President Bush has repeatedly characterized Kerry’s health care plan as involving government taking over individual healthcare decisions. For instance, he recently said that : “My opponent’s proposal would be the largest expansion of government-run health care ever. And you know something, when the government pays the bills, it makes the rules. His plan would put bureaucrats in charge of dictating coverage, which could ration your care and limit your choice of doctors.” (edited to remove audience booing.) His campaign has recently released two ads (‘Your Doctor’ and ‘Complicated Plan’) which repeat this charge. These claims have already been rejected by various independent organizations. Now, however, a group of 68 health finance experts have come out with the following statement (via Mark Kleiman):
“We are 68 people with more than a thousand years of combined professional and academic experience in health care finance and organization. As a group, we neither represent nor endorse a particular political party or viewpoint about health care reform.
We have reviewed the health care finance proposals put forward by Senator John Kerry. Their primary thrust is to make the federal government a reinsurer when a single insured individual incurs health care costs greater than $50,000 in the course of any one year.
Because high-cost individuals account for a large proportion of the total cost of health insurance, this reinsurance is intended to make private health insurance more affordable for both employers and individuals and thus reduce the number of uninsured individuals and families. This approach is fully consistent with maintaining a health care finance system largely run by private insurance, private employers, and private medical providers.
Although Senator Kerry’s proposals should be subject to a full analysis of their cost and impact, any claim that they amount to “government run health care” or a “government takeover” of the health care system or of health care decision-making is simply inconsistent with the facts. We are not aware of any expert in health care or health care finance, whatever his or her political orientation, who believes otherwise.” (emphasis added)
The signers are some very serious people with real expertise in health care economics. Check out their records and resumes for yourselves. And if President Bush repeats this charge tonight, bear their statement in mind.
“This approach is fully consistent with maintaining a health care finance system largely run by private insurance, private employers, and private medical providers.”
Unless the costs go above $50,000.
And they note that “high-cost individuals account for a large proportion of the total cost of health insurance”.
That cost will be administered by the government.
Which would involve “bureaucrats in charge of dictating coverage, which could ration your care and limit your choice of doctors”.
Unless the Kerry plan involves the fiscally crazy idea of not trying to control the health care costs that his policy would be responsible for.
Which is what the Bush administration is saying.
No, Sebastian, that is not what he is saying. He is saying that this could limit your choice of doctors (speech quoted above.) In the same speech, he says that this puts us on the path to ‘Hillary-care’. His ad (‘Complicated plan’) says it involves “rationing, less access, fewer choices, long waits.” He also describes it as a ‘government takeover’ of health care, not a program that we or our employers can choose to buy into or not. All of this is just plain false.
“In the same speech, he says that this puts us on the path to ‘Hillary-care’.”
Doesn’t it? Isn’t the currently articulated Democratic plan to get government managed health care a piece at a time instead of all at once because of the Hillary-care failure to get it all at once?
“He is saying that this could limit your choice of doctors (speech quoted above.)”
How is the government going to manage costs if it doesn’t limit your choice of doctors and choice of care? Is this an unlimited reinsurance benefit? Are costs going to be unregulated? Have you seen Medicare and Medicaid? What about the large number of doctors who don’t accept patients under those plans because of the maze of government restrictions? Isn’t that likely to ‘limit your choice of doctors’?
Um, what exactly is wrong with a government-run health plan? I have no complaints about ours…
Um, what exactly is wrong with a government-run health plan? I have no complaints about ours…
You have to ask a lobbyist for the HMO industry…I’m sure they have all kinds of scary bedtime stories that will chill your bones…but for those of us who have lived in countries that have universal health care, it remains a mystery.
I mean if health care for ALL Americans was superior to that in Canada or the UK, that would be one thing.
But then again, that’s where you begin to understand the reluctance…rich Americans don’t give a rat’s ass about ALL American’s health care…until they get fired and lose theirs that is.
Let me explain this slowly so that even Sebastian can understand it.
There’s a difference between assuming risk and dictating coverage.
Kerry’s proposal is about the former. It manages costs because private insurance companies no longer have to worry about trying to identify risky patients and keeping them out of their particular risk pool. It has nothing to do with “bureaucrats” “dictating” anything.
Edward: I mean if health care for ALL Americans was superior to that in Canada or the UK, that would be one thing.
I think the problem really is that many Americans are predisposed to believe that American health care just IS superior to that in Canada, or the UK, or France – and don’t want to look at the facts that would tell them that it isn’t.
I think the problem really is that many Americans are predisposed to believe that American health care just IS superior to that in Canada, or the UK, or France – and don’t want to look at the facts that would tell them that it isn’t.
I can’t believe the ones who have no coverage at all are so inclined. Surely some health care is better than none, no?
It’s a “am I my brother’s keeper?” issue, IMO. My answer is “yes,” but then I’m a liberal, so …
The fact that many small businesses who struggle to provide health care could have one less business-crushing headache with universal health care doesn’t seem to matter to the supposedly pro-small business crew. That’s where I get confused.
While I haven’t experienced healthcare in the US, some friends of mine just moved back to Canada after a few years in the US. They were extremely glad to be back under a government-run system.
I keep hearing that some people believe that a government run system dictates which doctors patients can see. I’ve never been told which doctors I could go to, ever. Even specialists only require a letter from your GP.
As for “the maze of government restrictions”, a few years ago I was involved in the creation of a clinical information system that was aimed at the US medical clinic/hospital market. The level of bureacracy and administration overhead in the US is an order of magnitude above what we have, so much so that a selling point of our application was that it had an expert system installed that aided doctors in perscribing medication and treatment for patients based on what their health plan allowed. We have no maze of bureaucracy like the US system.
“Let me explain this slowly so that even Sebastian can understand it.
There’s a difference between assuming risk and dictating coverage.”
So the US assumes risk for the most expensive patients. The ones that the health care experts say are a large percentage of total costs. But it doesn’t limit the coverage at all. The US government will just pay for anything that such patients want? Don’t be silly. The US government will pay for certain things at certain times when you have certain diseases. They will pay for it when administered by certain lower-cost doctors. Those things involve limiting coverage and specifiying doctors. If you don’t do those things, you don’t have a cost savings. If you don’t do those things, you have a cost explosion.
Be as conscending as you want, you aren’t distracting me from basic economic facts. Either the government will implement heavy restrictions, or this would be one of the most expensive benefits in the history of the US government. Perhas the ‘or’ is inappropriate. It is quite possible that the government could implement heavy restrictions AND it could be one of the most expensive benefits in the history of the US government.
Either the government will implement heavy restrictions, or this would be one of the most expensive benefits in the history of the US government.
Are you saying that private health plans don’t do the same thing, or are not faced with the same economic realities?
Both plans are iterative garbage.
Mandatory private insurance not mediated by the employer, please.
Additional details
here
and
here
To expand on praktike’s comment: Here is Kerry’s actual proposal for assuming part of catastrophic costs:
Note that he proposes reimbursement for a portion of catastrophic costs. Because the insurance companies would still pay approximately 25% of costs over the threshold (and because the threshold is high enough that that’s still a significant cost), they would still have an incentive to control costs.
His plan also says:
Note: employers and their insurers, not the government, must put these plans in place, and would administer them.
If you can find me any evidence that Kerry proposes putting government officials in charge of people’s health care decisions as part of his catastrophic coverage proposals, it would be good to cite it here.
I don’t have to, you already did:
“Under this proposal, the pool would reimburse private and public employer and group health insurance plans that meet certain qualifications for a portion of catastrophic costs.”
Just because you put the rules in the ‘qualifying plans’ portion doesn’t mean you aren’t making the rules. Abiola has an excellent chess analogy describing this if you play the game.
“The resulting savings would decrease family premiums by up to $1,000 annually.”
This of course is not a ‘savings’ because it would be paid for by US taxpayers. I’m willing to have an argument about whether or not that is good, but whatever it is, it most certainly is not a ‘savings’.
Alekhine’s defense is fantastic, and I employ it frequently to great chagrin.
A question about catastrophic health costs in the US from a furriner: What happens to people with no healthcare coverage come down with catastrophic illness, say bowel cancer? Do they just die in the street? Or are they guaranteed care at public cost?
Look. Bush has been saying that this is a government-run health care plan. He has said it would “put bureaucrats in charge of dictating coverage, which could ration your care and limit your choice of doctors.” Kerry’s plan would not put bureaucrats in charge of dictating coverage. It would not “put bureaucrats, not your doctor, in charge of your health care decisions.” (From ‘Your Doctor’ ad.) It would not lead to rationing, long waits, lower choice of doctors, etc., etc.
Bush has not criticized Kerry’s plan on the grounds that it involves government making rules about which plans qualify. He has criticized it on the grounds that it lets government bureaucrats make your health care decisions. (To be clear: Bush claims that the government will make not only the rules, but also the decisions those rules govern.) And that’s false. As is the implication in talk of a ‘government takeover’ that any of this is mandatory.
“Bush has not criticized Kerry’s plan on the grounds that it involves government making rules about which plans qualify. He has criticized it on the grounds that it lets government bureaucrats make your health care decisions.”
I guess I’m not seeing your distinction. Kerry is touting this as a solution to what he sees as a serious problem. In order to qualify, a plan would have to follow the government rules. That involves government bureaucrats making your health care decisions–the Bush charge which you are portraying as a scare tactic. If we don’t have a significant amount of participation, the ‘problem’ will not be solved. So either lots of plans qualify–bringing them under government bureacratic decision-making, or they do not Kerry’s solution is not much of a solution because most people will be in health care programs not effected. So either Bush’s criticism is correct, or Kerry’s plan isn’t particularly helpful.
This of course is not a ‘savings’ because it would be paid for by US taxpayers.
Actually, not all of the $1,000 gets borne by US taxpayers. The reason is that health care premiums are calculated in part by taking into account the likelihood that the insurer will have to bear high costs. It’s a lot harder to predict the percentage of 10 people who will become seriously ill in the next year than it is to predict the percentage of 1,000 people that will get sick. Therefore, the smaller the risk pool, the higher the premiums. Kerry’s proposal gets at the problem, and premiums will go down as a result, and especially for small businesses, the engines of job creation. Then there’s the fact that insurance companies no longer will need to spend exorbitant sums to identify high risk individuals.
So, anything that costs $30,000+ will be covered 75% by the government and 25% by the insurer? If so, will the government force the insurer to cover that entire 25% or will the government allow the insurer to require me to cover 10% (if an in plan doctor) or 20% (if an out of plan doctor) as required by my current PPO plan?
Why do I think that this will encourage ACL reconstruction prices to rise from say the $25,000 I expect my pre/post op care + surgery to cost to $30,001?
OK: here’s the distinction. We have:
(a) a government rule saying, here are the criteria you must meet in order to count as having an effective cost-containment plan. These criteria need not say anything whatsoever about which sorts of treatments should be given in which cases, etc. They might, for instance, say that treatments that aren’t standard, and that exceed a certain cost, should be evaluated by a second, independent physician.
(b) an insurer, who makes decisions about coverage, in accordance with the plan.
(c) a doctor, who advises the patient on which treatments would be best, probably informed by what’s covered.
(d) the patient, who actually makes the decisions.
Now, I assume when Bush says that Kerry’s plan “would put bureaucrats, not your doctor, in charge of your health care decisions” he overlooks (d): your doctor is not currently in charge of your health care decisions; you are. I assume that Bush does not mean to suggest that the government will take over the role of the patient (i.e., that treatment will be forced down people’s throats.) But he quite clearly suggests that government will take over from your doctor, which is obviously false. But it’s also false that the government will take over from your insurer. It will take over part of the risk. It will set up criteria that insurers must meet if, and only if, they want to hand over that part of the risk. But nothing you have said thus far even begins to suggest that those criteria will amount to government making decisions about what’s covered and what’s not, which is what Bush and his ad people say.
It’s as though Bush said: the people who support charter schools want to take decisions about your child’s education away from teachers and give them to government bureaucrats, and when asked to support this claim, said: well, the government will set up criteria that charter schools must meet to qualify for funding. That would not begin to constitute ‘taking decisions about your child’s education out of the hands of teachers’. And neither does the Kerry plan constitute taking decisions about your health out of the hands of doctors.
“a government rule saying, here are the criteria you must meet in order to count as having an effective cost-containment plan. These criteria need not say anything whatsoever about which sorts of treatments should be given in which cases, etc. They might, for instance, say that treatments that aren’t standard, and that exceed a certain cost, should be evaluated by a second, independent physician.”
These suppositions seems somewhat different from how the US government operates. And if Kerry meant something dramatically new in his concept of ‘qualify’ I would suspect he would tout this radical idea high and low. Furthermore your indirect method can be worse than direct control. It can spawn a hugely wasteful business in trying to figure out what satisfies the governments qualification regulations. (See the frightening craziness surrounding Sarbanes-Oxley).
“It can spawn a hugely wasteful business”
One, this is just handwaving. You’re not offering any facts. Two, you’re still bouncing back and forth between your criticisms and the question of whether Bush’s are dishonest. Three, the whole criticism is just vapid rhetoric, anyway. The ‘bureaucrats’ will ‘dictate coverage’? They already do. The insurance companies employ an army of them.
“One, this is just handwaving. You’re not offering any facts.”
That is what happens when a hugely important part of a proposal like “which insurance companies qualify” is left undefined. It turns talking about it into an exercise in speculation. I’m speculating based on the government’s other forays into health care cost control (Medicaid an awful failure), indirect control (Sarbanes-Oxley) and general tendencies (Democrats have tended to support government control of medical industries). If you don’t like it, ask your candidate to clarify. He won’t, because his clarification is likely to scare off voters. But don’t blame me for pointing out rather obvious loopholes and governmental tendencies.
Sebastian: “These suppositions seems somewhat different from how the US government operates. And if Kerry meant something dramatically new in his concept of ‘qualify’ I would suspect he would tout this radical idea high and low.”
Now, which government operations, exactly, are you talking about? Because I can think of any number of areas in which, when the government says “you must adopt a program that meets certain criteria in order to qualify for federal funding”, it operates exactly like this. “This” being: the government sets up certain criteria for providing funding to organizations of a certain kind; these criteria need not involve any government intervention in those organizations’ decision-making; only organizations which meet the criteria get funded. This is how charter schools work, how government financial aid for college students works, how government assistance to various social service agencies works, etc., etc.,etc. I don’t see why the thought that Kerry’s reinsurance plan might work this way is so breathtaking.
In any case, if this is the heart of Bush’s defense of his characterization of Kerry’s health care plans, wouldn’t you think that he might offer some support for his interpretation of Kerry’s plans?
Jonathan Cohn:
It is also exactly not how huge numbers of government programs work–especially in the health care arena. If you accept any Medicaid patients, you have to accept all sorts of rules about all sorts of other things. Medicaid has all sorts of enormously restrictive rules.
Furthermore you are using examples where federal funding is either small (schools) or having to do mainly with local issues (welfare). And when it comes to public schools you are flatly wrong anyway. The hugely expensive mandates for mainstreaming disabled children have come in with federal funding. College aid is a huge exception to how our government normally operates–see resistance to doing the exact same thing in precisely the same economic area when you call it ‘school vouchers’.
If you accept federal highway funding you get all sorts of strings attached that have very little to do with funding.
It is a matter of well known and well understood Democratic Party intentions to gain control over health care. If Kerry wants to make a proposal not in keeping with that, he ought not leave huge loopholes in ‘qualifying’ sitting out there. It is exactly what he does with ‘getting the job done’ in Iraq. He gets to maintain a tough pose while still appealing to the get-us-out-now crowd by not defining his terms. Here he gets to pretend that Democrats aren’t interested in taking over health care by failing to give hints about what insurance companies need to do to ‘qualify’. If Bush is wrong, all Kerry has to do to smack him down is note what he really means by qualify. He will not, because he does not mean what you portray.
His plans are always straddles between two completely incompatible goals. This is just another example. He wants to appeal to the take-over-health-care Democrats while not scaring off people who understand the need for a very open market. Who knows what he will really do? But Bush showing how ambiguities tend to be resolved in favor of typical bad Democratic thinking on markets doesn’t seem dishonest at all.
I didn’t see your 3:18 post.
“Why Kerry’s plan, which introduces no similar micromanagement into medical decision-making beyond what exists already, empowers Washington bureaucrats more than Bush’s Medicare bill isn’t readily apparent.”
Hello. A) this proves my point on the micromanagement. B) It is readily apparent, because it expands the meddling way beyond Medicare.
Sebastian: the difference between Kerry’s proposal and the Prescription drug benefit is the difference between insurance and reinsurance — i.e., the difference between a program which (like the drug benefit) pays medical costs directly and one (like Kerry’s) where the government picks up part of the costs of insurance given by others, who themselves administer cost-containment programs. That’s a lot of the reason for saying that Kerry’s plan would not involve micromanagement by government: because insurance companies are already doing the things that (in the case of the drug benefit) need to be done by governement.
There’s a reason I said charter schools, not public schools. If we look at both, we find that sometimes government programs come with strings, sometimes not. The question, of course, is: which sort of program is Kerry proposing? I still see no evidence that it would come with the sort of strings that would make it remotely defensible to say that it takes health care officials away from doctors and gives them to government bureaucrats.
Finally, speculating about long-standing Democratic plans for health care isn’t evidence. Some Democrats decided in the wake of the failure of the Clinton health care plan that any changes to the health care system would have to involve incremental changes to existing and accepted programs. Others are still hoping for single-payer plans. We differ widely. Kerry is generally incrementalist, except for his catastrophic reinsurance plan, which is specifically designed not to involve the kinds of government control over individual health care decisions that Bush talks about.
When I am president, all Americans will be implanted with this so as to give me complete control of the nation.
What I want to know is where Kerry will get the allied bureaucrats in his secret medical plan. Germany’s and France’s are obviously quite busy.
What Sebastien’s argument mistakenly presupposes is that there is no rationing or bureaucratic control of health care in our present system. Obviously, Sebastien doesn’t work in health care, and is healthy, as anyone with even passing familiarity with our current system knows that’s not the case.
Tell ya what, my conservative friends: after you’ve wasted the better part of an hour talking to an idiot case manager about why your patient can’t have needed treatment, then you can come back and tell me how “evil” a single-payer and/or government controlled health care system would be.
after you’ve wasted the better part of an hour talking to an idiot case manager about why your patient can’t have needed treatment,
Or, in my case, go in for treatment only to find out a week after the fact that your HMO refuses to cover it. Laff riot, that is.
“then you can come back and tell me how “evil””
I’ll take ‘equally evil’ for $500, Alex.
Perhaps it would be less evil if you had the choice to leave your insurance company if they sucked. Perhaps that would be more likely if your employer didn’t mandate a provider to you. Perhaps that would be more likely if employers weren’t funding your health care.
JKC: That sure says it.
Two other true things. Bush has no plan, and his criticism of Kerry’s plan is dishonest.
How good is Kerry’s plan? I don’t know. But I’ll take someone honestly trying to deal with a problem over the do-nothing liar.
This Democratic Strawman fellow sounds like an intriguing candidate! If only he had a website….
What I don’t like about rationing or bureaucracy done by the government is that there will only be one rationing policy and one bureaucracy to deal with. I’m not a fan of monopolies – in business or in government, which is why I’m dumbfounded as to everyone’s excitement about building one for health care.
which is why I’m dumbfounded as to everyone’s excitement about building one for health care.
That’s because this one’ll be a caring monopoly 😉
“What I don’t like about rationing or bureaucracy done by the government is that there will only be one rationing policy and one bureaucracy to deal with. I’m not a fan of monopolies – in business or in government, which is why I’m dumbfounded as to everyone’s excitement about building one for health care.”
All the more reason to be glad that Kerry has not proposed creating one.
I’m not a fan of monopolies – in business or in government, which is why I’m dumbfounded as to everyone’s excitement about building one for health care.
Because it’s a natural monopoly, and functions better as a public administration based on maximizing quality of care for the greatest number of individuals for the best possible price rather than maximizing profits for shareholders.
I don’t understand the enormous amount of paranoia that I see exhibited by Americans when it comes to suggesting that government handles this service, especially when there are so many excellent examples of other governments doing it capably. And you trust the government to run the judicial system and the military, don’t you?
sidereal,
I agree, but how do you force this on people? I think anyone in CA will tell you that every driver is supposed to be insured, but they all pay for “uninsured motorist” coverage just the same.
Will emergency rooms be required by law to turn away those without health insurance? If so, how will that affect the Hippocratic Oath? Or, will the government simply assume that treating the uninsured would violate this portion of that oath: so long as the treatment of others is not compromised thereby,?
I don’t presume a lack of rationing. I presume that if you have insurance your make choices based on the what you want available. Government intervention typically homogenizes those choices.
crionna,
there are various models, but essentially the idea is that everyone is guaranteed emergency coverage. Doctors and ambulances don’t ever turn anyone away. Everyone is required to enroll in a medical plan (shopping around for whichever one they like) and those with lower incomes have their plans subsidized out of a central fund. Those who choose not to get a plan because they are idiots will have to be paid for out of something equivalent to an uninsured motorist tax, but the incidence of that should be low, because for anyone for whom the cost is onerous, there is subsidization, and because the legal requirement means you can tie it to things like getting a driver’s license, possibly even getting a job, etc.
Under this model the incentive to keep emergency events rare is on the insurance companies, just as auto insurance companies currently have an incentive to keep auto accidents rare, and spend a vast amount of money on safety standards testing and so on. Wouldn’t it be neat if there were a hundred-billion dollar industry deeply interested in keeping you out of the emergency room?
Elective and preventative medicine costs also come out of the plan, but obviously there’s no uninsured motorist equivalent there, since there’s no Hippocratic requirement.
well, i’m totally confused.
i thought the purpose of the Kerry plan was to drive down the cost of health care insurance by socializing the cost of caring for the chronically ill.
if insurers can shift most of the cost of the chronically ill to the US govt, then rates should go way down for a number of reasons. a. lower costs. b. lower uncertainty. c. increased competition.
Lower rates, and easier entry into the insurance market (for the self-employed and those with pre-existing conditions) should result in fewer uninsured.
now, i understand that the taxpayer is assuming a new cost. but it’s not like the care wasn’t being given and the costs spread around among those holding insurance policies.
look at this another way. the chronically ill and disabled exist. who should pay for their care, the fellow policy-holders or society as a whole? [what are you buying when you buy health insurance? bargaining power plus risk-sharing, it seems to me.] since a lot of these people are being dumped by their carriers and their costs socialized anyway, why not create a more rational system?
Francis
D-P-U,
Because it’s a natural monopoly, and functions better as a public administration based on maximizing quality of care for the greatest number of individuals for the best possible price rather than maximizing profits for shareholders.
You can make the case that people get a more egalitarian distribution of care under a nationalized health care system. That is enough for some – but not enough for me. You simply cannot say that the quality of the care is maximized.
Meanwhile, I have never witnessed a government agency minimize cost and maximize quality. Usually the opposite is true.
There are a lot of people completely fed up with the American system right now. Some are doctors – I know a few – who are so fed up that they’re trying new alternatives that address these problems. Such individual and distributed actions are impossible under a monopolized, nationalized system – therefore prohibiting anything innovative, effective or new. I’m not willing to pay that price with my health, or anyone elses.
I don’t understand the enormous amount of paranoia that I see exhibited by Americans when it comes to suggesting that government handles this service, especially when there are so many excellent examples of other governments doing it capably. And you trust the government to run the judicial system and the military, don’t you?
Most Americans I know – right or left, liberal or conservative – don’t trust the government. With things like the Judiciary and the Military, you throw up your hands and know that you have to do it this way. I look at Military procurement costs and start to cry if I imagine my health care operating in such a manner.
Meanwhile, I don’t want to have political arguments about health care. I want to choose a plan – or no plan. My aunt in Canada has been suffering with arthritis – and is now indulged pointlessly with homeopathic “care.” I don’t want to argue with these fruitcakes that homeopathic is greek for “doesn’t work” and is a waste of taxpayer dollars. I don’t understand why my mentally ill friend in Britain practically has to get arrested to get any care; whilst my mentally ill friends from the inner city were staying all-expenses-paid at santitoriums-for-the-stars.
I’m willing to get behind a government plan that gets health care to those who don’t have it because they can’t afford it. But I am not willing to have a stagnant, festering and corrupt one-size fits all system – and that’s what we’d get.
I’m as confused as fdl, and I started this thread. Who, exactly, is supposed to be talking about creating “a monopolized, nationalized system”, let alone “a stagnant, festering and corrupt one-size fits all system”? If anyone can give me any reason — any at all — to think that either candidate has proposed one, great. If not, why are we talking about it?
since a lot of these people are being dumped by their carriers and their costs socialized anyway, why not create a more rational system?
Exactly. As it stands now these costs are borne by hospitals and physicians, and are undoubtedly reflected in the rates paid by insured patients. So we have the absurd system whereby there is a tax on illness to cover the costs of the uninsured. If we’re going to pay for it anyway, and we are, why not try to be sensible about it?
Hilzoy,
If not, why are we talking about it?
DPU didn’t seem to understand why anyone would have opposition to government-run health care – and I was trying to get at my particular take.
That’s not to say that this has anything to do with Kerry’s plan, or what the experts said in their statement, so yeah, we may be derailing.
double-plus, just because medicine is as heavily regulated (and heavily protected) as utilities doesn’t mean it’s a natural monopoly. The monopoly aspect of modern medicine in the US is more an artifact of history than of a need for centralized infrastructure, as is clear when you look at poorer countries, and I submit that not only is medicine not a natural monopoly but that treating it that way does more harm than good.
I share sidereal’s POV. This is a recurring double-bind in complex systems, and in fact the name I use for it is “The Doctor’s Dilemma.” The doctor does not get paid to keep you healthy — she gets paid to treat you when you’re sick. That central fact places the doctor in a difficult situation.
Theoretically HMOs (and to a lesser extent insurance companies) mitigate that problem, but the fact that they are so heavily regulated apparently raises the barrier to entry and reduces their exposure to market forces so much that the desired effect isn’t showing up. Plus right now it’s barely possible for citizens to rock that kind of special-interest gravy boat, let alone tip one over. Just look what happened to the Clinton plans*, or ask yourself why we have so many banks and so few credit unions when credit unions do all the same things cheaper and better and more efficently.
I happen to think if there were lots of HMOs and it were easy to set one up this wouldn’t be a problem, but any way you cut it it’s a thorny issue.
Francis, that was a very lucid and thought-provoking explanation. Thanks.
Jonas, what are these ” individual and distributed actions” that your doctor friends are trying out? Not homepathy surely? 😉
* I’m not saying they were good plans, just that the Clintons had a mandate to rock the boat and didn’t do so.
The doctor does not get paid to keep you healthy — she gets paid to treat you when you’re sick. That central fact places the doctor in a difficult situation.
Which is why an excellent solution is a national health service where the doctor is getting paid to keep you healthy.
Ah. I see. Just so we’re clear.
Personally, I think our health care system (the part about payment, not the part about the wonderful medical advances) is so badly broken that a lot of options that I would not normally prefer start looking like improvements. We are, as fdl said, already paying for the uninsured, just indirectly, via hospitals passing on the costs for their care to other customers. Doing it this way is obviously worse for the uninsured, who would be better off not having to get seriously ill before they can see a doctor; it’s worse for us, both in terms of cost and of having contagious disease around; it’s worse for anyone who needs to use a hospital emergency room because of, well, an emergency; in fact, it’s hard to think of anyone who wouldn’t benefit by finding some better way of doing this, preferably one involving access to preventive care.
Jonas: Meanwhile, I have never witnessed a government agency minimize cost and maximize quality. Usually the opposite is true.
Canada’s government-managed healthcare system seems to refute this. Our per capita expenses for care are about half of the US system ($2,163 USD per individual in Canada compared to $4,887 in the US), while our level of care is practically identical (our life expectancy is higher than the US, and our infant and child mortality is lower).
My aunt in Canada has been suffering with arthritis – and is now indulged pointlessly with homeopathic “care.” I don’t want to argue with these fruitcakes that homeopathic is greek for “doesn’t work” and is a waste of taxpayer dollars.
Not sure why you’re bringing this up, as homeopathic care isn’t covered by our system (user pay if you want to waste your money on it). Additionally, my mother suffered one of the most crippling forms of chronic arthritis that her physicians had seen, yet received excellent care, including hip replacements, all for free. My sister also suffers from the same malady, and is also receiving excellent care.
Radish,
Most involve dropping support for insurance completely. It’s at the point where Doctors can make more money by simply not bothering to hire dozens of people filing paperwork. Afterwards, their costs drop to the point that their rates actually look reasonable. They generally then retailor their services so that they are more convenient and competitive.
Ironically, I heard about a homeopath who did this, and is doing quite well… unfortunately.
I pass on Brad DeLong’s take on this. Hard to believe that this was almost half a year ago when Brad wrote it. I’m glad that the Bush administration, in conjunction with our national media, has worked so hard to make sure that Americans understand these kinds of options and the relative merits of each…
Radish: .. I submit that not only is medicine not a natural monopoly but that treating it that way does more harm than good.
Then why, of all the industrialized nations, does the US have the poorest record on caring for the health of its citizens in terms of a cost/benefit ratio? I submit that it’s because most other industrialized have a nationalized healthcare system.
“Personally, I think our health care system (the part about payment, not the part about the wonderful medical advances) is so badly broken that a lot of options that I would not normally prefer start looking like improvements.”
But the medical advances part is hooked quite closely to the fact that medical practice is highly renumerative. Which is to say expensive. My problem with most Democratic plans (especially with respect to drugs) is that they pretend that an environment of numerous medical advances is a baseline to build upon, without realizing that they often undercut it with their policies.
But that only has to do with Kerry’s plan, because it is, as you say, “Some Democrats decided in the wake of the failure of the Clinton health care plan that any changes to the health care system would have to involve incremental changes to existing and accepted programs. Others are still hoping for single-payer plans.”
Note exactly what you say. Not that some Democrats decided to change their idea of attempting to implement a government-controlled program. But that they decided to change their method of persuing that goal to incremental changes in existing programs. The goal is bad, so I’m not thrilled with Kerry’s incremental steps toward it.
Furthermore the plan is poor in its own right as I mentioned above.
BTW, what qualifications are likely in a health care plan if not qualifications on the type and cost of care?
D-P-U,
The per-capita expenses you detail are compelling – but life expectancy and infant mortality are not. Both life expectancy and infant mortality are far too dependent on behavior, as opposed to treatment, for it to be a meaningful metric. The second I see some studies with some very targeted statistics, I’ll definitely have an open mind about it.
She must be so hopped up on homeopathic goofballs to be able to tell anymore, I guess! In any case, my point still stands – I do not want to have political debates, or select candidates, based on the type and manner of care I’d like to have. Individuals selecting the plan they want at least theoretically can accomodate more preferences and choices.
But… but… it’s not free!
By the way, for those of you opposed to expanding health care coverage, go read Gary Farber’s blog and tell it to his face.
Sebastian: I meant: they gave up on the entire idea of one big fix and opted for smaller fixes to immediate problems. It’s not part of a secret master plan, and if it were, I’d expect opponents of its later steps to be able to defend their views.
Qualifications: well, it says on the web site.
Both life expectancy and infant mortality are far too dependent on behavior, as opposed to treatment, for it to be a meaningful metric.
True, but you have to agree that those statistics are certainly strongly influenced by healthcare. On top of that, as government has a strong incentive (keeping healthcare costs down) to encourage healthy citizens, government programs tend to stongly promote preventitive strategies. For example, there are universal outreach programs to care for infant health, and other programs to encourage good excercise and nutrition. These programs, while not specifically part of healthcare, are a resulting benefit of a nationalized healthcare system.
The second I see some studies with some very targeted statistics, I’ll definitely have an open mind about it.
Here you go. A PDF joint report on Canadian and US healthcare systems. Key findings are the interesting bit.
But… but… it’s not free!
It was as far as we were concerned.
“Our per capita expenses for care are about half of the US system ($2,163 USD per individual in Canada compared to $4,887 in the US)”
I’d be curious to see the breakdowns, but I can think of a few good reasons:
a) The US pays for a vast majority of the medical R&D in the world.
b) The US hybrid Medicare/Medicaid/Employer funded/private insurance/HMO/insert acronym fiasco is extremely expensive to wade through.
“while our level of care is practically identical (our life expectancy is higher than the US, and our infant and child mortality is lower)”
Actually, if you adjust for race, that’s not true. Caucasians in the US and Canada have equivalent life expectancy and infant mortality rates. African Americans have a lower LE and something like a 10% infant mortality. The same is true of Canadian aboriginals. Whether that’s genetic or socioeconomic, I dunno. But the country within which you receive your care is not a factor.
Great link, ++-good. Once again, Americans prove we can out-fat-slob anyone.
I’d be curious to see the breakdowns, but I can think of a few good reasons:
a) The US pays for a vast majority of the medical R&D in the world.
b) The US hybrid Medicare/Medicaid/Employer funded/private insurance/HMO/insert acronym fiasco is extremely expensive to wade through.
Here’s an article on Wikipedia about that. Canada also has a fair bit of R&D costs as well. We’re doing a lot of stem-cell research right now for some reason…
I don’t have the references at my fingertips right now, but I seem to recall that about 25% of US healthcare costs are dealing with bureaucracy, while the Canadian system has around 10% or so. Alos, a signifiicant proportion of US costs go to insurance company overhead like advetising, while only a miniscule proportion of that is spent in Canada.
Our drug costs and healthcare professional salaries are also lower.
Ah, marketing. That’s the one lever that a government monopoly has that the free market can’t beat. 0$ for marketing.
But if there’s suddenly a requirement for massive direct to consumer marketing by health insurance companies, it’ll require a lot of advertising. Television advertising costs will go up and they’ll look for alternative means. Where will that money go? The blogs, that’s where.
Dibs on medical-insurance-pundit.com
On top of that, as government has a strong incentive (keeping healthcare costs down) to encourage healthy citizens, government programs tend to stongly promote preventitive strategies.
You see a benefit, I see a slippery slope. What few government programs we have currently for health care are being used as an excuse to micromanage the health choices of their citizens – regarding food, tobacco, etc – in order to lower costs. I find this unacceptable. To me, the public health begins and ends with preventing epidemics and providing care to those who don’t have it. If your health is not a private matter of liberty, I’m dumbstruck to tell you what else is.
A PDF joint report on Canadian and US healthcare systems. Key findings are the interesting bit.
Sorry friend… it’s a poll. I’m looking for very targeted studies, detailing actual levels of care and measuring its effectiveness, the habits and demographics of the patients, and expenditures, dollar for dollar. That would end this debate for me.
The Bush position on this is absurd, and I’ll tell you why. Even if we assume for a moment that participation in the Kerry plan will result in fewer choices for those insured under policies covered by his system it doesn’t translate into an increase in restrictions in the whole system.
We live in a free market economy and if the restrictions placed on plans are significant the market for premium plans that don’t carry those restrictions will grow. The only two things that the Kerry plan will change are 1) better coverage for those who can least afford it 2) an increased demand for premium insurance plans. To think otherwise is to assume that our economy has lost the ability adapt to changing market demands. Has Bush lost faith in the economic roots of the United States? Or is he just spewing propaganda that isn’t supported by the facts?
Ah, marketing. That’s the one lever that a government monopoly has that the free market can’t beat. 0$ for marketing.
The FDA could do that today. I’m tempted to say they ought to – while bringing back that prohibition on pharma advertising that I had the pleasure of living under for most of my life.
I find this unacceptable. To me, the public health begins and ends with preventing epidemics and providing care to those who don’t have it. If your health is not a private matter of liberty, I’m dumbstruck to tell you what else is.
So you see things like helmet and seat-belt laws and vehicle safety regulations as infringing on your liberty? I see those as the same kind of thing. And I don’t see my government encouraging me to exercise, eat right, and making me look at gross medical pictures on cigarette cartons if I choose to smoke as much of an infingement on my liberty.
After all, it’s not like we’re being forced to do jumping jacks in front of the telescreen. The government is still accountable at election time for their policies, and healthcare is extremely high in most Canadian’s political priorities. Which is why we continue to have the system that we have. We like it.
To each their own, I suppose. I just like paying less for quality healthcare.
“that prohibition on pharma advertising”
I can’t figure out if they still have that fun rule where you’re either allowed to say the name of the drug or what it does, but not both. Like ‘There’s a new drug out that cures asthma and diabetes. It’s awesome. Ask your doctor about it’ or ‘Lipizene is awesome. Totally awesome. Ask your doctor about it’.
I don’t watch commercials anymore, so I miss out on that fun.
“So you see things like helmet and seat-belt laws and vehicle safety regulations as infringing on your liberty?”
I’m butting in, but yes. If the rationale is that seat belts prevent you from flying out and hitting other people, well that makes sense. If it’s to prevent you from killing yourself, it’s an infringement on liberty. I’m pretty sure it’s the latter. The problem is that the government, the organization that makes law, is also, in this case, the one with a vested interest in keeping medical costs down. That allows them to pass laws with that goal. That’s horrible.
I believe the ideal is that you and your insurance company have an interest in keeping your medical costs down. And part of your medical insurance policy can stipulate whether you wear your seat belt, drive a safe car, or whatever, and that affects your premium.
One other problem with employer mediated health insurance, as long as I’m bludgeoning it all day, is that there’s a flat rate per employee, so the premium can’t be catered to the lifestyle of each person. If you want to smoke 10 packs a day and ride a motorcycle without a helmet all night, great, but you’ll be paying your insurance company for it.
“I see those as the same kind of thing. And I don’t see my government encouraging me to exercise, eat right, and making me look at gross medical pictures on cigarette cartons if I choose to smoke as much of an infingement on my liberty.”
Probably not, but it’s really expensive. Money that could go to. . you know. . feeding people who are starving.
So you see things like helmet and seat-belt laws and vehicle safety regulations as infringing on your liberty?
Helmet and seat-belt laws? Yes. Vehicle safety regulations – no. Cars and roads are a heavily regulated system for the safety of all those involved collectively, and that’s fine by me. But helmets and seat-belts are just straight-up nannyism – and I say this as a person who wears both. Not to mention something that erodes respect for the law, which is a pet-peeve of mine.
And I don’t see my government encouraging me to exercise, eat right, and making me look at gross medical pictures on cigarette cartons if I choose to smoke as much of an infingement on my liberty.
All these particular things, as far as I’m concerned, are up to the individual, preferably with the consultation of a physician or another expert of their choosing.
What does “eat right” mean? Hint – the government will never be able to figure it out. Different schools of diet faddism will battle to the death at who gets to peddle their religion on the people’s dime.
It is a basic premise of liberty not to have the government using your money and the authority of law to try to influence what should be completely private matters of individual choice.
The government is still accountable at election time for their policies, and healthcare is extremely high in most Canadian’s political priorities.
I do not want my diet, or ability to make private health decisions, dependent on the successful election of politicans who agree with me.
Don’t mind me, I’m just cranky I can’t have unpasteurized milk or cheese… because I’m incapable of making that decision for myself, apparently.
To each their own, I suppose. I just like paying less for quality healthcare.
Bet I pay less than you 😉
I’m butting in, but yes. If the rationale is that seat belts prevent you from flying out and hitting other people, well that makes sense. If it’s to prevent you from killing yourself, it’s an infringement on liberty.
If I am killed, no problem, I have no objections. But if I am crippled for life because I didn’t want to wear a bike helmet, then my future care is a cost that society must bear. That doesn’t seem fair.
Even if you have insurance, then that cost is borne by future policy-payers, or by company shareholders. While that may be marginally more fair, there is still a cost because you didn’t want to muss up your hair. Or because you wanted to make an abstract point about liberty.
And if you don’t have insurance, then the cost is once again borne by others.
I think having the state encourage healthy practices is still the best route.
Speaking of liberty… This may be off topic, but while some may be saying that liberty is infringed by a nationalized healthcare system, my healthcare-overseeing government allows me to travel to any country I want to, see boobs and other naughty bits on public television networks without making a fuss, marry whichever gender I wish, smoke marijuana if I choose to, and will not kill me under any circumstances. Seriously, put this in perspective. Government initiatives to improve public health are not an infringement, nor a slippery slope toward state control. It’s simply good government.
I don’t watch commercials anymore
You know they’re coming for you…
If it’s to prevent you from killing yourself, it’s an infringement on liberty. I’m pretty sure it’s the latter.
Does that mean you’d support a referendum, say, to remove seat-belt laws from the books?
“But if I am crippled for life because I didn’t want to wear a bike helmet, then my future care is a cost that society must bear. That doesn’t seem fair.”
No, your insurance company pays for it (remember, in Utopia, health insurance is mandatory), which leads to..
“Even if you have insurance, then that cost is borne by future policy-payers, or by company shareholders”
That’s right. Which is why, if you are the sort of person who rides a motorcycle without a helmet, their actuary tables will decide that you need to pay them a lot of money every month and your medical insurance costs will probably be crippling. They might even refuse to cover you, although there’d be reams of regulation about that. And to keep you honest there’d be clauses built into the contract about penalties if your situation is triggered by a non-helmet-wearing incident, yadda yadda. Lots of lawyers. The important thing is, it’s your choice whether riding without a helmet is worth the cost to you or not (beyond the obvious cost of your life, because you’re a suicidal buffoon).
“while some may be saying that liberty is infringed by a nationalized healthcare system…”
I’d say on the whole Canada has more liberty than the US. For some reason American Libertarians focus excessively on economic liberty and pay comparatively little attention to social liberty (which is why any random group of Libertarians will be about 80% conservatives who just like to be contrarian).
Regardless saying one thing is good does not mean another thing isn’t bad. You could privatize health care and education and have SUPER liberty!
“Does that mean you’d support a referendum, say, to remove seat-belt laws from the books?”
Yes. On its own merits, I don’t think it’s a big deal. I and everyone in my family always wear seat belts, and it’s a good idea, so it’s hard to generate a lot of outrage about a law that makes you act smart. But on principle I’m opposed, and seat belt laws are notorious (at least around here) for being essentially arbitrary justifications for being pulled over and inspected by the highway patrol, which I very much do not approve of.
D-P-U,
Society, through government, must bear costs all the time that are directly attributable to the liberty of its citizens. Restriction of liberty and choice on this basis opens the door to any restriction of any and all behavior.
It is quite clear that many more physically taxing sports (American football, perhaps hockey) cause the participants much permanent and chronic injury that drives their health care needs up. I don’t care about these sports, or many at all, so why don’t we prohibit these completely unnecessary activities to reduce these unfair costs?
Let’s say you were only allowed to build one kind of house. One design means no need for costly government approval of the design. One design means economies of scale that will save people money! One design means we can prohibit fireplaces, wet bars, and other aspects of homes that increase costs borne by society.
I’m unaware of the ideological distinction that can be drawn to preclude the ridiculous examples I just gave. Meanwhile, preserving the right to smoke marijuana you mentioned on your list of Canadian liberties is likely completely dependent upon adopting a stance similar to the one Sidereal and I are advocating – that it is your choice and not the governments business whether it’s good for you or not.
Sidereal,
Tempting to think that sometimes, but man, you read something like this and you just have to start crying.
I don’t have any particular problem with striking nanny laws, so long as a mechanism exists to capture, roughly, the worst of the externalities.
And i don’t have a clue how to capture the externalities of riding a motorbike without a helmet. If all the people in California who wanted to ride bikes w/out helmets came together in one insurance pool, the rates would likely be astronomical (ok, i’m guessing — i have no evidence at all for that statement). how many of that crowd would be willing to pay for that policy? and who should pay for the cost of the jerk who doesn’t buy the policy and gets brain-damaged? other bike riders? all other users of the roads (ie, pay at the pump no-fault insurance)? society at large (more or less the current system)?
the free-rider (ooo, good pun) problem is really bad when it comes to accident insurance. hence nanny laws.
Francis
p.s. i heard a story that one advantage of helmets is that the edge will break the rider’s neck in a bad fall, thus killing him and saving society the cost of another parapeligic. any truth or urban legend?
Jonas: “something like this”
Aaaarrrggh. I wag my finger at you reproachingly, Canada.
fdl: “any truth or urban legend?”
Heck, if that were a good rationale, we could just arm paramedics with ballpeen hammers, and they could make a judgement call about how expensive this particular injury is going to be. Very Clockwork Orange.
Heck, if that were a good rationale, we could just arm paramedics with ballpeen hammers, and they could make a judgement call about how expensive this particular injury is going to be. Very Clockwork Orange.
Reminds me of the discussion I heard on Public Radio once. The issue was anti-aging medicine – essentially asking whether hypothetical treatments that radically extend the human lifespan are good or bad. On the “this is bad” side was a gentleman who placed at the center of his argument that life-extension drugs would bankrupt social security.
Let’s save social security! Hand me a ballpeen hammer!
to return to the principal theme of the thread,
why is reinsurance by itself a bad idea? yes, it is possible that prohibitive conditions could be attached, in which case the employer would tell the govt to pound sand and no one is worse off.
let’s compare health care with education for a second. Some school districts, like LA Unified i’ll bet, spend huge sums of money educating a small number of kids with serious problems: no english skills, broken family, ADHD, autistic etc. I’ll bet that there are suburban districts across California which spend a much smaller fraction of each educational dollar on the problem kids, freeing up the rest of the budget for educating mainstream kids.
I think that sucks. Having a close friend with an autistic kid, I see the tremendous resources he demands. Should he be stuck in a warehouse program, never to develop life skills, or should the state invest substantial dollars (a) just because its the right thing to do and/or (b) so he might someday become a taxpayer instead of being a liability. I don’t think anyone will be surprised where i come out on that issue.
but then the question is who pays? the district or the state? the kids in districts with a high percentage of problem kids or taxpayers as a whole? and really, we are asking the same question about health care. How wide of a pool should be paying for high-cost people, and by what mechanism?
i know nothing about NCLB, so i don’t know if it is intended to address high-cost kids by providing federal dollars. but i have heard a lot about unfunded federal mandates.
but the current system of health care insurance, with all the dumping of patients and the grilling regarding pre-existing conditions and preventing the free mobility of labor due to the need to keep coverage is just NUTS. seems to me that reinsurance could solve a lot of those problems.
Francis
Then why, of all the industrialized nations, does the US have the poorest record on caring for the health of its citizens in terms of a cost/benefit ratio? I submit that it’s because most other industrialized have a nationalized healthcare system.
Hm. I suspect that the causal relationship isn’t all that clear, but I’m not well enough informed to disagree with any confidence. Income and/or access inequality? Poor diet? Overuse of heroic measures in hopeless cases? How bout if I just think out loud?
I’m a pretty hard-core decentralist, and uncomfortable with policies that solve problems by fiat instead of by natural selection. As attractive as single-payer solutions are in some ways, they rub me the wrong way.
There are plenty of problems that really do benefit from centralized solutions, but they’re the exceptions rather than the rule and the Kerry plan definitely has some of that flavor (though for some reason I’m not feeling too particular this year ;-). So it’s more that I’m down on single-payer than firmly opposed to starting down the slippery slope Jonas and Sebastian are worried about.
That said, the Kerry plan strikes me on the whole as a net winner. At the very least it’s a good faith effort with a couple of ideas I can totally get behind (rebate pool, let states negotiate), a couple more that I’m cautiously enthusiastic about (FEBHP, quality bonus) and a couple I plan to actively oppose (tech bonus, details of malpractice plan). And Frances’ summary rocked…
Whether that’s genetic or socioeconomic
IIRC net worth is almost perfectly correlated to health over large samples… Too lazy to look it up though.
interesting debate…
Aaaarrrggh. I wag my finger at you reproachingly, Canada.
While to lazy to click the link, I assume this is in reference to the “fifi” fine.
While I have no real problem with fining homophobes for slurs, and double that for automobile salesmen, I agree that it isn’t the solution. And I’d think that most Canadians agree that this is over-the-top. Expect it to be appealed.
Hm. I suspect that the causal relationship isn’t all that clear, but I’m not well enough informed to disagree with any confidence.
There’s some useful statistics here.
I’d say on the whole Canada has more liberty than the US. For some reason American Libertarians focus excessively on economic liberty and pay comparatively little attention to social liberty (which is why any random group of Libertarians will be about 80% conservatives who just like to be contrarian).
I’m sorry, my point was unclear. I wasn’t crowing that Canadians have more liberties than our bretheren and sisteren (?) Americans, my point was that Americans daily accept a great deal of intrusions on their individual liberties without too much complaint, yet the thought of national healthcare evokes horrific images of forced diets, exercise programs, and East-Berlin-like medical clinics.
I don’t get it.
On its own merits, I don’t think it’s a big deal. I and everyone in my family always wear seat belts, and it’s a good idea, so it’s hard to generate a lot of outrage about a law that makes you act smart. But on principle I’m opposed, and seat belt laws are notorious (at least around here) for being essentially arbitrary justifications for being pulled over and inspected by the highway patrol, which I very much do not approve of.
On what principle do you distinguish between seatbelt laws and, say, speed limits or traffic lights?
[I’m not trying to trap you or anything — I think I can guess how and it’s a reasonable enough principle — I’m just trying to get a sense of how and where you’re drawing the line.]
There’s some useful statistics here.
Thanks, though the press release doesn’t really address what I’m asking. I’m not disputing that the US system sucks rocks, I’m just skeptical that nationalizing is a safe way to fix it… I don’t know that I’m interested enough to really educate myself by wading through country data at the WHO site — will poke around some I guess.
I don’t get it.
touche. point taken 😉
“I’d say on the whole Canada has more liberty than the US. For some reason American Libertarians focus excessively on economic liberty and pay comparatively little attention to social liberty”
Not if you count freedom of speech or of the press as social liberties. Both are far stronger in the United States.
“On what principle do you distinguish between seatbelt laws and, say, speed limits or traffic lights?”
Potential to harm others.
Not if you count freedom of speech or of the press as social liberties. Both are far stronger in the United States.
Not this election cycle they aren’t. Free speech zones, anyone?
No, even with the free speech zones concept, the US has much freer speech and freedom of the press than Canada.
No, even with the free speech zones concept, the US has much freer speech and freedom of the press than Canada.
As a friend of mine was turned away from the US border in the 1980’s because he had a copy of Emma Goldman’s “Living My Life” in the car, I’d have to disagree.
And it was published in the states too.
Freedom of the press? Try showing a nipple on TV and see what happens.
Yeah, nobody in Canada ever gets in trouble for stuff that they broadcast.
Not that I’m defending the FCC, because I’m not. But Canada’s certainly got its own idiosyncracies about this stuff.
i heard a story that one advantage of helmets is that the edge will break the rider’s neck in a bad fall, thus killing him and saving society the cost of another parapeligic. any truth or urban legend?
Thanks for your concern Francis, but that’s an urban legend.
However, if you’re looking for that type of story for your argument quiver, its true that the leather suits worn by sportbike riders tend to keep body parts together in a canyon accident where the bike and rider go off into the trees. No searching for arms and legs. So that saves a little money right there.
Here is an article with some stats and refs about Traumatic Brain Injury with some discussion about helmet and injuries. The costs associated are quite mind-boggling.
Oof. Speaking of liberty, do you guys know that if you come visit me in Canada, smoke a Cuban cigar here, which is legal under Canadian law, and then return to the US, you can be fined a quarter million dollars and go to jail for ten years?
Harsh. Even though I don’t smoke, I’m tempted to light up a Havana just to celebrate my freedom to do so. If only it weren’t for the Canadian government’s intrusive anti-smoking campaign. 🙂
Try showing a nipple on TV and see what happens.
Tried it. Nothing happened.
I interpreted dpu as suggesting that self-censorship is rampant — and more than a little bit hypocritical — in the US compared to CA. not that the laws are more restrictive as such… was that not the point?
I interpreted dpu as suggesting that self-censorship is rampant — and more than a little bit hypocritical — in the US compared to CA. not that the laws are more restrictive as such… was that not the point?
Don’t remember, all this nipple talk has left me a bit woozy.
Wait! No, my point was that the discussions about liberty were a bit abstract, as Americans seem to pay little attention to actual infringements of their actual liberties on a daily basis, yet get worked up over perceived invasions of liberty in the form of national health coverage, even if it seems cheaper and more effective than other systems, and provides the same or more freedom to the individual.
Yeah, that was it. The cuban cigar thing was just because I’m increduluous that you guys put up with that nonsense. Ten years in prison and a quarter million fine for smoking a cigar in another country! Unbelievable.
Show me someone prosecuted like that and I’ll show you another fun part about the system–jury nullification.
Show me someone prosecuted like that and I’ll show you another fun part about the system–jury nullification.
Free Tommy Chong!
dpu: Tommy has been freed wednesday july 7th 2004. But the example still stands IMHO.