory uses that expression, and he uses it a lot. Makes it sound as if it might be about him. As well, you are another who always attacks those who argue against you with something unrelated to the issue being contested. Whether I-Got-Mine or not is not the question here, but rather is what I do have going to be subject to confiscation by the crowd that has little tolerance for the idea of private property and individual choice in matters NOT the legitimate purview of the federal government.

On the issue of Canada, any comparison of a government delivered service is weak since it is barely more populated than several of the states in the US and they do, like Europe, avoid most of the costs associated with national defense.

[cleek]

Thullen has been known to be humorous and incisive but not here this time.

pphht, you're waaaay off, on that.

confiscation

yeah, that question was settled a long time ago. welcome to the 21st century.

[Ben Alpers]

The British and the Canadian systems are really a bit of a distraction when it comes to our current reform debate. Neither of them is remotely on the table. The right spends lots of time lying about them and it's worth correcting their lies. But it's also worth pointing out that nobody is proposing anything remotely like the British system. And those who are proposing a system like Canada's are being systematically shut out of the discussion by the White House and the Democratic congressional leadership.

If one wants to compare American proposals to (very, very roughly) similar systems overseas, continental European countries are a lot closer to the most progressive options under serious discussion right now.

[Bob. L]

It might be useful if we could get people to distinguish between single-payor and real socialized medicine. In the UK, where they have true socialized medicine, those who work in the public health plan, which is the one available to everyone, are employees of the government, from the physicians down to the janitors. The government pays their salaries. They get no compensation from their patients. (This is probably a bit over-simplified, but it's the primary point.)

In a single-payor system, the doctors and others still charge whatever it is they charge (or get the people with whom they have contracts to let them charge), but instead of billing the patient or an insurance company, they bill the government. This is obviously different from the British system. In particular, in economic terms, doctors and others who work in the system lack any financial incentive to reduce costs. British doctors can cut costs without fear that their incomes will drop. The benefit of the savings can accrue to the government and result in lower taxes. I'm not accusing American doctors of being greedy or unethical -- just human.

I don't think anyone is seriously proposing British socialized medicine for the US. It has its virtues, but I don't think the American public would tolerate it even if they fully understand it. The most snyone is proposing is single-payor (Obama is not, though he did flirt with it at times), and there is a great ongoing fight about how to alter incentives so doctors don't keep costs high in order to keep their incomes high. You don't have to dislike doctors or begrudge them a decent income to realize that the costs of medical care in the US are in an upward spiral that cannot possibly be sustained.

Never forget Stein's Law -- whenever a trend develops that cannot be sustained, it won't. The issue at this time is how we cope with spiraling health costs, which have already priced so many people out of the market. We'll do it one way or another, but surely the least desirable one is to price care so far out of the reach of most people that the majority of Americans have the choice of inadequate care or insolvency. But that's where we're headed, and anybody reading this could soon be faced with a choice of bad health or bankruptcy. That's what BHO means when he says that the status quo is the worst of all choices.

The ideal health bill would provide universal necessary coverage at minimum necessary cost. Anything in a bill that is not conducive to that goal should be discarded, and anything not in a bill that could be conducive to that goal should be added. We could get from here to there, you know, if people would stop worrying about killing grandman and losing Stephen Hawking and instead started worrying about a future when the average American cannot get decent health care because it's too expensive. We're probably less than a decade from that if we don't do something sensible -- and quickly.

[jonnybutter]

We don't have [free public education system] to think about. We have a "pay an amount unrelated to your use of it" system.

So now you want a health care system where payments are equally unrelated to your use of it, and you're again going to pretend that's "free".

Do you think they're going to fund universal insurance via property taxes? I don't think so. You have written a true statement as far as it goes, but your comparison is all wrong.

Otherwise, I sort of implicitly agree with Brett here and disagree with GOB: strict local control of the public school system is really stupid, and not only because of how it's funded (but that, too). I'd like to hear a substantive defense of it.

[jonnybutter]

Also - guys, let go of your pickle. I think Publius knows that it isn't really 'free'...c'mon.

[efgoldman]

Thullen may be a little over the top, [Heavens. When did THAT ever happen?] but as usual he's absolutely right.

We DON'T get to choose (except by electing people we think will vote for/against certain things) where our tax $$ are spent. And the fact that we spend hundreds of billions on useless weapons and an even more useless Mideast war is the ultimate proof. Who knows, if Bush, Cheney and their enablers hadn't done that (fat chance!) we might have ended the previous administration with some of Clinton's surplus left over.

The best argument is still Steve Benen's (sorry, no link): Why aren't brett and dddave and their friends insisting we go back to private, competing fire and emergency services departments? dddave, certainly, can afford to hire his own. We'll just put, say, red ribbons around all his properties and the municipal or county departments will know not to respond there.

[publius]

yes, what jonny said. by "free," i mean that taxes are gathered and services are then provided without direct charges -- like school.

[Johnny Canuck]

"If one wants to compare American proposals to (very, very roughly) similar systems overseas, continental European countries are a lot closer to the most progressive options under serious discussion right now."
Posted by: Ben Alpers

One would have thought the Dutch system would be getting a lot of attention. I believe it was a private insurer system with a public option, but the public option has now been eliminated leaving universal coverage by private insurers.

[Johnny Canuck]

"On the issue of Canada, any comparison of a government delivered service is weak since it is barely more populated than several of the states in the US"

GoodOleBoy needs to be reminded that Canada doesn't have government delivered service, what it has is a single payer system in each province, administered by each province. I have no idea what the relevance of population density is.

[Uncle Kvetch]

One would have thought the Dutch system would be getting a lot of attention. I believe it was a private insurer system with a public option, but the public option has now been eliminated leaving universal coverage by private insurers.

I believe you're right about this--with the caveat that those private insurers are strictly regulated as to what they have to cover and what they can collect in premiums. I don't know if we can reasonably hope for that kind of regulation, given the political influence of the insurance industry.

On a more meta level, the discourse is so riddled with bad faith and outright silliness that it's well-near politically impossible to cite any other country's system as a model or inspiration--no matter how well it works--without provoking hysteria. Witness Obama's recent rhetoric about coming up with a "uniquely American" solution.

[Pithlord]

You can distinguish publicly-funded from state-run, but there is a tendency for the former to become the latter. In theory, doctors in Canada are independent contractors, and they do have autonomy in renting office space and hiring clerical staff. But in practice, their compensation is negotiated through a process that looks a lot like collective bargaining, and unelected state bodies decide what procedures are covered, who gets hospital time and so forth (I'm thinking of British Columbia, here, but most provinces are similar).

Whatever the merits of a Bismarckian, public or free market sysytem, I don't think most medical procedures should be "free" to most people. I'd provide state catastrophic coverage with an income-based annual deductible and HSAs. Brad DeLong proposed this and Kerry had something similar.

[Johnny Canuck]

their "compensation is negotiated" , don't you mean a 'fee for service' schedule?
And in US, don't the insurance companies do much the same? or how do insurance companies decide how much they will pay?

[Gary Farber]

"and they do, like Europe, avoid most of the costs associated with national defense."

Insofar as this is true, it's largely because they confine themselves, for the most part, despite sending a noticeable contingent to Iraq, and making other contributions to international peace-keeping (Sudan, at the moment, but recently in Iraq, Haiti, Sierra Leone, Kosovo, Macedonia, Ethiopia and Eritrea, and elsewhere), to primarily spending their defense money on national defense, which is to say, protecting their borders from invasion, rather than by investing in some 737 bases around the world, eleven aircraft carrier fleets, some 9000+ aircraft, and a vast host of bloated weapons programs, all intended to project power around the world and dominate the world militarily, rather than for "defense."

Canada, on the other hand, believes in a Canada First Defense Strategy.

Who would you suggest is a likely candidate to invade Canada that they need to be spending a lot more money defending against?

[Gary Farber]

"On the issue of Canada, any comparison of a government delivered service is weak since it is barely more populated than several of the states in the US and they do, like Europe, avoid most of the costs associated with national defense."

I'm not following the point you're trying to make here: you're saying that Canada's population of ~33,212,696 is so small that -- for reasons you leave unstated -- we have nothing to learn from how they supply health care to people, in a way that the overwhelming number of Canadians are">http://voices.washingtonpost.com/ezra-klein/2009/07/americans_fear_canadas_health-.html">are very happy with? .

[Gary Farber]

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"IT IS NOT FREE! The british pay for it. We will pay for it if it comes here."

d'd'd'dave, of the nearly nearly 46 million Americans without health insurance, how many of us do you think would do worse under the British, or Canadian, or French, or German, health care system? Why do the British find their health care system so popular, as well? As do the French and the Germans with their own, far more than Americans overall do with our health care system?

Four-link limit makes me make another next comment.

[Gary Farber]

Why this?

Why does David Cameron, the leader of the British Conservative Party say this?

[...] David Cameron today insisted that the Conservative party stood "full square behind the NHS" as he sought to distance his party from comments made by a Tory MEP who rubbished the British health service in a series of American interviews.

The Conservative leader branded Daniel Hannan's views on the NHS "eccentric" and insisted he did not agree with them.

[...]

Cameron said today: "I don't agree with Daniel Hannan. The Conservative party stands full square behind the NHS ... We back it, we are going to expand it, we have ring-fenced it and said that it will get more money under a Conservative government, and it is our No 1 mission to improve it.

"As I said at the party conference, you can sum up our priorities in three letters: N. H. S. That is as true today as it was then."

Asked about Hannan's remarks, Cameron replied: "He does have some quite eccentric views about some things, and political parties always include some people who don't toe the party line on one issue or another issue. But no one should be in any doubt: the NHS is our No1 priority ... It is one of our greatest national institutions and we want to expand it and improve it."

Andrew Lansley, the shadow health secretary, said the MEP had done the NHS and Americans a disservice by presenting a "negative and partial view".

Earlier, Cameron sent out a strongly worded email of support for the NHS.

The Conservative leader's message, published on his blog, said that millions of people, including his own family, were grateful for the care they had received by the institution.

Weird, isn't it?

[Gary Farber]

"...and unelected [...] bodies decide what procedures are covered, who gets hospital time and so forth"

Unlike the current U.S. system, where patients decide these things for themselves, and there are no third parties intervening between them and their doctors in making such decisions!

[GoodOleBoy]

'GoodOleBoy needs to be reminded that Canada doesn't have government delivered service, what it has is a single payer system in each province, administered by each province. I have no idea what the relevance of population density is.'

Thanks for pointing that out, my mistake. The reason I mentioned population goes to numerous comments here whenever I have mentioned state governments, insurance companies, and state regulated healthcare systems instead of federal. The retort is invariably that the numbers are not big enough to spread the risks appropriately. It's amazing that countries much smaller than the US can have a system at all.

"and they do, like Europe, avoid most of the costs associated with national defense."

Gary, I do understand your point and I agree that some of our recent military adventures raise questions. The fact remains that since WWII we have built a foreign policy and military establishment that seems to have as an underlying assumption that we are the protector and defender of the free world (or some portion of the world, you name it). I'm no expert in this, but it would be a nice benefit for americans if we could get out of the costs of doing that (or have all who get the supposed benefits share the costs). Would you say that we could just drop it, dissolve our weapon systems and bring all our soldiers home and close all those military establishments abroad?

[John Spragge]

Gary, I think you meant to write Afghanistan, rather than Iraq. Canada did not participate in the latter adventure, saying we did not consider it prudent. Canada has, on the other hand, had "boots on the ground" in Afghanistan right from the beginning.

[Jesurgislac]

IT IS NOT FREE! The british pay for it. We will pay for it if it comes here.

Cost of my monthly NI tax bill: £167
Cost of my recent trip to A&E to confirm that my bumped wrist was just a nasty bruise, not a sprain: £3 (bus fare there and back)
Cost of my dad being alive, fit, and well at the age of 82 with a dodgy ticker: Priceless.

[Jesurgislac]

Average annual premium for US health insurance: over $4,700 cite
Equivalent in GBP: £2847.80 cite
My annual income tax: £3500 (approx).
What I pay annually for my prescription medication: £104
Charge made every time I visit my GP: £0.0 (the practice I chose to be registered with is five minutes walk away from home, 20 minutes walk from work).
Cost of my great-aunt living to be with us till the age of 94, despite a serious heart attack in her 80s, mild dementia, and very bad osteoparosis: Priceless.

[John Miller]

GOB, the concept of risk pools is only partially brelated to numbers. It has more to do with spectrum of covered lives. Insurance companies have had an alarming tendency to keep out of their risk pools the ill, the likely to be ill or those who have been ill in the past. They are also staring to either not cover or cover at high costs those with family histories of problems, even if the insured to be has no personal history.

Medicare, on the other hand, covers what woudl almost entirely be considered a high risk pool, which is why per capita spending on Medicare patients is higher, although not that much, than per capita spending is Canada.

I realize you were not really being serious with your statement about numbers, but others might have thought you were.

[ckc (not kc)]

Would you say that we could just drop it, dissolve our weapon systems and bring all our soldiers home and close all those military establishments abroad?

...try it, you'll like it!

[byrningman]

Well, I lived in the US for several years, just lived in the UK for several years, and have just moved to Canada. My anecdotal experience suggests that the people of Canada and the UK are far happier with their health care systems than the people of the USA. Indeed, I've already met quite a few Americans here in Canada who sing the praises of the Canadian health care system and regale me with horror stories of the US one. Have yet to run into anybody pining for the US system.

People everywhere complain about their health care systems, because obviously medical attention is something that just about anybody could happily receive an infinite quantity of, but it is always going to be in finite supply. Generally speaking though, every British person who complains about the NHS wants the government to spend more government money on it, and most people seem to oppose rather than support the Labour government's efforts over the past few years to introduce 'market efficiencies' in the NHS.

I've also had private health insurance on top of the state-provided care in both the UK and Canada. So even a socialised health care system or a single-payer system doesn't eliminate the free market; and because the private insurance companies have to offer a very compelling service at a compelling price to make it worth your while, I pay far far far less for this bonus insurance than I did in the US, or that my girlfriend in NYC currently does. In fact, at my middle class earning level, the cost of the extra bonus insurance is negligible - around the cost of an iPod. They've also never refused me anything, unlike extortionate health plans in the US that apply ridiculous copayments and so forth, although I don't receive much medical attention in general.

My other point is that national defence costs are irrelevant, because the Canadian, British etc. health care system are far cheaper than the US one. this study shows that comparable countries' systems are half as expensive per capita as the US one, and ranks the US worst of the bunch (although it ranks Canada second worse!).

[Gary Farber]

"Gary, I think you meant to write Afghanistan, rather than Iraq."

Yes, when I referred to "sending a noticeable contingent" I meant to type "Afghanistan."

"Canada did not participate in the latter adventure, saying we did not consider it prudent."

On the other hand, that's not entirely true. Canada did send one guy as part of Operation IOLAUS, part of "United Nations Assistance Mission for Iraq (UNAMI)."

This operation involved the deployment of a CF officer to be one of the Assistant Military Advisors (AMA or A/MILAD) for the United Nations Special Representative of the Secretary-General (SRSG) leading the UNAMI mission. This officer was authorized to carry out tasks assigned to him by the Military Advisor (MILAD) to the SRSG, in accordance with his mandate as approved by the United Nations. The officer was employed as an expert on the mission as an unarmed member of the SRSG UNAMI staff.

Task Force Iraq (TFI) was a detachment of Canadian Expeditionary Force Command (CEFCOM) and represented the forces assigned to Operation IOLAUS. As the sole officer assigned to TFI, the A/MILAD was also designated the Task Force Commander.

So, y'know, you sent a commander of a Task Force. Who happened to be entire task force.

Which seems very impressive to have on your record, doesn't it?

But let's not forget the major contributions from:

[...] When it became clear that the United Nations was unwilling to back military action against Iraq, Mr. Powell named 30 countries that would pitch in. Nations contributing troops included Tonga, Mongolia, Nicaragua and Latvia. In all, 38 nations sent soldiers over the past six years, typically in groups numbering in the low hundreds, in rotations that were usually brief and sometimes even furtive. Japan sent a force but announced that it would not fight. Dutch troops had to be deployed just to guard it.

Iceland sent the smallest contingent, even before it cut its force in half — which left only one Icelandic soldier in Iraq.

I'm sure every last person was appreciated.

GOB: "I'm no expert in this, but it would be a nice benefit for americans if we could get out of the costs of doing that (or have all who get the supposed benefits share the costs). Would you say that we could just drop it, dissolve our weapon systems and bring all our soldiers home and close all those military establishments abroad?"

I wouldn't be quite that abolutist, of course. I'd certainly retain, in fact, a standing Army, and Navy (though maybe combine the Air Force back into the Army and Navy), and keep a variety of weapons, and planes, and ships, and I can see a reasonable argument for some overseas bases, mostly some naval ones for ship maintenance, and even a few air bases to as to at least be able to provide humanitarian assistance at times, as well as, in fact, retain some ability to support some allies in certain emergencies or events. I'm not planning on issuing a Precise Plan.

But overall I don't think we should be the World's Policeman, and maintain a vast military empire, and wind up spending the amounts on this chart I posted here the other day:

I also observe that a lot of our deployments and, as Nell was discussing recently, our Status Of Forces Agreements almost always calling for us to retain the rights for U.S. military personnel to avoid being caught up in the justice system of countries we have bases in, we wind up with an awful lot of cases of our people committing rapes and other crimes, and often getting away with it, or with very light punishment, and thus causing a lot of friction with our allies, rather than good will. This is often the case with our foreign bases in general, which we generally have to, aside from the expense of them in and of themselves, we have to pay huge sums of what amount to bribes to those countries so they'll let us have the places in the first places. Just look at our history of that sort of thing in, say, the Philippines, and Japan (particularly Okinawa). Plus there's the way we make those places environmental toxic dumping grounds, also further not endearing us to our friends.

I think we can afford to cut back an awful lot, without turning completely pacifist and isolationist.

Jesurgislac, I hope you don't mind or object to my saying so, but I'm genuinely glad to see you posting here again! Welcome back!

[Gary Farber]

A different chart (source):

And:

[...] * US military spending accounts for 48 percent, or almost half, of the world’s total military spending
* US military spending is more than the next 46 highest spending countries in the world combined
* US military spending is 5.8 times more than China, 10.2 times more than Russia, and 98.6 times more than Iran.
* US military spending is almost 55 times the spending on the six “rogue” states (Cuba, Iran, Libya, North Korea, Sudan and Syria) whose spending amounts to around $13 billion, maximum. (Tabulated data does not include four of the six, as the data only lists nations that have spent over 1 billion in the year, so their budget is assumed to be $1 billion each)
* US spending is more than the combined spending of the next 45 countries.
* The United States and its strongest allies (the NATO countries, Japan, South Korea and Australia) spend $1.1 trillion on their militaries combined, representing 72 percent of the world’s total.
* The six potential “enemies,” Russia, and China together account for about $205 billion or 29% of the US military budget.

I'm thinking that if we just cut back, approximately, to what all of Europe, China, Japan, Australia, and Russia, spend combined, that we might be able to scratch by defending ourselves, and lending a helping hand or two here and there.

I think we can stave off being occupied by, say, a joint Chinese/Russian/North Korean/Cuban/Iranian/Venezualan/plus ten more countries thrown in for good measure, without even having to resort to guerilla war and shouting "Wolverines!," and even have something left over to support some overseas allies.

Then there are our nuclear warheads. We currently maintain some 2,202 strategic warheads and non-strategic warheads (give or take; I don't take their figures as precise). I think if we cut back to, say, only being able to drop 500 fission and fusion bombs on someone, while maintaining a strategic submarine ballistic missile capability as part of that deterrent, that they'd probably still be capable of deterring any state or combination of states from nuking us, don't you think?

We've already just agreed:

[...] The Mutual Understanding we have just signed with the President of the United States says that our two countries can have from 500 to 1,100 carriers of strategic arms, and from 1,500 to 1,675 warheads. These are the new parameters within which our dialogue will be going on and where we hope to achieve final agreement that will be part of the new treaty.

That was President Medvedev in his joint news conference with President Obama on July 6, 2009. How about we further cut back to a third of these warheads? Do you think we'd be in danger of losing deterrence with someone, or of a first strike?

Would that be too moon-beam/left-wing radical-crazy?

[Marty]

"I think we can stave off being occupied by, say, a joint Chinese/Russian/North Korean/Cuban/Iranian/Venezualan/plus ten more countries thrown in for good measure, without even having to resort to guerilla war and shouting "Wolverines!," and even have something left over to support some overseas allies."

The only challenge is that a huge portion of this budget is to pay, feed and house people. We would have to find something else for them to do that would be productive. Not a problem for me but it does get lots of attention when cuts are talked about in Congress.

[Gary Farber]

"The only challenge is that a huge portion of this budget is to pay, feed and house people. We would have to find something else for them to do that would be productive."

Marty, being part of a military that isn't actually used, but is simply "prepared" to support and fight wars we're not in, is not being productive.

If we switched to paying all these extra (by the above definitions I've used, which don't call for abolishing the military) people to dig holes in the ground, and fill them up again, instead of also paying for the infrastructure of weapons and mission accomplishment we currently unnecessarily pay for, we'd be saving a lot of money, let alone if we instead paid them to, say, fight forest fires, build roads and bridges, and generally do things that would strengthen our economy, rather than drain it to pay for the largest military-industrial complex the world has ever known, bar none.

On the other hand, the argument that we have to have the size military-industrial complex we have because it's the world's largest welfare system, and we can't otherwise find cheaper and more productive ways to make use of these people in our economy, isn't an argument that I think will go very far.

As I've said a million times before, a simple negative income tax system would be a heck of a lot cheaper.

Not to mention all the immense number of engineers, industrial workers, and other people, we'd free up for productive uses in our economy, rather than just building or supporting weapons systems.

[Marty]

Posted by: Gary Farber | August 16, 2009 at 10:22 PM

No disagreement from me.

[Catsy]

We don't have one to think about. We have a "pay an amount unrelated to your use of it" system.

Much like our "pay an amount unrelated to your use of it" system of publicly-funded emergency responders?

Or our "pay an amount unrelated to your use of it" interstate highway system?

I'm getting to the point of consigning conservative whinges about communitarianism to the same bucket of delusional fantasy as gliberatarian whinges. If either of them ever actually got their way and had to do without the benefits of our socialist big government that they take entirely for granted, they might just rethink their shallow ideology.

We're all in this together. Some folks get that. Some don't.

[Limagolf]

Hen people say "free" healthcare or "free" other-government-sevice, they should use the expression, tax funded healthcare, etc.

That would be much more accurate.

[Hartmut]

I read in the weekend German papers that at least one US state intends to charge prison inmates for their stay (the article said something about $90 per day) and that other US states think about the idea also. This pay-for-mandatory-use sounds like the perverse logical consequence of the liberatrian line of argument also found in the discussion about public education and health insurance with government involvement.
---
I'd be very careful to use the Netherlands in the health care/insurance discussion in the US. That would open another front for the professional liars crying 'euthanasia'* becasue the Netherlands have something that can be misconstrued that way (to my knowledge it is even highly controversial in Dutchistan itself).

*and on camera equaling 'Obamacare' to the final solution ("they called it the final solution. I wonder how they will call ours"; quoted from memory; Rachel Maddow showed the clip several times).

[Uncle Kvetch]

They've also never refused me anything, unlike extortionate health plans in the US that apply ridiculous copayments and so forth

Purely anecdotal, but still and all: My partner just spoke on the phone with his sister and Texas last night. Seems his 20-something-year-old niece had to have some necessary surgery. Unfortunately, the insurance she gets at work has a deductible of six thousand dollars for hospitalization. Not enough to wipe them out, but enough to f*ck up a young person's credit rating for years to come.

Six thousand dollars. I'm still trying to wrap my head around that.

[Uncle Kvetch]

s/b "his sister in Texas," obviously

[Brett Bellmore]

"Much like our "pay an amount unrelated to your use of it" system of publicly-funded emergency responders?

Or our "pay an amount unrelated to your use of it" interstate highway system?"

Neither of which it would be remotely honest to call "free".

[Nupek]

health benefits offered by morning walk
The secret of longevity for a major section of people who are ‘ octogenarians ‘ – That is People who are in their eighties would be morning walk which was done for decades. People have nowadays gradually started realizing the importance of morning walk in shaping the health of human body. But still there are umpteen number of people who do not unwind themselves from their mechanical lives. Technological advancements have made life more simpler in all respects but we humans must also pay the price for it if we do not allocate time in our hectic schedule for some physical work like walking or visiting Gym’s. Around fifteen years ago, TV remotes were rarely found in houses and hence we used to walk at least for changing channels. But now ? Sitting hours together in front of the idiot box, continuously feeding the stomach with snacks or sweets, leading to obesity. If you question a doctor on the health benefits offered by walking he would give you a long lecture. Let us see some of the benefits.
1) It is a stress buster which instills a feeling of freshness to the body as well as mind.
2) blood circulation is promoted, reducing greatly the chances of high blood pressure.
3) Checks obesity by burning unnecessary calories of fat in the body.
4) It makes the joints more strong and hence people would be less susceptible to Orthopedic troubles associated with old age.
5) Chases away neck pain and back pains.
6) If you go walk in a park surrounded by trees, you will inhale more fresh air, containing higher concentration of oxygen, thereby bringing down breathing problems too.
7) Keeps sugar levels under control.
http://nupek.com/health/health-benefits-offered-by-morning-walk/

[Jesurgislac]

Brett: Neither of which it would be remotely honest to call "free".

Cost of NHS expressed as percentage of GDP: 8.3%.
Cost of US "healthcare" expressed as percentage of GDP: 15.3%
Cost of a penniless student who developed Motor Neurone Disease at the age of 21 being supported by the NHS for a lifetime of thought to become a world-renowned theoretical physicist: priceless.

No, Brett. Keeping Stephen Hawking alive and as able as MND allows him to be wasn't "free". But in the US he would have died, because it would not have been profitable to your health insurance companies to keep him alive, and yes, Brett: for Stephen Hawking as for any other Brit, it is worth it.

[CharlesWT]

"Unfortunately, the insurance she gets at work has a deductible of six thousand dollars for hospitalization."

Doesn't seem like an unreasonable deductible for a young person in good health. Since she knew in advance what the deductible was, she choose to take the risk of not setting aside money to cover the deductible. An argument for health savings accounts.

[John Thullen]

Well, Jes, to be fair, as an American Hawking would have been able to make his own way in the world without government coddling and hold down three jobs (we still have circuses and sideshows over here don't we, or have the politically correct liberals ruined that as well) and not fussed about with useless theories about black holes, which have no commercial value and therefore deserve no government grant money (well, unless they threaten to suck Orrin Hatch to oblivion).

He would survive and recover like Terry Schiavo did to get his own apartment and use the emergency room for medical crises on a frequent basis. Why he wouldn't opt for a high deductible insurance policy is beyond me.

The FOX network could hire him on as a sidekick (Theory-Boy, they could call him) to Glenn Beck or Bill O'Reilly and they could program his voicebox to mechanically agree with them as they flicked paperclips at him for the amusement of the FOX audience.

Rush Limbaugh could take time out from doing the Michael Fox herky-jerk to hold his throat and talk funny like a black crippled theoretical physicist (dem is black holes, not white holes)

He could hire an agent and make the rounds as a contestant on the reality shows, maybe as one of a dozen dissing 20-somethings staying in the beach condo for a weekend or as Kate's new love interest on the revival of "Cheaters".

I'm imagining that I'm amusing right about now, but really, I'm deadly serious.

Hawking could be named to a death panel -- for balance.

[Hartmut]

Hawking was on FOX! Okay, rather in (at least) one Futurama episode than on FOX 'News' but the former has/had more awareness of reality anyway.

[Michael Cain]

Gary Farber, on defense spending: "I'm thinking that if we just cut back, approximately, to what all of Europe, China, Japan, Australia, and Russia, spend combined, that we might be able to scratch by defending ourselves, and lending a helping hand or two here and there."

As a hypothetical, assume Iran were to announce that the Strait of Hormuz was closed to all oil tankers bound for the United States or Western Europe. There is exactly one country with non-nuclear offensive capabilities -- blue water navy, large ground forces, air support, logistics -- to force the Strait open. I think one can make a case that no coalition of countries that excluded the US could mount such an operation before they were crippled by oil shortages. OTOH, the US capability is a classic public good, in that Western Europe would reap the benefit of a reopened Strait without having to pay the bill.

It seems worth noting that China, whose interests are less likely to be aligned with those of the US than Western Europe, is increasing its military spending rapidly, and much of the increase appears to be going to the blue water navy and logistical support that are required to project force outside of their borders.

This is wildly off topic for this thread. Eric Martin, if you're reading, perhaps you could do a main post on this topic?

[Jesurgislac]

CharlesWT: Since she knew in advance what the deductible was, she choose to take the risk of not setting aside money to cover the deductible.

Well, now you've established by that impossibly ignorant comment that you are filthy rich and you know no one who isn't so rich that "setting aside" $6000 a year is just a "choice". (Don't try to claim that I have no idea how well off you are. Anyone who thinks it's just a "choice" whether or not to set aside $6000 a year on top of the savagely expensive health insurance payments the US health insurance companies tax from you, is clearly not only insanely wealthy but so snobbish they have none but insanely wealthy friends. Nice for you.)

When I was 28 I had my tonsils out. Cost to me, beyond of course my income tax, was about £10: my busfare to the hospital (a friend gave me a lift back); all the non-prescription painkillers I bought after the free supply of pills from the hospital was used up; and 2 litres of quality ice-cream.

Plus of course the standard two weeks off work, legally mandated paid sick leave after a minor op, stretched to 18 days because the op was on a Wednesday and my workplace/the GP agreed I might as well get a sick line to carry me over to Monday. Oh wait, you guys don't get that, either, do you?

No wonder we live longer than you do. Die in the service of your corporate owners, you Boxers, neighing "I will work harder!" But at least be aware you're being conned. Boxer just got sent unknowing to the knackers yard...

[Uncle Kvetch]

Doesn't seem like an unreasonable deductible for a young person in good health. Since she knew in advance what the deductible was, she choose to take the risk of not setting aside money to cover the deductible.

She makes about $18,000 a year. And she's only been in the job for a couple of years. But yeah, I'm sure she could have squirreled away 6 grand in that time if she had any sense of responsibility.

Anything else I write in response to this will get me banned from this site forever, so I'm going to shut up now.

[Pithlord]

What a lot of this discussion misses is that all OECD countries are facing similar problems with their healthcare systems. We all face exploding costs from demographics and from the way third-payer systems and innovation interact to drive cost of care ever higher.
At
No one in the rest of the OECD wants the US system, which tells you something. But I wish we would reconsider free-at-the-point-of-delivery for all procedures for all people. Just spending more on the public systems isn't really a solution: given the demographics even if we do spend a lot more, the amount per patient is going down. At some point, you need roads and child protection workers.

re byrningman's comment, the Canadian discussion is poisoned somewhat by knee-jerk nationalism, much like the American discussion of the defence budget.

[Turbulence]

But I wish we would reconsider free-at-the-point-of-delivery for all procedures for all people.

I don't know what this means. I've used a number of medical services lately and almost none of them were free. I ended up paying between $15 and $400 for each visit. The only exception was my annual eye exam. Every prescription I've ever had involved a copay as well. Now, perhaps my experience is unrepresentative; maybe there are millions of people who can just walk into any doctor's or pharmacist's office and not have to pay a cent, ever. Do you think there are?

Or are you referring to the fact that because medical billing is a nightmare, many offices insist on mailing a bill after the treatment rather than demanding payment in advance or on site immediately after treatment?

[Brett Bellmore]

What's your point, Nupek? That if you approve of something that costs money, it's appropriate to call it "free"? Don't think I'm willing to sign onto that usage.

[Pithlord]

Turbulence, I'm really speaking from a non-US OECD point-of-view. I realize this is an American discussion, but this thread raises the benefits of "free" healthcare in other OECD countries. I think we need to consider means-tested deductibles and co-payments.

In Canada, it's one of the principles of the Canada Health Act that you don't pay in a doctor's office, but in most provinces you do pay in a pharmacy

[Turbulence]

I'm really speaking from a non-US OECD point-of-view. I realize this is an American discussion, but this thread raises the benefits of "free" healthcare in other OECD countries. I think we need to consider means-tested deductibles and co-payments.

Ah, thanks for explaining. I'm open to the possibility that making people pay directly might alter behavior and reduce the growth in costs. However, we seem to have a lot more deductables and copays in the US than in other countries, and the result seems to be that we have a faster rate of cost growth than those other countries. If we're going to experiment with systemic interventions to reduce the growth of costs, shouldn't we start with those that correlate rather than anti-correlate with lower costs?

[Francis D]

IT IS NOT FREE! The british pay for it. We will pay for it if it comes here. And you're talking about egregiously dishonesty. Look at yourself.

Free in the context of the NHS means Free at the Point Of Delivery - we don't have any damn fool private bureaucrats asking how the patient can pay before they will be treated.

But compared to the American system, yes it is damn well free. In 2006 (the latest year the WHO had data for last time I checked), our government spent less per head on healthcare than yours (state + federal combined) did. That is because your system is a barbaric monstrosity that sucks money out of people like a leech and makes it out of denying care to those that need it. (Of course, the fact your government takes the most expensive groups may have something to do with this...)

Nationalised healthcare: That way you only need to pay once.

[liberal japonicus]

Feeding the OT beast a bit

Michael Cain wondered about Chinese attempts to develop a blue water naval capability.

This may be driven less by US dominance than by pressure from India, which recently announced a homegrown carrier (which may have been a ploy to get a cheaper price for the refitted Russian carrier) and recently finished a nuclear sub and plans on constructing 5 more.

[Carleteon Wu]

Brett and dddave
We don't have one to think about. We have a "pay an amount unrelated to your use of it" system.
Fat lot of right you have to complain about dishonesty.

IT IS NOT FREE! The british pay for it. We will pay for it if it comes here. And you're talking about egregiously dishonesty. Look at yourself.

Id like to take the opportunity to thank both of you for correcting the misperception among 8-year-olds that 'free health care' and 'free public education' do not have a cost to anyone. Next, I expect to see you in front of the Dunkin Donuts, waving smudged handmade signs, protesting that the "13th donut is free" is in fact a henious lie.

[Carleteon Wu]

GOB,
what I do have going to be subject to confiscation by the crowd that has little tolerance for the idea of private property

I think that the proportion of Communists in the US by any name is vanishingly small. ymmv.

On the issue of Canada, any comparison of a government delivered service is weak since it is barely more populated than several of the states in the US and they do, like Europe, avoid most of the costs associated with national defense

You mean, like the UK (4th in the world in military spending), France (3rd), Germany (6th), and Italy (7th)? Spain (16th), the Netherlands (19th), Poland (20th)? Greece (22nd), Sweden (26th), Norway (29th)?
Heck, just France and the UK spend slightly more on defense than China, Russia, North Korea, Iran, and Pakistan combined.

That's overlooking the point that you don't have one (a point, that is)- the UK and France deliver health care at a much lower cost to their population. What does that have to do with their (much larger than you knew) military expenditures?

[Carleteon Wu]

Michael C,
There is exactly one country with non-nuclear offensive capabilities -- blue water navy, large ground forces, air support, logistics -- to force the Strait open. I think one can make a case that no coalition of countries that excluded the US could mount such an operation before they were crippled by oil shortages.

I think the Brits and the French could manage it, maybe in conjunction with some other European forces. We could easily do with half of our navy tied up around the Korean penninsula and half of our ground forces doing occupation duty in the Middle East.
Europe could mobilize a full-sized aircraft carrier and half-a-dozen light carriers along with support craft, hundreds of modern aircraft, a few thousand MBTs (mostly Leopard 2s, but about 800 Leclercs and Challenger 2s), etc.
And they're modern- if we include Japan and North Korea, we're talking about 20 AEGIS-equipped ships, dozens of AWACs. etc.
And if the Russians are included, that substantially increases the coalition navy- another full-sized carrier, several missle battlecruisers, herds of submarines, etc.
Im not saying they could polish off China without rolling up their sleeves, but we're talking about Iran- military expenditures around a tenth of the UK or France. And we're not talking about conquering and pacifying Iran, just suppressing their ability to shut down the Straits.

[Jesurgislac]

Pithlord: What a lot of this discussion misses is that all OECD countries are facing similar problems with their healthcare systems.

Not at all. There is no developed country in the world that is facing problems anything like those presented by the "healthcare system" of the US. None whatsoever. No other country has a healthcare system run to benefit health insurance companies at whatever detriment to the health of the people. The US does, and the problems caused by your healthcare system are unique; simple to resolve: yet uniquely difficult.

Unique because no other country has permitted health insurance companies to use people like this unchecked; simple to resolve because the solution is to adopt a national health insurance scheme to which all are subscribed, tax-funded, additional private insurance purchasable if so desired; uniquely difficult because the system of corporate lobbyists means that you will never get a majority of Congresspeople or Senators to vote for a system that will so cut into the profits of their best friends.

I don't see a solution. You have a government run by corporate interest, regardless of the lives or health of the voters: you apparently can't change it: you're all going to be used like Boxers.

[Jesurgislac]

And indeed, it appears from this thread that a working majority, faced with the insuperable problem of corporate control of your government, would much rather talk about US military spending instead of how your lives will be used up and thrown away for health insurance companies to profit.

[Gary Farber]

"There is exactly one country with non-nuclear offensive capabilities -- blue water navy, large ground forces, air support, logistics -- to force the Strait open."

So you think that all of Europe, Russia, China, Canada, India, Brazil, Australia, Israel, Saudi Arabia, Egypt, South Korea, and Japan, say, put together, couldn't do it?

But set that aside. You're saying that if we only, say, had five carrier battle groups, instead of eleven, and only 3,000 warplanes, instead of 9,000, we couldn't do it?

Because that seems implausible to me.

[Gary Farber]

"But I wish we would reconsider free-at-the-point-of-delivery for all procedures for all people."

Of course, you're completely making up the idea that we have any such thing. Or, more charitably, you are completely ignorant of what services are and aren't available to those without health insurance.

[russell]

Although I abhor the level of involvement and influence of the federal government in our educational process, nowhere yet has that involvement shown the potential to eliminate an individual's choices in obtaining an education

Perhaps there is a lesson there.

IT IS NOT FREE! The british pay for it. We will pay for it if it comes here.

I don't know whether to laugh or hit myself over the head with a 2x4.

WE PAY FOR IT NOW, DAVE. WAY, WAY MORE THAN THEY DO. AND 15% OF US HAVE NO COVERAGE AT ALL.

We have a "pay an amount unrelated to your use of it" system.

Since she knew in advance what the deductible was, she choose to take the risk of not setting aside money to cover the deductible.

It's hard for me to have a dialogue with points of view that boil down to "They're going to take my money and give to that guy", and "It's their own damned fault they're miserable".

It makes me want to send people afloat on an ice floe with a Buck knife, some twine, a fish hook, a book of matches, and a gallon of fresh water, just to see how they will make out.

Seriously, wouldn't that be libertarian paradise?

[Gary Farber]

India "...and recently finished a nuclear sub...."

Just for clarification, from that same article:

[...] But he stresses that it could be several years before the submarine is inducted into the Indian navy.

"My sense is that it would take India anything between three and five years if everything moves as per plan and design to have a submarine that would be deemed operationally credible with nuclear propulsion," said Bhaskar. "What is significant about the launch is that India now has publicly acknowledged its quest to acquire a nuclear submarine and has shown it has the ability to design and build such a platform."

It's an experimental test, not a working warship. At present, "India plans to build a fleet of five nuclear-powered submarines" in the exact same sense that America "plans" to go to Mars.

I'm sure we'll both fulfill these plans at some point, and we're both designing and building stuff that puts on the track to fulfill those plans -- eventually -- but not any time in the next few years.

[Gary Farber]

"...instead of how your lives will be used up and thrown away for health insurance companies to profit."

Oh, for god's sakes, most of us have written hundreds of thousands, if not over a million, words on the subject. We're not obliged to repeat all those words yet again on this single thread for your entertainment.

[Jesurgislac]

russel: It makes me want to send people afloat on an ice floe with a Buck knife, some twine, a fish hook, a book of matches, and a gallon of fresh water, just to see how they will make out.

Seriously, wouldn't that be libertarian paradise?

No. Too much free ice. :-p

[CharlesWT]

Jesurgislac:

"Well, now you've established by that impossibly ignorant comment that you are filthy rich and you know no one who isn't so rich that 'setting aside' $6000 a year is just a 'choice'."

Hummm...(checks pockets—one credit card almost tapped out, one ten, one five, two ones, five quarters, two dimes, four pennies)...no, guest not.

"(Don't try to claim that I have no idea how well off you are..."

So you're the one sending me emails from England telling me I've won a lottery.

Uncle Kvetch

"She makes about $18,000 a year."

Let's see...(pulls out 2008 W-2 form)...yep, I made all of $1,354.59 more than that.

I would guess she and/or her employer paid a much lower premium for a deductible that high. There's always tradeoffs.

[russell]

There's always tradeoffs.

Damned straight.

You can always just freaking die.

[CharlesWT]

"You can always just freaking die."

As far as I know, that's 100% guaranteed, not a tradeoff.

[Jesurgislac]

I predicted CharlesWT "You just have to CHOOSE to 'set aside $6000 a year" RichGuy would come back and cry poormouth, didn't I?

How come these rich, rich guys who say it's just a "choice" if you fail to save six thousand dollars are suddenly all "Oh, I'm POOR REALLY" when they're called on it?

Are they scared we're going to ask them to finally buy their round in the virtual pub? Hey, it's only virtual money...

[Hogan]

"She makes about $18,000 a year."
Let's see...(pulls out 2008 W-2 form)...yep, I made all of $1,354.59 more than that.

I would guess she and/or her employer paid a much lower premium for a deductible that high. There's always tradeoffs.

I'll bet she has granite countertops, too.

[Carleteon Wu]

I would guess she and/or her employer paid a much lower premium for a deductible that high. There's always tradeoffs.

It's not clear how you thought that she could just save 6k for unforeseen medical expenses though; you previously said that this was a choice on her part, but if you're living on less than 20k then you should have some idea how ludicrous that sounds. It's not unlikely that she choose a high deductible because this was the only way she could afford insurance at all, rather than (as you imply) a choice to save some cash from her insurance payment for luxuries.

[russell]

As far as I know, that's 100% guaranteed, not a tradeoff.

If, yes.

When, how, and under what conditions, no.

Also, where there is no realistic set of options to choose among, "tradeoff" doesn't have a lot of meaning.

You can save 1/3 of your income in case you have a medical emergency, or you can eat, or you can have a place to live.

Pick one. It's a tradeoff.

[liberal japonicus]

"At present, "India plans to build a fleet of five nuclear-powered submarines" in the exact same sense that America "plans" to go to Mars."

At the risk of being accused that I want to talk about military expenditures more than health insurance (I'm actually awaiting, with bated breath, of the invocation of 27% here), the time frame here is precisely the same as the time frame that the Chinese are looking at for their own plans. However, the Chinese also seem to be looking at their military spending as a stimulus plan/floorwax combination (hey, it worked in WWII)

That India has already launched the Arihant, has plans for 5 more AND has already negotiated the purchase of 6 new French subs, makes things look a little more solid than 'we're going to Mars!'

Slightly related to this is the story of the Varyag which is quite interesting in that regard.

[CharlesWT]

"It's not clear how you thought that she could just save 6k for unforeseen medical expenses though; you previously said that this was a choice on her part, but if you're living on less than 20k then you should have some idea how ludicrous that sounds."

"You can save 1/3 of your income in case you have a medical emergency, or you can eat, or you can have a place to live."

Based on the information provided by Uncle Kvetch, I really don't know what her circumstances are. If she is sharing living expenses one or more other wage earners, living with her parents, e.g. and doesn't have legacy expenses like a student loan, putting aside $6,000 or paying higher premiums might be relatively easy to do. But, if she living by herself or has children or someone else to care for, every day for her may be an exercise in hanging by the fingernails.

I'm not defending the status quo. I agree will everyone else here that there is a great deal of room for improving how health care is delivered in the US. I just may not agree on how it should be done.

[Francis D]

So what do you propose, Charles?

For what it's worth, I don't think that America could pull off a system as cost-effective as the NHS*. That would take utterly redesigning the system from the ground up. Instead you should be modelling yourselves on the Dutch or German model by taking the insurance companies by the balls using regulation and squeezing until they sing soprano.

* The NHS isn't the best healthcare system in the world. But it is damn cost-effective. Just historically very impoverished by international standards (thank you, Maggie) and still spends less per head on public healthcare than the US does.

[Jesurgislac]

CharlesWT: Based on the information provided by Uncle Kvetch, I really don't know what her circumstances are.

Yet, based on the information provided by Uncle Kvetch, you were totally sure that for her, setting aside $6000 was just a "choice".

I just may not agree on how it should be done.

Someone as wealthy as you, for whom $6000 is just a "choice", probably sees the US health care system at its bonniest angle. After all, when you can choose to set aside $6000 and frown like a rich guy at the people too improvident/too poor to think of doing that, you can undoubtedly afford to pay the best premiums for the best promise.

But Francis D is right: the US is too backward to be able to step right up to deliver the NHS. You'll have to go for something less cost-effective and less accessible, probably a bit more bureaucratic, than our streamlined, accessible, responsive system. You probably can't, in other words, hope to crawl up from 37th in the world to match the 11th in the world (the NHS): but if you didn't live in a country where corporations run the government, you might be able to achieve a system something like most countries in Europe, where the government regulates the bejesus out of health insurance corporations. Which would be better than what most people who aren't as shamelessly wealthy as you are, for whom $6000 is a major amount of money not pocket change, have now.

[CharlesWT]

"So what do you propose, Charles?"

Some possibilities:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

• Repeal all state laws which prevent insurance companies from competing across state lines.

• Repeal government mandates regarding what insurance companies must cover.

• Make costs transparent so that consumers understand what health-care treatments cost.

• Enact Medicare reform.
The Whole Foods Alternative to ObamaCare: Eight things we can do to improve health care without adding to the deficit. (An unfortunate title no doubt picked by WSJ editors, not Mackey himself.)

[CharlesWT]

"Someone as wealthy as you, ...as shamelessly wealthy as you are..."

Gosh! I wish I was as least one tenth as wealthy as you seem to think I am. :(

[John Miller]

Charles, thank you for providing a list.

HSA's have limited appeal as many people can't afford them and there are many drawbacks to them.

Number two I totally agree with. But it really wouldn't make much difference in the long run.

Number three pretty much means taking states out of the regulatory business. The reason for mm uch of this is to prevent low cost policies being sold as something great and having so much fine print that bthe insureds get killed (sometimes literally) by the results.

Repealing what insurance companies must cover definitely reduces the cost of insurance, but how does it reduce the cost of health care? And most of that is done at the state lev el, so again you want the federal government to do all the regulation, I presume.

Definitely woudl like more transparency, although all that would likely do is have people put off necessary treatment. Picking a doctor or a treatment is not the same a buying a car.

Medicare reform always comes up, but people seldom explain what they mean by that. long term, the thing that would have the greatest impact on the cost of Medicare is meaningful reform of the rest of the system. Unfortunately, as long as we keep financing of health care services through a for profit insurance industry, that won't happen.

[CharlesWT]

Dr. Anne Doig, the incoming president of the Canadian Medical Association, said her country’s health care system is “sick” and “imploding,” the Canadian Press reported.

“We know there must be change,” Doig said in a recent interview. “We’re all running flat out, we’re all just trying to stay ahead of the immediate day-to-day demands.”

Canada’s universal health care system is not giving patients optimal care, Doig added. When her colleagues from across the country gather at the CMA conference in Saskatoon Sunday, they will discuss changes that need to be made, she said.

“We all agree the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” she said.
[...]
Canadian Health Officials: Our Universal Health Care Is 'Sick,' Private Insurance Should Be Welcomed

[Hartmut]

russel: It makes me want to send people afloat on an ice floe with a Buck knife, some twine, a fish hook, a book of matches, and a gallon of fresh water, just to see how they will make out.

Seriously, wouldn't that be libertarian paradise?

Jesurgislac: No. Too much free ice. :-p

And since the ice (if older than 2 years) is fresh water, the gallon of fresh water is a wasteful subsidy.

[Jesurgislac]

Charles WT suggested:

Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).

Those "legal obstacles" wouldn't happen to be the kind of regulation that's meant to ensure customers don't get themselves tied up in an agreement that they can't afford and doesn't suit their needs?

Also, how exactly are people who can't afford HSAs or high-deductible insurance plans going to be helped by this? You may not be able to imagine people so poor exist, from your dizzying heights of wealth, but there are about 40 million of them in the US...

Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

Income-tax benefits tend to help the wealthy over the poor. All right for richies like you, who think six thousand is pocket change, but not so good for people who can't afford health insurance at all.

Repeal all state laws which prevent insurance companies from competing across state lines.

Unless there's some shining example of a health insurance company somewhere that doesn't ever attempt to cheat its clients by denying them health care because it would cut into their profits to do so, then I fail to see what use this would be, either. (Friends and news reports from all over the US would seem to indicate that health insurance companies are all much of a muchness with scumminess.)

• Repeal government mandates regarding what insurance companies must cover.

That will benefit health insurance companies enormously, because they will be able to legally deny coverage of expensive kinds of health care to their customers, but it's hard to see how this would be of any use at all to the customers who find their expensive health insurance policy just doesn't cover cancer.

• Make costs transparent so that consumers understand what health-care treatments cost.

"Wow, chemotherapy for my liver cancer is THAT expensive? I had no idea! Think I'll have a manicure instead." Yeah, right.

Enact Medicare reform.

What, the Matt Santos reform? "My ideal plan is very simple: just delete the phrase 'over 65' from the Medicare statute."

That would work. As Santos says in the West Wing debate: allow everyone in the US access to an efficient health care system and force the private health insurance companies to compete with it.

Gosh! I wish I was as least one tenth as wealthy as you seem to think I am. :(

If you are not in fact so wealthy, and for you six thousand dollars is a major and significant part of your annual income, not a trivial sum it would just be a "choice" to set aside, then why were you spouting the kind of ignorant nonsense that made you sound like you couldn't understand people for whom six thousand dollars is a lot of money?

[Uncle Kvetch]

Based on the information provided by Uncle Kvetch, I really don't know what her circumstances are.

Hey, don't let that stop you. Oh, that's right...you didn't.

It's also very telling that you assume that she "chose" a high-deductible option over a different one. A hell of a lot of people don't get to "choose" among different employer-provided options--you take what they offer and hope for the best.

But you knew that.

[Francis D]

Charles:

Of course the CMA wants private health insurance. Doctors paid per procedure make out like bandits.

As for those wholefoods suggestions (which caused the Wholefoods forums to be removed due to the response):

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).

High deductible health insurance plans: Because we all want the employers to be able to tell their employees they have insurance while providing next to none.
HSAs: Saving with what freaking money? This does not tackle any of the real problems.

In fact, what he proposes here is making the bugs in the system explicit and calling them features.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

This might actually be the one good suggestion you mentioned.

• Repeal all state laws which prevent insurance companies from competing across state lines.

Yay! A regulatory race to the bottom. So all insurance companies get to set up in states which allow them to claim to cover pregnancy while not covering labour or delivery. And hospitals get even more bureaucratic as they need to learn to deal with even more different and subtly incompatable insurance companies.

• Repeal government mandates regarding what insurance companies must cover.

So any consumer who isn't extremely careful about 40 pages of small print can end up getting screwed. Why don't we just repeal the FDA as well and allow ketchup companies to go back to using rotten tomatoes?

Of course, showing American citizens how much is spent on paying the salaries of insurance companies, shuffling paper around, and other aspects not related to healthcare would be a good thing.

• Make costs transparent so that consumers understand what health-care treatments cost.

Good luck with that! How do you make them transparent? Although it does touch on one way the American system is awful - prevention is cheaper than cure.

• Enact Medicare reform.

Not in the hands of anyone who could produce that list of methods of making the problems worse.

I notice you missed quoting the point in the article at which he shows himself to either not understand humans or to be actively trolling:
Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program

[Carleteon Wu]

CharlesWT- if you click through the Fox News link to the original story, you see things such as:
Doig, who has had a full-time family practice in Saskatoon for 30 years, acknowledges that when physicians have talked about changing the health-care system in the past, they've been accused of wanting an American-style structure. She insists that's not the case....
"a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage....
He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget....
The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium, Netherlands and France.

That is, they aren't debating abandoning universal coverage for their citizens or going to an American system. They are talking about making changes to their system to improve it, and appear to be at least as interested in European models as the US.
Thus, a devastating development to those who argued that the Canadian system is perfect, but for the rest of us only mildly interesting.

Since you posted without adding any comment, perhaps you could expand on the purpose of drawing our attention to the article?

[Johnny Canuck]

is Carleteon Wu one and the same person as Carleton Wu?