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The man said it…

“The role of government is to provide good health care for our seniors. We made that commitment, interestingly enough, when Lyndon Baines Johnson was the President.”

President George W. Bush
15 March 2006

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38 comments to The man said it…

  • Remind me why it is so vital to keep Hilary Clinton out of the Whitehouse because she is going to nationalise the US healthcare system and turn it into a mess like Britain’s abominable NHS?

  • Ah, that immortal line from Grandpa Simpson springs to mind:

    “People these days, always wantin’ somethin’ for nothin’! [walks into social security office] I’m old; gimme, gimme, gimme!”

  • Brian

    “Remind me why it is so vital to keep Hilary Clinton out of the Whitehouse because she is going to nationalise the US healthcare system and turn it into a mess like Britain’s abominable NHS.”

    Not so, Perry. If the state of America’s public housing is a reliable indicator, and I believe that it is, this country simply doesn’t want socialized health care. We killed it in 93 and we will kill it again in 09, if necessary.

    Brian

  • Brian

    Sorry, I was quick on the draw. Perry’s question seems to have provided its own answer.

    Brian

  • The Wobbly Guy

    Brian-Don’t underestimate the stupidity of people. Bush came within a few hundred votes of losing in 2000, and even his margin of victory in 2004 was no clear indicator that the responsible folks were on the ascent on the issue of healthcare.

    In other words, there’re still plenty of people in the US who’d vote for socialized public healthcare in an instant. Perhaps enough to make their dreams a reality in 08. And your reailty into a nightmare.

    It’s always very simple for them, because they can resort to emotional appeals that for all their lack of logic, never fails to sway a significant portion of people.

  • It’s amazing that so many people are dumb enough to be bribed with their own money.

  • Verity

    Wobbly, I don’t agree. Americans have an almost genetic aversion to socialised healthcare.

  • Mitch, perhaps they aren’t so dumb. Perhaps many, even most, believe it isn’t their money at all. Its money provided by “those that can afford to lose some of it”.

    Whether the tax burden will fall that way is a far more complicated question, or was that your point?

    SJG

  • Duncan

    “Americans have an almost genetic aversion to socialised healthcare.”

    Unfortunately, you are wrong. Many of us had to learn the evils of socialised healthcare and other bad ideas, on our own. People don’t call it “socialized healthcare”, they say, “Do you mind paying slightly more taxes to make sure everyone is taken care of” to which a large percentage of people will respond “Of course not”

    I’d say the average American doesn’t even really GET THE ISSUE, or it’s implications. Americans seem to have lost the connection between Government “solutions”, and getting taxed out the ass.

    Everday the papers read “X” millions/billions of dollars wasted/scammed/lost and generally put to poor use, but no outrage. The Govt. blowing millions on pork barrel projects doesn’t even get a second look, we’re so used to it. The term “Billions” when applied to government spending has lost meaning as to how big that number really is.

  • David Beatty

    Along those lines, there is a thread at Megan McArdle’s that delves into what a single-payer health care system might look like in the United States. Sadly, medicine is one of the most highly regulated markets around, along with education, transportation (esp. airlines), and energy. The government isn’t going to be able to fix what it messed up in the first place.

  • “…this country simply doesn’t want socialized health care. We killed it in 93 and we will kill it again in 09, if necessary.”

    That is obviously ridiculous. “Socialized health care” in America is already a fact. It only varies from examples like NHS in degree.

  • Dude

    I support “socialized” healthcare despite its flaws. I have seen what private insurance companies charge in the U.S., and anyone who has had to deal with a private insurance company for anything knows how eager they are to raise premiums (or even deny coverage entirely) at the slightest excuse, and how actually getting what you paid for if you need it is like pulling teeth.

    Somehow I _highly_ doubt that my taxes would magically go down by hundreds of dollars each month if my (Canadian) government got out of the health-care business. On the contrary, they’d probably just keep the money and then I’d be saddled with another several hundred dollar bill to pay each month. Plus, knowing what I do about the practices of insurance companies I would hate to find myself in an emergency room without coverage because my premium check didn’t quite arrive on time or some such nonsense. Yeah, great fun… Get beat up and robbed on the street, then go bankrupt as a result of the medical bill as the icing on the cake.

    Some things should be non-profit and available to all regardless of means, and health care is one of these things.

  • Well, dude, if everyone agrees with you, then why the need for the State to provide it via taxation? If everyone, or nearly everyone, agrees, they will all contribute into a range of charitable schemes or such to provide healthcare for all.

    By having it as direct contributions to a range of providers in thsi way, people will stop funding inefficient or incompetent providers in a snap and direct their donations to those who provide the sorts of services people wish to see provided and in the best way possible.

    If you make it via taxation and by a monopolistic State mechanism, ‘not for profit’ will slide into ‘not for use’.

  • hm

    Dude,

    some of the regulars might find this somewhat perplexing, but I have to agree with you on this one, in prinple.

    After all, sick is not something one is readily seeking to become. However, there is, as always, a fine line between being sick involuntarily and being sick for the sake of being sick (or willfully neglecting ones health etc).

    At the end of the day, just like the state should do no more than give needy people shelter and food (instead of houses and cheques), the public health care system should be limited to a very basic system that is so bad, it serves to discourage people from using it.

    I think America pretty much runs with such a system right now and it had better stay that way.

  • Verity

    Dude: “Some things should be non-profit and available to all regardless of means, and health care is one of these things.”

    Why? Who said?

    Healthcare is absolutely no concern of governments and thus there should be no means of coercion to force people to pay for other people’s healthcare.

    People weren’t dropping dead in the streets before governments got involved. People belonged to mutual societies and took out their own insurance. For the very feckless or very poor, there were charities run, and contributed to, by people who wanted to do this. Churches and synagogues took care of their own, contributed to on a voluntary basis by parishioners.

    I disagree strong with you, Dude.

  • toolkien

    Dude,

    As long as human behavior cannot be controlled, health care should not be freely given. Sure many people have genetic disorders which they choose not to have, many illnesses (conceived at a relatively young age) are a product of choice – diets, sexual behavior etc etc.

    My father, for example, was diagnosed with diabetes, did very little by way combating it through diet. He smoked and eventually had heart problems. Even after surgery, he continued to indulge. He used several hundred thousands of dollars of taxpayer money for dialysis, and died anyway due to his lack of control.

    Behaviors and health are directly tied in many cases, and unless we are going to control behaviors to a great degree, we can’t be collectively responsible either. Of course there are those who compaign for such control and the seem to be winning the war.

    Lastly, the US has an accrual basis debt of $45,000,000,000,000, and personally held wealth is roughly the same. The majority of this debt are the health and welfare benefit plans known as medicare and social security. The economics don’t allow for universal care, and a straight welfare reallocation punishes good decisions and rewards bad decisions, as do most forced reallocations.

    A better system is allowing people to freely allocate some of their equity for others if they so choose. Forcing a reallocation is harmful and immoral.

  • Sadly, Dude has perfectly summarised mainstream opinion.

  • I would also hasten to add that the average insurance company’s extreme skepticism is partially attributable to the varying degrees of dishonesty exhibited by a surprisingly large proportion of their clients in the event of a claim.

  • J

    I agree than many, I would say all Americans regard UK style healthcare as either:

    1. The worst imaginable healthcare system.
    2. The next worst imaginable healthcare system after their own.

    Do not underestimate the deep, visceral loathing of the people for HMOs (Health Management Organisations).

    The US and UK healthcare systems have, in fact, one thing in common – they are both financially unviable in the long term.

  • J, I’ve noticed that many of the people advocating UK-style healthcare here are the same ones who loath HMOs. I’ve been able to make a few of them stop and think by asking them why it’s such a good idea to force everyone into a single giant HMO that doesn’t have any competition.

  • “”Some things should be non-profit and available to all regardless of means, and health care is one of these things.”

    Oh, yeah? Well, let me put the thing this way, then:

    In order to make “these things” “available”, you’re going to first have to come take something of mine away from me so that you can convert that value to your purposes. I’m here to tell you that you’re never going to get it. Never, ever.

    Try it.

  • veryretired

    Politically, Bush, or any other American politician, has no choice but to give endless support to the idea of subsidized health care for senior citizens. They are the most powerful, organized, and relentless voting bloc in the country.

    Any mention of slowing, cutting, or disagreeing with the proposition that seniors are entitled to anything they think they need is suicide. When Gingrich mentioned cutting back on Social Security increases back in the 90’s, he was crucified in the press, and soon forced out.

    I remember several near hysterical conversations with my mother about her absolute conviction that this “Gringgich” person was going to abolish social security and render her impoverished.

    Anyone who expects Bush to propose rational policy initiatives as regards social security, Medicare, et al at a time when his approval ratings are already sinking is dreaming. It would destroy any chance of republicans holding the house and senate in the upcoming elections, which is exactly what that statement was about.

    It’s all politics, and always is.

  • Ken Hagler –

    Those that paused at your illustration are more rational than most of the benighted folk besotted with socialized healthcare. The true believers I know would simply respond “ah, but it’s one giant HMO controlled entirely by The Government, and as we all know The Government is selfless, driven by the purest of objectives and the answer to all our problems and prayers – if only we had more of it.”

    Or words unto that end.

  • RobtE

    It’s amazing that so many people are dumb enough to be bribed with their own money.

    Perhaps not so much dumb as a victim of that age-old concern, the desire to be thought well of. Disapproving of state-funded health care is commonly seen as a willingness to consign “the most vulnerable in our society” to the dustheap in the pursuit of personal greed. If one wishes not to hand over an ever greater portion of one’s earned income to the Chancellor, one is by definition a selfish bastard, in it only for one can get for himself. Unfortunately, the only remaining moral evil left in Britain is to be selfish, unkind, uncompassionate, uncaring. The result is that either you support state funding for any “vulnerable” cause that comes down the turnpike or you’re a no-goodnik.

    Let’s face it, it takes a special kind of moral courage to put one’s head above the parapet and say publicly, “Hey, you’re old. You’re going to die soon anyway and I don’t want to pay for your hip op.” Like it or not, most people just want a quiet and peaceful life, and it’s far easier to just go along to get along. Soak the rich? Sure, why not? It probably won’t affect me; after all, I’m just an average joe, with a family and a mortgage and so on. Nothing to do with me, gov. See, I’m one of the good guys.

  • permanent expat

    If you’re a snowboarder, by choice, and run into a tree, maybe not by choice…..try sueing the tree…but on no account expect me to pick up the tab. There comes an age when you know that you are responsible for yourself, no matter what hand you’ve been dealt. Some folk never reach that age & will surely suffer. Life isn’t fair……who said it was?

  • Ian

    Dude, as a fellow Canuck, I have to disagree with you. Like all government planning the attempt to plan our healthcare system has been, disastrous to put it kindly. Do you have a family doctor? If you do congratulations, because a hell of a lot of us don’t. Do you ever wonder why that is? Well, of course we can thank our omniscient government for that. 15 years ago everyone thought there were too many doctors now after cutting medical school spaces we’re reaping what we have sown(Link).

    If the family doctor example doesn’t work for you, how about diagnostic equipment. In my neck of the woods we didn’t get an MRI machine until the mid-90’s, prior to that patients had a choice drive to the States or try to get an appointment at the nearest government MRI 2 hours away. Here’s a summary(Link) of the situation in Ontario last year wrt CT’s and MRI’s.

    In fact your assumption about private healthcare somehow abolishing the public system is a fantasy at best. Most Canadians for some misguided reason see government provided healthcare as some kind of national icon. The debate in Canada will never be one between fully private or fully public – the question is should individuals be allowed to not contribute to the public system and purchase their health insurance privately. As it stands right now everyone pays for the public white elephant regardless of use.

    Unfortunately for people like me there are too many people like you who are perfectly willing to leave their health in the hands of government bureaucrats.

    As a postscript I totally agree with toolkein above.

  • veryretired

    But expat, that’s just the point. The progressive drumbeat for decades has been that life is SUPPOSED to be fair, it could be fair, and it would be fair, if only those mean, greedy capitalist plutocrats would let go of some of their filthy lucre, and let those benevolent fellows in the senate and house, who are filled with compassion for the poor and vulnerable, set up some programs to take care of these impoverished elderly citizens in their fragile old age.

    Somewhere along the way, the fact that these seniors are the wealthiest group in the society got lost, rather conveniently, and the fact that the greatest part of the funding comes out of the hides of the working middle class, who are trying to raise their own families, was relegated to a footnote in very small print on page 1095 of the Omnibus spending bill.

    If your a democrat and the teacher’s union calls, you answer. If your a republican and the Nat’l Assn of Manufacturers calls, you answer.

    No matter what you are, if AARP calls, you not only answer, but you stand at attention while they talk, and you take copious notes.

    Seniors vote and send checks. That’s all any political type has to know.

  • permanent expat

    Omnibus? To me that means a charabanc……you enter this unfair life & make the best of it. If you’re fortunate your family & friends will support your best efforts to make something of yourself. You’ve been dealt the random cards. Play them.

  • S. Weasel

    Feh. There are a zillion places I can go for a heaping helping of snark about America. Now I remembered why I stopped bothering with this one.

  • Feh. There are a zillion places I can go for a heaping helping of snark about America. Now I remembered why I stopped bothering with this one.

    What an odd remark. So because we do not what the USA to end up with a miserable healthcare system like ours in the UK, that is ‘snark’ about the USA? Or is making critical remarks about Dubya ‘snark’ abiut the USA? But hey, feel free to just hang out on sites which do nothing but sing the Battle Hymn of the Republic & God Bless America is that is what floats your boat.

    Funny really, we usually get flak for being too pro– American!

  • ResidentAlien

    Billy Beck is right. There is nothing remotely like a free market in health care here in the US. Every aspect is regulated and controlled and there is heavy spending funded by taxpayers.

    The whole thing is a stinking mess. I have commented here before on the particular insanity of the COBRA laws. Interestingly I have found that support for a “socialized” system is quite high amongst entrepreneurs and small business owners becuase they simply cannot handle having to deal with the healthcare bureaucracy.

  • I believe it is fair to say most Republicans did not think George W. Bush was motivated to run for the presidency for the primary reason of cutting or controlling spending. But it is also fair to say that they did not think he was Lyndon B. Johnson. And that’s what he’s turned into.

    Peggy Noonan. March 16, 2006

  • John McVey

    I am rather tired of (and of the dodging of in responses) the “no fault of their own” line for socialised healthcare – and for any other form of welfare for that matter. In terms of the core argument for healhcare or any other welfare provision, it does not matter whether or not that line is true in any given case, it or to what degree Moral Hazard is generated by socialisation, or who is making what excuses to stick their hands in who elses’ pockets, or how much or little it may actually cost in any event. The question is, in the use of property which of these alternatives takes priority: “I earned it” or “I need it”? Take care of that and you wipe out the lot in a single stroke.

    The bottom line is that our lives are our own, our properties are our own, both to do with as we please (without violating others’ rights), and if you can’t argue against socialised healthcare without giving that fact prominence and a central role then you’re conceding the battleground. As someone from the Ayn Rand Institute once wrote, one person’s poverty is not a claim on another person’s prosperity. One either accepts this completely and integrates it into argumentation, or one does not accept it at all. There is no compromise possible: the instant you accept an opponent’s “but” (real or prospective) you’re actually or at least giving the appearance of accepting the premise that any random stranger can, even for the most allegedly innocent of motives, have a claim upon you that supercedes any merely selfish right to keep your own property. As first, that any competent economist will tell you needs (however construed) are unlimited while resources are not, and second, that the sum of all random strangers is the collective, the slightest hint of giving any priority to need over earn means you would have just conceded in principle the idea of the lone individual as the property of the collective, to be used and disposed of as best suits collective needs – welcome to Rawls’ nightmare world.

    You’re never going to make serious headway until the no-fault question is tackled head on, without ducking it by downplaying how prevalent it may be or what degree of fault actually exists blah blah blah. If you’re afraid to say NO to even the most genuine of dire needs, ultimately you can’t say no at all. I know very well that such a position wont be taken lightly. If you’re going to make arguments you will also have to frame your position in such a way as to avoid any appearance of principle VERSUS practicality, and exercise good rhetorical skill without compromising one’s principles by making valid points while retaining emotional connection with whom you’re addressing. For healthcare, this means showing:

    – that morality and practicality are logically demonstrable to be one, that the only way to determine practicality consistently is by reference to moral principles rationally determined by exclusive reference to identifiable facts (don’t groan – if you can’t accept that or get that across then you’ve lost before you’ve started)

    – that as an application free-trade in healthcare is both moral and practical, both in general and for key particular issues as the nature of the audience dictates

    – that ‘need’, in normal civil conditions at least, never supercedes ‘earn’ and that needs in excess of ability to meet them requires the needy to make requests, NOT demands, upon others

    – that, as well as there would always be charity such that nobody requesting help would go without basic care under laissez-faire (and would often receive more than basic), free-trade everywhere would continually reduce the need for such charity in the first place through increasing real incomes and increasing quality of goods and services just as has already happened for the last 300 years

    – that the so-called “good-intentions” underlying socialised-anything are not even remotely good (ie that the idea of need superceding earn implies the individual as nothing but collective property whether its proponents want to admit it or not)

    – that, as the counterpart of the unity of practicality and morality is the unity of immorality and impracticality, socialisation will always inevitably lead to disaster, again both generally and for key issues

    – how socialisation has contributed to existing disasters

    – and whatever other issues (such as seniors perfectly capable of self-funded care sticking their hands in others’ pockets) needs to be addressed in particular for your audience.

    Yes it’s a big ask, and you REALLY have to know your stuff right down to the philosophical core as it goes beyond healthcare and into pretty much the entire edifice of welfare, and ultimately the nature of all economic freedom or lack thereof. Hats off to anyone who can do it – and they would have my vote hands down (I voted today in South Australia’s state elections – what a depressing chore that was).

    JJM

  • Simon, that is exactly what I meant. When you go to “soak the rich,” there are never enough rich people to go around. “Rich” comes to mean anyone standing around with a dollar in his pocket and a blank look on his face.

    One thing that I think should be addressed is that it is not HMO’s or insurance companies that should be seen as the issue, but rather (1) the issue of compulsion, which is the moral basis of libertarian thought, and (2) the issue of free voluntary association. No serious libertarian thinks that the ideal society is atomistic chaos. The idea of forming associations for a purpose is fundamental to American democracy. Why should we not form groups to bargain effectively for health care? There are plenty of associations of doctors here; why not associations of patients? I’m not just talking about an anarcho-syndicalist model here. Why not a Costco or Wal-Mart as a buyer and seller of medical care?

    This is not a far-fetched idea. There were plenty of mutual aid societies and fraternal organizations before they were forced to either drop this feature or convert to regulated insurance companies. There are plenty of alternative methods that could arise. The most efficiency would be gained by removing as many intermediaries as possible between the person receiving the benefit and the entity paying for it. Ideally, they would be the same person, but the price tag for a major health disaster practically prevents this.

    Health care is not much different from any other economic good. You must ration it in some way, either on terms of price, on queuing/gatekeeping (like Canada), or by organized theft (one level of care for the Party elite; everyone else go to the devil). Whether to subsidize its purchase by the less well-off, either through charity or government, is a political decision. Politics is where we do the practical working-out of our morality as well as our interests.

    If you look at it from a financial planning perspective (applied microeconomics), one of the first principles of insurance is to accept the risks that would not be ruinous and insure the rest. For example, taking an auto insurance policy with a $1,000 deductible is usually a better idea than a $500 deductible, assuming that the extra layout for an accident would not send you to the Sallies for soup, soap, & salvation. Any sort of insurance plan should start from that point.

  • Verity

    I like the idea of buying health care at the supermarket. Companies like Tesco’s can drive prices into the ground with their buying power. Of course, the NHS could do that, as a private company, too. Tesco’s already sells pet health insurance.

  • Robert

    I hate to be a pessimist, but there’s probably no complete solution to the problem of financing the provision of healthcare, as it’s an example of market failure.

    In most areas, left to its own devices, over time the market produces better-quality products a lower prices. This is most obvious with computers, but also applies pretty much everywhere: compare modern cars with the ones made thirty years ago.

    But healthcare isn’t like that. It produces new, often life-saving, products, but often at great cost: think heart transplants, for instance. Even when the condition being treated is not life-threatening, the trend is still for costs to rise. When Britain’s National Health Service was established in 1948, the standard treatment for an arthritic hip was a walking stick; now it’s a hip replacement. In many ways, this is a wonderful development; I know people who have had hip replacements, and have got a new lease of life as a result. But the costs are far higher: several thousand pounds (dollars) versus a few pounds (dollars). The arrival of new, even more sophisticated treatments in the future will, almost certainly, ensure this trend continues.

    How, then, to pay for all this. On the one hand, there’s the socialized model of Canada’s healthcare system and Britain’s NHS. They do at least ensure that nobody is uninsured, but are not without their faults, waiting lists being the chief one.

    On the other hand, the regulated private system of the United States provides great service, with prompt treatment and the latest technologies, for those who have insurance, but leaves tens of millions uninsured. There’s also the question of how long health insurance premiums can continue rising by 10% a year. (This last point is something with which I’m only too familiar. As a freelance consultant I don’t get employer-provided healthcare and have to pay full freight for my coverage.)

    It’s difficult to see what can be done about this. However, a good start would be to tell people that, if they want the medical coverage just about everyone feels they’re entitled to, they’re going to pay a lot more for it, whether it’s delivered by the government or private companies.

  • Verity

    Ah, yes, those “tens of millions uninsured”.

    1. Many of those tens of millions are young people. They have opted not to buy into expensive insurance because they – rightly, in the overwhelming number of cases – are not expecting to get majorly sick. They pay for their own doctors’ visits and their own minor treatments and that costs them much less than huge annual premiums.

    Another whacking great segment of these “tens of millions” are retirees who have some capital built up which they keep invested rather than spending in on insurance premiums. Most of this group have the funds to pay for their own treatment when the need arises.

    Third, many people who have opted to be uninsured and have investments they can cash in, are now going to India for treatment for approximate 1/4 to 1/3 the cost of exactly the same treatment as that procedure costs in the US. These groups of Indian hospitals are the equal in comfort and hygeine of any Americn hospital and, obviously, far superior to hospitals in Britain. At the moment, I read recently, the success of Indian cardiac surgery has a tiny edge, a percentage of one percentage point, over American cardiac surgery outcomes.

  • Paul Marks

    George Walker Bush is a statist shit, next bit of shocking news – ice is cold.