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Why I prefer French health care
- maxharris 17y agoThis is a great example of why libertarians are not to be confused with Objectivists. Objectivism provides the essential philosophical basis for individualism and long-term rational selfishness required to properly support political conclusions in favor of freedom. Libertarians, on the other hand, don't know or understand the philosophy from which many of their political conclusions were copied, and are thus susceptible to reverting to political conclusions that appear momentarily practical, or consistent with altruism (which many libertarians implicitly embrace). On top of that, "libertarian" has come to means so many things that it means nothing - there are libertarians in favor of and against abortion, in favor of and against anarchy, in favor of and against anti-trust regulation, to name a few random examples. Objectivism isn't pervasive enough yet for political change based on it to occur, and libertarianism is a political dead end (because it's not consistent with the terrible mixed bag of present-day American values, or with itself.) So if you consider yourself a libertarian, and you don't like where Welch and his ilk are heading, I invite you to read Ayn Rand and new scholarly works that examine her philosophy deeply (Tara Smith's "Ayn Rand's Normative Ethics: The Virtuous Egoist".)
- Semiapies 17y agoYou also forgot that Ayn Rand repeatedly denounced libertarianism while alive and made it clear she was not for minimal government, non-interventionism, or pretty much any of the major concerns of libertarian movements. Sadly, libertarians like me will be tarred with the Randroid label until the end of time, even the anarchists I've known who trace their ideas back to Lysander Spooner. Over the same timeframe, Objectivists will alternately denounce libertarianism and claim they invented it. Just one of those eternal tempests in a very small teacup.
- xenophanes 17y agoI don't think Rand said that. If she did I'd like to read it. Cite please where she says she doesn't want minimal govt. (She did say she didn't want zero govt.)
- Semiapies 17y agoYes, and she repeatedly dismissed any non-Objectivists pursuing minimal government as anarchists. Anyone not under her sway simply couldn't be correct. Like the GOP, she talked a fine game about capitalism, but that is all.
- xenophanes 17y agoThat's an assertion. Do you have a cite?
- Semiapies 17y agoI'm not getting into a cite game on things Rand repeated so often that she said she was tired of people asking her about them. She repeatedly dismissed libertarianism as nothing more than a dressed-up leftist anarchist movement. Unless you have something more substantive to ask than "Oh, yeah?", we're done here.
- xenophanes 17y agoI have read a lot of Rand, both fiction and non-fiction, and never seen her say it once. Can you please point me to a source to read so I can correct my understanding of Rand's views?
- Semiapies 17y agoA good starting place would be googling "ayn rand" libertarianism. You will hit a lot of cited remarks by her among the hagiography and such.
- philwelch 17y agoI read way too much Ayn Rand myself when I was about 17. Seven years later, I've found that Rand contradicts herself in a number of places--chief among them, as cited by generations of anarchist libertarians, is the inherent contradiction between the non-aggression principle and government. Where she doesn't contradict herself, she makes handwavy arguments backed by vague assertions about human nature which, by and large, don't hold up to the actual evidence. I've also found that treating social and political issues as axiomatic mathematical systems is the wrong way to go about things in the first place. Finally, you may have misread the central point of the article. It wasn't an unreserved support of socialized medicine, but rather an acknowledgement that, whatever the problems socialized medicine has, the fucked-up, cronyist mixed system we have in this country is even worse.
- maxharris 17y agoYou misunderstand Rand. The important thing about her philosophy is her ethics, her epistemology and her metaphysics. My opinion is that once this is understood, the contradictions you see cease to exist. (Specifically, non-aggression is a conclusion, and is not axiomatic.) The political stuff is just a downstream consequence of a much deeper set of ideas. It's important, but politics is at the periphery of Objectivism (in that Objectivism has political implications, just like any other philosophy), far from the core.
- philwelch 17y agoNo, I understand Rand pretty well, though admittedly not as well as I used to. Her ethics comes to a conclusion--non-aggression--that contradicts with her political conclusion--government. Axiomatic logical systems don't mean you can derive contradictory conclusions as long as one is further downstream than the other. (If you do, you have chosen contradictory axioms, which has problems, especially if you explicitly choose non-contradiction as an axiom!) Not to mention, the logical path between Rand's axioms and the rest of Rand's philosophy goes through a thick layer of vague handwaving and unjustified assumptions.
- Semiapies 17y ago
- Nwallins 17y ago> Libertarians, on the other hand, don't know or understand the philosophy from which many of their political conclusions were copied What is the basis for this assertion? > and are thus susceptible to reverting to political conclusions that appear momentarily practical, or consistent with altruism I don't understand why you are using the word reverting. Are you implying there is something wrong with political conclusions that appear practical or altruistic? > On top of that, "libertarian" has come to means so many things that it means nothing That people exist who pervert a term does not render the term meaningless. > there are libertarians in favor of and against abortion, in favor of and against anarchy, in favor of and against anti-trust regulation I agree there is no clear-cut libertarian stance on abortion, because there are several confounding factors upon which libertarianism does not opine -- e.g. when does life begin? The libertarian umbrella does indeed ostensibly cover anarchy, and it should not be a surprise that there is a spectrum of belief. If you desire a concrete libertarian platform, you can look to the Libertarian Party. > libertarianism is a political dead end (because it's not consistent with the terrible mixed bag of present-day American values Can you elaborate on this? By calling it a dead end, you are saying it has no future, but you are basing this on present-day values, as though these values can never change in the future. I am still unsure as to which values you refer. > or with itself.) Libertarianism does indeed cover a spectrum of beliefs. I don't see how that implies that it is a political dead end. Other viable political philosophies cover spectrums of belief (e.g. republicanism, conservatism, populism, liberalism, etc.)
- ugh 17y agoAre the Europeans who implemented that momentarily practical solution quite a few years ago currently not free? Won’t they be free in the future?
- thrdOriginal 17y agoThis is a great example of someone comparing the principles of one (political) philosophy to some practitioners of another political philosophy. i.e. apples to oranges.
- abstractbill 17y agoThis subthread is a great example of why progress in American politics seems so hard to come by: Every potential policy change seems to devolve into a discussion about what team people are on, and the similarities and differences between all the different teams (to me it's often very reminiscent of Monty Python's Life Of Brian - Peoples' Front of Judea vs Judean People's Front, etc).
- Semiapies 17y agoFunny that you cite an example meant to satirize British politics. Or in other words, welcome to democracy. :) The alternative in the US of course is bipartisanism, which has given us wonders not limited to every iteration of the PATRIOT act, including the recent renewal.
- ibsulon 17y agohttp://progressive.stanford.edu/cgi-bin/article.php?article_id=427 http://progressive.stanford.edu/cgi-bin/article.php?article_... speaks of the place of privilege in Objectivism. If every child was guaranteed equal access to health care, food, shelter, good education, and health care, I would have less of an issue. However, as Objectivism stands, what we really see is a de-facto neo-feudalism.
- Semiapies 17y agoWelch does hit it on the head. The current US system is nothing like a free market, and it sucks. France's system (and Germany's) sucks rather less than the UK's or Canada's - or the US's. I'd advocate for a freer health care market, but that's not on the table. In lieu of that, I'd advocate a more French-style system, but that's not on the table. So, I generally just sit health care debates out, aside from talking side issues with people.
- froo 17y agoI have issues relating to other's health care problems. I suppose here in Australia we're spoiled. For example. I have the best private health coverage I could find and I pay less than $130 a month AUD; but it doesn't stop there. We still have a free health care system if you're ok with waiting for major ops. In terms of what it would cost me for a GP visit. My current GP costs about $20 a visit but often I can claim the majority back with our Medicare Bulk Billing system (not to be confused with the US Medicare.) Our system seems to work extraordinarily well. Those who want to pay for health care can (like I do, it's not that expensive) ... those who can't afford too are still covered by our free system.
- xenophanes 17y agoOne thing you don't mention is the cost of the "free" system. Remember, TANSTAAFL.
- deleted 17y ago[deleted]
- froo 17y agoOops, sorry I wrote the comment when I woke up in the middle of the night. Ok, Medicare in Australia is a funded by an income tax levy that every Australian pays, set at 1.5%. It's an almost paltry sum of money when you consider it's free healthcare. My private health insurance also receives a rebate from the Australian Government. From what little I understand about the system, the Australian Government funds this out of my Medicare levy I pay, so that I'm not paying twice. We also have plenty of other medical programs running in Australia - like the Pharmaceutical Benefits Scheme which helps low income people afford the medications they require. I'm not up on the numbers, but I think it caps the costs of certain medications at about $5 It works well, I don't know too many people that complain about our system at all. The cost of health care certainly isn't an issue at all that weighs on too many peoples minds
- ErrantX 17y agoFrance is a poor general comparison for the reasons specified later. The UK system is something of a compromise of the two and worth consideration. Actually I thought about this a little today: The US system is biased towards the extremely ill - it is essentially a bet against you getting an uncommon illness. The UK system is biased towards the mildly ill - if you have an uncommon illness it doesn't work as well. So it is a bet against not getting an uncommon illness.
- ZeroGravitas 17y agoRarity and severity are two different things. I can't tell which you mean. I would guess the UK system would bias against rarity since if you make spending decisions centrally you can get more bang for buck, the more people get the disease.
- ErrantX 17y agoIm talking rarity I think, yes. Because common and uncommon illnesses can be severe. My point is that in the UK you can go see a doctor and get drugs with little effort/cost etc. Whereas if you have something rare or costly the chances of effective care diminish. It's the reverse in the US because basic care is fairly expensive (if you need it) but if you have a rare or chronic condition the care is available.
- martythemaniak 17y agoThis is one of the funnier (funny as in sad) aspects of the US Healthcare debate - while half the populace is railing on and on against some imaginary gargantuan bureaucracy, from an end-user perspective healthcare systems like Canada's are great. You have a simple periodic billing system (every paycheque) and access to everything is a simple card-swipe away.
- SamAtt 17y agoYour point really isn't valid. The questions in this debate are quality of care and and cost. People against systems like the one in Canada claim they will cost too much and be of a poorer quality than what the U.S. has now. So ease of use doesn't invalidate anyone's point The argument you make is like someone claiming McDonalds is better than a Fine Restaurant for the diner. Because you can swipe your card at the counter in Mcdonalds where you have to get a pen and fill out the receipt at a Restaurant.
- RyanMcGreal 17y ago>People against systems like the one in Canada claim they will cost too much and be of a poorer quality than what the U.S. has now. They might claim this, but they would not have the data to back the claim up. * Canadian health care costs less than half the money, per capita, as American health care. * Median wait times in Canada are the same as or better than in the US. As someone who lives in Canada and has had many opportunities to experience Canadian health care - from head injuries to electrocution to infected burns to pneumonia - I can state anecdotally that the publicly funded, single payer medical care I and my family have received has been uniformly timely, professional, skillful and professional.
- marshallp 17y agoThere is a slight problem, in the US a botched operation leading to death can result in the victims's family getting compensated. In canada you're told to shut up. Also the banning of private care and noninclusion of drug benefits in most of canada is draconian and half assed at the same time.
- SamAtt 17y agoThere are two parts of this piece: the Anecdotal and the Macro. Anecdotal evidence seems irrelevant to me. My experience with the U.S. system is completely different from his. I've never wanted to go to a Doctor that was "out of network", I can always get an appointment next day, my co-pay is $10, meds are never more than $20 or so and my insurance company has never come back wanting money from me. Does that make me right? Of course not. On the macro he's still against France's system for it's "punitively high tax rates that will have to increase unless benefits are cut" and he still endorses a free market system so I don't see this piece proving anything in that regard.
- mrkurt 17y agoHe's still against France's system on a macro level vs a true market based system... which seems like an unachievable alternative, unfortunately. It sounds to me like he thinks "Free Market" > France > UK/Canada/etc > ... > Current US system. And the macro level influences your anecdotal experience too. Will you still have that same care you're happy with if you lose your job?
- SamAtt 17y agoI'll have the same care for at least 18 months after losing my job and even after that I'd have a variety of government programs that would provide for me. But the main point is that no one in the U.S. thinks our system isn't screwed up. The question is whether single-payer is the solution or not.
- orblivion 17y agoWell what it does prove is that the European system isn't the unmitigated disaster that conservatives and libertarians here claim it is. I'm personally all for a free market system, but I think it's counterproductive to be in denial when the other side brings up a damning data set.
- SamAtt 17y agoPardon me for quoting from something I wrote above but I didn't want to retype. The bottom line is Data Sets can lie (though I agree single-payer is certainly not the disaster some make it out to be). The quote... If you look at the breakdown of things you'll see that a lot of the cost difference is because people in the U.S. have a choice and they choose the more expensive option. There are also issues of tort reform which the U.S. desperately needs. Because the current system leads doctors to order thousands of dollars in additional treatments to rule out things that Canadian doctors don't have too (and while the actual suits themselves are a relatively small portion spent on health care it should be mentioned that the U.S. pays 4 times more per capita on malpractice suits) As for wait times it's true but the base line number doesn't take into account the fact that many don't have health care. Again I reiterate the U.S. system is screwed up. But the fact is people with insurance in the U.S. tend to have shorter wait times and it's only when you factor in things like free clinics and government programs that the wait times rise above those in Canada.
- Judson 17y agoIt is important to note that with the current tax rates as high as they are (on the caugh rich, $150,000+), we can't feasibly move to a system like France's would (all things constant) raise tax rates even more, without reducing spending[1]. The key point the author suggests, and which I agree, is the breaking down of market barriers such as: - Why do I need a $200+ doctors visit to a "specialist" to get a prescription anti-fungal creme? (Answer: FDA) - Why does a visit to a "doc-in-a-box" cost me $25 (copay) and my insurance company $75+ when I was only there for 15 minutes (after a 30min wait)? (Answer: AMA regulates supply of doctors. We may have needed that before technology basically automated routine doctors visits, but we don't need such stringent accreditation for a bad cold diagnosis (flu scare).) [1] http://online.wsj.com/article/SB124958049241511735.html http://online.wsj.com/article/SB124958049241511735.html
- orblivion 17y agoDoes France not have their equivalent of the FDA and AMA?
- marshallp 17y agoThe problem is American doctors are smug elitist's who believe they're worth half a million dollars a year and american society believes they're worth it too (possibly through watching too much medical dramas on television). Every other country in the world treats theur doctor's as humanitarians who deserve an above average but honest wage.
- Judson 17y agoI guess the real question is, do you have to go to school for 10 years to be a generic MD who can read the output of a machine and tell me my white blood cell count is elevated so I probably have an infection. Here is an antibiotic. btw, I'm not saying that years of school aren't worth it for docs that are more specialized (aka surgery)
- orblivion 17y ago
- jcnnghm 17y agoIf we want lower-cost health care, we should enact stricter intellectual property laws, and require other countries license and pay full fair for medical advancements made in the United States. 82% of global R&D spending in medicine comes from the United States. The author of the article was frivolously using medical resources, which is why he couldn't get insurance. If he has been so healthy that he hasn't missed more than three days of work due to illness since 1986, why does he need "routine checkups" every four months. If I was looking at that from the perspective of an insurer, the conclusion that I would draw is that, should this guy ever actually come down with something, he'd be in the hospital for months.
- DennisP 17y agoThree times a year is frivolous? In Japan people go to the doctor an average of 14 times a year. They spend six percent of their GDP on healthcare and have virtually no waits even for elective surgery. The U.S. spends 17 percent. As for IP, what we should really do is get rid of pharmaceutical patents entirely. There are plenty of other ways to fund the research. Half is funded by the government anyway, and a lot of what the big pharms fund is "me-too" drugs and ways to extend existing patents, which makes the spending numbers kind of misleading.
- smutticus 17y agoFraming the argument as socialist vs capitalist is not helping us work towards a real solution to America's health problems. France is not a socialist democracy nor is the USA a true capitalist republic. We need to dissociate ourselves from idealology driven plans and name calling. That said I have enjoyed the medical care of The Netherlands and the USA at different times and I much prefer the Dutch system. It's just cheaper and less hassle. They're both public/private organized but for whatever reason the Dutch system is just easier for me to deal with. I don't know which one is socialist or which one is free market or whatever. The Dutch one is just cheaper and I get better service. Maybe the USA can attain lower costs and better service through introducing more competition. Or by training more doctors or public support. I don't care what idealology my elected leaders pick. Just come up with a plan, show me what I have to pay to go to the doctor and I'll decide if I move back to the USA when my time in Holland is up. But that's not going to happen if we as Americans can't move away from infantile and outdated idealogical debates rooted in cold war fear mongering.
- 100k 17y ago> Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. So he opposes "ObamaCare" but loves the French system (no surprise, the French system is clearly one of the best in the world) which he has access to by virtue of marrying a Frenchwoman. New Reason health care plan: marry a European!
- anamax 17y agoWhether or not the French, Canadian, German, or UK govt can do healthcare doesn't tell us anything about whether the US govt can do healthcare. What is it about Medicare and other existing US govt healthcare that convinces folks that the US govt can do healthcare on a larger scale? That's why I make my offer. Let's give Obama free rein wrt healthcare for folks whose healthcare is already done via the US govts at any level. Not just Medicare/Medicaid (and the state programs), the IHS and other programs, but local, state, and federal employees as well. I'll even throw in companies that get more 70-80% of their revenue from govt. That's easily 40%+ of the population. Note that those folks are already under "single payer". In return for free rein, the cost per covered person is capped at today's rates for the first two years and then decreased 5%/year each year for the next four years. Since single payer advocates claim at least a 30% savings and that's just a touch over 20%, that per-person savings should be a slam dunk. To sweeten the pot, he can use the money from the per-person cut to increase the number of people covered. I'm willing to consider letting other folks/companies buy into the program for the budgeted amount. The only thing non-negotiable is the total amount spent per person. Yes, he's free to negotiate, remove import restrictions, and the like. However, he can't force people to accept the prices that he'd like to pay - he can only refuse to do biz with folks who don't charge what he'd like. And, if he removes import restrictions, that applies to everyone, not just folks under obamacare. At the end of six years, we'll know for sure whether the US govt can do healthcare. Heck - I suspect that we'll know earlier. Deal?
- DennisP 17y agoThe German system is not government healthcare. Everybody has private, nonprofit insurance. Arguably they're less socialized than we are, since they have no Medicare, Medicaid, or VA. Japan is the same, with more choice than Germany: 2000 insurance companies, take your pick. What they share with France: a mandate, a national price list for services, no claim denials allowed for anything on the pricelist, no coverage denials, electronic medical records, subsidies for the poor. They do better on stats than we do, at much lower cost.
- anamax 17y ago> They do better on stats than we do, at much lower cost. Irrelevant because that doesn't imply that the US govt can do that. (Also irrelevant because the German and Japanese populations are very different.) That's why I proposed the experiment - let's see what the US govt can do. Many of us prefer Google to other search engines. Google's existence proves that better is possible, but it doesn't prove that Yahoo or Bing can do better than they do.