# American Exceptionalism **URL:** \ **Category:** Great Debates\ **Created:** [July 1, 2016, 5:56am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853 "2016-07-01T05:56:05Z")\ **Posts on this page:** 20\ **Page:** 10
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [July 3, 2016, 8:00pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/181 "2016-07-03T20:00:15Z")
So all you Europeans bashing the US, what other country in the world do you want to be the big shot? Russia? China? ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 3, 2016, 8:03pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/182 "2016-07-03T20:03:59Z")
At the end of the day discussions like this always have two sides–obnoxious jingoists, and obnoxious anti-American haters. The reality is America is the most powerful and the wealthiest country. “Exceptionalism” is a values/opinion judgment with no meaning. Some people view it as exceptional, some do not. When jingoism causes Americans to lose sight of areas in which the country can improve, and areas in which the country has behaved badly, it is a problem because it hurts our ability to better ourselves. But the opposite of this isn’t sweeping pronouncements that America is the worst thing ever, should be deeply ashamed of existing, that most of everything about America is shit, and that it’s all because Americans are big dumb dumbs that don’t know any better. The counterpoint to stupid jingoism should be that America is a large, complex country with large, complex international commitments and responsibilities. It has a democratic system that mostly works, but has some real bad rotten parts that need improved. It has a set of domestic policies which are mostly okay, but often serve people less than it could and less effectively. Many other OECD countries can offer us lessons here because they’ve spent the 20th century living under the umbrella of American protection and have consequently, been free to devote more resources to some of this stuff than we have. ---
**Author:** ![Kobal2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kobal2/32/20_2.png) [@Kobal2](https://boards.straightdope.com/u/Kobal2)\ **Post date:** [July 3, 2016, 8:22pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/183 "2016-07-03T20:22:35Z")
> [@Urbanredneck](#): > > So all you Europeans bashing the US, what other country in the world do you want to be the big shot? > > Russia? > China? Iceland. ---
**Author:** ![Hiker](https://avatars.discourse-cdn.com/v4/letter/h/3be4f8/32.png) [@Hiker](https://boards.straightdope.com/u/Hiker)\ **Post date:** [July 3, 2016, 8:34pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/184 "2016-07-03T20:34:12Z")
> [@Urbanredneck](#): > > So all you Europeans bashing the US, what other country in the world do you want to be the big shot? > > Russia? > China? It is true that you get bashed a lot and often undeservedly, but you must admit that at times you really are asking for it. I mean come on: If someone on this formum were to open a thread claiming that Denmark was the best country in the world in every way that counts and that you should be accepting it as a shining example, it would not be long until a lot of American posters who never had a beef with the Danes would show up with lists of issues where Denmark sucked in their opinion. If you want to be popular, showing some humility might help. > [@Kobal2](#): > > Iceland. You beat me to that one. 😉 ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [July 3, 2016, 8:38pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/185 "2016-07-03T20:38:16Z")
> [@Urbanredneck](#): > > So all you Europeans bashing the US, what other country in the world do you want to be the big shot? > > Russia? > China? I suspect the EU, as one entity. ---
**Author:** ![Half\_Man\_Half\_Wit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/half_man_half_wit/32/21766_2.png) [@Half\_Man\_Half\_Wit](https://boards.straightdope.com/u/Half_Man_Half_Wit)\ **Post date:** [July 3, 2016, 8:48pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/186 "2016-07-03T20:48:08Z")
> [@Martin\_Hyde](#): > > But the opposite of this isn’t sweeping pronouncements that America is the worst thing ever, should be deeply ashamed of existing, that most of everything about America is shit, and that it’s all because Americans are big dumb dumbs that don’t know any better. I don’t think that’s an entirely fair characterization of the arguments in this thread. Remember, its OP contends that America is ‘the hope of the Earth, the city on the hill, and the gem of the world’. The response to this, in my eyes, has been an entirely measured pointing out of ways and areas in which America might stand some improvement. To try and strawman this into wholesale condemnation of everything America is and stands for just belies the sort of black-and-white, you’re either for America or against it mindset that’s behind much of the trouble with its self-imposed need for exceptionalism. It eliminates all possibility of measured response, and any even mildly critical voice is shouted down among reminders of how, without America, we’d probably all be Communists or Nazis by now. America has accomplished many things. But it also faces difficult problems, and one of the greatest hurdles in addressing these problems is America’s image of America, and the widespread inability to even accept and take to heart the mildest criticism. ---
**Author:** ![octopus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/octopus/32/3716_2.png) [@octopus](https://boards.straightdope.com/u/octopus)\ **Post date:** [July 3, 2016, 8:52pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/187 "2016-07-03T20:52:47Z")
> [@Kobal2](#): > > Iceland. Who? ---
**Author:** ![octopus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/octopus/32/3716_2.png) [@octopus](https://boards.straightdope.com/u/octopus)\ **Post date:** [July 3, 2016, 8:54pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/188 "2016-07-03T20:54:12Z")
> [@Velocity](#): > > I suspect the EU, as one entity. If the UK is an indication I wouldn’t make that bet. ---
**Author:** ![Sampsiceramos](https://avatars.discourse-cdn.com/v4/letter/s/8e8cbc/32.png) [@Sampsiceramos](https://boards.straightdope.com/u/Sampsiceramos)\ **Post date:** [July 3, 2016, 9:41pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/189 "2016-07-03T21:41:25Z")
> [@Urbanredneck](#): > > So all you Europeans bashing the US, what other country in the world do you want to be the big shot? > > Russia? > China? You’ve conveniently left out the opportunity to answer “nobody”. I’d rather prefer every country be entirely accountable to a jury of its peers, and not have outliers like the USA or Russia (or the EU as a supranational entity, for that matter’s sake) who seem empowered by their military or economic clout to swing their dick every which way with little regard as to what they end up breaking. Getting rid of the goddamnable security council which so thoroughly emasculates the actual power of the UN would be an excellent start. ---
**Author:** ![DerekMichaels00](https://avatars.discourse-cdn.com/v4/letter/d/f14d63/32.png) [@DerekMichaels00](https://boards.straightdope.com/u/DerekMichaels00)\ **Post date:** [July 3, 2016, 9:48pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/190 "2016-07-03T21:48:12Z")
> [@Sampsiceramos](#): > > You’ve conveniently left out the opportunity to answer “nobody”. I’d rather prefer every country be entirely accountable to a jury of its peers, and not have outliers like the USA or Russia (or the EU as a supranational entity, for that matter’s sake) who seem empowered by their military or economic clout to swing their dick every which way with little regard as to what they end up breaking. > > Getting rid of the goddamnable security council which so thoroughly emasculates the actual power of the UN would be an excellent start. that sounds as possible as eliminating all class distinctions. We saw how well that worked out from 1917-1991. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [July 3, 2016, 10:31pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/191 "2016-07-03T22:31:31Z")
There’s too much going on here in this absurdly open-ended topic for me to address every point that’s come up, but a few of the things that have bugged me the most … > [@Martin\_Hyde](#): > > … But America’s free press is by far second to none. And as **HMHW** noted, the Press Freedom Index at _Reporters Without Borders_ ranks US press freedom at #41 in the world. By sheer coincidence (I wasn’t looking for it) I just came across this article last night in the _Columbia Journalism Review_: [The shadowy war on the press: How the rich silence journalists](http://www.cjr.org/analysis/shadowy_war.php) Another example I can think of is David Koch’s significant financial contribution to PBS. Who knows what havoc this has already wrought, but we do know that in at least one instance PBS had a film critical of the Koch brothers and decided not to run it. This is PBS, understand: a public, non-commercial, broadcaster, the kind that in other countries would be the one bastion of independence free from commercial and pecuniary interests. > [@Martin\_Hyde](#): > > Well I mean what’s interesting is you’re obviously presenting yourself as deeply knowledgeable and the holder of the “real truth.” But you’re not well acquainted with the facts. Health insurance companies are a very small part of the costs of health care, like less than 10%. I actually provided a breakdown in another thread, and basically 70% of costs are due to healthcare providers (i.e. people like doctors and nurses) and hospitals. Around 15% is due to pharmaceuticals and medical devices. Something like 10% is due to home health aides and nursing homes, and the last 5% is “other.” Inside that 5% are the costs of health insurance companies in the form of the profits they extract from the system. > > It’s no doubt that health insurance companies will fight for their survival politically, but you’re buying into a false narrative if you think they’re why we have expensive healthcare in the United States. One of my family members was involved in the historic fight to extend public hospital insurance in Saskatchewan to make it the first province in the country to have universal coverage for all medical services. It was also a bitter political battle in which even Americans got involved, with the AMA and American health insurance lobbyists sticking their noses in and making much the same failed arguments that they’re making today. The fight was ultimately successful and the Saskatchewan model worked so well it was eventually adopted by all provinces and became the basis of a national system that was enshrined in a foundational statement of principles in the Canada Health Act. Saskatchewan voters didn’t believe the lobbyists’ lies and fear-mongering, and with an established proof of how well single-payer worked, neither did most other Canadians. Today most Americans still do, as if insurance lobbyists’ mendacious bullshit was a self-evident truth. In the many decades since, I’ve followed issues in health care economics with interest, especially following such notables as [Ewe Reinhardt](https://www.princeton.edu/~reinhard/), a world-renowned specialist in health care economics at Princeton. And in practical day-to-day experience, I and most of my family live in Canada, but some close family members live in the US, and we compare our experiences frequently. I’m sorry, I don’t mean to sound arrogant, but when someone tells me that on matters of health insurance I don’t know what I’m talking about, and as proof, regurgitates the same deceptive talking points we’ve been hearing from health insurers for half a century, I just find it rather mildly amusing. Health care economics is an enormously complex issue, and no one has all the answers or even a full understanding of all the factors in complex situations in different countries. Yet underlying the complexity some basic truths can be identified, beginning with the fact that the profits or revenues of the health insurance industry is not the issue at all. The actual problem lies in how private health insurance _ **structurally changes** _ the intrinsic nature of how health care is delivered. At the risk of oversimplying a complex issue, it’s fair to say that it has profound structural impacts in two ways: 1. **It’s clinically intrusive and administratively wasteful**. It shifts a portion of clinical decision-making away from the medical practitioner and his patient and moves it to a bureaucrat who is motivated to avoid or minimize payment. To an insurance company, your health care is technically a “medical loss”. Single-payer or its equivalent is, by contrast, almost completely non-intrusive – a counter-intuitive fact about “government-run health insurance” that is sometimes called Reinhardt’s Irony, in honor of the above. This has a whole plethora of cascading consequences: claims denials and treatment compromises, and high costs because the patient ultimately has to pay both for the insurance bureaucracy that tries to avoid paying claims and for the medical bureaucracy that is constantly fighting it. The net result in an administrative nightmare awash in paperwork and bureaucracy that is enormously costly and wasteful. 2. **It has almost no capacity for cost control**. In private insurance as it exists in the US, there is neither an authority nor an incentive for cost control; insurance companies are happy to pay what the market demands, and pass the costs on to their customers. This is no small factor. The costs for common medical procedures in the US are often many multiples of what they are just across the border in Canada – not a few percentage points higher, but often many times higher. To be sure, it’s technically possible to achieve cost controls in a multi-payer system, but to do that you’d need a strict regulatory regime that imposes negotiated standardized fees and a uniform community-based rating system. But such a regime, as in Germany’s statutory health insurance system, would for all practical purpose be a _de facto_ single-payer system. Put 1 and 2 together and then look at any chart of per-capita health care costs and see where the US sits, and one can begin to understand. Incidentally, and quite apropos in a discussion about American exceptionalism, Reinhardt recently made the interesting observation that although single-payer (or its _de facto_ regulated equivalent) is the preferable health care model, it may indeed have problems working well in the US – not because the US is too big, or too diverse, or any of the other talking points we often hear, but [because the American political system is too corrupt](https://www.washingtonpost.com/news/wonk/wp/2014/01/16/is-the-u-s-too-corrupt-for-single-payer-health-care/). > [@Martin\_Hyde](#): > > That’s not an accurate history of our revolution or of American history. Our _elites_ fought a war of independence to get economic independence from Britain, because it benefited their business interests … Most of the FFs feared the people and feared mob rule, and made great pains to establish a system by elites and for elites. The Founding Fathers weren’t yeoman farmers or laborers rebelling against a powerful aristocracy, they were the leading men of business, law, industry in the colonies. That doesn’t refute what I was saying. Part of the independence movement was indeed to get away from imposed colonialism and rule by aristocracy, which was precisely why such a strong emphasis was put on democratic principles. The reason for the elitism and deliberate hobbling of government that reflected an underlying distrust of democracy is that it was appropriate for the times, when only a relatively small minority like the Founders had any education or any reasonable understanding of the world. > [@Martin\_Hyde](#): > > I’ve yet to find a democratic country where being born rich and powerful doesn’t give you greater access to political power than being poor. The nativist populism embodied by Donald Trump is driven by “globalization’s losers” and we’re seeing it on both sides of the Atlantic. The reason is simply–many people are being told by elites (both political and business) that free trade is good for them. The ones who are seeing a decline in their way of life in spite of that, are finding it a hard pill to swallow and are rebelling against the very concept of elites. But the fact that they have elites to rebel against, all over the OECD, suggests that America isn’t some unique dystopian hell hole where the rich have lots of power. Yes, but you misunderstand the argument. It’s not that the kinds of things some of us have been criticizing are qualitatively unique to the US, it’s the extent to which they have become _ **extreme** _ in the US. > [@Martin\_Hyde](#): > > Many Americans just aren’t interested in banning guns, and don’t respond to mass shootings that are on the news the way the political left “wants them to.” I actually find this to be a pretty logical behavior. Mass shootings are a boogeyman. In 2013 we had 6500 gun homicides in which we knew the type of gun used in the FBI’s reporting. > > Of those, 5782 were committed with hand guns, 308 with shotguns and 123 with “other guns.” The “scary evil rifles” liberals say we should “obviously” be banning because some Muslim shot up a gay club accounted for 285 homicides–or ~4% of the homicides in which we know the type of gun used (there were 8400 total homicides, and about 2000 where the FBI doesn’t know the type of gun used.) > > Responding to spectacular events that are like 1% of gun deaths a year, in a country with 6-7000 people dying every year from handguns, with something like an assault weapons ban is to me a perfect example of an uninformed overreaction and I frankly view it as a credit to America we aren’t buying into it. I agree with you that it’s mass shootings that get most of the public attention, and that some of this attention is misdirected to the sensational rather than the more mundane but much more prevalent gun fatalities, but the fact is, both things are problems. Mass shootings may only account for a tiny percentage of gun deaths, but that’s only because gun deaths are so damn common in the US. The US is plagued by dozens of mass shootings every year, more or less, depending on how you measure them, while other countries go for decades without them or never had them at all. And the problem of particularly lethal rapid-firing weapons with large magazines that have no actual non-military use is a legitimate one. That said, the general proliferation of guns and the day-to-day carnage caused by them is a different and a very significant problem. Another article I came across by sheer coincidence that I wasn’t particularly looking for: **Tiny trigger fingers: the deadly mix of children and guns in the U.S.** Between 2007 and 2014, 488 children from birth to age 14 were killed in unintentional firearm incidents, according to the Centers for Disease Control. It doesn’t have statistics for last year yet. > **[Tiny trigger fingers: America's deadly mix of kids and guns | CBC News](https://www.cbc.ca/news/world/america-children-gun-deaths-1.3654711)** > > Between 2007 and 2014, 488 children died in gun-related incidents. Gun control groups keep calling for stricter laws while rights groups say there's no need. Families, meanwhile, grapple with guilt, grief and a "kaleidoscope of pain." Take a look at the picture of the little tiny girl who looks to be about seven years old, with the lunatic towering above her showing her how to fire a handgun. It should be labeled “American exceptionalism”! > [@Martin\_Hyde](#): > > At the end of the day discussions like this always have two sides–obnoxious jingoists, and obnoxious anti-American haters. The reality is America is the most powerful and the wealthiest country. “Exceptionalism” is a values/opinion judgment with no meaning. Some people view it as exceptional, some do not. > > When jingoism causes Americans to lose sight of areas in which the country can improve, and areas in which the country has behaved badly, it is a problem because it hurts our ability to better ourselves. > > But the opposite of this isn’t sweeping pronouncements that America is the worst thing ever, should be deeply ashamed of existing, that most of everything about America is shit, and that it’s all because Americans are big dumb dumbs that don’t know any better. > > The counterpoint to stupid jingoism should be that America is a large, complex country with large, complex international commitments and responsibilities. It has a democratic system that mostly works, but has some real bad rotten parts that need improved. It has a set of domestic policies which are mostly okay, but often serve people less than it could and less effectively. Many other OECD countries can offer us lessons here because they’ve spent the 20th century living under the umbrella of American protection and have consequently, been free to devote more resources to some of this stuff than we have. I basically agree with that assessment, although I don’t think that the reason you offer in your last sentence is correct. ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [July 3, 2016, 10:33pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/192 "2016-07-03T22:33:21Z")
> [@DerekMichaels00](#): > > that sounds as possible as eliminating all class distinctions. We saw how well that worked out from 1917-1991. It’s quite possible. There have been long stretches of history without superpowers, and instead a multitude of [Great Powers](https://en.wikipedia.org/wiki/Great_power) existing in a state of rough parity of military and/or economic power. 1815-1914 was one such stretch. Whether such a condition is strictly _better_ than one with one or more superpowers is a matter for argument, but there’s no law of the universe requiring superpowers to exist. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 3, 2016, 11:47pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/193 "2016-07-03T23:47:14Z")
Those rankings are nonsense, the U.S. is one of the few countries where you can print largely whatever you want. Several of those listed above us have hate speech and libel laws that would never survive constitutional scrutiny here. That’s a politically motivated hack-list. The United Kingdom being ahead of us is absurd–their libel laws are ridiculous. Their laws against commenting on ongoing political elections, likewise absurd. Looking at their methodology, the only argument against us being #1 is we prosecute journalists who won’t reveal their sources in criminal investigations and we prosecute “whistleblowers” (who aren’t journalists at all.) So the Reporters Without Borders rankings are really just a list of countries that give journalists “supra-special privileges regular citizens are not entitled to”, not a list of actual press freedom. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 3, 2016, 11:52pm UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/194 "2016-07-03T23:52:45Z")
> [@](#): > > In the many decades since, I’ve followed issues in health care economics with interest, especially following such notables as Ewe Reinhardt, a world-renowned specialist in health care economics at Princeton. And in practical day-to-day experience, I and most of my family live in Canada, but some close family members live in the US, and we compare our experiences frequently. I’m sorry, I don’t mean to sound arrogant, but when someone tells me that on matters of health insurance I don’t know what I’m talking about, and as proof, regurgitates the same deceptive talking points we’ve been hearing from health insurers for half a century, I just find it rather mildly amusing. I don’t much care if you sound arrogant–you just sound simply misinformed. Health insurance companies are not the major drivers of costs in American healthcare. You appear to deeply dislike them, but you simply don’t understand the costs involved. Hospitals and doctors charge such high prices because they essentially function as regional monopolies and a guild-like work system. If you just swapped out government with health insurance companies that would not change–unless you institute cost controls. Health insurance companies are not why we don’t have cost controls, they are a naturally developing salve to the consequence of not having cost controls. When a product is so needed, and when the producers of it can artificially control its supply (like the AMA does by making sure the number of seats in medical schools across the country has barely budged since the 1970s) then the only means to control costs is with government intervention. You’ve for some reason chosen to look at the issue 100% backwards. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [July 4, 2016, 12:01am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/195 "2016-07-04T00:01:42Z")
> [@](#): > > That doesn’t refute what I was saying. Part of the independence movement was indeed to get away from imposed colonialism and rule by aristocracy, which was precisely why such a strong emphasis was put on democratic principles. The reason for the elitism and deliberate hobbling of government that reflected an underlying distrust of democracy is that it was appropriate for the times, when only a relatively small minority like the Founders had any education or any reasonable understanding of the world. No-it wasn’t. It was to get away from British elites ruling over American colonial elites. > [@](#): > > Yes, but you misunderstand the argument. It’s not that the kinds of things some of us have been criticizing are qualitatively unique to the US, it’s the extent to which they have become extreme in the US. Opinion with no substance. > [@](#): > > I basically agree with that assessment, although I don’t think that the reason you offer in your last sentence is correct. American spent around ~8% of GDP on defense for the early phase of the Cold War, decreasing down to 5% under Jimmy Carter, then going up to 6-7% under Reagan. It’s fallen down to around 3.5% now. Canada, as a point of example (and in refusal to live up to its NATO commitments) spends 1% of GDP, largely because Canada knows it could disband its military entirely and America would still protect it for geopolitical concerns. Canada is a parasitic leach, and so is the European Union, when it comes to defense. If you don’t think spending 3.5x as much on defense, accounting for 53% of our discretionary spending, has taken money away from other things like domestic social programs, you’re gravely mistaken. There’s an old allegory about guns and butter, that largely holds true. According to [this](http://taxfoundation.org/article/comparison-tax-burden-labor-oecd-0), we actually have the same tax burden as Canada and a slightly higher tax burden than the United Kingdom. So the idea that we could just jack taxes up isn’t as realistic as it might at first seem (most people forget Americans pay significant state and local taxes, many countries like Britain have very low taxes other than national ones, the council tax which is akin to a property tax in Britain is immensely lower than American property taxes, as one example.) ---
**Author:** ![octopus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/octopus/32/3716_2.png) [@octopus](https://boards.straightdope.com/u/octopus)\ **Post date:** [July 4, 2016, 12:34am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/196 "2016-07-04T00:34:32Z")
> [@Sampsiceramos](#): > > You’ve conveniently left out the opportunity to answer “nobody”. I’d rather prefer every country be entirely accountable to a jury of its peers, and not have outliers like the USA or Russia (or the EU as a supranational entity, for that matter’s sake) who seem empowered by their military or economic clout to swing their dick every which way with little regard as to what they end up breaking. > > Getting rid of the goddamnable security council which so thoroughly emasculates the actual power of the UN would be an excellent start. Why would any of the major powers voluntarily cede power to weak countries? How is that in the interest of the big 5? Even Ali G knows what’s up. [https://www.youtube.com/watch?v=aV3ncKB8a4s](https://www.youtube.com/watch?v=aV3ncKB8a4s) ---
**Author:** ![Kobal2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kobal2/32/20_2.png) [@Kobal2](https://boards.straightdope.com/u/Kobal2)\ **Post date:** [July 4, 2016, 12:41am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/197 "2016-07-04T00:41:31Z")
> [@octopus](#): > > Why would any of the major powers voluntarily cede power to weak countries? How is that in the interest of the big 5?[URL=“[https://www.youtube.com/watch?v=aV3ncKB8a4s](https://www.youtube.com/watch?v=aV3ncKB8a4s)”] Um, fairness ? Not being both judge and party ? Checks and balances ? Mwahaha who am I kidding. Pass that bottle again. ---
**Author:** ![Sampsiceramos](https://avatars.discourse-cdn.com/v4/letter/s/8e8cbc/32.png) [@Sampsiceramos](https://boards.straightdope.com/u/Sampsiceramos)\ **Post date:** [July 4, 2016, 12:49am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/198 "2016-07-04T00:49:16Z")
> [@octopus](#): > > Why would any of the major powers voluntarily cede power to weak countries? How is that in the interest of the big 5? > > Even Ali G knows what’s up. [https://www.youtube.com/watch?v=aV3ncKB8a4s](https://www.youtube.com/watch?v=aV3ncKB8a4s) The question was as to preference, not what is considered realistically achievable. America as a superpower is the least bad option for the foreseeable future - not because it is somehow an exceptionally great country, but because it is less exceptionally awful than Russia and China on a number of important matters. This does not change the fact that I consider the existence of superpowers a blight on the world and would greatly prefer none existed at all - and certainly that none existed in their more-or-less wholly unchecked current state. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [July 4, 2016, 1:12am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/199 "2016-07-04T01:12:32Z")
> [@Martin\_Hyde](#): > > I don’t much care if you sound arrogant–you just sound simply misinformed. Health insurance companies are not the major drivers of costs in American healthcare. You appear to deeply dislike them, but you simply don’t understand the costs involved. > > Hospitals and doctors charge such high prices because they essentially function as regional monopolies and a guild-like work system. If you just swapped out government with health insurance companies that would not change–unless you institute cost controls. Health insurance companies are not why we don’t have cost controls, they are a naturally developing salve to the consequence of not having cost controls. When a product is so needed, and when the producers of it can artificially control its supply (like the AMA does by making sure the number of seats in medical schools across the country has barely budged since the 1970s) then the only means to control costs is with government intervention. > > You’ve for some reason chosen to look at the issue 100% backwards. That is so astoundingly counter-factual that I wonder if you even read or understood what I was saying, most notably the parts that you didn’t quote, including the two fundamental reasons for US health care costs that I cited. Do you believe those reasons are wrong, and I just “don’t understand” something? Because that’s what every study in health care economics indicates to be the primary cost contributors. Instead, you say something about “regional monopolies”, whatever that’s supposed to mean. First of all, even here in the land of “socialized medicine” in Canada, clinics and hospitals are demonstrably competitive, competing for ratings, patients, service revenues, donations, and capital grant money. And secondly, that service delivery landscape is much the same in many other countries, so if that’s why it’s the big cost driver, why doesn’t it do so in all those other countries? You state as fact that “health insurance companies are not the major drivers of costs in American healthcare”. Do you understand what I mean when I say that they _ **structurally change** _ the fundamental nature of the entire health care system? Please go back and read those two numbered points again that you failed to quote or respond to. I really don’t think you understood them. You state as fact that “If you just swapped out government with health insurance companies that would not change–unless you institute cost controls.” That is just flat-out wrong. It’s been estimated that you’d save about $350 billion a year just on the elimination of administrative overhead if there was true universal health care. Furthermore, that’s just the tip of the iceberg – you can’t just dismissively rule out “cost controls” and, frankly, I don’t think you quite understand what the term means. It’s a concept that goes hand in hand with the community-based rating model of health care funding as opposed to the private insurance risk-rated model; essentially it’s part of the concept that turns health care funding from the failed and inappropriate “insurance” model into an integrated public service model. And it reflects the fact that it’s fundamentally immoral for private business to be meddling in clinical decision-making, let alone making life-or-death decisions, as they frequently do – [sometimes in unconscionably direct fashion](http://www.nbcnews.com/id/28393752/ns/health-health_care/t/teens-family-sues-cigna-over-denied-transplant/). It means that on the “premium” side – the costs paid by consumers either in taxes and/or direct payments – rates are the same for everyone, and claims are automatically paid in full and never adjudicated (hence the absence of clinical meddling and claims denials). And on the payment side, the government (or regulated agency) works with the medical profession to establish a fee schedule acceptable to the providers and matched to available funding, with the providers having full input into the relative medical effort and expertise required for procedures, and this being translated into dollar amounts through collaborative negotiation. And then those fees are paid promptly, in full, usually through automated billing and EFT. No muss, no fuss, little overhead. Nothing even remotely like that happens in US health care, yet something like it happens in every other developed country in the world. When you look at a chart of per-capita health care costs among developed nations, you see the consequences of that. Anything else is pure denial. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [July 4, 2016, 3:16am UTC](https://boards.straightdope.com/t/american-exceptionalism/758853/200 "2016-07-04T03:16:55Z")
> [@Martin\_Hyde](#): > > Canada, as a point of example (and in refusal to live up to its NATO commitments) Examples, please. [Previous page](https://boards.straightdope.com/t/american-exceptionalism/758853.md?page=9) [Next page](https://boards.straightdope.com/t/american-exceptionalism/758853.md?page=11)