Which would you rather have: Free Education or Universal Healthcare?

[teledyne]

Yes, that's right. The United States has decided to offer its citizens a choice: free education, all the way up to post-graduate studies (minus cost of materials and books), or free healthcare, which we all know means a single-payer healthcare system where the burden is no longer a single person/entity but society as a whole.

The choice is yours, so pick!

[Dirt]

We're rich enough as a country to provide both.

[Tom McNamara]

Can't have universal healthcare and birthright citizenship when you have an enormous border with a 3rd-world country. Free education isn't far behind in terms of government expenditure.

[Rimbo]

Fuck both of those; I want free beer.

[Sarkus]

Assuming the free education is retroactive, my student loan burden demands I choose that option.

[Jason McCullough]

Healthcare, of course, as education doesn't do you much good if you're dead. Education is also more or less a "there's only so many slots and you're competing for them" deal, so free college degrees for everyone doesn't help the janitor's earnings all that much to pay for that non-free health care.

Can't have universal healthcare and birthright citizenship when you have an enormous border with a 3rd-world country. Free education isn't far behind in terms of government expenditure.

Mexico (https://www.cia.gov/library/publications/the-world-factbook/geos/mx.html).
Life expectancy at birth:
total population: 75.63 years
male: 72.84 years
female: 78.56 years (2007 est.)

United States (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html):
Life expectancy at birth:
total population: 78 years
male: 75.15 years
female: 80.97 years (2007 est.)

[Sarkus]

Healthcare, of course, as education doesn't do you much good if you're dead. Education is also more or less a "there's only so many slots and you're competing for them" deal, so free college degrees for everyone doesn't help the janitor's earnings all that much to pay for that non-free health care.



Mexico (https://www.cia.gov/library/publications/the-world-factbook/geos/mx.html).
Life expectancy at birth:
total population: 75.63 years
male: 72.84 years
female: 78.56 years (2007 est.)

United States (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html):
Life expectancy at birth:
total population: 78 years
male: 75.15 years
female: 80.97 years (2007 est.)

Plus, Mexico already has nearly universal health care in place. They aren't coming here to overcome our health care system, they are coming here for jobs. Whether we have universal health care or not we're already paying for what Mexican immigrants are using.

[Siren]

Free Education, plz.

[DoomMunky]

Both, duh. We could easily afford each of them. Build a few less bombers, because if the prices Call of Duty 4 quotes at me when I die are correct, we're getting shafted.

[SpoofyChop]

We're rich enough as a country to provide both.

You mean that other people in this country are rich enough to pay for your education or healthcare.

I bet there are people rich enough to pay your mortgage and a vacation to Hawaii too!

[Demon G Sides]

Free Education, with refund to current college students.

plzkthx.

[Unicorn McGriddle]

Free education, because a less ignorant electorate will do many wonderful things, universal healthcare included.

[Qenan]

Since I'm past 40, "free" healthcare. Although it isn't going to be remotely free; at best, it will just shift costs to the upper-middle class.

[tromik]

It's hard to say - I've never known live without having both. Okay, university tuitions and aren't paid for, but I pay way less than students in the States do.

[Glenn]

Can't have universal healthcare and birthright citizenship when you have an enormous border with a 3rd-world country.I don't know what logic train you got on that made you want to overturn the 14th Amendment, but you need to get off at the next stop and start heading back the other way.

[Tom McNamara]

I don't know what logic train you got on that made you want to overturn the 14th Amendment, but you need to get off at the next stop and start heading back the other way.

Simmer down, chief. I just said you can't have both.

[Marcus Walser]

Simmer down, chief. I just said you can't have both.

Sure you can.

[Tom McNamara]

Sure you can.

Well... you've got me there.

[Andrew Mayer]

You mean that other people in this country are rich enough to pay for your education or healthcare.

I bet there are people rich enough to pay your mortgage and a vacation to Hawaii too!

Are you rich enough manage to avoid the diseases incubated by people without healthcare, or survive the plague without anyone educated enough to look for a cure.

If you want to go live in the woods, get off mah intarnet!

[Sarkus]

I don't know what logic train you got on that made you want to overturn the 14th Amendment, but you need to get off at the next stop and start heading back the other way.

What does the 14th amendment have to do with it? Tom may be concerned about the consequences of granting a free education and healthcare to children born in the US (and thus citizens) of illegal immigrants, but I don't see where that's a challenge to the provisions of the constitution.

[JPR]

I would like neither.

[Linoleum]

I want a pony.

[Mordrak]

Are you rich enough manage to avoid the diseases incubated by people without healthcare

Quarantine and incinerate. Problem solved.


, or survive the plague without anyone educated enough to look for a cure.
We'll have a treatment, rich people don't want to die. It'll just cost money.


If you want to go live in the woods, get off mah intarnet!
I bet there's poor people in the woods too. They'll just try to steal my canned chili.

[jpinard]

Healthcare. A healhtier person can afford to work while going to school, and will have a better life thereafter having the security. Opening your own business also would be fantastic as you could actually afford health care instead of going without.

[Glenn]

Well... you've got me there.Maybe you should flesh out your theory a little beyond Too Many Penguins, and then criticize others for being glib.

[Glenn]

What does the 14th amendment have to do with it? Tom may be concerned about the consequences of granting a free education and healthcare to children born in the US (and thus citizens) of illegal immigrants, but I don't see where that's a challenge to the provisions of the constitution.He didn't lodge a general complaint against illegal immigration, he went straight for the part that's guaranteed in the Reconstruction Amendments.

[Sarkus]

He didn't lodge a general complaint against illegal immigration, he went straight for the part that's guaranteed in the Reconstruction Amendments.

You need to lay this out for me because this is not making any sense at all. I've read and reread the statement you quoted and don't see how what he said is a constitutional issue, unless you are trying to imply that he's advocating children of illegal immigrants born in the US shouldn't have these theoretical benefits. If that's the case, I think you are way off base in your interpretation of his statement. You're making assumptions about what he meant that are not supported by his words.

[Incendiary Lemon]

I want a pony.

I had a workplace survey today. I also requested a Pony.

[MyNameIsWill]

I'd like to keep my salary, kthx

[Aeon221]

Cut my taxes, I'll find ways to pay for the other shit myself.

[Brian Rucker]

If I had to chose...it'd be a tough call. On a personal level, obviously, healthcare. I'm out of college and I don't have kids.

However on a national level both have secondary effects that are crucial beyond the obvious. Nationally funded healthcare would lift a huge burden from business. Employee insurance costs crazy fucktons and is only going up. It would also lower costs for just about everything because if all the health providers are negotating as a group they'll get the prices they want. Advertising would be much less of an expense for medical product folks as they would be working through government systems rather than trying to sell broad swaths of individuals and institutions. That said, you'd need seriously good checks in place otherwise we end up with a medical-industrial complex that will probably get just as fucked up and ridiculous as the military-industrial complex (which is still not nearly as bad as healthcare is as it's currently being handled). You also get people out of emergency rooms for colds and into medical clinics which will again reduce costs and debt in a big way.

Education, on the other hand, feeds all fields and keeps our workforce worth that little bit extra on the global stage. We need to keep our technological edge if we can't claim that much of an industrial one. We need as many smart people as we can pump out to compete with other countries that are currently cleaning our clocks. Advances in healthcare, maybe better models for government services and just basic science will help drive down healthcare costs and improve services well down the road. Solutions to all our big problems are far more likely to come out of an educated public than not. It will also help level the economic playing field that's currently tilted further than it's been since the 20's. If we're going to be the egalitarian America we really need to be - this is the direction we need to go.

So, I'm torn.

In the end I guess healthcare. Yes, it serves my immediate concerns best but if we can lower those costs we'll simulate the economy. A stimulated economy means more tax revenue. More tax revenue will create a window to offer free education among other things. That and fucking castrate the neocons. Get us out of Iraq. Make nice with the world. Reduce our currently wasteful military spending.

[Gordon Cameron]

I would rather have both, but failing that I will take health care.

[Mister Widget]

Universal health care, absolutely. We already have free education through high school... the problem is, it sucks so badly that we have to teach college freshmen remedial writing and math. As it is, you've already got people complaining that their four years at college don't prepare them for any real job. Sending ever-increasing numbers of poorly-educated high school students to college would only further water down the value of a college degree.

So add universal health care and fix the free education system that's already in place. Or maybe we could compromise: free medical school for everyone!

[DoomMunky]

So add universal health care and fix the free education system that's already in place. Or maybe we could compromise: free medical school for everyone!
Attention! The above = win.

[cliffski]

You mean that other people in this country are rich enough to pay for your education or healthcare.
I bet there are people rich enough to pay your mortgage and a vacation to Hawaii too!

Who says its not in the interests of the wealthy to pay for these things? I'd happily pay more tax if it meant that people were healthier and more educated. Poor, sick people are more likely to rob my house or mug me in the streets.

Plus, I know I'm pretty lucky to have the income I do. I had parents that cared about my education and my local school was great. That's just sheer luck, and I'm big enough to admit that. I can do without a few luxury goods if it means people at the bottom of the heap learn to read and write and don't have to worry about getting sick.

And from an economic POV, I prefer to live in a country with a healthy and educated workforce, because its better for the economy. People with better jobs buy more games :D.

[Andrew Mayer]

So add universal health care and fix the free education system that's already in place. Or maybe we could compromise: free medical school for everyone!

That's how it worked for my grandfather in Germany at the turn of the previous century.

His top five score on the national graduation test meant that he was allowed to attend any university for as long as he wanted to go. He decided to become a dentist, and actually had to complete his MD program first, and then specialize in dentistry.

[Robert Sharp]

Free education, because a less ignorant electorate will do many wonderful things, universal healthcare included.

Haha. You should try talking to college graduates. In fact, the percentage of college graduates among voters is probably pretty high. Has it really helped?

[Andrew Mayer]

Haha. You should try talking to college graduates. In fact, the percentage of college graduates among voters is probably pretty high. Has it really helped?

Turns out yes.
(http://en.wikipedia.org/wiki/Voter_turnout)
The most important socioeconomic factor in voter turnout is education. The more educated a person is, the more likely he or she is to vote, even when controlled for other factors such as income and class that are closely associated with education level

Depending, I guess, on whether or not you actually care whether people are engaged with their society and capable of evaluating their own self-interest.

[Glenn]

You need to lay this out for me because this is not making any sense at all. I've read and reread the statement you quoted and don't see how what he said is a constitutional issue, unless you are trying to imply that he's advocating children of illegal immigrants born in the US shouldn't have these theoretical benefits.That would be the latter half of his either-or proposition. Universal healthcare over here, 14th Amendment over here, never the twain shall meet.

But that argument isn't exactly A to B to C*, it requires a lot of assumptions about what "universal healthcare" precisely means, the economics of illegal Penguin-ation, as well as a blanket assertion that the illegal Penguin problem is completely intractable without applying the Dubya doctrine to certain Constitutional guarantees. Which gets us right back to the argument I disagreed with originally.

If you want to argue intent, I don't care whether he desires X or is simply stating as a fact that X is necessary to reach desirable outcome Y. That might provide the foundation for yet another cliched morality discussion between Jack McCoy and Fred Thompson at the end of Law & Order, but I don't think it has a practical application here.

[Robert Sharp]

Voter turnout is automatically a good thing? Just showing up doesn't show that education has led to better voting practices...just MORE voting practices.

[Sarkus]

That would be the latter half of his either-or proposition. Yeah, I get it, he's probably banging away at the first half, and the latter is just rhetorical filigree.

But that argument isn't exactly A to B to C, it requires a lot of assumptions about what "universal healthcare" precisely means, the economics of illegal Penguin-ation, as well as a blanket assertion that the illegal Penguin problem is completely intractable without applying the Dubya doctrine to certain Constitutional guarantees. Which gets us right back to the argument I disagreed with originally.

If you want to argue intent, I don't care whether he desires X or is simply stating as a fact that X is necessary to reach desirable outcome Y. That might provide the foundation for yet another cliched morality discussion between Jack McCoy and Fred Thompson at the end of Law & Order, but I find it has little practical application.

I give up. I asked you to explain and what you've provided above explains nothing. Fred Thompson? Penguins? Bush references?

I can only assume you are applying some previous interpretation of Tom's statements to this situation, statements I have no knowledge of. I'm taking his statements in this thread at face value and as far as I'm concerned you have yet to provide an example of what he's said having anything to do with the 14th amendment.

[Andrew Mayer]

Voter turnout is automatically a good thing?

Yes

Just showing up doesn't show that education has led to better voting practices...just MORE voting practices.

Democracy is stupid!

Edit: I'm gonig to revise the snark here and point out that educated voter turnout is a good thing. We're not talking Tammany hall here. These are motivated voters.

[Jafisob]

Free Education

We already have free education or mostly free education available. Join the Army or National Guard, serve your term, and get college money. It is what I did.

Don't want to serve? Thank the people who put their lives on the line for you, be quiet, and pay. Once you get a good job then pay off your loan(or your parents) and live a good and safe life in a great country.

kthxbye.

You mean that other people in this country are rich enough to pay for your education or healthcare.

I bet there are people rich enough to pay your mortgage and a vacation to Hawaii too!
QFT

[Tom McNamara]

All I was saying was that we have a very long border with a 3rd-world country, and that greatly complicates the issue of universal healthcare when the U.S. has birthright citizenship. I never said or implied that birthright citizenship was bad, nor do I even feel one way or the other about illegal immigration. I feel the same way about that as I do about the Sun: It's there, it's huge, it affects everything around us, it's not going to go away anytime soon, it's a permanent part of our lives, and we'd better figure out how to handle it before we get burned.

[Glenn]

I give up. I asked you to explain and what you've provided above explains nothing. Fred Thompson? Penguins? Bush references?Was it really that inscrutable?

Mr. McNamara's argument is that universal healthcare is impossible because of the influx of Mexicans and birthright citizenship. Birthright citizenship is Amendment 14, Section 1. Ergo, the United States is precluded from universal healthcare by the 14th Amendment.

If you're so Randian that universal healthcare isn't something you'd want even if it were totally feasible, proceed directly to hell. Assuming Mr. McNamara's not in that group, the 14th Amendment is a hindrance preventing the US from achieving a desirable outcome that every other first world country managed decades ago.

To me that certainly sounds like he's proposing the repeal fo the 14th Amendment.

The Dubya Doctrine is shredding the Constitution whenever it gets in your way.

Penguins are a reference to my earlier post where I substituted them for Mexicans. Which in turn was a reference to a children's book, Too Many Penguins.

Fred Thompson is that guy who used to be on L&O with the trophy wife that looks like a pudgy former stripper. He also recently concluded a disastrous run for President, and looks like a caricature of a basset hound. His favorite color is red.

[Tom McNamara]

I never said anything about "Mexicans." The border is a sieve for all of Central America. Most of them ride north in and on trains. When they pass villages, the locals toss food and water at them. It's ridiculously dangerous, and they can get deported back to their home country at any point on the journey. I don't know why you're getting so hot and bothered about the 14th Amendment, or why you're implying that I'm some kind of right-wing racist. I'm really not interested in making enemies, or in being a punching bag. You seem really willing to get in somebody's face about this, but I am not going to be that guy, and you are going to have to deal with that.

Edit: Besides, I lived with two gay roommates in San Francisco -- on Castro Street -- so I'm pretty sure I'm not a shadow agent for the New World Order.

[Sarkus]

Was it really that inscrutable?

Yes


Mr. McNamara's argument is that universal healthcare is impossible because of the influx of Mexicans and birthright citizenship. Birthright citizenship is Amendment 14, Section 1. Ergo, the United States is precluded from universal healthcare by the 14th Amendment.

If you're so Randian that universal healthcare isn't something you'd want even if it were totally feasible, proceed directly to hell. Assuming Mr. McNamara's not in that group, the 14th Amendment is a hindrance preventing the US from achieving a desirable outcome that every other first world country managed decades ago.

To me that certainly sounds like he's proposing the repeal fo the 14th Amendment.


You are jumping to all kinds of conclusions with this illogical progression.

Tom's statement seems pretty clearly to me aimed at pointing out that a consequence of universal healthcare in the US would be that immigrants would cross the border and have children, thus taking advantage of the birthright citizenship clause. I don't happen to agree with him, as my other comments in this thread show, but it is a valid point to bring up. At no point did he suggest that the 14th amendment would stop universal healthcare and at no point did he suggest that the 14th amendment would have to be repealed.

This is one of the strangest "leaps of logic" I've ever seen, even on the internet.

[Robert Sharp]

Yes



Democracy is stupid!

Edit: I'm gonig to revise the snark here and point out that educated voter turnout is a good thing. We're not talking Tammany hall here. These are motivated voters.


Democracy may actually be stupid. But that wasn't my point. If they are motivated voters aware of issues, that's fine. I was only pointing out that stats indicating turnout do not prove anything. I'm sure you know that, though. It just seemed odd because of the link chosen. And your Tammany Hall example proves that your first answer was incorrect.

[Mordrak]

We already have free education or mostly free education available. Join the Army or National Guard, serve your term, and get college money. It is what I did.


If other nations can achieve it, why can't we?


Don't want to serve? Thank the people who put their lives on the line for you, be quiet, and pay. Once you get a good job then pay off your loan(or your parents) and live a good and safe life in a great country.
While I respect members of the armed forces for their public service (several of my family members have served), this just reminds me why I don't want to live in a police state.

[Anti-Bunny]

Which would you rather have: Free Education or Universal Healthcare?
I love that someone considers it 'free' education. I would rather be free to choose to pay for education (and also healthcare).

[Glenn]

I never said anything about "Mexicans."Which is why I avoided saying it until pressed. But let's be honest, they're the majority of illegals and the conversation about illegal immigration always involves a ridiculous little dance where both sides try not to be the first to say the secret word.

I don't know why you're getting so hot and bothered about the 14th Amendment, or why you're implying that I'm some kind of right-wing racist.If I thought you were racist, I would have said so in my first post. But as stated previously, I think the argument that constitutional reforms are necessary to fix illegal immigration takes you down a really dark road. Personally, I think coherent policies are what's needed, and we should probably try that first.

I'm really not interested in making enemies, or in being a punching bag. You seem really willing to get in somebody's face about this, but I am not going to be that guy, and you are going to have to deal with that.I didn't intentionally ignore your previous post or anything. Beyond that, whatever, it's the internet, we don't really know each other, no reason to mince words.

Speaking of which...

[Glenn]

At no point did he suggest that the 14th amendment would stop universal healthcare...Yes he did, you imbecile, that was his entire first post. You know, the one you read and re-read and desperately furrowed your brow over.

I keep ratcheting down the bar for you, and every time I worry I'm being condescending. And yet you manage to limbo under.

PS. HUR HUR LERN TO USE LOGICS HUR.

[Dirt]

You mean that other people in this country are rich enough to pay for your education or healthcare.

I bet there are people rich enough to pay your mortgage and a vacation to Hawaii too!

I fully expect you to mandate to your wife that you send your kid to private school between the ages of 5 and 18.

[Sarkus]

Yes he did, you imbecile, that was his entire first post. You know, the one you read and re-read and desperately furrowed your brow over.

I keep ratcheting down the bar for you, and every time I worry I'm being condescending. And yet you manage to limbo under.

PS. HUR HUR LERN TO USE LOGICS HUR.

Here's his entire first post:

Can't have universal healthcare and birthright citizenship when you have an enormous border with a 3rd-world country. Free education isn't far behind in terms of government expenditure.

See anything about the 14th Amendment in there? Nope. You are just interpreting it (incorrectly) that way. You are the one who has interpreted this to have something to do with the 14th Amendment, when Tom himself has denied that was ever his intent.

[Jason McCullough]

All I was saying was that we have a very long border with a 3rd-world country, and that greatly complicates the issue of universal healthcare when the U.S. has birthright citizenship. I never said or implied that birthright citizenship was bad, nor do I even feel one way or the other about illegal immigration. I feel the same way about that as I do about the Sun: It's there, it's huge, it affects everything around us, it's not going to go away anytime soon, it's a permanent part of our lives, and we'd better figure out how to handle it before we get burned.


.....but how? As pointed out, it's not like Mexico is going to up and move here for an extra two years of lifespan for their kids.

[Jafisob]

If other nations can achieve it, why can't we?

While I respect members of the armed forces for their public service (several of my family members have served), this just reminds me why I don't want to live in a police state.

We have achieved it. Join the service.

Don't hide behind dramatic words like 'police state' when 'I don't want to put my ass on the line' or 'I want something for nothing' is what you mean.

[Glenn]

birthright citizenshipSee anything about the 14th Amendment in there? Nope. You are just interpreting it (incorrectly) that way.
All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside... It's the very first line, so it's not like you can claim you just skimmed and it escaped your notice. Maybe for an encore you can argue the right to bear arms is entirely separate from the Second Amendment.

****LIGHTNING ROUND****
There is no express grant of habeas corpus in the Constitution.

[Sarkus]

It's the very first line, so it's not like you can claim you just skimmed and it escaped your notice. Maybe for an encore you can argue the right to bear arms is entirely separate from the Second Amendment.

****LIGHTNING ROUND****

Again, where does Tom say anything about denying birthright citizenship?

Tom's the one who wrote the passage and he has clearly stated that your interpretation of his statement is wrong. It's pretty clear that you feel use of the term "birthright citizenship" raises red flags but all I can say is that nothing's been said here to support the conclusion you are drawing from the use of that term, IMHO.

Let's just leave it at that.

[cliffski]

We have achieved it. Join the service.

Don't hide behind dramatic words like 'police state' when 'I don't want to put my ass on the line' or 'I want something for nothing' is what you mean.

I get free health care in the UK, and I don't have to run the risk of being blown apart by insurgents in order to qualify. Nor is it 'something for nothing'. Everyone in the UK who pays tax helped pay for my 'free' health care.

If the US is the worlds biggest economy, its kinda silly that you guys can't afford to give people health care, unless they are prepared to sign up to kill foreigners.

[Jafisob]

I get free health care in the UK, and I don't have to run the risk of being blown apart by insurgents in order to qualify. Nor is it 'something for nothing'. Everyone in the UK who pays tax helped pay for my 'free' health care.

If the US is the worlds biggest economy, its kinda silly that you guys can't afford to give people health care, unless they are prepared to sign up to kill foreigners.

Actually we were talking about education.

I am in favor of some type of nationalized health care plan for a variety of reasons. Perhaps some type of nationalized minimal coverage for everybody over 18-65 with suplemental health care being provided for by employers or available for purchase. Kids and S.Citizens get full coverage.

Yes, gasp, a two tiered system.

Obese people and smokers should have to pay a significant premium. People under 30 who are less at risk, and less able to pay, should pay less.

[Gordon Cameron]

I love that someone considers it 'free' education. I would rather be free to choose to pay for education (and also healthcare).

As I am free to put myself in decades' worth of debt for higher education, and also free to pay cripplingly high monthly premiums for health care -- premiums which rise at a far more rapid rate than my income -- I would be interested in exchanging said "freedom" for some other option.

Of course, anyone who is unable to keep up with the wonders of the Invisible Hand has only themselves to blame for being a lazy bum, and deserves the squalor disease filth & decay that come their way.

[Hanzii]

Actually we were talking about education.

I am in favor of some type of nationalized health care plan for a variety of reasons. Perhaps some type of nationalized minimal coverage for everybody over 18-65 with suplemental health care being provided for by employers or available for purchase. Kids and S.Citizens get full coverage.

Yes, gasp, a two tiered system.

Obese people and smokers should have to pay a significant premium. People under 30 who are less at risk, and less able to pay, should pay less.

People who live in polluted areas with a higher risk of cancer should pay more.
So should people with handicapped children. And those born with a terminal disease really shouldn't be covered - it's just too expensive.

I live in a country which provides both (up to and including university), I really don't want to give either up. I agree completely with cliffski.

[Anti-Bunny]

As I am free to put myself in decades' worth of debt for higher education, and also free to pay cripplingly high monthly premiums for health care -- premiums which rise at a far more rapid rate than my income -- I would be interested in exchanging said "freedom" for some other option.

Of course, anyone who is unable to keep up with the wonders of the Invisible Hand has only themselves to blame for being a lazy bum, and deserves the squalor disease filth & decay that come their way.

Of course you would. It's free, who would say no?!?

On that note, explain to me why everyone else shouldn't buy me groceries or pay my car payments.

[Hanzii]

Of course you would. It's free, who would say no?!?

On that note, explain to me why everyone else shouldn't buy me groceries or pay my car payments.

If you can't see the difference, then you're really too dense to explain anything to.

[Dirt]

The groceries part is a tough one, nobody should have to starve in the richest country in the world. The car payment thing is taking it too far; if nothing else, every city does have public transportation.

[Jafisob]

People who live in polluted areas with a higher risk of cancer should pay more.
So should people with handicapped children. And those born with a terminal disease really shouldn't be covered - it's just too expensive.

I live in a country which provides both (up to and including university), I really don't want to give either up. I agree completely with cliffski.
Which country do you live in and why didn't you mention it in your post since you refered to it? What is the cost to the standard of living to offer the things you are talking about? Do you have a large influx of dirt poor and uneducated people streaming into your country that you would have to offer these free benefits to?

I am glad you agree with cliffski but, ummm, he was referring to health care in the post I replied to and not education like you were referring to.

[Anti-Bunny]

The car payment thing is taking it too far; if nothing else, every city does have public transportation.
Mine doesn't.

[Aeon221]

Voter turnout is automatically a good thing? Just showing up doesn't show that education has led to better voting practices...just MORE voting practices.

What? Democracy isn't about ensuring that everyone is a perfectly educated voter before allowing them to vote. We'd get, like, one voter every year if that were the case. Democracy is about getting as much input as possible before making a decision, and trying to make that decision a compromise that reflects everyone's wishes. More people voting is an unmitigated good -- the less people as a proportion of the population that vote, the more power nutjob fringe groups have. If anything, not voting should be punished with a fine, like in Australia.

[Anti-Bunny]

If you can't see the difference, then you're really too dense to explain anything to.

Actually, the point is that there isn't a real difference. The line drawn is arbitrary and based on emotional reasoning.

[Robert Sharp]

Lots of cities, including big cities, do NOT have public transit. That's just a patently false statement. Perhaps we should though. Then you could add that to the list of "free" things we'll get to enjoy with our higher taxes.

[Robert Sharp]

What? Democracy isn't about ensuring that everyone is a perfectly educated voter before allowing them to vote. We'd get, like, one voter every year if that were the case. Democracy is about getting as much input as possible before making a decision, and trying to make that decision a compromise that reflects everyone's wishes. More people voting is an unmitigated good -- the less people as a proportion of the population that vote, the more power nutjob fringe groups have. If anything, not voting should be punished with a fine, like in Australia.

I think this is a ridiculous statement, personally. Random input from ignorant people cannot be considered an unmitigated good. And punishing not voting with a fine goes against the liberal ideals that support democracy in the first place. You should have a right not to vote.

I just don't understand this idea that voting is inherently good. Apparently the burden of proof is on me to prove that, though. OK, why don't we let children vote? If input is automatically good, what's wrong with their input? I think what's wrong is that they aren't intellectually and experientially prepared to vote, and so as a society we feel that their input is not welcome in our democratic systems. Fair enough. But how is that different from an adult who is child-like in his/her approach to politics?

Look, I'm not against education. I absolutely think more education would be better overall for voting practices, as long as the education includes some politics. But it doesn't. Many majors can graduate college with little or not political science, philosophy, history, or whatever subjects add to our political understanding.

All I asked for was some evidence that free university tuition would lead to BETTER voting practices. What I got was something about voting turnout. IF there's a relation between the two, I'd like to see it, but it will take more to convince me that voting is inherently a good thing than just throwing words like 'unmitigated' around.

And to clarify, I never said perfectly educated. That's an unfair reading of my point. I'm only talking about some minimal understanding. I'm talking about competency here, not full autonomy (with understanding).

[Hanzii]

Which country do you live in and why didn't you mention it in your post since you refered to it? What is the cost to the standard of living to offer the things you are talking about? Do you have a large influx of dirt poor and uneducated people streaming into your country that you would have to offer these free benefits to?

I am glad you agree with cliffski but, ummm, he was referring to health care in the post I replied to and not education like you were referring to.

Because I'm arrogant enough to think most people here know it by now...

Anyway, I'm from Denmark and the standard of living here is usually rated one of the highest on the planet (by OECD and whoever rates these things). And no, immigration is not that big an issue here (whoever I do put my money/votes where my mouth is and am one of the people in favour of increased immigration as well as going back to spending 1 percent of our GNP on foreign aid... right now it's a measly 0,7).

I'm
not convinced that immigration is as huge an issue as you guys make it, either. I think the "why should I pay for others"-sentiment expressed vy anto-bunny and others plays a larger role.
If you guys really wanted it, you could afford it.
Jason pointed out, that's it's unlikely mexicans will cross the border for health coverage and hey, the money universal healthcare would save you could be used on free education.

[Hanzii]

Actually, the point is that there isn't a real difference. The line drawn is arbitrary and based on emotional reasoning.

If you truly believe this, I'm just going to write you off as morally corrupt instead of dense.
Still not worth explaining stuff to.

[Jafisob]

Short Story: The parallels between Denmark and the USA are low enough for it to be a very poor comparison when saying ~"My country(Danes) have it so I don't see why you(USA) can't do it too".

Consider the situation in Denmark:
-Small homogeneous population
-Limited immigration from poor countries
-No border with a third world country
-Lower standard of living than the USA
-Very high taxes
-Taking further steps to limit immigration(because if you don't your magical system goes down the crapper)

Denmark is a rich welfare state. They seem to have there stuff together as they have a relatively high standard of living and significant services. Congrats. It seems like a nice place to live. However it seems clear that if they were put on the border of a third world country they would have to either change there system, limit immigration, or suffer a dramatic decrease in the standard of living.

"Danes are proud of their highly developed welfare safety net, which ensures that all Danes receive free health care and need not fear real poverty. Over the past 20 years, however, the number of Danes living on transfer payments has grown to about 1 million working-age persons (roughly 20% of the population), and the system is beginning to show strains. Health care and care for the elderly particularly have suffered, and the need for welfare reform is increasingly discussed because of the coming sharp decline in the ratio of workers to retirees. More than one-quarter of the labor force is employed in the public sector. Thus 61% of the adult population in Denmark is either dependent on transfer payments, i.e. entitlement benefits, or is employed by government at central, regional or local level (2005). However, as of July 2007 only 3.3% (90,500) of Danes are officially unemployed."

Did I mention I have a small amount of Danish blood? Can I immigrate? I could live with the lower standard of living if I had job security, free health care, no poverty, and lived in a society with less cross culture bashing(because you know there are less people of diversity). Not having the military from my country off in some corner of the world, not being bagged on by other jealous nations, and having to worry less about being attacked by nut bag terrorists would be a big pluses as well. I could also come on to Internet forums and say bad things about the USA and how my country does it better without mentioning how different the situation is for my country.

[cliffski]

The reason people argue for free universal health care and education is that these provide huge mutual benefits for the whole of society. A healthy and educated workforce means a better economy, less crime, and actually lower health care costs (because prevention is cheaper than cure).
Its in societies collective interest that my neighbour is healthy and educated. Its not really of mutual benefit as to whether or not he has a car, or can afford cable TV.
I'm very much a capitalist, but believe in universal health care and education, and subsidised public transport. Ensuring everyone can get to work and be flexible enough to switch jobs also oils the wheels of the economy.

[Anti-Bunny]

If you truly believe this, I'm just going to write you off as morally corrupt instead of dense.
Still not worth explaining stuff to.
Ah, yes, the classic 'anyone who disagrees with me is evil' argument. Well played.

[Zarathustra]

Neither. Because they are not free and people should earn these things, not be given them.

[cliffski]

anti-bunny, regardless of any moral objection to paying towards someone else's healthcare, do you not agree that collectively, everyone in the US is better off if everyone in the US has better health care?
Can't you see the self-interest argument?

[Anti-Bunny]

anti-bunny, regardless of any moral objection to paying towards someone else's healthcare, do you not agree that collectively, everyone in the US is better off if everyone in the US has better health care? Can't you see the self-interest argument?

No, for several reasons.
A) you grow the government, which is bad for everyone.
B) you actually DECREASE the quality of healthcare as we've seen again and again and again and again in every other country that's nationalized their medical industries.
and C) you're taking more of people's income and taking jobs away from the free market and into government control, which is bad for the economy.

[Hanzii]

Ah, yes, the classic 'anyone who disagrees with me is evil' argument. Well played.

No. The classic 'if you can't see the difference between free MMR vaccine and free Porsches, then our views are so far apart that this thread could span countless of pages and we'd be no closer at understanding each other, so why bother'-argument.

Also, what cliffski said.
I believe in the free (but regulated) market. I also believe that liberitarians are batshit insane (and morally corrupt).

[Ezdaar]

Neither. Because they are not free and people should earn these things, not be given them.

Just like people earn the situation they are born into.

[cliffski]

No, for several reasons.
A) you grow the government, which is bad for everyone.
B) you actually DECREASE the quality of healthcare as we've seen again and again and again and again in every other country that's nationalized their medical industries.
and C) you're taking more of people's income and taking jobs away from the free market and into government control, which is bad for the economy.

you suggest that healthcare in the UK and France etc is worse than the US? and that our economies are suffering due to health care?
On what are you basing that?

[cliffski]

Neither. Because they are not free and people should earn these things, not be given them.

surely on average, the money they save from free healthcare, they spend and gets taxed to pay for it.

Its not like space aliens provide it.

[shift6]

If we equate the current level of free education (high school) with free health care (ERs at the county hospital, etc) and reframed this thread as "which should build on what we have now", then I'd pick education. In short, I believe that a generally more educated populace would take care of themselves better (smoking, fast food, exercise, etc) in the aggregate, and by so doing would lower the general bill for health care in the US. Succinctly, the average person would need less health care if he took better preventative measures on an everyday basis.

Further, a higher standard of education would, I believe, lead to greater national wealth (by whatever metric you like) and thus increase the general standard of living which is usually equated with better overall health. In addition, better educated people tend to get better jobs and those jobs would presumably come with some kind of employer sponsored health care plan. Finally, I like to think (and I have no proof for this) that if people were a little more educated there would be more support for truly groundbreaking medical work like stem cell research. This directly improves health care as well.

I think that making a choice between the two is analogous to whether one is taking a short-term view or a long-term view. Do we toss these hypothetical resources into building something which might result in a much healthier future two generations down the road, or do we take care of current health issues without really looking to how to minimize and eliminate them in the long run? That's not an easy choice.

[Robert Sharp]

Any proof that well-educated people are healthier? I'm not denying it. I'd just like to see some evidence beyond your belief. If it's there, that's a nice argument.

[Dirt]

Well, no public transportation is definitely something that needs to be fixed. The ability to move around for jobs to provide for their loved ones is a right that everyone should have. Just as having access to the best health care that can be provided should be available to everyone, so they can be healthy enough to keep working and providing for the ones they love.

I don't disagree with people who think of universal health care as charity. I can't think of a better way for me to spend my money than to give another person the chance to live, the gift of life.

[skedastic]

It's extremely well-known that more educated people are healthier (I've seen this referred to as the most well-established result in the social sciences). But what we need to establish in this context is that education causes health, which is much more difficult than merely establishing that education is correlated with health. There is ample evidence that education does, in fact, cause health (example paper (http://www.econ.ku.dk/okojn/Public/Research/jarendt.pdf)). These results are strong enough that it is quite common for health economists to argue that an incremental government dollar spent on education will increase population health more than a dollar spent on health care.

[Mordrak]

It's extremely well-known that more educated people are healthier (I've seen this referred to as the most well-established result in the social sciences). But what we need to establish in this context is that education causes health, which is much more difficult than merely establishing that education is correlated with health. There is ample evidence that education does, in fact, cause health (example paper (http://www.econ.ku.dk/okojn/Public/Research/jarendt.pdf)). These results are strong enough that it is quite common for health economists to argue that an incremental government dollar spent on education will increase population health more than a dollar spent on health care.

I think we also have to understand what is meant by health care, part of health care can be health education. That's why nationalized health care systems focus on prevention much more than ours, it's much much cheaper, and more effective in the long run.


Further, a higher standard of education would, I believe, lead to greater national wealth (by whatever metric you like) and thus increase the general standard of living which is usually equated with better overall health. In addition, better educated people tend to get better jobs and those jobs would presumably come with some kind of employer sponsored health care plan. Finally, I like to think (and I have no proof for this) that if people were a little more educated there would be more support for truly groundbreaking medical work like stem cell research. This directly improves health care as well.


Giving everyone a BA or BS will not result in significantly more wealth. There's only so many slots to fill in jobs here in the US. You'd just be diluting is the worth of the degree.

[Mordrak]

We have achieved it. Join the service.

Don't hide behind dramatic words like 'police state' when 'I don't want to put my ass on the line' or 'I want something for nothing' is what you mean.

I'm not hiding behind words like police state, but there are many reasons the US has turned out the country it is. The current members and organization of the armed service are just one part.

Either serve or shut up and enjoy the freedoms the military provides is a dangerous mentality.

[skedastic]

I think we also have to understand what is meant by health care, part of health care can be health education. That's why nationalized health care systems focus on prevention much more than ours, it's much much cheaper, and more effective in the long run.


I don't know of any evidence that substantially more preventive care, nor health education, is provided under socialized health care or insurance systems. But that's beside the point: we were talking about plain ol' education, not health education specifically. The argument is that more education causes people to choose to behave in manners which produce more health, and empirically this effect is strong enough that producing a little more education increases health more than producing a little more health care (at the margin, it is surprisingly difficult to show that health care has any effect on population health whatsoever).


Giving everyone a BA or BS will not result in significantly more wealth. There's only so many slots to fill in jobs here in the US. You'd just be diluting is the worth of the degree."Everyone" wouldn't benefit from a degree, but that's irrelevant as no one is proposing to force everyone through 16 years of education. At the margin, the people who would obtain degrees if college were more heavily subsidized would experience substantial wage gains. One reason to support subsidized education is that the government will be able to claw back some of those increased wages through taxes, which helps to offset the severely regressive nature of subsidized higher education (even in places where university is "free," kids from wealthier families are much more likely to go, so reducing the price through subsidies has the direct effect of helping the rich more than the poor).

[Mordrak]

I don't know of any evidence that substantially more preventive care, nor health education, is provided under socialized health care or insurance systems. But that's beside the point: we were talking about plain ol' education, not health education specifically. The argument is that more education causes people to choose to behave in manners which produce more health, and empirically this effect is strong enough that producing a little more education increases health more than producing a little more health care (at the margin, it is surprisingly difficult to show that health care has any effect on population health whatsoever).


I see, but that leads to...


"Everyone" wouldn't benefit from a degree, but that's irrelevant as no one is proposing to force everyone through 16 years of education. At the margin, the people who would obtain degrees if college were more heavily subsidized would experience substantial wage gains. One reason to support subsidized education is that the government will be able to claw back some of those increased wages through taxes, which helps to offset the severely regressive nature of subsidized higher education (even in places where university is "free," kids from wealthier families are much more likely to go, so reducing the price through subsidies has the direct effect of helping the rich more than the poor).


That's true and I agree, but the premise of the thread was universal health care or free education? Thus I was assuming the education would similarly be universal (or at least attempt to be). If it was free education, but not universal that's a different matter. Since education is correlated with health, providing limited free-education to those who would more than likely end up educated anyway, means you're really just maintaining the status quo and not improving the general health or education of the populace. You're just reducing the financial burden on those already receiving those benefits.

[skedastic]

Providing college for "free" doesn't mean that everyone will go to college, it rather reduces the cost of going to college (the main cost remains, though: the opportunity cost of lost wages). More people will choose to go to college if college is cheaper. Those people will enjoy greater incomes (and health, even after controlling for income).

[Mordrak]

Providing college for "free" doesn't mean that everyone will go to college, it rather reduces the cost of going to college (the main cost remains, though: the opportunity cost of lost wages). More people will choose to go to college if college is cheaper. Those people will enjoy greater incomes (and health, even after controlling for income).

Yes, I understand. The deciding factor is if there will enough of those people to make it worthwhile to further subsidize education. If in practice, only 1% of the populace see significantly improved incomes and health, then the program's benefits would seem to be marginal, no? It just depends on whether the numbers work out in favor of subsidizing.

[skedastic]

Suppose zero additional people would choose to go to college if college were subsidized more heavily. Then the subsidy is entirely a transfer from taxpayers to college students. This is a (regressive) redistribution of income, but the only real cost of the program is the inefficiency we face when raising tax dollars. Simply, if more people don't go to college when we subsidize college, the subsidy is real cheap.

That said, empirically, college attendance decisions are moderately elastic to the cost. For example, Dynarski 2003 (http://links.jstor.org/sici?sici=0002-8282%28200303%2993%3A1%3C279%3ADAMMTE%3E2.0.CO%3B2-J&size=LARGE&origin=JSTOR-enlargePage) finds that an additional $1,000 in aid increases enrollment probability by almost 4%. If college were "free," we should expect substantially more people to attend.

On the other hand, incremental health care expenditures are not very effective at producing health. That doesn't (necessarily) mean that health care isn't effective at producing health, it rather means that, given what we could get for, say, 8% of GDP, the extra health we can get by increasing expenditure to, say, 10% of GDP is surprisingly small. In general, health care isn't nearly as effective as most people think it is. The social determinants of health turn out to be more important, and probably the most important of those social determinants is education.

[Lurb]

The Socialist Party just won the election here today, so I get to keep both things for at least 4 years more. Yay!

[SlyFrog]

Need to know what "free education" means.

Is it an excuse for lazy people to stay in school until they are 30, or is there some sort of weeding out process?

Does free education also mean free room and board while obtaining that education, or is just the tuition covered?

[Jafisob]

I'm not hiding behind words like police state, but there are many reasons the US has turned out the country it is. The current members and organization of the armed service are just one part.

Either serve or shut up and enjoy the freedoms the military provides is a dangerous mentality.

The current members and organization of the armed service are directed by the government. The vast majority of this government never served in the military, not even the so called hawks. Blaming the military for some negative aspect of this society is not appropriate.

I could turn around and say:
There are many reasons the US has turned out the country it is. The members of the current population who never served, feel no obligation to serve, and give no respect to those that have are just one part.

Inferring a police state mentality for those that respect national service is a dangerous mentality.

BTW: Either serve or shut up and pay for your college is different than your statement.

[Robert Sharp]

Need to know what "free education" means.

Is it an excuse for lazy people to stay in school until they are 30, or is there some sort of weeding out process?

Does free education also mean free room and board while obtaining that education, or is just the tuition covered?

Presumably, you would need to be full time in order to get benefits of this sort. Schools will not allow you to remain a full time student if you are failing classes all the time. The system would prevent the sort of abuse you are worried about if done correctly.

[ravenight]

No, for several reasons.
A) you grow the government, which is bad for everyone.

Or you could just take the money from the cost of providing "democracy" to countries that don't want it.

B) you actually DECREASE the quality of healthcare as we've seen again and again and again and again in every other country that's nationalized their medical industries.

Link? Your evidence for this is, what, a record made by Reagan in 50s?

and C) you're taking more of people's income and taking jobs away from the free market and into government control, which is bad for the economy.

The basis for this statement is a 300 year old book that is as relevant to modern economies as The Communist Manifesto is. The government providing jobs doesn't hurt the economy, just like Microsoft making almost all the operating systems doesn't hurt the economy. There aren't 2 markets, one for things done by the government and one for all the "free" things.

Hey, I have an idea, let's privatize the military, police force, fire departments, sanitation - think of how many jobs we'll put back into the free market and how much smaller the government will be!

Either serve or shut up and enjoy the freedoms the military provides is a dangerous mentality.

Though, if "serve" meant more than just go kill foreigners, it would be pretty sensible. The military is necessary for some things, but having people trade 4 years of service in any number of government branches would make good sense in return for their education costs.

[Mordrak]

The basis for this statement is a 300 year old book that is as relevant to modern economies as The Communist Manifesto is.


I agree with this.


The government providing jobs doesn't hurt the economy, just like Microsoft making almost all the operating systems doesn't hurt the economy. There aren't 2 markets, one for things done by the government and one for all the "free" things.
This I don't agree with. There are positive and negative effects to Microsoft being as dominant as it is. Hurting the economy can mean many different things. Having a few large players may be great for corporate profits, but it may not be in the longterm best interest of the economy or society.


Hey, I have an idea, let's privatize the military, police force, fire departments, sanitation - think of how many jobs we'll put back into the free market and how much smaller the government will be!
Don't joke. There are people here that think we (or at least entertain the idea seriously) should have private police rather than public.


Though, if "serve" meant more than just go kill foreigners, it would be pretty sensible. The military is necessary for some things, but having people trade 4 years of service in any number of government branches would make good sense in return for their education costs.Sure, but his statement was basically Spartan. It put an inordinate amount responsibility on the military for our freedoms, rather than things like general system of government or other forms of civic duty. It was basically, serve the armed forces or don't voice dissent.

[cliffski]

As the populations of india and china see their living standards rise, and all 2 zillion of them are desperately keen to improve their education, I think any nation that isn't prepared to put serious effort into educating its workforce is fucked. Unless you want to have a nation of minimum wage drones working for Chinese and Indian managers who take the profits back to the home country with them.

[Reldan]

How many of your countries are, deep down, dependent on the fact that the US has such a powerful military to secure your borders? How much do you guys spend to defend yourselves? Not much, huh. You get to spend that money instead on social programs and handouts.

You rely on us and our ridiculous defense spending to make sure everyone plays nice. In a way, the US is subsidizing your education and your universal health care by taking on the burden of defense - a role we've been stuck in since WWII. You'd all be speaking Russian right now otherwise.

[Jafisob]

We already have free education or mostly free education available. Join the Army or National Guard, serve your term, and get college money. It is what I did.

Don't want to serve? Thank the people who put their lives on the line for you, be quiet, and pay. Once you get a good job then pay off your loan(or your parents) and live a good and safe life in a great country.


...
Sure, but his statement was basically Spartan. It put an inordinate amount responsibility on the military for our freedoms, rather than things like general system of government or other forms of civic duty. It was basically, serve the armed forces or don't voice dissent.

If English is not your native language I can see how you misread my statement. If not then I call Shenanigans.

There is a debt of gratitude you owe the people who serve/served and particularly those who serve/served in times of conflict. If college assistance is offered to these people it is something they have earned. If you want something, earn it. Gratitude and the expectation of earning benefits is not a 'Spartan' or 'Police State' mentatility.

Our freedoms are because of our general system of government and other forms of civic duty and not the military. However, without the military, our system of government and other efforts would be a moot point unless of course we could bamboozle another society into protecting us.

[Jason McCullough]

How many of your countries are, deep down, dependent on the fact that the US has such a powerful military to secure your borders?

Taiwan is currently the only country plausibly defended by the United States. This has been easy answers to easy questions.....

[wisefool]

B) you actually DECREASE the quality of healthcare as we've seen again and again and again and again in every other country that's nationalized their medical industries.


Erm, Canada?

Half of health expenses are already paid for by Medicare and/or Medicaid. Old people tend to be the ones who die from cancer and cardiac problems. The sets of different rules involved are a nightmare.

For what it's worth, Medicare spends about 5% in administration costs (from memory), whereas private commercial insurances use about 25-30%.

[Sarkus]

Taiwan is currently the only country plausibly defended by the United States. This has been easy answers to easy questions.....

Well, you could add Japan to that list in that Japan's military forces are relatively small and they benefit from the US bases. If Japan was forced to carry a heavier load it would have some impact on their economy, but then again there are other issues that a militarily strong Japan leads to.

However, in general I agree that Reldan is wrong in making this a big deal. While the US military does, in effect, protect countries other than the US, the impact on our budget is not so high that it really impacts social programs in a general sense any more than other parts of the budget does.

[Lizard_King]

Well, you could add Japan to that list in that Japan's military forces are relatively small and they benefit from the US bases. If Japan was forced to carry a heavier load it would have some impact on their economy, but then again there are other issues that a militarily strong Japan leads to.

Japan is the fifth biggest spender on defense in the world. The issues about Japan pulling its weight stem from the rigidly constrained mission of that military, not from any actual weakness. Don't get me wrong, the US is an important factor in their defense strategy, but I don't think it's accurate to characterize their situation that way.

[Reldan]

So you don't feel that the strength of the US military has deterred and prevented wars against any countries other than Taiwan and Japan?

Military spending is not a pittance. It's averaged 300-400 billion a year since WWII, not counting the additional cost of actual wars.

It's also an area where spending is very disproportionate between the US and the European democracies which enjoy all these great social benefits.


A democracy will continue to exist up until the time that voters discover they can vote themselves generous gifts from the public treasury

[Sarkus]

So you don't feel that the strength of the US military has deterred and prevented wars against any countries other than Taiwan and Japan?

Military spending is not a pittance. It's averaged 300-400 billion a year since WWII, not counting the additional cost of actual wars.

It's also an area where spending is very disproportionate between the US and the European democracies which enjoy all these great social benefits.

Military spending is not a pittance, but what's $500b in a $2-3t budget? It's not what is keeping us from embracing more social services.

Some people may point to cost as a reason why we can't do these things, and they are right in the sense that our financial house is not in order, but our military spending is not what is stopping us. Instead it's a lot of people who have philosophical and political reasons not to want these programs.

[Jason McCullough]

So you don't feel that the strength of the US military has deterred and prevented wars against any countries other than Taiwan and Japan?

Military spending is not a pittance. It's averaged 300-400 billion a year since WWII, not counting the additional cost of actual wars.

It's also an area where spending is very disproportionate between the US and the European democracies which enjoy all these great social benefits.

I said "currently" because we obviously deterred the USSR all those years.

That said, "we saved your ass from the commies" is more than a little misguided. We did it mostly because of financial and empire-building reasons, not out of the goodness of our hearts. That didn't hurt, of course.

[cliffski]

How many of your countries are, deep down, dependent on the fact that the US has such a powerful military to secure your borders? How much do you guys spend to defend yourselves? Not much, huh. You get to spend that money instead on social programs and handouts.

You rely on us and our ridiculous defense spending to make sure everyone plays nice. In a way, the US is subsidizing your education and your universal health care by taking on the burden of defense - a role we've been stuck in since WWII. You'd all be speaking Russian right now otherwise.

Stop doing it then. Nobody is forcing you to waste all your money on guns dude.

[Sarkus]

Japan is the fifth biggest spender on defense in the world. The issues about Japan pulling its weight stem from the rigidly constrained mission of that military, not from any actual weakness. Don't get me wrong, the US is an important factor in their defense strategy, but I don't think it's accurate to characterize their situation that way.

In simple terms, Japan's defense expenditures as a percentage of GDP or their national budget are a lot less than the US, by factors that go way beyond the difference in the size of our economies. There are a lot of reasons for that, but unlike the European countries that have NATO for group defense (and thus they don't have to spend a lot of money individually), Japan is almost exclusively tied to the US.

My point is that if we weren't linked to Japan the way we are, Japan would have to try and find allies, allies it won't find in the region because anger over WW2 is still strong, particularly in the Koreas and China. The end result would be that Japan would have to expand it's small but technologically advanced military.

Edit: Also, in a more "apples to apples" comparison looking at the European Union, you see they are spending a lot more money on defense than Japan, relative to population, economy, etc. It's not at US levels, but it is pretty high. Which is another reason why defense spending can't be used as a crutch to explain the lack of universal healtcare and education in the US.

[Jafisob]

Stop doing it then. Nobody is forcing you to waste all your money on guns dude.

I agree.

Dear President Reldan,

Stop wasting all the money on guns when I want more butter. Mmmmm butter.

[Mordrak]

If English is not your native language I can see how you misread my statement. If not then I call Shenanigans.

There is a debt of gratitude you owe the people who serve/served and particularly those who serve/served in times of conflict. If college assistance is offered to these people it is something they have earned. If you want something, earn it. Gratitude and the expectation of earning benefits is not a 'Spartan' or 'Police State' mentatility.


It is, because you're saying that benefit that right now is exclusive to the armed forces and must remain that way or else armed service men aren't sufficiently rewarded for their service. I'm sorry, but I'll ask whatever I wish of my government without regards for other's feelings. College funds, signing bonus, health care, etc, are incentives to join the military that's it, not some sanctified moral code of deservedness.

"Earning" is such a loaded term. It means jack shit under a market economy, other than you got some one to give you money.

I'm sorry you feel like your contribution doesn't matter unless you receive exclusive government benefits.

[SlyFrog]

Presumably, you would need to be full time in order to get benefits of this sort. Schools will not allow you to remain a full time student if you are failing classes all the time. The system would prevent the sort of abuse you are worried about if done correctly.

I do not see how failing students would help, except in the most egregious cases. It's pretty easy to do an absolute minimum of work but not actually fail out, at least at the institutions I've attended, and I would imagine that other institutions would be even easier than those.

[Jafisob]

It is, because you're saying that benefit that right now is exclusive to the armed forces and must remain that way or else armed service men aren't sufficiently rewarded for their service. I'm sorry, but I'll ask whatever I wish of my government without regards for other's feelings. College funds, signing bonus, health care, etc, are incentives to join the military that's it, not some sanctified moral code of deservedness.

"Earning" is such a loaded term. It means jack shit under a market economy, other than you got some one to give you money.

I'm sorry you feel like your contribution doesn't matter unless you receive exclusive government benefits.

Good counter point. Unfortunately it does not match your previous statements where you stated I basically said: "...serve the armed forces or don't voice dissent." as well as calling my statements Spartan and insinuating a police state mentality. You were implying something much different from what I was saying.

There are in fact other ways to get a college education partially or fully paid for including academic excellence. It is far from the exclusive right of the military. There is of course also the option of paying for your education yourself or taking a loan. No one is denying anyone a right because they did not serve in the military.

In my opinion earned does in fact mean something and any college benefits given to the military is earned. Tough training, deprivations, distance from friends and family, loss of personal freedom and risk of life and limb. Umm, yeah, earned.

========And now more on topic with the post title=============================
We can't afford to give everything to everybody. In a perfect world all education would be free**. In a small high tax welfare state where we did not have any concerns beyond our borders we could probably afford to do so. This is not the case in the USA.

Some form of Nationalized health care might go a long way in paying for itself by standardizing billing(billing is a huge cost for physicians which must be passed on) and allowing for group negotiations on drug prices. In an either or proposition I favor the health care alternative.

** Except law school ;-)

[Mordrak]

Good counter point. Unfortunately it does not match your previous statements where you stated I basically said: "...serve the armed forces or don't voice dissent." as well as calling my statements Spartan and insinuating a police state mentality. You were implying something much different from what I was saying.


No, it's pretty clear you what you were saying. Telling someone to shut up is saying, well, stop talking, or stop using their voice to say things you don't like.


There are in fact other ways to get a college education partially or fully paid for including academic excellence. It is far from the exclusive right of the military. There is of course also the option of paying for your education yourself or taking a loan. No one is denying anyone a right because they did not serve in the military.
Yes, there are other ways to get college funds and there decent are arguments on the many sides of this issue. Saying it doesn't show proper respect to those that have earned it, specifically armed service members, is not one of them.


In my opinion earned does in fact mean something and any college benefits given to the military is earned. Tough training, deprivations, distance from friends and family, loss of personal freedom and risk of life and limb. Umm, yeah, earned.
Military individuals may "earn" it, but that doesn't make them or it special. That's the problem with words like earn, because the standards vary so much it's practically meaningless, other than, you made some money doing something.

[Nick Walter]

I do not see how failing students would help, except in the most egregious cases. It's pretty easy to do an absolute minimum of work but not actually fail out, at least at the institutions I've attended, and I would imagine that other institutions would be even easier than those.

In a free market environment the institutions are motivated to try and keep any student, however marginal, in the system so that he or she can keep paying. In a publicly funded model, the motivation flips and the institutions are more likely motivated to set and maintain high standards. Or at least, they are if the system is put together right.

[Jafisob]

No, it's pretty clear you what you were saying. Telling someone to shut up is saying, well, stop talking, or stop using their voice to say things you don't like.

Yes, there are other ways to get college funds and there decent are arguments on the many sides of this issue. Saying it doesn't show proper respect to those that have earned it, specifically armed service members, is not one of them.

Military individuals may "earn" it, but that doesn't make them or it special. That's the problem with words like earn, because the standards vary so much it's practically meaningless, other than, you made some money doing something.
I don't think there is any benefit in debating a simple word like 'earn'.

"Tough training, deprivations, distance from friends and family, loss of personal freedom and risk of life and limb." Yes, I would say those who serve are special, especially those that volunteer and serve during times of conflict.

Please try not to put words into my mouth that I did not say.

Let me rephrase/reorder several of my last few posts:
-We don't have the resources to offer free education to all citizens.
-I would put in my vote for the nationalized health care over free education for all. In a magical world of infinite resources and no conflict(except for cool computer games) I would like both
-Oh by the way, if you want free education it is currently available as a benefit of national service.
-Other methods to help pay for a college education are available

[Mordrak]

Please try not to put words into my mouth that I did not say.


I'm not.

[cliffski]

I read a book by a UK economist who cited a study showing that the average americans spending on bureaucracy for healthcare was higher than the average UK citizens contribution towards healthcare.
In other words, just by making your system universal, it would pay for itself instantly in the reduction of bureaucracy.
Unless you think paying for an army of rich US lawyers to deny people health insurance claims is the best use of Americas resources, which I doubt.

[Jafisob]

I read a book by a UK economist who cited a study showing that the average americans spending on bureaucracy for healthcare was higher than the average UK citizens contribution towards healthcare.
In other words, just by making your system universal, it would pay for itself instantly in the reduction of bureaucracy.
Unless you think paying for an army of rich US lawyers to deny people health insurance claims is the best use of Americas resources, which I doubt.

Yes, exactly the reason I am now a proponent of some type of National Health Care or at the very least a national standard for health care payments to reduce overhead.

[teledyne]

I read a book by a UK economist who cited a study showing that the average americans spending on bureaucracy for healthcare was higher than the average UK citizens contribution towards healthcare.
In other words, just by making your system universal, it would pay for itself instantly in the reduction of bureaucracy.
Unless you think paying for an army of rich US lawyers to deny people health insurance claims is the best use of Americas resources, which I doubt.

That is amazing. Could you link the book or the study the author/economist was referring to?

Also, another idea to complement universal healthcare is supplemental healthcare. Chances are there's going to be something the government isn't going to pay for, like transferring your soul into a toaster, but a healthcare insurance company would totally provide. You pay an extra amount monthly just like you do now, except that you rest assured knowing your soul has been transferred into your chrome 4-slice laser toaster. Mmm, toast never tasted so good.

[skedastic]

I read a book by a UK economist who cited a study showing that the average americans spending on bureaucracy for healthcare was higher than the average UK citizens contribution towards healthcare.
In other words, just by making your system universal, it would pay for itself instantly in the reduction of bureaucracy.


The U.S. system is definitely administratively wasteful, but those numbers just aren't right. The highest estimates (which are likely to be exaggerated) of U.S. administrative costs are about a grand per capita (cite (http://www.pnhp.org/publications/nejmadmin.pdf)). U.K. government health care expenditures per capita are about $1,700 per capita (cite (http://www.nber.org/papers/w11833)). What is more, all systems have non-trivial administrative costs, they don't fall to zero under single payer systems. Administrative costs under Canada's system, for example, are about one-third those in the U.S., so if the U.S. could replicate Canada's spending patterns, costs per capita would fall by around $700 per capita. That's a very substantial savings, but it's about 1/3 per capita governmental spending in the U.K. (and recall governmental spending in the U.K. doesn't, of course, include substantial private spending).

On the other hand, that $700 per capita would be enough to provide insurance to the uninsured in the U.S. Perhaps that's the statistic you read.

[SlyFrog]

In a free market environment the institutions are motivated to try and keep any student, however marginal, in the system so that he or she can keep paying. In a publicly funded model, the motivation flips and the institutions are more likely motivated to set and maintain high standards. Or at least, they are if the system is put together right.

Why would they be so motivated? They are still being paid cash for students, it's just not coming from the students.

Halliburton is a great example of why I distrust entities to have the public's best interest at heart when they are being paid by "public funding." Most organizations rapidly evolve to sucking all they can get out of the trough. As we have seen elsewhere, government oversight to prevent this often seems nonexistent.

[Nick Walter]

Why would they be so motivated? They are still being paid cash for students, it's just not coming from the students.


All it takes is a funding formula tied to success criteria.


Halliburton is a great example of why I distrust entities to have the public's best interest at heart when they are being paid by "public funding." Most organizations rapidly evolve to sucking all they can get out of the trough. As we have seen elsewhere, government oversight to prevent this often seems nonexistent.

Bad comparison I think. You are comparing educational institutions to privately held for-profit instituitions.

Sure there needs to be safeguards on good spending of the publics money but I think those are old and adequately solved problems. There are certainly plenty of publicly funded institutions at lower educational levels that seem to avoid excessive waste.

[cliffski]

That is amazing. Could you link the book or the study the author/economist was referring to?


http://www.amazon.com/Undercover-Economist-Exposing-Poor-Decent/dp/0195189779

[SlyFrog]

Bad comparison I think. You are comparing educational institutions to privately held for-profit instituitions.

Sure there needs to be safeguards on good spending of the publics money but I think those are old and adequately solved problems. There are certainly plenty of publicly funded institutions at lower educational levels that seem to avoid excessive waste.

I do not think it matters. From what I have seen, institutions "grow" to meet their available funding, whether they are profit or non-profit. In fact, non-profits are even more likely to simply take as much funding as they can get in my experience, as they do not have an end goal of using the money to maximize returns for shareholders.

If you have ever seen budget time come around for one of these entities, they never turn down a source of funding. They will always find a use for the money, even if it means mission creep.

We already have public schools that are an example of this. The nation's K-12 schools are not for profit, get paid by the student. Whether they have been producing good results for the funding they have received per student is obviously an issue of debate right now.

[Nick Walter]

I do not think it matters. From what I have seen, institutions "grow" to meet their available funding, whether they are profit or non-profit. In fact, non-profits are even more likely to simply take as much funding as they can get in my experience, as they do not have an end goal of using the money to maximize returns for shareholders.

If you have ever seen budget time come around for one of these entities, they never turn down a source of funding. They will always find a use for the money, even if it means mission creep.

We already have public schools that are an example of this. The nation's K-12 schools are not for profit, get paid by the student. Whether they have been producing good results for the funding they have received per student is obviously an issue of debate right now.

I think your point it outside of the scope of this debate then. I thought you were arguing something specific to education but it looks like you simply dont trust government to spend money reasonably well at all in any context.

If you want to argue the libertarian angle that government can't manage anything efficiently so government shouldn't be given any money, then okay we can have that debate. I don't think that's the topic at hand though, which is whether govt funded health care of govt funded education is a better idea. No matter what waste level you believe the government operates at, both alternatives would be equally encumbered. Unless I missed your point and you were hypothesizing that the education realm has some special inherent possibilities for waste that health care doesnt?

[Mordrak]

We already have public schools that are an example of this. The nation's K-12 schools are not for profit, get paid by the student. Whether they have been producing good results for the funding they have received per student is obviously an issue of debate right now.

Public schools (K-12) are not a good example of mission creep and wasteful spending. Poorly performing public schools are often underfunded (at least in California) and those that are overly funded (due to high property values) have much higher competency rates of students and teachers.

[SlyFrog]

I think your point it outside of the scope of this debate then. I thought you were arguing something specific to education but it looks like you simply dont trust government to spend money reasonably well at all in any context.

If you want to argue the libertarian angle that government can't manage anything efficiently so government shouldn't be given any money, then okay we can have that debate. I don't think that's the topic at hand though, which is whether govt funded health care of govt funded education is a better idea. No matter what waste level you believe the government operates at, both alternatives would be equally encumbered. Unless I missed your point and you were hypothesizing that the education realm has some special inherent possibilities for waste that health care doesnt?

I think that it does, because I think "needs" under the educational system are much more difficult to define and control than they are under a healthcare system.

Though there are obviously hypochondriacs and others with difficult to define illnesses out there, in general, people seek healthcare on a specific basis to meet a specific need (e.g. broken arm, heart disease, etc.).

Though again I will grant you there may be certain exceptions such as people seeking diagnoses for mental and other illnesses that may be difficult to debunk and will allow them to avoid work, receive government money, etc., I still think there is a much greater chance of a free education leading to a good chunk of society simply taking a four or greater year joyride on the government dole. I think it would be much more difficult to refuse education (at government cost) to someone who simply wants to bum around for four more years and is wasting the money than it would be to refuse treatment to someone who is faking an illness.

[teledyne]

http://www.amazon.com/Undercover-Economist-Exposing-Poor-Decent/dp/0195189779 Thanks! While the author doesn't specifically cite the study, I, coupled with my Google-fu, was able to find the article in the New England Journal of Medicine. University proxy or lots of money may be required to view the PDF (http://content.nejm.org/cgi/reprint/349/8/768.pdf). Below are two tables I found interesting:

http://content.nejm.org/content/vol349/issue8/images/medium/10t1.gif
http://content.nejm.org/content/vol349/issue8/images/large/10t3.jpeg
The second table screams massive efficiencies. Then again when there's only one payer, it kinda makes sense. I would love to get my hands on the OECD's data, as it covers the G8 countries and also goes into administrative expenditures, both private and public.

[skedastic]

I don't have the book handy. Can someone quote what Harford actually says? Notice Table 1 above estimates mirrors the figures in my post above, which shows that it is clearly not true that U.S. administrative expenditures per capita are greater than U.K. total expenditures per capita.

[Sarkus]

If you had asked me three years ago about a government run universal healthcare program, I would have been adamantly opposed to it. However, I've had some medical issues since and my view of the system we have in the US has changed. It's unbelievably inefficient and insanely expensive.

That said, any national healthcare program is going to have to involve legal reforms. The medical malpractice payouts have gone well beyond what is even reasonable under the circumstances and have driven up the insurance costs doctors have to pay (and of course that increases costs for everyone else).

Let's look at a case that's in the news right now: John Ritter's death. His wife is suing the doctors involved for $67m. Setting aside the question of whether the doctors are actually at fault, at what point is $67m justified in compensation for his death, especially since a nice big chunk of that will end up not with the family but with the lawyers involved? We can argue the value of human life up to an infinite number, but realistically it's time the legal system come up with a more realistic valuation. Should Ritter's family get $5-10m? Sure, but the rest is totally unnecessary. Death of a family member should not guarantee the family is set for generations.

[Nick Walter]

I think it would be much more difficult to refuse education (at government cost) to someone who simply wants to bum around for four more years and is wasting the money than it would be to refuse treatment to someone who is faking an illness.

I guess I don't see that. A few good standardized tests ought to shake out the wastrels. Especially if administered by a different organization than the one doing the education.

[SlyFrog]

I guess I don't see that. A few good standardized tests ought to shake out the wastrels. Especially if administered by a different organization than the one doing the education.

Even that questions, however, what you are trying to do in weeding people out. Are you concerned that people are taking the education for a purpose? They might be quite good at testing, and may actually be learning, but may be still just getting the education for the free ride, as opposed to attempting to gain skills and become a productive member of society. Perhaps the motivation or eventual outcome does not matter. I could respect an argument that it does not, but it does at least to me. I have no desire to see the state pay for four or more years of someone's philosophy degree, for example. I would like for there to be something tangible and productive gained and given back to society for the money spent (and no, though I again can respect a counter argument, I do not believe gaining the "ability to think" or becoming a more well-rounded person is worth those state funds).

[Reldan]

Even that questions, however, what you are trying to do in weeding people out. Are you concerned that people are taking the education for a purpose? They might be quite good at testing, and may actually be learning, but may be still just getting the education for the free ride, as opposed to attempting to gain skills and become a productive member of society. Perhaps the motivation or eventual outcome does not matter. I could respect an argument that it does not, but it does at least to me. I have no desire to see the state pay for four or more years of someone's philosophy degree, for example. I would like for there to be something tangible and productive gained and given back to society for the money spent (and no, though I again can respect a counter argument, I do not believe gaining the "ability to think" or becoming a more well-rounded person is worth those state funds).


And of course things would go positively pear-shaped if it were suggested that the government only fund educations that are aimed at getting real degrees that have an actual real-world value.

What can you do with an English degree again?

[Nick Walter]

Even that questions, however, what you are trying to do in weeding people out.Are you concerned that people are taking the education for a purpose? They might be quite good at testing, and may actually be learning, but may be still just getting the education for the free ride, as opposed to attempting to gain skills and become a productive member of society. Perhaps the motivation or eventual outcome does not matter. I could respect an argument that it does not, but it does at least to me. I have no desire to see the state pay for four or more years of someone's philosophy degree, for example. I would like for there to be something tangible and productive gained and given back to society for the money spent (and no, though I again can respect a counter argument, I do not believe gaining the "ability to think" or becoming a more well-rounded person is worth those state funds).


Okay, you just moved the goalposts so many times that they got nauseous and puked on my lawn. What do you mean, what is the testing for? It's a solution to the problem you originally were posting about punk!

In a general sense, testing for the best and weeding out the rest is a way to match the limited educational resources with those people who would most benefit from them. Yes, standardized testing as an approach can have limitations but this isn't a problem space with a perfect solution available. This is an old problem and we've never been able to find a better compromise between all the considerations of workably evaluating education outcomes than standardized testing. So I latched onto that solution as an answer to weeding out those who aren't cutting it in a free education system.

As to your objection that some types of education aren't worth wasting public money on, well, tough cookies. I happen to agree with you but the institutions of academia and the general public probably won't. Though I suspect it would be possible to move to a model where instituitions can control how many openings they have in program X, where X is engineering or philosophy or law or whatever, and use testing or strict admission guidelines to weed out all by the best Y applicants. Thus funding could be used to keep the number of students in area X small if it's not something that society needs more of.

[SlyFrog]

In a general sense, testing for the best and weeding out the rest is a way to match the limited educational resources with those people who would most benefit from them. Yes, standardized testing as an approach can have limitations but this isn't a problem space with a perfect solution available.

I did not mean to move the goalposts. I really did not understand. See, my confusion is that if you use standardized testing to weed people out (other than perhaps weeding out the people who can not even be bothered to show up for the test), you are no longer providing free public education to all citizens (much in the way I assume people mean when they talk about providing "free healthcare" to all citizens).

Instead, you are now providing the equivalent of government scholarships to the best and brightest, or the best half of society, or whatever your metric is. Which may be fine, but is a long way from giving the entire body of citizen a free (presumably equal, regardless of "merit") education.

[Reldan]

I did not mean to move the goalposts. I really did not understand. See, my confusion is that if you use standardized testing to weed people out (other than perhaps weeding out the people who can not even be bothered to show up for the test), you are no longer providing free public education to all citizens (much in the way I assume people mean when they talk about providing "free healthcare" to all citizens).

Instead, you are now providing the equivalent of government scholarships to the best and brightest, or the best half of society, or whatever your metric is. Which may be fine, but is a long way from giving the entire body of citizen a free (presumably equal, regardless of "merit") education.

I took a standardized test (the SAT) while enrolled in public school (high school) and did really well on it. As a result I was able to get scholarships to continue my education from both my state and my public university which covered all of my expenses.

Apparently Nick's world is already here, if that's how he defines "free public education."

One down, just Universal Health Care to go!

[Nick Walter]

I took a standardized test (the SAT) while enrolled in public school (high school) and did really well on it. As a result I was able to get scholarships to continue my education from both my state and my public university which covered all of my expenses.

Apparently Nick's world is already here, if that's how he defines "free public education."

One down, just Universal Health Care to go!

Betcha my SAT scores were higher. Neener neener! And if they weren't I'm going to blame differences in the test between when you took it and when I took it and handwave the differences in our scores away anyway, so don't bother replying with them ;-)

I think the only difference between the scholarship model you are suggesting and the model I'm suggesting is that the scholarship model sets the bar very very high. Only a small handful of the population get a free post high school education. I'm advocating something with the bar set lower so that a LOT of people could get a free education if they could prove they were working at it by demonstrating some learning. In practice, I'm sure we'd quickly do what other countries with publicly funded universities have done and use various criteria to separate students into schools of varying difficulty and prestige based on merit and ability.

Can any of our posters from countries that actually do publicly fund university educations comment on if I'm close?

[teledyne]

I don't have the book handy. Can someone quote what Harford actually says? Notice Table 1 above estimates mirrors the figures in my post above, which shows that it is clearly not true that U.S. administrative expenditures per capita are greater than U.K. total expenditures per capita.

Thanks to Amazon:
Researchers at the Harvard Medical School found that the administrative costs of the US system, public and private, exceed $1,000 per person. [...] The cost of US bureaucracy is also more than three times the $307 cost per person for the administration of the Canadian health system, which produces noticeably superior health outcomes.

That said, any national healthcare program is going to have to involve legal reforms. The medical malpractice payouts have gone well beyond what is even reasonable under the circumstances and have driven up the insurance costs doctors have to pay (and of course that increases costs for everyone else).

In a way, doctors and hospitals would be contractors for the government as I'm sure they wouldn't be limited to just providing care for American citizens. If a universal healthcare system is in place, it would certainly increase tourism since tourists would no longer fear the long dick of the healthcare system if and when they get injured without any U.S. insurance.

From this graph that I made, with data from OECD's list of frequently requested data (http://www.oecd.org/document/16/0,3343,en_2649_37407_2085200_1_1_1_37407,00.html), I found this below:
http://i14.photobucket.com/albums/a322/teledyne/healthcare-graph.png
Over time, the cost of healthcare is increasing and the amount of services received, that is through med school graduates [edit: which could be fixed by implementing free education!], is decreasing. Whether this is due to legal costs, med school costs, income/class parity remains to be seen but nevertheless the statistics are scary. Perhaps it's because so many Americans do not have healthcare, not as many doctors are needed.

Also, notice how from 93-99 the expenditures stay pretty linear. Then of course in 2000 it shoots up. Not that I'm trying to imply anything (like the cost of healthcare is Bush's fault) but the change in cost curve starting in 2000 is interesting.

[Nick Walter]

If you had asked me three years ago about a government run universal healthcare program, I would have been adamantly opposed to it. However, I've had some medical issues since and my view of the system we have in the US has changed. It's unbelievably inefficient and insanely expensive.

That said, any national healthcare program is going to have to involve legal reforms. The medical malpractice payouts have gone well beyond what is even reasonable under the circumstances and have driven up the insurance costs doctors have to pay (and of course that increases costs for everyone else).

Let's look at a case that's in the news right now: John Ritter's death. His wife is suing the doctors involved for $67m. Setting aside the question of whether the doctors are actually at fault, at what point is $67m justified in compensation for his death, especially since a nice big chunk of that will end up not with the family but with the lawyers involved? We can argue the value of human life up to an infinite number, but realistically it's time the legal system come up with a more realistic valuation. Should Ritter's family get $5-10m? Sure, but the rest is totally unnecessary. Death of a family member should not guarantee the family is set for generations.

Do you have any evidence that this is a large problem? It seems to be one of those things that everybody knows is true so nobody ever cites statistics or studies when proclaiming how bad malpractice issues have gotten. Of course, things that everybody knows often turn out to be urban legends.

[Jafisob]

I'm not

...a man. I like to grossly mischaracterize what people say because I feel so inadequate. Please accept my apology.


Accepted.

[Sarkus]

Do you have any evidence that this is a large problem? It seems to be one of those things that everybody knows is true so nobody ever cites statistics or studies when proclaiming how bad malpractice issues have gotten. Of course, things that everybody knows often turn out to be urban legends.

The GAO (General Accounting Office, part of the US Congress) did a study released in 2003. While they noted there were other factors than just payouts in malpractice lawsuits involved in raising the cost of malpractice insurance, the concluded that the "GAO found that losses on medical malpractice claims-which make up the largest part of insurers’ costs-appear to be the primary driver of rate increases in the long run."

That said, it's just one factor of why health care can't be simply "nationalized." The last thing we need is bureaucracy on top of an already insanely expensive system.

[skedastic]

Thanks to Amazon:

Thanks, that's the same commonly bandied about figure I gave. cliffski seems to have misquoted.


If a universal healthcare system is in place, it would certainly increase tourism since tourists would no longer fear the long dick of the healthcare system if and when they get injured without any U.S. insurance.

Get treated at a Canadian hospital with no insurance. Find out what happens.

[Jafisob]

Thanks, that's the same commonly bandied about figure I gave. cliffski seems to have misquoted.




Get treated at a Canadian hospital with no insurance. Find out what happens.

My mother had a toe nail torn off during a scuba trip in Canada and went to a Canadian hospital. She got billed for a very large sum of money. Canadian health care is for the Canadians. Everybody else please open your wallets.

[Nick Walter]

The GAO (General Accounting Office, part of the US Congress) did a study released in 2003. While they noted there were other factors than just payouts in malpractice lawsuits involved in raising the cost of malpractice insurance, the concluded that the "GAO found that losses on medical malpractice claims-which make up the largest part of insurers’ costs-appear to be the primary driver of rate increases in the long run."


Just googling "malpractice insurance costs" came back with
this (http://www.cbsnews.com/stories/2004/04/02/eveningnews/consumer/main610102.shtml) as the first hit. Several other stories on similar themes, including some articles referencing studies, are also returned. Seems to not be so cut and dried though of course the insurance companies are blaming courts and outrageous awards.


That said, it's just one factor of why health care can't be simply "nationalized." The last thing we need is bureaucracy on top of an already insanely expensive system.

I think the theory is that the bureaucracy could replace large chunks of the inefficient and insanely expensive system. Hopefully the bits that are adding a lot of cost without adding any benefits in health outcomes.

[Jafisob]

Just googling "malpractice insurance costs" came back with
this (http://www.cbsnews.com/stories/2004/04/02/eveningnews/consumer/main610102.shtml) as the first hit. Several other stories on similar themes, including some articles referencing studies, are also returned. Seems to not be so cut and dried though of course the insurance companies are blaming courts and outrageous awards.



I think the theory is that the bureaucracy could replace large chunks of the inefficient and insanely expensive system. Hopefully the bits that are adding a lot of cost without adding any benefits in health outcomes.
According to discussions with my brother in law and sister(both MD's) malpractice, while a larg expense, is not the boogeyman everybody makes it out ot be. The cost of billing and getting paid is.

[Nick Walter]

According to discussions with my brother in law and sister(both MD's) malpractice, while a larg expense, is not the boogeyman everybody makes it out ot be. The cost of billing and getting paid is.

I've heard some horror stories about that latter topic myself, but I'm always hesitant to accept anecdotes. I wish I had a good source on this one to share but my google-fu seems to be failing me here.

[Jafisob]

I've heard some horror stories about that latter topic myself, but I'm always hesitant to accept anecdotes. I wish I had a good source on this one to share but my google-fu seems to be failing me here.
Well this anecdote is straight from my brother in law and best friend's mouth and both are in private practice. My sister does cancer research and is not in private practice so she only hears things from her husband and fellow physicians.

A standardized billing methodology might go a long way in reducing medical costs. Whether this is through nationalized health care or a medical standards group is up to debate.

[Sarkus]

According to discussions with my brother in law and sister(both MD's) malpractice, while a larg expense, is not the boogeyman everybody makes it out ot be. The cost of billing and getting paid is.

That may very well be true. Of course, the question is which is really justified and which isn't. Or maybe they are all unjustifiably expensive.

Here's a personal example of how stupid this system has become. Last summer I went to the emergency room because of intense pain in my knee. I checked in, talked to a nurse for a few moments, and later saw a doctor. The doctor poked and prodded and bent my knee a few times, then gave me a prescription (not the drugs) for a pain killer and told me to go see my orthopedic specialist. No x-rays, no tests, a total of maybe 15 minutes with the doctor. I have very good health insurance but my personal payout part of that visit was nearly $500. God knows how much the insurance paid on top of that.

If the Feds merely replace the insurance companies on the top of an unchanged pyramid like this, my guess is that most of us will be paying a lot more for insurance than we are now.

[cliffski]

That's just insane. That wouldn't cost you more than $10 here (prescriptions are about £5 I think).
That means that people here go see a doctor when they first have a problem 9cheaper to fix) not when they are at deaths door (v expensive to fix).
It's a better system.

[Jafisob]

That may very well be true. Of course, the question is which is really justified and which isn't. Or maybe they are all unjustifiably expensive.

Here's a personal example of how stupid this system has become. Last summer I went to the emergency room because of intense pain in my knee. I checked in, talked to a nurse for a few moments, and later saw a doctor. The doctor poked and prodded and bent my knee a few times, then gave me a prescription (not the drugs) for a pain killer and told me to go see my orthopedic specialist. No x-rays, no tests, a total of maybe 15 minutes with the doctor. I have very good health insurance but my personal payout part of that visit was nearly $500. God knows how much the insurance paid on top of that.
....

You should know because they should have sent you a statement of how much they paid and how much you paid as well as the UCR(usual and customary rate) .

This might be a case where the hospital over billed you. In these cases you should always call both your insurance and the hospital. A 500 dollar bill on top of insurance sounds like an error to me. Deliberately tacking on questionable fees and charges to see if you are gullible enough to pay them is becoming much more common in the U.S. .

This might also be a case where you went to the emergency room without pre-authorization from you insurance company and got nailed with the high fees.

...

If the Feds merely replace the insurance companies on the top of an unchanged pyramid like this, my guess is that most of us will be paying a lot more for insurance than we are now.

If the feds are the one stop insurance standard they can mandate how much the hospitals will charge and in which situation.

[Ezdaar]

This might also be a case where you went to the emergency room without pre-authorization from you insurance company and got nailed with the high fees.



This phrase really captures one of the biggest problems of the current system.

[Siren]

I worked for a medicare insurance company for a brief period. You wouldn't believe some of the outrageous charges that were on some of the bills. $25 for a "mucous recovery system" that ended up being nothing more than a box of tissues the patient needed is the one that still sticks with me the most.

This is why civilian health insurance scares the hell out of me, and has consequently led to me only going to a doctor when absolutely utterly necessary. When I was a military dependant, there was no dealing with any of these weird charges, and the process was much more streamlined.

[TheTrunkDr]

This phrase really captures one of the biggest problems of the current system.
Yep, nothing like pre-authorizing that emergency room visit. I just love calling up my insurance company and saying;
"Hey, it's me, I'm unconscious in my over-turned car on the other side of the freeway with massive internal and external bleeding. In fact, I think I can see my pancreas and I'm pretty sure both my legs are broken, can I get an ambulance and emergency room visit authorized..... yes I'll hold."

[TheTrunkDr]

I worked for a medicare insurance company for a brief period. You wouldn't believe some of the outrageous charges that were on some of the bills. $25 for a "mucous recovery system" that ended up being nothing more than a box of tissues the patient needed is the one that still sticks with me the most.
This is a situation created by the insurance companies as they'd refuse legitimate costs forcing doctors to come up with ridiculous ones so that they actually get a reasonable reimbursement.

This is why civilian health insurance scares the hell out of me, and has consequently led to me only going to a doctor when absolutely utterly necessary. When I was a military dependant, there was no dealing with any of these weird charges, and the process was much more streamlined.
It's amazing how little hassle there is when the only part of the process you're involved with is that actual treatment. Outside of personal issues (being far from friends and family) not having to worry about paying for whatever health issues may come up is by far the thing I miss most about Canada and a very compelling reason why I don't plan to stay in the US permanently.

[SlyFrog]

That's just insane. That wouldn't cost you more than $10 here (prescriptions are about £5 I think).
That means that people here go see a doctor when they first have a problem 9cheaper to fix) not when they are at deaths door (v expensive to fix).
It's a better system.

I assume you are saying it would cost you $10 in directly paid costs. What would the state subsidy cost?

The counter to your point (which is reasonable enough) is that it also means people may be more inclined to go see a doctor for every little ticky-tack issue that does not really need a doctor, just because it is so inexpensive to do so.

[TheTrunkDr]

So we're going to rehash the discussion of the cost of health care in a public system vs. a private system again?

[Gordon Cameron]

The counter to your point (which is reasonable enough) is that it also means people may be more inclined to go see a doctor for every little ticky-tack issue that does not really need a doctor, just because it is so inexpensive to do so.

Are there many people apart from hypochondriacs who are like that? I'd have thought the norm would be extreme aversion to anything to do with doctors and pills and needles and such unless absolutely necessary. But maybe I'm projecting an atypical attitude.

[Nick Walter]

The counter to your point (which is reasonable enough) is that it also means people may be more inclined to go see a doctor for every little ticky-tack issue that does not really need a doctor, just because it is so inexpensive to do so.

Umm, isn't that the status quo? My copay to drop by the doctor is $30. I resist the urge generally because I don't like doctors much but my wife takes my kid in for every silly little thing. And the doctors don't seem to be discouraging us, they just cheerfully accept the copays and bill the insurance companies.

[SlyFrog]

Umm, isn't that the status quo? My copay to drop by the doctor is $30. I resist the urge generally because I don't like doctors much but my wife takes my kid in for every silly little thing. And the doctors don't seem to be discouraging us, they just cheerfully accept the copays and bill the insurance companies.

Yes, and people are too stupid to connect the, "Why are my insurance costs skyrocketing," with, "I take my kid in for every silly thing."

People do not tend to do a good job tracking through things like that. Apparently the separate payments to the insurance company for premium costs and the copay to the doctor's office just do not link up in their heads.

My point is that we should not encourage that by a system that simply exchanges the government (with us paying "premiums" in the form of tax dollars) for insurance companies. Unless you do something to bring down medical care costs or the pointless use of medical care facilities, all you are doing is shifting the cost from one place to another.

You are not creating some magical world where healthcare only costs $10 a visit. It may not cost you any extra money if you do not pay taxes, but someone is paying for it.

[Nick Walter]

Yes, and people are too stupid to connect the, "Why are my insurance costs skyrocketing," with, "I take my kid in for every silly thing."


I find any analysis of a problem that starts with the sentiment that people are too stupid to solve the problem to be utterly useless. If we've set up a system that is beyond the majority of people to use properly that's a fault of the system and not the people.


You are not creating some magical world where healthcare only costs $10 a visit. It may not cost you any extra money if you do not pay taxes, but someone is paying for it.

So you are in agreement with Sarkus that the most likely outcome of government paid health is that we keep all the current inefficiencies in place and just make the government pay for them instead of the insurance companies? That seems like such a bizarre assumption to me, if we are going to nationalize health care why would we only go half way. Government standards for usage, practices, etc ought to accompany government takeover of the payments.

[SlyFrog]

I find any analysis of a problem that starts with the sentiment that people are too stupid to solve the problem to be utterly useless. If we've set up a system that is beyond the majority of people to use properly that's a fault of the system and not the people.

I disagree. The stock market is too complicated for the majority of people to use, and yet it works fine. People are greedy. They want someone else to take care of it. Sometimes stupidity is an intentional ignorance that will not be dispelled.

It does not take a rocket scientist to understand that healthcare is not paid for "free," and since your insurance company is paying for it, premium increases might in part be due to constantly going to the doctor for stupid and trivial things. It is the fault of the consumer who does not get that. It's not exactly a difficult connection to see, most simply do not want to see it, because it is much easier to complain about them skyrocketing insurance costs.

Of course the insurance companies have been making money hand over fist, so it's not exactly like they are incredibly sympathetic babes in the woods either.

So you are in agreement with Sarkus that the most likely outcome of government paid health is that we keep all the current inefficiencies in place and just make the government pay for them instead of the insurance companies? That seems like such a bizarre assumption to me, if we are going to nationalize health care why would we only go half way. Government standards for usage, practices, etc ought to accompany government takeover of the payments.

I do not know why it is a bizarre assumption. We half-ass stuff all the time with government. We should not go half-way, but we probably will.

And given Walter Reed and its wonderful job with our vets, I'm not sure I want government standards for usage, practices, etc. accompanying government takeover of the payments.

But I know, the problem with government sponsored/funded facilities now is that they don't have enough money. The problem with government institutions can always be resolved by throwing more money at them. It's never a systemic issue, it's always a funding issue.

[cliffski]

I assume you are saying it would cost you $10 in directly paid costs. What would the state subsidy cost?


No idea. And that's the beauty of it. I've had to take some pills before, and so has my partner. Neither of us know if they are dirt cheap or mega-expensive. So when you get ill here, your only concern is 'how do I get better' and never combine with 'how much does it cost'. That alone probably reduces stress related illness by huge amounts.


The counter to your point (which is reasonable enough) is that it also means people may be more inclined to go see a doctor for every little ticky-tack issue that does not really need a doctor, just because it is so inexpensive to do so.

Wow, what a disaster. that means we catch diseases and problems EARLY. I can see how that's really inefficient.
I'm sure there are tens of thousands of people in the UK alive who would be dead if they had to pay for every doctors visit, because they wouldn't have caught stuff early enough to treat it.
BTW, those people will be working, and paying taxes.

[Nick Walter]

I disagree. The stock market is too complicated for the majority of people to use, and yet it works fine.


Invalid comparison. Not everyone needs or wants access to equities. Everyone wants and needs healthcare. Therefore the healthcare system must be made in usable by the average and below average.



I do not know why it is a bizarre assumption. We half-ass stuff all the time with government. We should not go half-way, but we probably will.


I know governments dont have a great efficiency record but from what I've read literally every country in the world with national health care gets better efficiency than the US. So even if we only achieve an average result for national health care we will be taking a big step forward.

[SlyFrog]

Invalid comparison. Not everyone needs or wants access to equities. Everyone wants and needs healthcare. Therefore the healthcare system must be made in usable by the average and below average.

Not anymore, with what has happened to pension plans and what appears to be happening with social security.

The healthcare system is usable by the average and below average. That does not change the fact that they are too stupid to understand it, or don't want to, depending on your viewpoint. You will not make it "usable" for the average and below average unless you just make it free.

By that logic, food purchases are also needed by everyone, and you should make that free to. After all, how are those poor average and below average people supposed to know that they should buy fruits and vegetables and not Twinkies, unless you feed them fruits and vegetables through an IV and ban Twinkies?

[Reldan]

Invalid comparison. Not everyone needs or wants access to equities.

Not everyone wants access to equities, but they sure as hell need it. It's the lack of understanding things like inflation, the shitstorm that Social Security will be by the time they retire, and even just basic financing principles in general that is going to come as an unwelcome shock when they get into their 60s and 70s and discover they own less than nothing.

I'm sure my lifetime of working, saving, learning, and investing will wind up funding not only their retirement, but their inevitable heart disease from a lifetime of eating Taco Bell, Ding Dongs, and Double Big Gulps. As a democracy, I see the creation of a universal health care program funded from tax dollars as inevitable - it's just a question of when.

I'm curious though, when you cite how efficient other national health care programs are, on what scale are they operating compared to how large such a program would need to be in the USA?

[Jason McCullough]

And given Walter Reed and its wonderful job with our vets, I'm not sure I want government standards for usage, practices, etc. accompanying government takeover of the payments.

Best Care Anywhere (http://www.washingtonmonthly.com/features/2005/0501.longman.html).

Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis.

The government runs more than a few health care systems, they're not all the same.

[SlyFrog]

Best Care Anywhere (http://www.washingtonmonthly.com/features/2005/0501.longman.html).

That is one of the worst, most scatter shot articles I have read. That's just terrible.

[Reldan]

Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.

I'd hope so, considering how the vets got diabetes from military service (http://www.diabetes.org/type-2-diabetes/agent-orange.jsp) in the first place.

[Nick Walter]

Not anymore, with what has happened to pension plans and what appears to be happening with social security.

The healthcare system is usable by the average and below average. That does not change the fact that they are too stupid to understand it, or don't want to, depending on your viewpoint. You will not make it "usable" for the average and below average unless you just make it free.

By that logic, food purchases are also needed by everyone, and you should make that free to. After all, how are those poor average and below average people supposed to know that they should buy fruits and vegetables and not Twinkies, unless you feed them fruits and vegetables through an IV and ban Twinkies?

I'm sorry, but this continuing perspective of "people are too stupid" is less than worthless. Yeah I privately harbor some similar sentiments but you can't deny reality and people are what they are. If the system isn't suited to be used and used properly by the average and below average then that is a failure of the system. This is true of every government system/service that should be accessible to all the population. Period. End of Story. Nothing further to discuss on that topic.

As to your other argument, which seems to be that making things accessible to the poor is a slippery slope towards communism, I'd advise you to look around you. We already provide a ton of free food to basically anyone that really needs it. Yet somehow our free market principles persist.

[Nick Walter]

I'm curious though, when you cite how efficient other national health care programs are, on what scale are they operating compared to how large such a program would need to be in the USA?

Excellent point, nobody has tried national health care with one system that would be on the scale of what the US would need have they?

We'd need more bureacracy for sure, but theoretically we'd also get more efficiencies of scale. I don't have a strong feeling either way I guess for whether that would make us net more efficient or net less.

[SlyFrog]

As to your other argument, which seems to be that making things accessible to the poor is a slippery slope towards communism, I'd advise you to look around you. We already provide a ton of free food to basically anyone that really needs it. Yet somehow our free market principles persist.

Yes, they persist because we draw distinctions, and do not assume that everyone should be entitled to free government food. I certainly am not entitled to it now, and am not certain why I should be entitled to free government medical care.

And "people are too stupid" is an entirely valuable point. The point is that attempting to reduce every service, even those that are critical, to the base level such that anyone who does not care to learn or put forth any effort to understand and use it is base populism. At some point, you maintain the service with safeguards and protections in place to benefit the parts of society that pay for the service, rather than saying, "Nope, some guy in Peoria doesn't get it, let's throw another hundred million at making it easier to use, hell, let's just give him money, because he doesn't understand anything else."

Excellent point, nobody has tried national health care with one system that would be on the scale of what the US would need have they?

China and the Soviet Union probably have, at least in terms of the population. Do not know about India.

[Jason McCullough]

That is one of the worst, most scatter shot articles I have read. That's just terrible.

Perhaps the book-length version would meet your incredible writing standards (http://www.quartertothree.com/game-talk/showthread.php?t=16165)?

[Robert Sharp]

While I disagree with Nick (I think the 'people are too stupid' premise is entirely appropriate), you can't seriously think that he means that the system has to be totally understandable to every single person. Nick only needs to say that it should be understandable to people who are of decent intelligence and using the system. That's not that high of a standard really and wouldn't demand majorly dumbing things down.

I do, however, worry that even reasonably intelligent people like cliffski will take the attitude that he has taken- who cares what it's costing the state as long as I get to use it without any hassle. I think that attitutde sucks because it suggests that free healthcare really is free, or that it makes no difference how much the meds cost the state. What's the tax rate in the UK compared to the U.S.? Surely the difference is at least partly caused by our different approaches to healthcare.

Now TrunkDR is right to suggest that the debate over the overall cost of each system will be long and probably inconclusive. I'm not trying to raise it as such. My point is only that the cost to the state DOES matter, and I would need to see some evidence that the system would even work in the U.S. (i.e. lower the average cost of healthcare for citizens) before I would even consider it.

[Nick Walter]

While I disagree with Nick (I think the 'people are too stupid' premise is entirely appropriate), you can't seriously think that he means that the system has to be totally understandable to every single person. Nick only needs to say that it should be understandable to people who are of decent intelligence and using the system. That's not that high of a standard really and wouldn't demand majorly dumbing things down.


I think our strong differences of opinion on how much respect we have for our fellow man is well documented, so let's not rehash ;-)

However, I think my point was unrelated to that actually. My point was utterly pragmatic. Whatever level people are at, and whatever someone in the top few % might think of the rest, it seems self evident that the system must be designed with usability for the below average. Because the below average are going to need it. They don't, as Robert pointed out, need to understand how everything works or is financed behind the scenes. They do however need to be able to actually go get health care when they need it, and the system should be designed so as to steer them into the usage patterns we want.

I suspect that people are reading something more complex into a very simple point I was trying to make. I was simply pointing out that from a pragmatic standpoint if we fear stupid people will use the system wrong by overusing it, or by using it for trivial things, then we can't just sit around and bitch about stupid people, we need to fix the system so that it can only be used right. This is probably my background in architecting software showing through, where I often have to remind people on my team this because it's a common mistake among developers to blame users for the softwares fault.


I do, however, worry that even reasonably intelligent people like cliffski will take the attitude that he has taken- who cares what it's costing the state as long as I get to use it without any hassle. I think that attitutde sucks because it suggests that free healthcare really is free, or that it makes no difference how much the meds cost the state. What's the tax rate in the UK compared to the U.S.? Surely the difference is at least partly caused by our different approaches to healthcare.


Again, how is that different than the status quo for insured people? What additional risk would we be taking on? The nice thing about government health care is that the government can in theory set guidelines about turning away overusers or users with trivial issues that a private practice can not for fear of liability or for fear of lack of revenue.

[skedastic]

What's the tax rate in the UK compared to the U.S.? Surely the difference is at least partly caused by our different approaches to healthcare.


Ballparking it because I'm too lazy to look up the exact figures, the U.S. spends about twice, a bit more than that maybe, per capita what the U.K. spends on health care. About 40% of U.S. health care expenditures are government funded and about 90% of U.K. expenditures are so funded. So a taxpayer in the U.S. under the current system spends roughly the same on government funded health care as a taxpayer in the U.K.

I would need to see some evidence that the system would even work in the U.S. (i.e. lower the average cost of healthcare for citizens) before I would even consider it.

Costs are only part of the equation. A full analysis also needs to consider how the quality and quantity of health care might change, and consider distributional issues. It's possible that the U.S. would be better off under socialized medicine even if costs rose, or worse off even if costs fell.

[Robert Sharp]

Oh, I agree. I was just saying that the cost is a starting point, where I would start to consider those other issues.

And Nick, that's a good point. People who use private insurance don't think much about the costs beyond their deductibles either. I guess my worry is that at least with private insurance you know how much YOU are contributing to it (it's right there on the paycheck). With a tax-based insurance, you are less certain because you don't know what percentage of your taxes are being used. I suppose that could be laid out, though. In fact, that would probably be best-to have the system open to public scrutiny. At least conciencious citizens could then act as a check on overspending and hold the state accountable for overspending on medicine.

[Robert Sharp]

I think our strong differences of opinion on how much respect we have for our fellow man is well documented, so let's not rehash ;-)



Yeah, I was intentionally avoiding that, actually. But I do want to clarify that I am NOT an egoist. I help people in many ways, and I respect many people (including you, actually). I'd help those people when they need it, if possible. I also default to respect for other people (for epistemic reasons). I just don't think they automatically deserve my respect just for being alive. I'm not trying to reopen the debate here either. I just don't want anyone to think that I have no respect for other people. In fact, I try to be respectful in this sub-forum, which is more than I can say for many people who claim to respect all other people (I don't mean you here, as you try to be respectful as well).

[Nick Walter]

Hmm, perhaps respect was the wrong term. I wasn't trying to imply anything or reopen a debate and derail this thread, so let me simply retract that statement with apologies.

[Robert Sharp]

No biggie. I do have a question though for you (and anyone else). Would it need to be a universal healthcare system, or would a minimal healthcare system suffice? Many people argue for a minimal system, a sort of safety net if you will, that creates equality of opportunity to get healthcare. This isn't really the same as a universal healthcare, but more of a system that keeps people from being completely unable to get necessary healthcare just because they are poor. Would that suffice for those who want universal healthcare? Because I might be able to get behind such a system. It would presumably cost less (though with insurance and pharmacy research driving up costs, it might not vis a vis a universal system). It would also still ensure that people aren't going without any health coverage at all.

[Nick Walter]

No biggie. I do have a question though for you (and anyone else). Would it need to be a universal healthcare system, or would a minimal healthcare system suffice? Many people argue for a minimal system, a sort of safety net if you will, that creates equality of opportunity to get healthcare. This isn't really the same as a universal healthcare, but more of a system that keeps people from being completely unable to get necessary healthcare just because they are poor. Would that suffice for those who want universal healthcare? Because I might be able to get behind such a system. It would presumably cost less (though with insurance and pharmacy research driving up costs, it might not vis a vis a universal system). It would also still ensure that people aren't going without any health coverage at all.

I'm not sure I'm clear on the distinction you are making between minimal and universal. Can you elaborate?

I do think the only way to get the efficiency gains from state health care to materialize are if the government is directly funding 90% of the health care going on. Funding in the sense that the government is simply paying a bill from a private doctor or in the sense that the government owns the clinic and pays the doctor's salary. Either way, that puts the government in the drivers seat in terms of setting standards and practices.

[Mordrak]

No biggie. I do have a question though for you (and anyone else). Would it need to be a universal healthcare system, or would a minimal healthcare system suffice? Many people argue for a minimal system, a sort of safety net if you will, that creates equality of opportunity to get healthcare. This isn't really the same as a universal healthcare, but more of a system that keeps people from being completely unable to get necessary healthcare just because they are poor. Would that suffice for those who want universal healthcare? Because I might be able to get behind such a system. It would presumably cost less (though with insurance and pharmacy research driving up costs, it might not vis a vis a universal system). It would also still ensure that people aren't going without any health coverage at all.

There are public clinics in many areas for the poor, which offer sliding scale fees. Many people receiving health benefits from the government go to these. They are woefully underfunded though. Getting an appointment can be weeks or months for a regular visit sometimes. They do have walk-in times set, but basically then you line up, and wait until they have an opening. This can be quick or long depending on traffic. Those that offer dental (which can be rare), sometimes have waits up to 6 months to be seen and then a year from that to have anything done if it's needed. That's because you'll have only a few dentists hop from clinic to clinic within a county. That's basically limited to cavities and pulling teeth (at least in my area). I don't think they handle eye vision, it's been awhile since I've been to the local ones.

*That's anecdotal information from California. I haven't been to a clinic (or to see a doctor in general) for quite a while, so I'm unsure how much has changed.

Edit: Also, AFAIK, no hospital that receives any kind of public funding can turn people away in an emergency situation because they are poor. That doesn't mean the poor won't receive an outrageous bill in the mail though.

What do you mean by minimum level of care?

[Robert Sharp]

Yeah, we already have something like what I mean in the form of emergency rooms that can't turn people away. But I meant an actual system that said that SOME services would be free, but not all. For example, if you get strep throat, you will die without antibiotics, so the government foots the bill for anyone to get antibiotics in such situations. However, if you get the flu, the government would NOT pay for you to go to the doctor for treatments because it's not the same situation. It isn't a necessary service for life (I know some people can die of the flu; it's just an example).

Other versions of this theory put it this way: A first tier would provide "enforced social coverage for basic and catastrophic health needs" with "voluntary private coverage for other health needs and desires" (from a biomedical ethics book that I am teaching this semester). This two-tiered system makes sure that basic health care is universal but privatizes everything else. In this way, wealthier people can still buy better coverage, thus allowing them to benefit from their wealth (some would say from the hard work it took to get that wealth). But those without wealth would still have basic coverage.

The trick, of course, would be making sure that the basic coverage is the same for everyone (in quality). People who are paying for private insurance are likely to want their own doctors, which would be better than the public doctors. For the system to work, you'd have to prevent that somehow, I would guess.

Note that I'm not necessarily advocating this...just throwing it out there.

[cliffski]

I do, however, worry that even reasonably intelligent people like cliffski will take the attitude that he has taken- who cares what it's costing the state as long as I get to use it without any hassle. I think that attitutde sucks because it suggests that free healthcare really is free, or that it makes no difference how much the meds cost the state.

I don't think it helps for an INDIVIDUAL to be thinking "holy fuck my illness is costing people lots of money". That won't help them get better. Those decisions are taken by the govt dept responsible for them, allowing or refusing care based upon costs and availability.
Nobody in the UK is unaware that the NHS is paid for from taxes. We just don't get upset that some of us pay in more than we take out and vice versa. Yes the NHS is expensive, but it provides decent worry-free health insurance to everyone in the country.
We think its worth it.

[Mordrak]

Yeah, we already have something like what I mean in the form of emergency rooms that can't turn people away. But I meant an actual system that said that SOME services would be free, but not all. For example, if you get strep throat, you will die without antibiotics, so the government foots the bill for anyone to get antibiotics in such situations. However, if you get the flu, the government would NOT pay for you to go to the doctor for treatments because it's not the same situation. It isn't a necessary service for life (I know some people can die of the flu; it's just an example).


I wouldn't be surprised if that's already built into many nationalized systems, but worked into which treatments would be initially covered unless the condition worsens.


Other versions of this theory put it this way: A first tier would provide "enforced social coverage for basic and catastrophic health needs" with "voluntary private coverage for other health needs and desires" (from a biomedical ethics book that I am teaching this semester). This two-tiered system makes sure that basic health care is universal but privatizes everything else. In this way, wealthier people can still buy better coverage, thus allowing them to benefit from their wealth (some would say from the hard work it took to get that wealth). But those without wealth would still have basic coverage.
Again, this seems like something pre-built into other nationalized systems (where people can pay for insurance which covers additional procedures).


The trick, of course, would be making sure that the basic coverage is the same for everyone (in quality). People who are paying for private insurance are likely to want their own doctors, which would be better than the public doctors. For the system to work, you'd have to prevent that somehow, I would guess.
Preventing everyone from having good doctors? Heh. That's certainly a loaded way to put it. Instead, I think it's a matter of how nationalization happens. If the split is based on procedures/treatments, you wouldn't necessarily have separate doctors, at least any more than you do now. If the difference between treatments is purely medication, than the private insurance is covering different medications, no need for artificially creating multiple tiers of doctors. If the treatments are a difference of procedure, you'd likely be paying for a specialist in that privately funded procedure. People already are referred out by general practitioners to specialists, so I really don't see the threat of two tiers of doctors that you see.

Secondly, the question of whether you're depriving people of hard earned rewards... well.. I guess it depends on whether you consider health a public good. If so, then there are limitations on the affect that wealth can have on public services (ie you can't use your wealth to deprive someone of a public service), but you can still go outside public services for expanded options.

For example: If the government won't cover viagra for your erectile dysfunction, I don't see why a nationalized system (one payer or otherwise) would prevent you from going out to the store and buying it.


I don't think it helps for an INDIVIDUAL to be thinking "holy fuck my illness is costing people lots of money". That won't help them get better. Those decisions are taken by the govt dept responsible for them, allowing or refusing care based upon costs and availability. Nobody in the UK is unaware that the NHS is paid for from taxes. We just don't get upset that some of us pay in more than we take out and vice versa. Yes the NHS is expensive, but it provides decent worry-free health insurance to everyone in the country. We think its worth it.


Didn't NHS come out of World War 2? Unfortunately, we haven't really suffered a crisis like that here in the US that would ingrain in us a similar level of empathy for our fellow humankind. The myth of rugged individualism still runs strong. I wish we were a kinder nation, but when it comes to money, we are greedy fucks.

[SlyFrog]

While I disagree with Nick (I think the 'people are too stupid' premise is entirely appropriate), you can't seriously think that he means that the system has to be totally understandable to every single person. Nick only needs to say that it should be understandable to people who are of decent intelligence and using the system. That's not that high of a standard really and wouldn't demand majorly dumbing things down.

Actually, I believe in most cases, people are stupid really means more that they are intentionally ignorant. They have at least a pretty good inkling of cause and effect, but intentionally do not run it down the entire way in their head. It gives a nice excuse why it is not really your fault when things go wrong - you didn't know after all!

It does not take a rocket scientist to figure out that someone is paying the doctor for all of your trips to the hospital, for example. People know that their insurer pays the bills above the deductible/co-pay. They know that doctor's visits are expensive, they certainly are not free. They would not buy insurance if they thought doctor's visits were cheap, so QED.

However, they then act astonished and surprised that insurance premiums increase. To me, the much more likely scenario is that people don't want to think about it and understand, because it is much more convenient to try to take the benefits of something and claim not to understand the drawbacks.

This is a type of willful ignorance that you see all the time, whether it be from our current subprime crisis (I just wanted a house, I didn't know that I couldn't afford $600,000 on a $30,000 income) to teenage pregnancy (gee, even though we've been warned, we never thought it would happen to us, what do we do now)?

I just do not buy that a lot of people will be helped, because what they really want is more, without any pain. I mean, more power to them I guess, that's what we all probably want in the end. It's just that some choose not to play dumb about not having known the consequences of decisions. Those people go to white collar prisons or resign as Governor of New York, or they successfully act confused about what "is" means.

[Reldan]

Actually, I believe in most cases, people are stupid really means more that they are intentionally ignorant. They have at least a pretty good inkling of cause and effect, but intentionally do not run it down the entire way in their head. It gives a nice excuse why it is not really your fault when things go wrong - you didn't know after all!

Rationalization is easier and more fun than rational thought any day of the week.

[Mordrak]

Actually, I believe in most cases, people are stupid really means more that they are intentionally ignorant. They have at least a pretty good inkling of cause and effect, but intentionally do not run it down the entire way in their head. It gives a nice excuse why it is not really your fault when things go wrong - you didn't know after all!

It does not take a rocket scientist to figure out that someone is paying the doctor for all of your trips to the hospital, for example. People know that their insurer pays the bills above the deductible/co-pay. They know that doctor's visits are expensive, they certainly are not free. They would not buy insurance if they thought doctor's visits were cheap, so QED.

However, they then act astonished and surprised that insurance premiums increase. To me, the much more likely scenario is that people don't want to think about it and understand, because it is much more convenient to try to take the benefits of something and claim not to understand the drawbacks.

This is a type of willful ignorance that you see all the time, whether it be from our current subprime crisis (I just wanted a house, I didn't know that I couldn't afford $600,000 on a $30,000 income) to teenage pregnancy (gee, even though we've been warned, we never thought it would happen to us, what do we do now)?

I just do not buy that a lot of people will be helped, because what they really want is more, without any pain. I mean, more power to them I guess, that's what we all probably want in the end. It's just that some choose not to play dumb about not having known the consequences of decisions. Those people go to white collar prisons or resign as Governor of New York, or they successfully act confused about what "is" means.

I really think you're grossly exaggerating the number of hypochondriacs out there just as you grossly exaggerated the average case in the subprime crisis. Also, you forget that advertising for medications is driving the over medication in this country. That leads to a lot of extra doctor visits to ask about said medication and it leads to a ton of extra costs for insurance companies. As I understand it, in Britain, it's illegal for pharma companies to advertise prescription level medications to consumers directly. I could be wrong, but if we reformed those laws, I think you'd see a sharp decrease in the average medication that Americans take and total number of visits.

Even considering that, I still think the numbers are low and it's just fear mongering.


Not everyone wants access to equities, but they sure as hell need it. It's the lack of understanding things like inflation, the shitstorm that Social Security will be by the time they retire, and even just basic financing principles in general that is going to come as an unwelcome shock when they get into their 60s and 70s and discover they own less than nothing.


Most people who are going to be living off social security when they supposedly retire do not make enough to have that investment offer anything other than a small emergency fund in case of a crisis.

[Reldan]

Most people who are going to be living off social security when they supposedly retire do not make enough that investment is going to offer anything other than a small security amount in case of a crisis.

Right. It's actually such a horrible thing to contemplate that most people simply choose not to think about such things. The less they know about finance, the easier it is to live day-to-day.

It still doesn't make the problem go away.

[Mordrak]

Right. It's actually such a horrible thing to contemplate that most people simply choose not to think about such things. The less they know about finance, the easier it is to live day-to-day.

It still doesn't make the problem go away.

You'd get depressed too if you constantly thought about how much your life sucks or that if you're stricken with a life threatening disease and destitution, you'd be better off investing in a .45 and blowing your brains out. I don't blame them for sticking their head in the sand instead.

[Robert Sharp]

Preventing everyone from having good doctors? Heh. That's certainly a loaded way to put it. Instead, I think it's a matter of how nationalization happens. If the split is based on procedures/treatments, you wouldn't necessarily have separate doctors, at least any more than you do now. If the difference between treatments is purely medication, than the private insurance is covering different medications, no need for artificially creating multiple tiers of doctors. If the treatments are a difference of procedure, you'd likely be paying for a specialist in that privately funded procedure. People already are referred out by general practitioners to specialists, so I really don't see the threat of two tiers of doctors that you see.


I think you misunderstood what I said there. I was saying some people might think they are being deprived of good doctors and would want to pay for doctors under the assumption that they would therefore be getting better doctors. It was that perception that I think should be prevented under such a system. That could be done by making sure the 'free' doctors really are well paid/rewarded/qualified/etc. So I was actually talking about preventing the multi-tiered thing, not encouraging it. Yes, there would still be specialists and such, though.

[SlyFrog]

Incidentally, I do agree with Nick that we can not simply throw these byzantine and arcane systems at people and expect them to understand them, and that government does owe its citizens a duty to make things as transparent and understandable as is reasonable.

I think we probably just differ as to what is reasonable and how far that effort should go.