During a debate about health reform on a professional website, a colleague posted the following statement, which irked me for a number of reasons.
“In addition to such successes as NPR and PBS, neither of which have never managed to become self-sustaining in their entire existence, don't forget other fine government-run examples such as Amtrak, the Post Office, the DMV, Medicare, Social Security, and the VA system. Quite a track record for the folks who want to completely revamp the US health care system by August, is it not? These clowns can't even run the cafeteria in the Capitol Building, but we're gonna let them overhaul health care? No thanks.”
First of all, I think NPR and PBS have been incredibly successful at their mission-providing classy, non commercial programming for public consumption. They could easily survive without government support-the last breakdown I saw indicated the level of government support at 10%.
Amtrak? I don’t know. I don’t use it, so I can’t really say. But they do seem to be getting people from point A to point B, still, despite their issues.
The Post Office? Not perfect, but it gets my mail where I need it to go for less than 50 cents.
The DMV in my state is simply a joy to go into. A few years ago, the governor’s wife decided that was going to be a pet project of hers, and they made a few common sense changes, and now, in terms of a place you have to go to every once in a while, it’s just fine. The smartest thing they did was station someone by the door. The moment you walk in, they ask you what you are there for, and they tell you what forms you need, hand them to you, and they tell you what line to stand in. It’s gorgeous, frankly.
Medicare? An insurance carrier that provides care to everyone with vanishingly small administrative costs? Social Security? A program to keep old people from starving to death?
The VA system has issues, to be sure. But I think the very least we can do for the fighting men and women is take care of them after they have done the same for us. They do need a special system devoted to their particular needs.
Foes of health reform seem to want it both ways-the government can’t do anything right, yet they will destroy health care if they get involved. If the government is so lousy at providing health care, provide it better and you have nothing to worry about.
You might say government’s enormous influence will tilt the playing field and make it an unfair competition. Well, that hasn’t happened with, say, Amtrak, or the post office.
And the crowning glory of the argument, to me, is that the alternative is the status quo. There was a editorial in the Washington Post, which I wish I could look up right now, that began talking about how one of the options in the health reform debate is guaranteed to result in increased taxes, increased costs out of pocket, and increased health care deductions from your paycheck: doing nothing.
Personally, I don’t believe that anything significant is going to happen, not because the participants don’t mean well, but because, in John Edwards’ phrase, the camel’s nose is under the tent. The special interests are all over this bill, and they will not allow anything to come out of this process that hurts them. The fix is in. As George Carlin used to say, this country was bought and paid for years ago.
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I read Ron Darling’s book, “The Complete Game”, and it was really good. It’s a baseball memoir, with several concrete examples about why he made certain tactical decisions during the course of his career. Well written, kind of baseball geeky, but enjoyable.
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I also read Malcolm Gladwell’s “Blink”, which was worth all the fuss people have made about it. It always pleases me to see people willing and able to cross disciplines and write engagingly about different fields.
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I also read a pretty funny book about fantasy football, Mark St.Amant’s “Committed”. The author quit his job to devote himself full time to winning his fantasy football league, and it’s a pretty funny story. It’s no “Fantasyland”, Sam Walker’s book about fantasy baseball, but it’s good.
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I am now in the midst of Grant Wahl’s “The Beckham Experiment”, about David Beckham’s adventures in US Soccer. It’s a loaner from my brother in law, and is proving to be a pretty good read, even for a soccer ignoramus like myself.
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I have one thought to add here... you and I agree pretty straight across the board. But here's my deal: Everyone wants stuff done. Our government does not have any money... duh. So how can they make anything happen without raising taxes? Can you make a demand and then cripple it by insisting that it be done for free? That's just dumb.
ReplyDelete"You might say government’s enormous influence will tilt the playing field and make it an unfair competition. Well, that hasn’t happened with, say, Amtrak, or the post office."
ReplyDeleteActually, in the case of the post office, the government has outlawed competition. To me, that is a pretty good example of competing unfairly.
And John Edwards is a perfect example of a special interest that blocks meaningful reform (such as tort reform).
ReplyDeleteEdwards has made a lot of money filing frivolous lawsuits against doctors*. He and his ilk oppose reforming this problem. Getting rid of frivolous lawsuits won't fix the health care sector, but it will sure help.
(*He successfully won lawsuits against obstetricians because the children had genetic birth defects. It takes some pretty impressive lying in the courtroom to get the guys delivering babies to cough up $$$$ for the problem of the mother and father having certain defective genes).
Huh... Other mail alternatives are outlawed... Damn! I better call FedEx, DHL, UPS, the dozens of couriers around the city... oh yeah and Yahoo mail, gmail... and all the POP servers...
ReplyDeleteCrap! How did I not see all this illegal activity right in front of my face every day??
Dude! Do you think I can get a reward for turning these people in?
It could be like my very own welfare system.
Lapis: Fedex/etc already know. It is illegal for them to deliver normal letters, like first-class mail. They get around this to deliver some through a loophole that lets them deliver letters for special/urgent circumstances.
ReplyDeleteYou learn something every day :)
I need to go to your DMV. When I go to the one in Thorofare, it makes me want to vomit. Then again, I go on the LAST day of the month, so that's probably where I go wrong.
ReplyDeletePS My reader is much happier with you in it.
I'm with dmarks on the "government run" stuff. I have used Amtrack a ton...it is VERY expensive and inefficient.
ReplyDeleteLast I checked my generation shouldn't count on social security even being around for our retirement and Medicare is a ticking time-bomb because both have serious funding flaws. Seems to me the federal government should implement a reasonable plan for controlling costs and managing those entitelment programs before expanding into larger stuff we can't afford.
Anybody can come up with stuff that people shouldn't have to pay for. I had a doula (a professional, but non-medical birth coach) for the birth of one of my children. There's lots of research that shows doulas help women have better, faster, less painful births. I even considered becoming one myself. I bet with the right research and stats, I could put forth a compelling case that if every laboring woman used a doula we'd SAVE money on epidurals, etc. Now THAT is something pregnant women should all get. Except that I don't think my neighbor should have to pay for mine.
I could come up with a million good ideas to improve the quality of life for everyone. The question is, who will pay for it?
One thing we agree on: Blink was an awesome book.
DMarks-
ReplyDeleteOnce again, you misstate the facts. Cerebral palsy is a genetic disease, yes. At the time Edwards was practicing law, that was not clear. Accordingly, Edwards argued, in hindsight wrongly, based on the facts available at the time, that the doctors could have avoided it by doing C
Sections.
And it is illegal for FedEx to deliver regular mail? I didn't know that, true. But is there any evidence at all they want to do this? They are good at what they do now. Why would they want to bother delivering junk mail?
It is fundamental to a free society to have a postal system-it goes to the heart of our ability to communicate with one another.
And Jeanne-as we have discussed-this money health care will "cost"? We're already spending it, now. Only as the system works now, Aetna gets to keep it.
Your neighbor shouldn't have to pay for the birth of your child? What about your coworkers, or the coworkers of whoever pays for your insurance? They pay for your health care all the time. It's called shared risk, which used to be a fundamental part of the concept of insurance.
The facts are with me on these issues.
ReplyDeleteIf the situation on CP was not clear, why did Edwards insist on lying and making innocent people pay? He didn't care what the truth was. He did not use "the facts available at the time". C-sections were considered to be a possibility for causing CP. Nothing was certain. Edwards laughed and lied all the way to the bank (and the barber). He never returned the ill-gotten gains, either.
I know more about the CP/etc issue than anyone reading this ever will.
Whether or not Fedex or other companies want to deliver something like first-class mail, they just can't. Thanks to a ridiculous law, the USPS has a monopoly on that.
"It is fundamental to a free society to have a postal system-it goes to the heart of our ability to communicate with one another."
Having competition, or even privatizing the USPS, would help this mission. You can't help but notice postal service customer support getting worse and worse. They don't have to bother to satisfy people, they aren't accountable.
On health care, "Only as the system works now, Aetna gets to keep it.". Or one of over a thousand other competing companies. If we went to single-payer, there'd be only one company. A monopoly. Our way or the highway. A monopoly run by an outfit that has been known to shoot those who disagree with them.
Thankfully, single-payer is not a danger at this time. But there is a bad healthcare bill sitting in Congress now, that includes such nasty features as the government fining individuals for refusing to buy into a health care plan of the govenrment's choice. Like the Hillary plan before it (which had jail terms), this plan contains senseless bullying of patients. Leave it to the government to make jail terms and criminal fines against patients part of health care. Why do Obama and the people who wrote this bill think it is a good idea to go to war against health care patients? You'd think that if the bad guys were supposed to be insurance companies, they wouldn't be going after patients, families, and small businesses.
Not to mention other bad parts of the bill, such as pork for roads, and the provisions to force small business to cut wages and fire people in order to offer health care plans.
Michael,
ReplyDeleteMy understanding is that Congress is still trying to find a way to pay for 1/3 of the President's health care bill. That was according to the President at his press conference last week.
I believe the plan is to tax the "highest earners." Even if you think that's a good idea (I don't), it seems a reasonable assumption that costs will increase as more players get involved, and our government will have to find other ways to pay for expanded benefits going forward. That means higher taxes.
I should also add that I don't oppose health care reform. Out-of-control costs are clearly a huge problem. I think there is some interesting movement towards "global" payments instead of fee-for-service. I need to learn more about it, but it sounds like something that might work to control costs. Moving toward electronic records would obviously be wise.
ReplyDeleteJeanne: Chances are it will cost three times as much as Obama and his allies say it will.
ReplyDeleteAfter all, look what happened to Americorps and Medicare, which cost so much more than the promises said they would.
Dmarks - that's exactly my concern. Once an entitlement exists, two groups emerge. First, people who want access to it (if that group gets it, this group should get it too!). Second, people who see a way to profit from it (from my earlier example, doulas could form a lobby, connect with women's issue groups, and convince legislators that requiring all insurers to pay for doulas would ultimately reduce costs).
ReplyDeleteEither way, I don't believe I know of an example where government intervention has led to improved quality, efficiency, and cost control.
"Either way, I don't believe I know of an example where government intervention has led to improved quality, efficiency, and cost control."
ReplyDeleteThe Interstate Highway System, Medicare, Public Broadcasting, the FDA, rural electrification, and the FDIC, for one thing.
DM-If you know about CP, then you know that the scientific consensus towards a wholly genetic cause was not there in the 1980s and early 1990s.
ReplyDeleteArguing on behalf of his clients (which was his job) based on the currently available scientific evidence(which was that CP could be caused by malpractice) is not lying. It is not his fault the knowledge he was relying on proved to be wrong in 2009.
DM-"A monopoly run by an outfit that has been known to shoot those who disagree with them."
ReplyDeleteGet real.
"Thankfully, single-payer is not a danger at this time."
Single payer is the only way out of this mess, but we're never going to get it.
"But there is a bad healthcare bill sitting in Congress now, that includes such nasty features as the government fining individuals for refusing to buy into a health care plan of the govenrment's choice."
You mean like the government taking your driver's license away if you don't have auto insurance? There are costs involved with being human-it is only right that you be asked to pay your share of these costs.
Good list Michael.
ReplyDeleteInterstate highway system...yep, this is exactly where I want my tax money going. Interstate commerence. The Constituion explicitly says this is the role of the federal government.
Medicare - I have read that doctors and hospitals are increasingly cutting their acceptance of medicare patients because the pre-set government payments don't cover their costs. In general, if a market isn't setting prices, the prices are wrong. I also thought there was a serious under-funding problem with this program.
Public Broadcasting - I don't like the government involved in media at all. That being said, I've contributed to NPR on and off, because I value their reporting and enjoy their shows and feel like I should pay for what I consume. I know only a TINY fraction of their money comes from the government they are covering, but I don't like it. Tax money shouldn't be going to any media outlet. I've stopped contributing, but would happily contribute again (in much higher amounts) if they stopped accepting taxpayer dollars.
FDA - While I admit the government has a role in protecting our foods and drugs, there are a LOT of problems with this agency. There is decidedly room improvement.
Rural Electrification - I don't know the first thing about it, but it sounds like a good thing.
FDIC - This is quasi-public and I don't know enough to comment.
So Jeanne-government is not entirely worthless, then?
ReplyDeleteNo, Michael, you have me on record. Government is not entirely worthless.
ReplyDeleteI feel about American government the way I do about my family. It's crazy, dysfunctional, and inefficient. I will do my best to be an agent for improvement. And I'll often fail. But I love it. I'm grateful for it. I wouldn't have any other one.
And why can't we all just get along?
ReplyDeleteI like Blink; you liked Blink. Can't we talk about that?
:)