[TheForge] OT Marginal Blacksmithing Question

[Justin Fellenz]

All

> I hope this doesn't get me thrown off this list or worse! 

I've been trying to lay out of this political stuff but as an expat
canuck with three doctors in the family, I'm getting sucked in. I agree
wholeheartely with what Mike said earlier, that business is not
appropriately mixed with health care. But self-interest can't be
extirpated from any arrangement that involves resources. As far as I'm
concerned (and this is where my lefty-libertarian side comes out)
governments are there to do without prejudice what no less monolithic
organization could do, and should otherwise stay out of people's lives.
Which self-interested corporation would build an interstate system,
fund national parks, maintain a military, or support a old-age stipend
or other social safety net? There's not much profit in these things
except the far-reaching utility of facilitating the transportation
necessary for business and defense, protecting resources for vague
benefits like "pleasure," "biodiversity" or "beauty," protecting the
country as (theoretically) opposed to a given corporate interest within
it, and having people not die of starvation in the streets. Like Mike I
am pleased to pay my taxes in return for these things. I get less and
less pleased when I see that less and less of the money I fork over
comes back to me or my fellow citizens.

Most of us are mostly ok at least in concept with the national parks,
the existence of the military, the national road system. Few people
think those are "socialist." But it gets tougher when the microscope
narrows to welfare and we see individuals milk the system. But like
democracy, which is both inherently flawed and the best option so far,
most of agree that at least some people are rightly taken care of by
the state. Like Sodom and Gomorrah, which were (almost) spared for a
few righteous people, most of us agree that it's wrong to reduce the
people who deserve our help to the lowest common denominator deserved
by those who rip off the system. Fact is, they always pull the rest of
us down.

So the Canadian healthcare system is much like welfare, in that it is
based on the idea that it makes sense to keep everyone healthy and that
some people really can't afford it. That's perhaps even more true with
healthcare than with welfare. The logic of some kind of universal
"insurance" is either that we hate to think of people dying for lack of
a few dollars, or for the solid strategic reason that sick people don't
produce--it's cheaper to keep them healthy than to lose their tax
revenue and other dividends. The latter is the only only one acceptable
here, but it's probably the real driving force there, too. The problem
is that in both countries "business" always creeps into the gap between
the macro and the micro: the society as a whole as represented by the
government has farsighted reasons for universal health care, but the
individuals at all levels, from hospitals down through individual
doctors, have personal goals that compete with and ultimately supercede
the overarching goals. Doctors come out of med school with huge debt
and huge payments and they need to feed their families, and they want
to do it as well as possible. Charity begins at home, so things happen
like office visits get charged as "consultations" for significantly
more money as an antidote to decreasing payouts and fixed or rising
expenses. Same thing happens here. The Candaian system as a whole is
configured to run at equilibrium rather than for a profit so when a
sub-element of the system pulls more money out than it should, it runs
up to the top as a detriment to the system as a whole.

Down here in a for-profit system the result is scumbag insurance people
who do everything they can to take the up-rolling losses and put them
back down to the bottom by charging more and refusing service based on
risk or technicality, usually to the very bottom, the people who can
least afford it. Again, in this country we can only really talk about
individuals, so it makes sense to make "high-risk" "individual" "take
responsibility" for their burden on the system. In Canada, we can talk
in terms of the systems without having Rush Limbaugh scream the dreaded
S-word, so the same internal losses result in a generalized lower
standard of care. Which is better? Which is fairer? Should the rich be
penalized in their health care for the poor's inability to pay for it,
or should those who can't afford a very expensive service bear their
inability to succeed financially all on their own? According to
currently fasionable principles of anti-socialism, it should be the
latter. But when you're sick and broke you don't need high-sounding
lectures on what you could have done without yourself in the land of
opportunity. You just need help. To me, that's what countries and
governments are for, to help out citizens when it's in no other
individual's interests (or within their means) to do so.

I have been lucky enough to have been working for companies that
subsidized my health care since I got out of school (and lucky enough
not to have gotten sick before that). I have found that health care
down here has been superb, but I recognize how lucky I am to have had
access to it. When my mom had a knee replacement screwed up twice in a
row in Canada--after long waits for the surgery both times--before she
came here and had it done right. She again was fortunate enough to be
over 65 and therefore under medicaid (she had paid her dues working
down here as a younger woman). Even with that, the additional insurance
meeded to make it not financially crushing for both of us was still not
cheap. Luck again that between the two of us we could afford it. 

Fact is, looked at without prejudice socialism is a lovely idea, just a
big word for cooperation. But like Lynn says, who can fault anyone for
wanting to look after their own? And doing that when two people want
one thing is the source of competition. Unavoidable. So there's a
balance to be stuck, and the economic right and left are just different
sides of the balance point, not one side or the other of the spectrum.
It's a subtle and complex thing that usually gets dealt with in binary
emotionalized terms. Fact is, few of us would want either side
untempered by the other.

I still think that health care should be state-run. Not, maybe, the way
it's been done in Canada, but if you want something to be run
equitably, as flawed as the government is, it's the most likely to do
so. It's not like you don't pay for health care (beyond taxes) in
Candada--the more you make, the more you pay, but if you make nothing
you still get care. Seems right to me. 

I think, for this country, there's another way to frame this that's
more business-focused. As I said above, it's probably cheaper to keep
people healthy than have them be sick. But more to the point, for most
of us on this list--and speaking as someone who plans on being
self-employed in the near future--it seems that a universal health care
system would remove a huge disincentive to self-employment and
ultimately result in more jobs and growth, given that some large
percentage of the jobs and economic power in the country already comes
from small business. Right now, if you dont work for a big company
you're screwed. You're slightly less screwed if you dont do anything
and just suck the system. But for those of us who want to work and
produce for our families, communities, and ultimately our country,
being saddled with health-care costs that are next only to housing
costs and with the risk of financial or physical ruin if the insurance
companies don't play, well, that seems pretty much counter to the
American ideal of the power to the people. Supporting small business by
reducing the risk that you'll get crushed by an injury or illness you
cant afford to fix or a debt you can't pay seems like it would benefit
everyone.

Comes down to which end of the money spectrum you identify with and who
you want to support--or whose propaganda and buzzwords you buy. Fact
is, it sucks in both countries unless you're rich. The rich profit more
here, the poor, on the scale of things, do better there. Inefficiency
and dishonesty plague both.

In the end I guess it comes back to Reis's comment about armor, that
the myth of the grassroots is alive but the lawn is rolled sod on a
truck bound for who knows where. Guess you can't trust anyone but the
people you'd share your dinner with.

JRF


I think
> Mike is
> correct. "Single payer" seems to be the only thing that can be
> considered.
> Business's are in the health care for one reason only, to make money.
> Otherwise why risk the start up costs?
> I don't think anyone could fault them for that but the methods to
> gain new
> customers are intended to deceive.
> That's the way they have chosen to maximize profits.
> 
> I know there's lots of smiths from Canada on this list. Can we here
> from
> them on how much they hate their system and wish they has the care
> that the
> US has?
> 
> Timidly, Lynn
> 
> 
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