I’d just as soon whack corporate welfare dollars and spend the 100+ billion dollars toward socialized medicine…
…maybe corporations feel those subsidies are a right eh? snicker snicker
Oh, and aynrandlover, lest you fein ignorance on the topic of corporate welfare, here’s a link to an essay that can get you up to speed:
’lover - I’m afraid that you are still mangling your points of view. I’m not talking about the individual desiring insurance. For the purposes of this argument I couldn’t give two hoots about that. I mean that from the point of view of society as a whole, i.e. the economy it is desirable that individuals have insurance. This is because insurance allows the capital that would otherwise have been needed to serve as a contingency to be used more efficiently, i.e. in investment.
Erk. I don’t think that you are understanding the argument unfortunately and I totally blame my inability to explain it concisely. I’ll try again tomorrow. For the time being just keep this in mind:
An NHS is nothing more than a VAST insurance scheme, with no need for the insurer to apply margins to their prices for either profits or disasters. This means it ought to be cheaper to the consumer.
pan
Zebra
Again, if you accept public law you accept public enforcement of these laws. A law is meaningless without some force behind it. So long as one agrees on a public legislative agency one also agrees on a public enforcement agency. Private enforcement agencies do not have the legal rights that the government does. In some cases it has more rights (searh rights, for example) and in some ways it has less. But they cannot be equal.
I do not doubt that there is some sort of benefit from public education. There is some sort of benefit from public medical programs as well. What I question are the principles these two decisions are based on and the ramifications of their application.
Public education is at once a sinkhole and a blessing. As I’ve noted, up to 40% of college students drop out within the first two years in public schools. Private schools do not have this dropout rate. If you go to a private school, you are serious and detremined. There is still a dropout rate, of course, but it is far lower. Public schools must accept everyone (otherwise it isn’t very public!) within reason while private schools may be as selective (based on relevant criteria) as they desire. That is, SAT scores, funds available, etc etc.
In fact, the public education angle is exactly what I was hinting at in my last post. We already have “decided” that education is a right, now the question becomes how do we enforce that right? If we nationalize insurance the result is more strictly controlled pricing of medical research costs, existing technology, pay, etc etc (the UK system IIRC pays doctors ona per visit basis of some sort, but this is still a flat rate). Educationwise we do something similar with similar side-effects. We nationalize school funding. This is, of a sort, “school insurance.” Its result is fixing professors pay scales, students per class, curriculum which can be achieved through existing funds, etc etc. There is a whole “trickle down” effect not on profit but on control.
Again, this is not deliberate or rigid control, but merely a result of the economy’s largest consumer taking stake in what was a private affair.
Anyway, protection is not a right, it is a consequence of public law (which is also not a right in the sense it used for health insurance so far). If we are naming health insurance as an inherent, rather than derived, right I’d still like to hear the reasoning behind this.
To clarify what I mean here, a derived right is one that exist only because of the government. Freedom of speech, for example, is an inherent right. Without government it would seem obvious. The right to a speedy trial, you’ll note, is meaningless without a government…it would be, by my standards, a derived right. A right granted by consequence of a legislative body. An inherent right is basically anything a man can do in anarchy.
It seems to be presented so far that education and insurance are inherent rights; by virtue of birth we deserve education much in the same way that we deserve to use out lungs to speak. kabbes seems to lean toward a derived right, but again this is not clear yet. Of course, I’m making up this distinction on the fly, anyone else may clarify, redefine, or whatever, just so long as we can tell what you are talking about.
kabbes I’m not talking about the individual desiring insurance either, not like you seem to think 
However, if you want a hole in your argumant you’ve got one now.
“…the economy it is desirable that individuals have insurance. This is because insurance allows the capital that would otherwise have been needed to serve as a contingency to be used more efficiently, i.e. in investment.”
First of all, the government is a non-profit organization. The best it can hope for is to break even budget-wise. Surplus funds must be spent. We agree insurance is desirable. We agree this is because of the capital insurance amasses and, for profit, invests for a return. Investments are very good for the economy.
The government cannot make money. If it runs insurance, any investments it makes for a profit cannot be stored. It must be immediately (economically speaking, of course) liquidized, turned over to existing programs, paying down national debt, etc etc. It cannot store funds! A private company can store funds in many different ways. That money is right there.
The argument you are giving is a very effective one, just not for socialized medicine. You might want to think about other infrastructure programs like power companies and phone companies. They were “heavily” regulated, but also charged with building the infrastructure. Profits were theirs. The market was (pretty much) theirs. There are things monopolies can do much more efficiently than competition. Your argument lends to a nationwide insurance, not a national one. Your argument supports a consolodated insurance group, or possibly two or three (due to our larger size than other countries). See?
Remember as well we are talking about a very rapid-growth area. Medicine is changing by leaps and bounds over other industries. Controlling profit in this area is EXCEEDINGLY dangerous to further growth, education, expansion, etc. A socialized medicine plan will both dampen incentive to enter the field and yet promote a healthier populous. Clearly a healthy populous is growing one, and it seems that the incentive to become a doctor is not quite enough to keep up with this. Hard to say, though, since it is a very recent trend.
Gary
“But I do think that a supposedly civilized and compassionate nature would view it as their responsibility to offer their most needy health care.”[emphasis removed]
This is interesting. I find your implied meaning of compassion to be a little paradoxical. That is, you see, a nationalized health care package would get its revenue from taxes. Taxes are not a matter of choice. Thus, we are forcing people to be compassionate…altogether an uncompassionate thing, eh? Seems in our attempt to be civilized we lost our civility
“We’re talking about a fairly basic level of compassion for your fellow person, and it doesn’t even need to cost you a dime.” Oh, it would cost me much more than a dime, I’m afraid. As well, I fail to see how the very recent ability of those in the medical profesion can possibly be a basic level of compassion. Perhaps you have a lower opinion of those in the field than I do. You know, doctors really are doctors…they need a pHD. This is neither basic, cheap, easy, or quick.
Health care research owes alot to government. Licensing of doctors is a government function. If health care is not a right, which I think it is, then people have a right to buy their own prescriptions, which they do not. Speaking of rights, do a few hundred companies have the right to maximize their profit from disease via government license? Why do people who pay cash pay more for procedures than if they had insurance? Its called collective bargaining, and that is the idea behind national health insurance, to bring sanity to something everyone needs at least once on their life and reduce waste and increase efficiencey. I have seen it discussed here, but perhaps it pays to remind ourselves that patents on medicines are offered by the people and are not an absolute right. If those patents would be modified slightly, we could bring down the cost of medicine without sacrificing research, which is still government funded in part. I propose the US government underwrite all health insurance by half, via state insurance commissions, using this majority interest to limit costs across the board, and requiring states to manage it (if they want all that money). Medicaid and Medicare would be left intact. Anyone can opt for their own premium insurance through a corporation. This would still not guarantee that everyone had access to health care, but doctors and hospitals wouldn’t be left holding the bag for speculative care. It would cost more, but would spur efficiency the way Canada achieves cost-cutting, by organizing it by state first. If this is naive, someone let me know.
I think it is problematic to discuss ethics and rights and duties when it comes to something as basic as this. People must imagine that hoarding printed money is a human right before they deem it necessary to let people die for their right to have it.
I noticed you did not address my arguments that a citizen should pay for the public education even if they are not using it. (I guess you agree)
My argument is not that healthcare is a right but a need.
It is a need of the group as well as the individual. The State benefits by doing everything it can to stop the spread of disease. The two best ways to do this is education and early detection. Education about, what the symptoms are like, how a disease is spread, and treatment for can and should dispersed to the general population. How? Where? The neighbor hood clinic of course. How can the state stop the spread of disease? By treating anyone with the disease. Not by treating anyone who can afford treatment. If an uninsured person on a bus coughs and makes 3 insured people sick who loses out. The insurance company? The employers of those three? What is the disease is deadly? Even with insurance an illness can destroy a family financially. This is bad for society. It is not good for the group to have a families life savings going to doctor bills instead of getting higher education for the children and building wealth for the family.
We need our citizens to be healthy.
( a little aside)
If I ran an issuance company I would give rate increases to those who did not get regular check ups. Why? If they did get these it would save the company in the long run, because early detection and treatment is far better then stepping in at the last moment.
More aside,
The police discussion is not part of the op so I hope we don’t get bogged down in this. It would be easy to envision system where private enterprise took over criminal investigation leaving prosecution to the State. Private Security could apply for warrants. Private Investigators could interview suspects and give them their Miranda rights. The problem is that poorer communities would not be able to afford the same level of protection as wealthy ones. This happens anyway in rural areas where there is one cop for a town or a county but let’s not digress to much in this direction.
We (the state) need our citizens to have a basic education level. We need to provide this not because the citizen thinks of it as a right but because the state needs an educated populace. If the average applicant for a job can read, write, add and follow directions it is a benefit to industry.
I am not sure what you are driving at with your drop out rates on public universities verses private ones. I would think that people who pay a small amount (yes you do pay to go to public university) may be more willing to cut their losses than someone who gets a huge government loan (or has daddy paying) to go to a private one. Your comment on this area seems to point an underlying disgust you have with poor people. Like they are not worthy of an education or health care. (my god if they didn’t live in squalor they wouldn’t get sick) I apologize if this isn’t the intention of your posting of the drop out rates but I don’t see any correlation to them and National Health Care.
I do not have the Right to a national defense but WE have a need for it. I do not have the Right to drive on well-maintained freeways but WE have a need for it. I do not have a right to an education but WE have a need for it. I do not have a right to health care but WE have a need for it.
So I am not arguing that it is a right but rather a public need. A public need that the State (we collectively) need to take of and provide.
brian
“If health care is not a right, which I think it is, then people have a right to buy their own prescriptions, which they do not.”
No way this makes any sense. The government can outlaw the private purchase of any number of things. Nuclear material, LSD, tobacco for a minor. This does not mean we’ve socialized anything, and again it depends on what you mean by right.
“Speaking of rights, do a few hundred companies have the right to maximize their profit from disease via government license?”
brian and everyone else
Perhaps we should move this discussion along the lines of what the hell you think “intellectual property” means. I will say this very clearly and concisely now: drugs are a technological invention and are intellectual property like all other manufactured things.[sub]simplification follows[/sub]
Do not decieve yourself to think it is any other way. The drug developer or drug development team (as the case may be) goes through many different means in order to create a drug with a specific effect. This is not done at random, it is not accidental. We start the drug development process by finding our target. Is it a specific protien? Is it necessary for the drug to penetrate the cellular wall? Etc. The drug development team then contacts the combitational chemists. They have a huge robot (which also has patents on it as intellectual invention) or robots which create literally millions of molecules. Between the two of them (along with some other analysts) they find a batch of molecules which have structures similar to the properties we hope to find. Or, if no such batch has been made, they proceed to make a whole family of molecules.
At this point there is some high-throughput screening to dismiss about 99% or more of the molecules as being too fragile, not having the right solubility, permeability, or not targeting the specific protien, etc. In the end we find maybe fifty or so (after several different screenings) which seem promising.
The tests are now much more detailed, and more of the compounds are analyzed across broad pH ranges, different conditions, etc etc.
So, after between 1-2 years (no kidding) we’ve got some molecules that are just promising as all get out. As you might have noticed, this molecule was invented and manufactured to do a particular task. Thus, the entire field is patent driven. Now we’ve got another wait while the FDA approves this drug which, again, can take years. Patents themselves are also not that cheap, but really that cost is negligible when compared to the sheer time/cost investment of developing a single drug. Then there’s the whole time and money spent on getting the sucker out on the market after all this has occurred.
If a company is lucky, and this is a definitely tricky average, but they will bring one drug to market a year. In reality this is an absurd average, many companies go a few years without bringing any to the market, then they might get two to come out simultaneously. And this is also only the largish ones, smaller companies don’t have those resources.
At any rate, in reading that I hope the idea of you deserving this drug has largely left your mind. Out of the literal millions of molecules produced a year and hundreds of thousands tested (by a single medium-to-large size company alone) next to nothing comes out of it. The patent on a drug lasts for fifteen years after which it has expired and may not be renewed. It is in the public domain now.
As well, in reading this I hope you have realized the sheer amount of effort required to bring something to your “disease.” They are profiting, yes. And they continue to profit, which enables them to make even more labs and buildings to develop even more drugs. All we can hope for is that this process is accelerated so more drugs come to market! Fixing market prices will not accelerate growth, and you are choking on your own goal if you do this.
If anyone is interested in the sheer size of these companies I would ask anyone in SoCal to visit a little town called Thousand Oaks. Just off the Highway (I forget the number, but IIRC it is the only major highway running through there) you will find a company so huge as to defy imagination. There are over 30 seperate buildings. The size of this installation is well over two to three city blocks. There are entire day care centers, gyms, and other resources in them. Complete libraries (including fiction and such) are in most of the larger companies. Their employess are treated very well. This is to attract the best and the brightest of which they need a lot to bring a drug out.
Sorry, but no government anywhere has shown me that it can attract the best and the brightest the way these companies can. You fix that and we can strike a deal.
zebra
I did address it. I mentioned that if one follows the path of private education they should get those tax dollars back. I also don’t like me, having no children, paying for a bunch of kids to go to school either. But then again, I “obviously” am neither civilized nor compassionate.
“Education about, what the symptoms are like, how a disease is spread, and treatment for can and should dispersed to the general population. How? Where? The neighbor hood clinic of course. How can the state stop the spread of disease? By treating anyone with the disease.”
Yeah, and where are you going to get the money to do this? As well, there are many more things that are in “the state’s” interest as well, but those are not regulated in the same way and proposals for their regulation falls short of ludicrous.
I am not in approval of any socialization plan, however I sometimes see their practicality. Roads, for example, are best managed by the government from a practical standpoint.
In the matter of education and technological development I think it is best left as a private matter.
As well, health care is not a need. If it is you make a mockery of the human race surviving in any way for the past 100000 years or whatever. Successful medical technology of the sort you are implying is a “basic need” has not been around for more than 100 years. Obviously it is not as basic as you think. Please rephrase.
AynRandlover,
I am aware that a typical medication costs 1 billion dollars to bring to market. I am also aware that pharmaceutical companies make alot of money. Good for them. It has been reported recently that Americans pay more for these medications because they do not buy in batch quantities like other countries do that supply health care to their citizens. Obviously these countries leverage their purchasing power the same way a drug company leverages its patent. I don’t know what the point of your lecture concerning intellectual property was all about, this is not an absolute right under any stretch of the imagination. As of now, we, the people, force medicines to be licensed out after 5 years. We force car companies to share their designs after one year. We allow benign inventions like songs and movies to carry a copyright for at least 27 years, or something like that. There is nothing absolute about this, and it doesn’t lead to anarchy if things are modified for the public good. Ask any economist about artificially paying too much for anything, and they will point out that this takes away from other sectors of the economy and leads to other problems.
Then again, brian, you bring me to the point I left off with for kabbes…this leads us to a national insurance company/ies, not a nationalized plan.
Economically speaking, if you were correct, it would serve us better to nationalize the phone system as well. This is not the case, and really doesn’t apply anywhere were strong technological advancements are necessary and/or rapid.
Again, as any econ book will tell you (if it is not biased) there are times when a private monopoly is very desirable. This was realized by our government to create our power system and phone lines, as well as other things I’m sure. We have not socialized either of these nor do we need to. We also do not need to socialize medicine in the same way. Perhaps, anyway. Let’s see how my government-endorsed monopoly goes over…
aynrandlover: For the love of God, paragraph breaks! Please!!!
Actually I am pretty sure no one can be refused medical care if they are dying. So right to life is actually covered.
As for the lower cost for more money, that is subjective. For one thing America is big and those countrys are small. America would cost more than 10% to provide the same level of care as those smaller countrys. Also the medical care will be worse than what Americans currently enjoy. You don’t think that all that extra money just dissapears do you? I would like to see some relevant statistics showing average health care of cost per health care. For example america consumes more drugs, maybe that means the extra money saves extra lives.
Ideology is a wonderful thing. It absolutely amazes me how many SDMBers allow themselves to get caught up in ideology to this extent. Do me a favor, arl, don’t move to my town.
Now, for some actual evidence as opposed to simplistic ideology. The U.S., contrary to the impression you may be getting from arl, already has very large pieces of its system, to the extent it can be called such, subsidized by the government, for reasons of minimal compassion and the advancement of public health, to wit:
1 - Medicaid, for the very poor.
2 - Medicare, for the retired.
3 - vaccination programs for schoolchildren.
4 - for corporate employees, health insurance that can be expensed by the corporation against its taxes, and that for the piece paid for by the employee, is counted against his federal income tax as a before-tax adjustment. What that means is that you calculate your adjusted gross income net of what you have to pay in to your corporate health plan, if you have one. Payroll taxes (Social Security and Medicare) are also excluded from this. What all this means is that a corporate employee gets subsidized insurance, while a self-employed person or someone working for a company without a health plan has to pay for the entire thing by himself if he wants it, at a high price because he is a single individual instead of a large group, and because he has to use his after-tax dollars to do it. The subsidy given to corporate health plans is what is technically called a tax expenditure, meaning that the government forgoes a certain amount of revenue in order to provide a tax subsidy to a specific class of individuals. This expenditure amounted, in the 1997 fiscal year, the last year for which I have figures at my fingertips, to 72.3 billion dollars. It was by a wide margin the largest tax expenditure being made. (Source: American Almanac, 1995-1996, table number 523, page 339. Later editions should have the same table.)
So, we’re already half way there. We have exactly two choices:
1 - Repeal all of the above.
2 - Finish the job, and give ourselves some form of national health insurance.
Otherwise, we will continue with the injustice we have today: a privileged group with highly subsidized insurance, whether through Medicare, Medicaid, or their company, and an out-in-the-cold group that has to pay for the whole thing on their own, or go without. For this injustice, as has already been pointed out, we pay out more of our GDP for health than does any other industrialized country.
Well a thousand years ago we didn’t need airports. If you want to live a free as a caveman please move to a cave. However societies evolve. They change over time. We grant the right to vote to women. We decide to go to the moon. We take on all manner of projects. Some fail but others bring great benifit to all. I am not mocking the survival of the human race by saying health care is a need. It has always been a need. There have always been doctors and medicine men. Are you saying there was no need for medicine over the past 10,000 years? It is a need and right now it is a need we can take care of.
** Phantom **
You rock!
Zebra
Zebra: geez, man, (woman?) you’re gonna make me blush!
Once more, for the hard of thinking. Your nation spends more of its gross income on healthcare than anywhere in the world. In contrast, it was recently found to have only the
37th most effective healthcare according to the World Health Organisation! **
[/QUOTE]
. Nationally, you’re spending over the odds for an inferior service.
Now, as a good follower of objectivism, and no doubt believer in capitalism and the “greed is good” philosophy, I hope you’d appreciate the sheer sense in not wasting money in this fashion. We could also discuss why a healthy workforce is in the economic interests of your country, which very much affects your own wealth (fewer sickdays, higher productivity, greater workforce diversity, etc). We could then, perhaps, argue that it would be in everyone’s benefit, from the poorest worker to the richest company owner, to see national healthcare set up, all for less money than the USA currently spends.
God damn time zones. Difficult to have a conversation staggered 12 hours apart.
Anyway, ARL we are about there from the point of view of my particular part of the argument in favour of an NHS. You suggest that my reasoning leads to a national insurance, not nationalised health. Indeed it does. But that’s rather the sticky part of it. How can you force a national insurance plan without making it nationalised? You are talking about a monopoly here and government monopolies tend to be a hell of a lot more benign than private ones.
Furthermore I still repeat myself: a government insurance plan does not need to include margins for profit or contingencies in their premium prices (i.e. taxes). This means that the charge to the consumer is lower, so capital investment in the private markets can be higher.
One more time: countries with nationalised health spend less money as a % of GDP on greater coverage. My arguments aren’t theoretical you know - they are well known and satisfy a lot of other governments that nationalised medicine is worthwhile.
Now FWIW I 100% agree with those saying that it is in a country’s interest to have a healthy educated populace. For those who have studied economics I’ll remind you that from a monetarist viewpoint the only way to increase the long-run productivity of an economy is to increase its basic resources and the education and health levels of the population qualify as such.
However my line of argument in favour of an NHS follows because medicine is a curious type of insurance and insurance is a curious type of good. A purely economic/actuarial argument without any hint of ideology. And I think that you are more likely to be persuaded by that, ARL.
pan
I’m exhausted. If any of you can get past the propaganda you’ve been subjected to, please take a look at the this. Not the BBC news report (excellent link though, Gary) but the full story: World Health Organsation Annual Report 2000
I’d be surprised if it was reported widely in the US.
London_Calling - that is a great document!
Cheers, Kabbes.
If that’s a little long for people at work the Press Releaseis available online.
Obviously, it’s better to read the main Report to understand how conclusions are reached. As an example of those conclusions:
“The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.”
Not to forget, on the very next line:
I guess that the UK’s NHS isn’t quite as bad as some members of this discussion would like to believe.
Saying that, I’d much rather us spend twice as much and be first.
pan
Cuba is ranked 39th.