(1) Our mutual discussion, which has been endlessly enlightening and enjoyable, seems to have moved from the health care reform issue to much broader philosophical/political issues that people have been debating for centuries with no resolution. This isn't really helpful in helping us to decide what we should do about health care here and now, and I think we should try to move discussion back to the specific problem of health care reform. Regardless of your political persuasion, what do you think can be done to make health insurance more affordable and avaialble to everyone? So we don't have 50 million uninsured, amother 50 million underinsured? To keep medical costs from rising so fast that companies can't afford to provide insurance, and to ensure that people aren't bankrupted by medical costs even though they had insurance? The fact is, like it or not, the system we have in place is what we have to start with, so how do we make things work better (which, to me, means more predictably, affordably, and equitably)?
(2) Some of the more general political issues raised take the form of canards that are not really true, and shouldn't be allowed to pass unchallenged: introducing them into the discussion only muddies the waters. Just a few that I have noticed saiing by in past postings--and I bring them up NOT to provide a "definitive" rebuttal or to open the broader issues for debate yet again, but simply because I want it on the record in our mutual discussion that these things are NEVER so simple as the sound bites/canards would have it:
- (a) "Redistribution" is a bad thing...Obama wants "redistribution", etc.: Well, let's see, if 100,000 people pay for fire insurance on their homes but only 100 people in that group have their homes burn down...they get to collect the insurance for their casaulty, while the other 99,900 merely pay their premiums, that's (horrors!) redistribution. So I assume that Bruce and others who rail about this sin have long ago cancelled their fire insurance and now self-insure? Or maybe redistribution isn't always such a bad thing? In which case, let's drop this canard. Do I hear conservatives complaining about what is usually called "corporate welfare," or huge government subsidies or tax breaks to various industries (sugar, dairy, cotton, motorcycles), which also amounts to "redistribution", from the lower part of the income pyramid to the upper parts? Not usually, so it seems that redistribution is only a problem in their mind when the money is going from the rich to the poor, not the other way around.
- (b) Government can't manage anything as well as private business: social security (broke), medicare (broke), etc. as examples: well, again, not so simple. First of all, I seem to recall lots of companies that have gone broke/bankrupt over the years--remember Enron? TWA? American Motors? Pan Am? --at least some of which also pillaged their workers' pension funds on the way down, or defaulted on pensions of workers who had been loyal to them for decades, leaving them without the retirement pension they had earned. So mismanagement is just as much a private as a public quality. Second, the problems with Social Security and maybe Medicare are fixable. For SS at least, if we raise by a few years the age at which one can begin to collect benefits (and thus extend the time in which workers have to pay into the system), we can I think put it on an OK footing. The problem with SS is not really mismanagement but demographic change: people are living in 2009 much longer than they were expected to in the 1930s when the system was created, and population growth has slowed, so the system has gotten increasingly out of kilter: too few workers supporting too many retirees, for too long. Congress can solve it by changing the payout age; you can say it's mismanagement that they haven't made these changes, but then as I said many private firms similarly failed to make changes and were bankrupted by their original assumptions. Medicare faces different something similar, perhaps, augmented there by the fact that the cost of health care (PRIVATE!) is skyrocketing--so how is that the government's fault? Anyway, I think it's just too simple, and misleading, to say that "government = mismanagement." So let's drop that canard too.
- (c) Government regulation makes business inefficient, etc.: but one can just as easily argue the opposite, that our problem is not too much government regulation of business, but too much business interference in government. As Christa pointed out, if you visit Europe today you find that many systems there (public transportation, health care, etc.) are superior to ours in terms of providing a good basic product fairly to everyone at reasonable cost. This enhances the quality of life of everyone there. We lack the same level of quality in these arenas (transit, health care) because the private industries affected by them have warped the political process. The pretty good light rail systems that most large and many smaller American cities had until the 1950s, for example, were axed in the '50s and '60s because the oil, auto, and tire industries jointly hired high-powered lobbyists to suborn the city councils of those cities so they would scrap their light rail and buy, instead, buses. This is a well-documented fact. So now, instead of a cleaner light rail network in our cities, we have a polluting system (perennially underfunded, too, because everyone was encouraged to buy a car, so no one wanted to use public transit any more). The same thing is happening now in the health care debate: the insurance companies, hospital corporations, and pharmaceutical concerns are pouring billions into lobyying to thwart change to a system that is making them rich and bankrupting everyone else. And many of their talking points/scare tactics are showing up in our own discussions: "socialized medicine"; "redistribution"; "death panels"; "health care rationing"; etc. C'mon, everyone, let's get beyond these empty phrases (many of them patently untrue), get back on track, and put our heads together to see if we can figure out what will make the system we have--which is where we must start today-- into a system that helps more people (ideally everyone) at a cost we can afford!
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