What if We Win the Healthcare Fight?

August 7th, 2009 at 4:04 pm David Frum | 143 Comments |

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What would it mean to “win” the healthcare fight?

For some, the answer is obvious: beat back the president’s proposals, defeat the House bill, stand back and wait for 1994 to repeat itself.

The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Not a good outcome.

Even worse will be the way this fight is won: basically by convincing older Americans already covered by a government health program, Medicare, that Obama’s reform plans will reduce their coverage. In other words, we’ll have sent a powerful message to the entire political system to avoid at all hazards any tinkering with Medicare except to make it more generous for the already covered.

If we win, we’ll trumpet the success as a great triumph for liberty and individualism. Really though it will be a triumph for inertia. To the extent that anybody in the conservative world still aspires to any kind of future reform and improvement of America’s ossified government, that should be a very ashy victory indeed.

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143 Comments so far ↓

  • sinz54

    ottovbs: I’ve shown you videos from YouTube, where Barney Frank and Jan Schiakowsky said exactly the same thing: The public option is our way to entice employers to force their workers into government-run care. I’ve shown you a video of the Berkeley professor who DESIGNED single-payer, explaining that it’s the way to “nudge” Americans toward single-payer.

    You keep ignoring it, you don’t even bother to look at it.

    You know perfectly well that’s what it is. But you won’t say so because the moment you open your mouth and admit it, ObamaCare is dead.

    The Dems are lying through their teeth.
    And so are you.

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  • sinz54

    barker13 asks: “Have you noted President Obama championing the French system or Dutch system or Singaporan system? ”

    Obama is too smart to go before the American people and say anything positive about France–you know, those “cheese-eating surrender monkeys.”

    Remember that John Kerry lost a lot of votes because Americans thought he “talked French.”

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  • jhh112

    To Sinz24 who said”
    jhh112: In America, a single-payer system is off the table.”

    If you bothered to actually READ my post, you would see that both Australia and France have both Medicare (emergency and catastrophic coverage) AND private insurance.

    I will add some more info on this, specific to Australia (where we lived for 9 years): (1) there is a 30% tax credit for the private insurance premiums you pay; (2) the younger you are when you start private insurance, the lower your premiums are for your whole life. This measure was set up to encourage people to sign up for private insurance from when they are young (as opposed to waiting until they are old). Immigrants joining the system, by the way, are grandfathered into this system when they show evidence of private medical cover in the country from which they came (this was our situation). The net result of all this is that 70% of surgeries are actually done under private insurance (in both publicly and privately owned hospitals), which allows more flexibility as to dates and so on.

    So Australia is NOT a single payer system, but features a mix of competition and collaboration between public and private insurance and provider entities.

    Australia and the US have remarkably parallel histories as British colonies which are peopled by immigrants from many different societies around the world–both are big melting pots. The US would do very well to adopt a medical system along Australian lines.

    [Parenthetically, the newly--and rationally--- reformed Australian tax system, which combines a national sales (aka "goods and services") tax of 10% on everything but food and medical care---and whose revenues go entirely to the six Australian states/territories---with a three rate income tax system with many fewer twists, turns, loopholes, and deductions than our IRS system, is also worth a look, too. Oh yes, and this new tax system was introduced by the conservative coalition govt of John Howard, whose political philosophy is basically similar to that of the GOP before it was taken over by the present group, whose approach is that of the Confederate States of America. ]

    Even France, which along with Malta (!!) is ranked at or near the top by the World Health Organization, has only a quasi-single payer system. When you go to the doctor, you pay what he charges right then and there. You then send in forms to the national insurance organization (think US Medicare) who reimburses you for a stated proportion of the cost. The doctors are independent professionals. To help pay for things not covered by the French national insurance system, French people can take out additional coverage from a variety of “mutuels”, ie, shared-risk health funds, which are in the cases I know about connected to employee pools of companies, industries, or the membership of trade unions.

    So, once again, actually knowing something about how other countries address problems is instructive. The fact is, of the nearly 5 billion people on the planet, only 300M or so inhabit the US. And yet, many of these other countries manage to deliver medical care comparable to that of the US in outcome, to larger fractions of their populations, at lower cost.

    I will conclude with a family update showing that the US system has its own horror stories of delays. My daughter, who went to university in Australia is now traveling around the world after graduation (we can afford that because going to Australian university is so much cheaper than it is in the US, and so young Aussie graduates often manage to see how other countries work through travel—there is an interesting story there). We arranged for private medical insurance for her travel thru a US firm specializing in insurance for ex patriates like students, missionaries, international professionals etc. This gives access to major US preferred provider networks and good coverage (including emergency repatriation) around the world. While in the US, she had a routine exam which turned up some abnormalities (cancer related) that need immediate follow up with a specialist. She is now in a major US city renowned for its many world class medical centres and doctors. None of the list of more than 100 relevant specialists close to her location could/would give her an appointment until January!. She finally was able to get in to see someone by working thru the office of the primary physician of a relative with the same last name.

    It is de rigueur for those opposed to any change in the our obviously superior. world-leading US medical system to point to alleged horrid delays in the Canadian medical system. A bit of reading around the web shows that these are exaggerated, but never mind for the moment. As everyone who has had experience in the US knows, getting timely appointments with a specialist when something has just been discovered is sometimes difficult to the point of being scary. These things are generally resolved by some sort of personal connection, as in the case of my daughter, which cuts thru the bureaucratic maze. But that is not so very different than in countries like, gasp, the old USSR–where I have seen similar dramas play out. (I even once provided hard currency for, er, a bribe to get someone injured in an accident into the “right” hospital. Sadly, this story did not end happily).

    My bottom line–and that of David Frum, the multi-national guy who started this thread— is that the US medical provider and insurance system is in need of some re-engineering. There are many ways to do this, and reasonable people can disagree and debate, but we have to do something if we are to remain a competitive society. Pretending that absolutely nothing needs to be changed in this “best of all possible countries” is irrational, dishonest, or both.

    The emanations from extreme elements in the GOP on reform of the health system, including most recently, the Queen of the Wingnuts, Sarah Palin, border on insanity. And yet the Republican leadership does nothing to distance themselves from these irresponsible ravings. That has to change.

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  • ottovbvs

    sinz54 // Aug 9, 2009 at 11:19 am

    ……..There Republican congressmen who want to start a war with Iran tomorrow but it’s not Republican party policy any more than a single payer system is Democratic party policy…….ranting and pulling odd statements from people on the fringes doesn’t amount to a hill of beans

  • ottovbvs

    …….The Sinz brain in action

    “sinz54 // Aug 9, 2009 at 11:29 am

    barker13 asks: “Have you noted President Obama championing the French system or Dutch system or Singaporan system? ”

    Obama is too smart to go before the American people and say anything positive about France–you know, those “cheese-eating surrender monkeys.”

    Remember that John Kerry lost a lot of votes because Americans thought he “talked French.”

  • barker13

    Re: Jhh112 // Aug 9, 2009 at 1:16 pm (#107) –

    “…specific to Australia (where we lived for 9 years): (1) there is a 30% tax credit for the private insurance premiums you pay; (2) the younger you are when you start private insurance, the lower your premiums are…”

    As to (1) — Again, both philosophically and practically, I’m a “flat tax” kinda guy. To my way of thinking you don’t get more transparent and “fair” (in the sense of equal treatment) than a flat tax with no loopholes, no governmental picking of “winners” and “losers” with regard to how people want to live their lives. Of course as a pragmatic matter I’m willing to accept the reality that “The Barker Way” ain’t gonna be the law of the land anytime soon. (*WINK*) Therefore, rather than get hung up on flat tax, let’s just put the whole “30% tax credit” deal aside and assume good faith negotiation and compromise would be possible were this a key part of the national debate. Fair enough?

    As to (2) –Hey… I’m with you… insurance should start at birth – and perhaps even upon conception! Exactly right… in order to make the numbers work in an actuarial sense we need to have the ENTIRE population (as as close to it as feasible) part of the payee pool just as the entire population is part of the treatment pool when and as necessary to one extent or another.

    “…new tax system…”

    Hey… while we may disagree on VAT vs. income tax vs. “whatever tax,” one thing we agree on is that the U.S. federal tax code (and this goes for most state tax codes as well to one degree or another) is a disaster and as it now exists is far more a cause of dysfunction than a viable hope for being part of the “solution.”

    What we need to do is make the math work on TAXES in relation to government EXPENDITURES.

    Hey… we can argue till hell freezes over (apologies to the global warming contingent) about who is taxed too little vs. who is taxed too much, but what we must all acknowledge is that when “income” is less than “outflow” on a consistent basis with countless underfunded/unfunded liabilities facing our nation in the future, we need to keep our eyes on the basis… on the ball… on figuring out how to balance the books!

    “The fact is, of the nearly 5 billion people on the planet, only 300M or so inhabit the US. And yet, many of these other countries manage to deliver medical care comparable to that of the US in outcome, to larger fractions of their populations, at lower cost.”

    And you live in WHICH country now…??? (You lived – past tense – in Australia, right?) (I get the feeling you’re back “home” in the States now, but please confirm.)

    In any case… I’ll take my chances here in the U.S. if (God forbid) one of these days after a routine exam my doctor calls me to say, “Mr. Barker, I’m afraid that I’ve got some bad news…”

    “While in the US, she had a routine exam which turned up some abnormalities (cancer related) that need immediate follow up with a specialist. She is now in a major US city renowned for its many world class medical centres and doctors. None of the list of more than 100 relevant specialists close to her location could/would give her an appointment until January!. She finally was able to get in to see someone by working thru the office of the primary physician of a relative with the same last name.”

    Should we assume she’ll be returning to Australia for treatment? Should we assume she’ll be utilizing the medical services of some other foreign country for her care, treatment, and follow-ups? OR… should we assume she’ll be receiving treatment and follow-ups HERE in the States…???

    Hey… I’m not gonna call you a liar, but I’m telling you flat out, neither I nor anyone I know has EVER been faced with a situation even remotely resembling what you describe. You’re telling us your kid HAS a cancer related illness diagnosed but was told no specialist would see her earlier than five months from now (even longer depending upon what your actual timeline is – I’m starting now thru January)? Sorry… sounds highly… er… irregular to me and doesn’t jibe with my personal experience at all.

    But, hey… in any case… all this is irrelevant now since she DOES now have an appointment with a specialist – right…???

    Oh… and btw… back to the issue of how long one might have to wait to see a doctor/specialist… don’t you believe there “might be” some link between supply and demand in terms of too many patients, not enough doctors?

    Stratospheric medical costs (and thus loan repayments) added to a litigious civil justice system in desperate need of tort reform coupled with the expenses of the American culture of “the best of everything” in terms of equipment and pharmaceutical availability/use coupled with downward pressure on doctor’s incomes coupled with artificial price fixing (low balling) by government (medicare/medicaid) coupled with early retirements…

    I’m just saying… government can’t simply mandate “creation” of tens of thousand of additional doctors – particularly specialists. Let’s for the moment go with the 47 million uninsured number. Let’s say Obama and Congress wave a magic wand and suddenly… they’re all “insured” too – just like me, just like you. Well if doctors are already backed up treating you and me (and your daughter)… what’s going to be the effect of “dumping” 47 million more patients on the system? Well…??? (*SHRUG*)

    “…alleged horrid delays in the Canadian medical system.”

    Nothing “alleged” about it.

    http://www.youtube.com/watch?v=sXJgkvF19QA

    Seriously. We could go back and forth for days… weeks….! Bottom line… again… nothing “alleged” about it.

    “As everyone who has had experience in the US knows, getting timely appointments with a specialist when something has just been discovered is sometimes difficult to the point of being scary. These things are generally resolved by some sort of personal connection, as in the case of my daughter, which cuts thru the bureaucratic maze. But that is not so very different than in countries like, gasp, the old USSR…”

    Yeah. Actually it’s a whole lot different. (*SNORT*)

    Get real, Jhh112. Everything’s relative. I’m aware of NO stats showing waiting times for a specialist to be longer in the States than in other first world nations – just the opposite in fact. But, hey… if you’ve got something to show us… I’m willing to be convinced.

    “…we have to do something…”

    Well THAT certainly clears things up! (*LAUGHING OUT LOUD*)

    Fine. I believe we’re ALL in agreement there. (*WINK*)

    “The emanations from extreme elements in the GOP…”

    Way to use your “word power” there, Jh! And yeah… by all means… let’s watch those “extreme elements” in the GOP.

    Yep. That damn GOP. Why can’t they simply avoid “extremism” like… er… the Democratic Party does… like the Green Party does… like ALL “other Parties” do. (*SMIRK*)

    “…the Queen of the Wingnuts, Sarah Palin, border on insanity.”

    Let it out, Jh… let it all out. (*WINK*)

    “…irresponsible ravings.”

    Good boy! (Or girl…???) Way to let it out! Feel better now…???

    (*SOLICITOUS INQUIRING GAZE*)

    BILL

  • ottovbvs

    111 barker13 // Aug 9, 2009 at 3:19 pm

    ” Hey… I’m not gonna call you a liar, but I’m telling you flat out, neither I nor anyone I know has EVER been faced with a situation even remotely resembling what you describe.

    Let it out, Jh… let it all out. (*WINK*)

    “…irresponsible ravings.”

    Good boy! (Or girl…???) Way to let it out! Feel better now…???

    (*SOLICITOUS INQUIRING GAZE*)

    BILL”

    Jhh112 // Aug 9, 2009 at 1:16 pm (#107) –

    ……………..Unfortunately a lot of private health insurance doesn’t cover psychiatric conditions which is why many people remain untreated

  • sinz54

    John Dingell, who ain’t no conservative, said recently about health care that “we’re not conducting this debate on a vital national issue with the intelligence and dignity it deserves.”

    On health care, there’s been hardly any debate at all between liberals and non-liberals.

    Long ago, liberals had fallen in love with all things Canadian, and so they expected Obama’s victory would bring America a Canadian-style single-payer system. With the only “debate” being about how many years it would take to complete the roadmap to full single-payer.

    On the left-wing blogs, I’m now seeing an awful lot of comments like “We were made to believe that Obama would fight for single-payer.”

    Where was Dingell for the last two years? Oh, he wanted single-payer too.

    And now Obama and Dingell are surprised that a lot of Americans don’t want single-payer plus a $1 trillion medical welfare program for the poor. So they’re put in the position of claiming the public option is an alternative to single-payer, when it was always planned to be the roadmap to single-payer. And they’re getting pinned daily on this lie.

    Obama could have gone about this a different way. He could have organized “Health Care Summits” in which MANY different health care models would be proposed and discussed by their advocates, everything from a British NHS-style system to a Heritage Foundation-style free market system. Televised on C-SPAN, the public could follow the debates and understand all that was at stake. Then, a bipartisan commission could have made recommendations about the way forward in health care reform.

    Instead, Obama chose to “not let a crisis go to waste” and worked with Pelosi to try to ram through a pure doctrinaire left-wing bill, the fever dream of all San Francisco and Vermont liberals.

    It’s pretty obvious by now that Obama’s election victory was a repudation of Bush. It sure didn’t signal a new American love affair with Canada.

    Except among liberals.

  • balconesfault

    Sinz … forgive me if I’m wrong … but haven’t you been advocating that defeat of Obama’s health care initiatives would be a first step to eliminating Obama’s political power to move any of his agenda?

    If this is the take of conservatives … and it certainly is the take of many conservatives … why should anyone expect them to be honest brokers on working towards a health care reform bill, no matter what the format used to reach a bill?

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  • jhh112

    To the guy up there calling me a liar:
    –I was born in the US and live in the US now. I have, however, lived in other countries for 14 of the last 30 yrs in connection with my work. I speak three languages fluently and several others badly, and so have generally been aware of what was going on around me. As a result, I have been able make absolutely direct comparisons of living costs, commercial conditions, everyday legal and banking affairs, income, sales, and property taxes, home and car repairs, and all sorts of insurance, and medical care from generalists to specialists to scheduled and emergency hospitalization. In some cases, these comparisons have been simultaneous—ie in one yr I paid income taxes to three different countries (each tax depended on the other two, which was fun). I still file both US and Australian tax forms every year, and can tell you all about the twists and turns in the evolution of tax law in both countries (The bottom line, BTW, is that Americans are lucky to be simultaneously well paid and moderately taxed.) I have had family members undergoing medical treatment in two different systems at the same time (by virtue of going back and forth), sometimes the same person for the same condition, so care had to be coordinated. I have lots of hard data, and being an engineer, I am happy working with numbers.

    –I never said that specialist wait times are longer in the US than elsewhere. Merely that I have direct experience of them being potentially as long as in any other horror story you hear. My daughter’s adventures in getting in to see a specialist are absolutely contemporaneous. As in, two days ago, an ongoing drama. I’d offer her phone number to the unbelievers, but I doubt she’d like the intrusion.

    Anecdotal information from family experience in two very different states (one Northeast, one Southeast) suggests there is more gatekeeping going on in medical practices, who seem to be limiting the number of new patients they take on. To be sure, this is time and place dependent, and your mileage may differ, but my point was to counter posters who voice fears that other medical systems which have universal coverage with substantial govt insurance components are guaranteed to be utter horrors in terms of waiting. My family has simply found that that is not the case, and we are not alone.

    —Finally, about Sarah Palin. I myself am basically a frugal New England Yankee who doesn’t waste money or have much tolerance for those who waste other people’s money. And having lived in Russia, I know about how communism works in practice (Russian is one of the languages I speak well). The state of Alaska is in fact the closest thing to a socialist state there is in the US. Why do I say this? Because Alaska taxes access to its petroleum reserves and pays some of the proceeds to its residents— Sarah Palin raised the payout to something like $3000 per yr per resident, yielding nearly $20K for a family of six. The state thus acts as an owner of the means of production. Which is, of course, what socialism is all about. Now that seems OK at first glance given the historical context–Alaska was a tough place to live for a long time, etc. But Alaska under Sarah Palin also managed to cop a cool $2 from the Federal govt for every $1 they paid in in Federal taxes, which Alaska uses to fund necessary things like roads and (famously) bridges. But wait a minute. They use taxes on petroleum, which raise prices paid by the rest of us, to give handouts to every Alaskan. And then they hit us AGAIN to pay for their infrastructure. So we are paying for their direct, non-means tested, public payoff (ie, vote buying) system. And then Sarah Palin is all over the Obama administration for spending money to stimulate the economy during the worst recession since the Great Depression? Seems pretty wingnut to me.

    (Most of the Red states that voted GOP in 2008 are in the same boat, taking in more aid from the Feds than they pay in taxes. Texas and Utah are the key exceptions to this. In contrast, all but a few of the Blue states consistently pay more to the Feds than they get back in aid etc, the leading payer being New Jersey. )

    And then last Friday Sarah outdid herself with claims that her Down’s syndrome kid like her famous Trig would be euthanized by the Obama health care plan. For starters, that is not true, it takes a whacko imagination to find that interpretation in a provision added–I gather— by one of the GOP senators from Maine to encourage better end-of-life care and counseling. And, even better, it turns out that at present, kids with birth defects like Down’s born to parents with private (ie, not employer guaranteed) insurance are often denied coverage because—and get this—their condition is deemed to be “pre-existing” by insurance companies. ( didn’t know this until this week, and I was gobsmacked to learn it thru a bit of Googling. Boy, am I glad I have employer coverage. (There is also the slightly off-topic factoid that Trig is something like 1/16th Yupik native Alaskan, which apparently may qualify him for coverage under federal programs for native Americans. )

    For a former VP candidate to be this off-the-wall on a major national issue is prima facie evidence of wingnut syndrome in my book. And truly, this from Sarah was a counterfactual “extreme emanation,” ranking right up there with that from the person who told his congressperson to “keep the govt’s hands off my Medicare.”

    That makes me wonder if the right tactic is to simply extend Medicare coverage downward in age. It is apparently no longer considered a govt program by those opposing other reform schemes.

  • Spartacus

    barker13 // Aug 9, 2009 at 10:48 am – This was not a ramble at all. I wanted to hear her views.

    Sorry for the delay in responding; I had passed out from reading your post on a different thread in which you came out in favor of universal coverage and the abolotion of pre-existing conditions :)

    “Hey… I WISH that the politicians (and the MSM) were focusing on specifics – focusing on SPECIFIC strengths and weakness of a number of foreign models. They’re not, though. I see no evidence whatsoever to point towards a trend among our “pro universal coverage/care” politicians and MSM to be actually dealing with this whole issue in a logical manner along the lines of how you and I would go about “negotiating” if you and I were powerful politicians.”

    I could not agree more strongly.

    “Have you noted President Obama championing the French system or Dutch system or Singaporan system? ”

    I suspect he doesn’t do this because of the extreme prejudice (not racial, but cultural prejudice) that so many Americans have against foreign societies – particularly of Europe, as well as the demagoguery that many on the Right would immediately engage in. If a U.S. Congressman were willing to take the time to push for a change in the name of “French Fries” merely because France, a long-time ally who happened to be right, refused to support our misadventure in Iraq, what chance is there of getting a fair hearing when stating that there are elements of the French system that are worth evaluating and considering for implementation here?

    Just look at these threads. You and I are on opposite ends of the ideological spectrum, but based on your posts above and on your post on a different thread today, I suspect we could probably come to some kind of compromise that results in real reform if we were the decision-makers. But look how long it’s taken for us to look past each other’s ideology, admit neither of us has a monopoly on all the facts and become willing to judge proposals on their merits. Now, compare that to Sinz, who after reading two of JHH112′s, still won’t concede that the French system is not a single-payer system despite the fact that JHH lived there and sounds to have way more knowledge about the French system than Sinz.

    Now, if Sinz, who owns a computer, has very good reading and writing skills, has more familiarity with the U.S. healthcare system than most Americans, possesses a well-above average knowledge of history and still ends up being DEAD WRONG and unwilling to concede his error about an indisputable fact, what hope would Obama have in trying to present a comparative evaluation to your average American? I mean when an under-employed plumber making $40k/year and believes he’s going to pay more taxes under Obama’s tax cut plan can become the officially appointed figurehead of the presidential candidate of a major political party, then I’m not very optimistic about this country’s ability to take the time to understand the facts and evaluate the issues on the merits. And, it’s not just conservatives or GOPers who don’t inspire my confidence; I think this transcends politics. It just so happens that on the issue of healthcare, it is the Right whose opposition seems less fact-based and more ideological.

    Incidentally, those of us who point out some of the comparative advantages in these other healthcare systems are not arguing that the U.S. should adopt those systems wholesale. Instead, we’re saying that there are other countries – Western countries – who are dealing with this issue in a much more cost-effective way without compromising outcomes and that we should consider replicating some of those features here. Again, let’s evaluate the pros/cons of all the options and choose those that work best irrespective of which ideologies might be offended.

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  • akindependent

    Barker 13:
    So your sister goes into remission, but she loses her job. Finally, she finds another one, but because she has a preexisting condition, she cannot be insured. She spends the rest of her life, until she is old enough to qualify for medicare, anxious about not only a possible recurrance of the cancer, but the knowledge that the lack of coverage would financially devastate her family.

    Or, she once had chest pain and went to the hospital and was relieved that it was only heartburn or stress. But she forgot to put it on her insurance application because it happened 10 years ago and it wasn’t anything significant. She sees the doctors you talked about, but the insurance company refuses to pay for her treatment because she “lied” on her application. Rescission.

  • akindependent

    Sinz 54 said: They offered alternatives to the so-called “public option with teeth.” Each and every one of the GOP’s proposals was shot down.

    Actually, more that 100 of their suggestions are in the house bill, including the living will consultations that inspired Sarah Palin to claim that Obama wants a death panel to encourage euthanasia. Newly reincarnated Republican leader Newt Gingrich today defended her distortion of this Republican proposal.

  • akindependent

    jhh112:
    I wish you would combine your posts, edit a bit, and publish in a mainstream venue. Your posts are so well documented and articulated I have no doubt they would gain a broad audience. Thank you for taking the time to give such thoughtful responses. Expect to find me cribbing from you on my hometown–Anchorage, AK–news sites.

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  • barker13

    Re: Jhh112 // Aug 9, 2009 at 9:03 pm –

    “To the guy up there calling me a liar:”

    Moi…??? Bill…??? Barker13…??? (*GRIN*)

    To recap…

    —–Hey… I’m not gonna call you a liar, but I’m telling you flat out, neither I nor anyone I know has EVER been faced with a situation even remotely resembling what you describe. You’re telling us your kid HAS a cancer related illness diagnosed but was told no specialist would see her earlier than five months from now (even longer depending upon what your actual timeline is – I’m starting now thru January)? Sorry… sounds highly… er… irregular to me and doesn’t jibe with my personal experience at all.—–

    I just call ‘em as I see ‘em, Jhh. (*SHRUG*) Heck… I thought I was being EXCEEDINGLY polite and – for me – diplomatic. (*WINK*)

    * Sparky! Tell him! Tell him THAT was ME being on my best behavior! (*LAUGHING OUT LOUD*)

    “The bottom line, BTW, is that Americans are lucky to be simultaneously well paid and moderately taxed.”

    I hear ya! (I wouldn’t use the word “lucky,” a lot of people over a lot of years worked their asses off and suffered to build the foundation of what we’ve got, but yeah, the American middle class has long enjoyed a living standards the world did and should indeed have envied.) (Of course there were and are negatives as well, but short answer… I we’re in agreement on the above quoted point.)

    Oh… and btw… I certainly don’t disdain your experience. In fact I salute you! (*SMILE*) No shit. Don’t let critiques and comments related to one (or even several) parts of your post blind you to those areas where we share common ground. (*SHRUG*)

    “I never said that specialist wait times are longer in the US than elsewhere.”

    (*SNORT*) (*CHUCKLE*)

    Ahh… com’on… engineers are supposed to be honest and trustworthy! (Hmm… or perhaps that Boy Scouts… or maybe West Point Cadets…) (In any case…)

    Listen. (*SMILE*) Jhh. I’m not gonna argue perceptions and inferences with you… you wrote what you wrote – I wrote what I wrote. I felt your “inference” (via your daughter’s tale of initially not being given a timely appointment with any one of 100 specialists) was… umm… off the mark – not a fair picture of what happens in the real world.

    “Merely that I have direct experience of them being potentially as long as in any other horror story you hear.”

    As I wrote originally, Jhh… I wasn’t calling you a liar; I was simply pointing out that your… er… direct experience is like nothing I’ve ever experienced. (*SHRUG*)

    “Anecdotal information from family experience in two very different states (one Northeast, one Southeast) …”

    Your anecdotal experience. (*SHRUG*) Not mine. Not that of anyone I know. You’re being honest with me… I’m being honest with you.

    “…my point was to counter posters who voice fears that other medical systems which have universal coverage with substantial govt insurance components are guaranteed to be utter horrors in terms of waiting.”

    Not guaranteed. Just more likely. (*SMILE*) And of course that varies nation to nation, class to class.

    “My family has simply found that that is not the case…”

    Sounds to me that the “class” thing is kicking in. AKA the “color thing”: green that is. (*WINK*)

    Com’on… again, Jhh, be honest… you’re the American upper middle class. In fact you’re the sophisticated world traveling representative of corporate America upper middle class American (occasional) ex-pat. People like you, people who send their daughters on world travels as college graduation presents aren’t exactly some poor lower middle class schmuck in Canada or the UK (or wherever) dealing with government bureaucracy. Guys like you (and yeah, like me) have resources and connections that come into play when the $hit hits the fan (as in the case of your daughter’s illness).

    “Finally, about Sarah Palin…”

    You mean… er… the Queen of the Wingnuts? (*RELATIVELY GOOD-NATURED SMIRK*)

    Listen. I could respond to your attacks on Palin and we could go on and on. Been there. Done that. (*SMILE*) In relative – and I mean compared to all other state governors, not just to her predecessors as Alaska governor – terms, Palin was a cost cutter and fiscal conservative and there’s just no way around that. Here earmark/federal funding requests were a downward line and doing stuff like selling the Governor’s jet is exactly the tone I want set by Republican governors. Again… we can go on and on… but Palin is as close to a true fiscal conservative in a relative (comparative) real world sense as you’re gonna see. Again… no way around that. (*SHRUG*)

    Hey… you wanna try and portray Palin as some sort of socialist… (*CHUCKLE*)… good luck with that.

    “…last Friday Sarah outdid herself…”

    Yeah, yeah… throwing red meat to the base… something NO politician EVER does.

    (*ROLLING MY EYES*)

    Hey… personally… that’s not my style. If you stick around and pay attention to my posts you’ll notice that I’m VERY specific and VERY fact-based and literal. I tend to fact check anything that sounds “too good to be true” or “too bad to be true” rather than risk getting caught up in passing along “bad” info.

    Still… slapping Palin on the wrist for a Facebook entry she made… (*CHUCKLE*) Are you AWARE of some of the stuff that comes out of Nancy Pelosi’s mouth or Harry Reid’s – or Obama’s… or Biden’s…??? Now I’m not justifying “bad behavior” by pointing to other “bad behavior, ” but what I am noting is that there’s a HUGE double standard in play here. (As Ireign has often pointed out.)

    Anyway, Jhh… hope all turns out well with your daughter!

    BILL

  • jhh112

    From Washington Monthly, today

    <>

    And guys, Palin’s Alaska, like most of the Red States depends on handouts from the Feds to keep their taxes low. It is easy to be ” fiscally conservative” when Federal tax payments from states like NJ, Mass, Calif. that put in more than they get back are funding nice Federal programs and jobs in your state. I live in the South, I speak fluent redneck, I get my electricity at great rates from the TVA, and I know how the game is played.

    And here is a link to the blog of Michael Kelly, a well-traveled, politically conservative surgeon, and his take on the French medical system (which is, as he explains, fee for service, avoids the problem of moral hazard , and is effective at delivery— all things I noted earlier, but laid out by him in professionally informed detail)—and which he suggests as a model the US should look at for ideas. He is not keen on the Canadian or British models and worries in other posts on his website that the proposed US reform leans too far in that direction. He has lots of other things to say on medical care and related issues.

    http://abriefhistory.org/?p=400

    And especially for Barker13—we can send our daughter around the world ONLY because five years of tuition for two degrees in Australia’s leading university cost a grand total of $US 15K, and she managed a half time job that paid her living costs for 3 of the five years. For the 9 yrs we lived in Australia, my wife and I made Australian salaries, and our maximum after tax annual income from two good jobs was something around $US70K (taxes in Australia until recently were twice what they are in the US for the same income, by the way. In 1997, for example, the 48% top bracket kicked in at a salary level of US$35k. And mortgage interest is not tax deductible). Since fuel, food and manufactured goods in Australia have become generally more expensive than they are on average in the US (think urban San Francisco or NYC), and sometimes much more expensive, our living standard was hardly at patrician levels even in our best years down under. So we know very well how ordinary people live. We work at going native wherever we are—-and native is generally cheap. And that is why we are well traveled.

    And now I am done here. Good bye and good luck to all the defenders of the status quo. As David Frum says, you might want to think about to do if you get your way and keep things just as they are while more and more people lose their employer-paid health care. I reckon there is no better way to turn the US into Argentina than to keep widening the gap between rich and poor in everything from money and education to health care. Thanks to the two Bushes and Reagan, who together are responsible for 70% of the accumulated debt of the US since Washington, we are well on our way to financial default—just like Argentina. Thanks to W, Cheney, Arrington and Gonzo, the government now has all sorts of enhanced executive powers, and can now tap phones and email with near abandon, and can even disappear inconvenient people —just like Argentina. It is possible to turn things around, but that requires more creative interaction than I see just now.

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  • Spartacus

    jhh112 // Aug 10, 2009 at 2:11 am

    I completely understand your frustration here. On many public policy issues, conservatives have become the intellectual descendants of “flat earthers.” Nevertheless, I hope you stick around because your posts are quite informative.

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  • Koso

    Any Repulican/Conservative should be very ashamed at the horrible lies we are telling to derail healthcare reform. Why? Just because we lost an election!

  • sinz54

    balconesfault: “why should anyone expect them to be honest brokers on working towards a health care reform bill, no matter what the format used to reach a bill?”

    Because that was their Grand Plan before Obama even got the Dem nomination.

    We conservatives are responding to the Dems’ calculated lies and duplicity.

    They chose to play dirty. Jan Schiakowsky said, long ago, to a cheering crowd of supporters:

    “A public option will put the private insurance industry out of business and lead to single-payer. This is not a principled fight. This is a fight about strategy for getting there, and I believe we will.”

    http://www.youtube.com/watch?v=zZ-6ebku3_E

    “This is not a principled fight.” That’s what you said.

    You liberals CHOSE to make this a fight based on lies and duplicity. You wanna play dirty?

    We’ll play dirty.

    They started it.
    We’ll finish it.

    Any Blue Dog Dem who votes for this piece of San Francisco/Vermont liberal garbage will be gone in November 2010. His political career will be over.

  • balconesfault

    The private insurance industry could … well … compete. Something that they’re increasingly not having to do, as more and more insurance markets in America are dominated by a very small number of providers. I too believe that creating of a public option will lead not to a single payer system … because we’ve seen functional models around the world where it does not … but to some form of nationalized universal coverage, which we seriously need.

    Sinz, you’ve steadfastly avoided all the points that various people have made that a nationalized system would lead to a business boom – increasing entrepreneurism and global competitiveness. In fact, except for your sympathy for the insurance industry, you’ve shown a certain antipathy for American business, talking derisively about how business would shed their employer-paid healthcare plans if a public option could take care of their workers.

    Why is it that the rest of the country must work extra hard, and take on extra debt, to ensure the economic viability of the health insurance companies?

  • linus bern

    Barker,

    Your fears about the Canadian health care system are completely unfounded. It does not take 3 months to get an appointment with a GP, it takes 1 – 2 weeks. You are not restricted to your GP’s opinion, you can consult other doctors and specialists. Your views are likely based upon misinformation disseminated by people who are getting rich fleecing the current system.

    The US would be extremely fortunate to actually adopt a Canadian style system of Universal Healthcare. It is clear though that any system you could come up with that moved you closer to Universal Healthcare will be designed deliberately to fail so as not to undermine the arguments of the freemarketeers.

  • Spartacus

    balconesfault // Aug 10, 2009 at 12:44 pm wrote: “Sinz, you’ve steadfastly avoided all the points that various people have made that a nationalized system would lead to a business boom . . . ”

    He steadfastly avoids the issues because he’s intellectually impotent in these matters. It’s exactly as Ottovbvs said – he’s like a squid who squirts ink into the water and then disappears.

  • ottovbvs

    …..Actually this is a very astute piece by Frum……it’s subtext is that if this situation is left unattended it’s going to start spiralling out of control as more and more companies cut benefits or increase employees share of costs and this could turn into a much more aggressive program of reform…..I’ve seen it suggested that this is the attitude of the insurance and pharma industries in the main….better to make a deal now and remain in the game rather than let the whole system breakdown and god knows what would come out of it…..the current system is sclerotic……it will be fixed by Obama or another at some point because it’s unsustainable……..this is what Obama and a lot of people see but not the far right and the foot soldiers they’v indoctrinated.

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  • LittleDEM

    Belatedly, a Thank You nonetheless for acknowledging that the status quo when it comes to healthcare is totally and utterly unacceptable. I don’t quite get why people still fail to see that fact. It’s like a train wreck in slow motion . . . It’s still a train wreck in the end.

    We need to solve this by deploying Healthcare Reform, ideally, in a bipartisan fashion. But if need be, Democrats need to do the best they can without Republican support.