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This is a great metaphor. Because if you don't change the oil in your car, your engine will slowly grind itself to death. People need to consume healthcare; it

This is a great metaphor. Because if you don't change the oil in your car, your engine will slowly grind itself to death. People need to consume healthcare; it's not a luxury good. And vaccinations are rarely given by the actual drs - that's what nurse practitioners are for. The problem in the US is not -- let me repeat -- NOT because healthcare services are too available because people don't have to pay. Many people avoid and delay going to the dr, because of costs, or inconvenience -- even for lifesaving tests and treatment. Hell, I had great insurance that cost $500 a month and still ended up paying amost $2k in total costs when I sprained both my ankles. (Long story.) And something like 80% of US bankruptcies are due to unexpected medical bills. The real problem is that there aren't enough doctors, and that's because the doctors' offices/hospitals are trying to be "lean" -- and that's because costs are so great. Lean is great for software, not for social services. And the reason the costs are so huge is that the whole system, from education to insurance, sucks. Compare the US to a country like Austria, with body of nationalized healthcare and -- to carry the metaphor -- a limb of private care. I moved here last August and I'm still constantly amazed by how well this country works (and how untrue most of the US' self-aggrandizement turns out to be). There are barely waiting times to see doctors, even highly sought-after specialists in Austria. You can hop into the ER in a major city and get in and out in under 2 hours. You never see the kind of wait times here that you see in the US, even in suburbia. (I moved here from various parts of Maryland, not exactly the most populous place in the lower 48.) There are more doctors. There are more female doctors. There are more doctors who really care. To my mind, this is due to several factors, including but not limited to: a) free higher education, meaning anyone who can do the work can become a doctor; b) low cost/high standard of living, meaning it doesn't take much means to survive while going to school; c) an ethic of social services; d) a nearly-single payer system reduces a huge amount of overhead & cruft; e) it's easy to manage patient billing and relationships with the insuring parties, because there are so few and they are not structured to for-profit; and d) no doctors are being driven out of business by high malpractice insurance premiums, due to all of the factors above. I had to go to the ER on a road trip thru the country a couple weeks ago. I immediately saw a doctor and nurse practitioner, and they were double-teaming me - one measuring my blood-pressure, the other drawing blood; one checking my blood-ox levels, the other listening to my chest, etc. I had x-rays, I had an EKG, and lab work, all inside of 2 hours. Then I got my medicines and left. And I paid... $0 for the ER visit, and about $12 for the medicines. On top of that, I was in there for what I suspected was bronchitis/pneumonia (I have crap lungs). But, unlike every time I've had that in the US, the doctors I saw looked at me and realized it was similar symptoms to both deep-vein thrombosis and congestive heart failure. Which is true. My heart's fine, but no one in the US has ever analyzed me that thoroughly when I presented with "obvious" symptoms. They were so on the ball, it was a world of difference. I felt safe and now I know my heart's fine. I've never had a medical experience that good in the US. Not for a second did they treat me with the jaded disregard you usually experience in US ERs. Clearly the cheap and easy availability of great care is not a problem. I really wish that I knew why Americans are, on the whole, always blaming the end-consumer for what are systemic deficiencies.

lionhearted 17y ago
I completely agree with you analysis of all the problems with the American system, though I'd suggest a different way to address the problem because there's some very real downsides to Austria's system as well. For fixing America's medical and insurance - in lieu of of free higher education, it'd be simple to drastically reduce requirements to practice medicine. To practice medicine in the United States, doctors have to go through crazy rites of passage, including years of their lives and hundreds of thousands of dollars. Groups like the American Medical Association have intentionally tried to keep the requirements very high, as that keeps doctors' fees and wages up by restricting supply. Undergraduate + medical school + residency is way more than necessary to become a competent doctor. Could anyone really claim with a straight face that 4 years of intense study, plus 2-4 years of hands-on apprenticeship wouldn't far more than enough to practice a specific kind of medicine? People pick up many skillsets as difficult as medicine to a competent degree in a lot less than 10 years and hundreds of thousands of dollars of costs. As for Austria, it's an interesting case, huh? Austria has one of the longest traditions of social services in Europe - Otto von Bismarck, Prussian Chancellor, was huge on it. Austria has lots of practice and does a pretty good job of offering a number of services. There's a few downsides, though. Of course, most people have probably heard the argument about how it slows growth and innovation, and there's some truth in that. Typically people counterargue, "Yes, but it's a worthy tradeoff to improve quality of life in the present." And there's merit in that too. But using Austria as a specific example - one of the real dangers of socialization of important elements of an economy is that it makes it much easier for the government to go totalitarian, as was seen under the Nationalsozialistische Deutsche Arbeiterpartei, the National Socialist German Workers' Party. Limited socialism can work with a very strong constitution to limit governmental powers. But without that, politicians become in control of the courts, military, and economy. That's a very dangerous combination. One of the tricky parts about socialism is that it can't adjust fast enough to fill diverse wants and needs. Governments are rock-and-hard-placed: A fast moving, fast changing government makes lots of mistakes. A slow moving, slow changing government doesn't adapt very fast. But one thing socialism is really, really, realy good at is making what Clauswitz (another Austrian-Prussian, genius military scholar) called "total war". That's where your entire economy, culture, and civilization is focused on conquering or destroying another civilization. Every major combatant during World War II went to a more socialized economy, including the United States and England. Government assumed control of much of the production and media. The Allies needed to, because the Germans and Japanese were that focused. One of the reasons that France fell is because it was severely overwhelmed in terms of technology: Less aircraft, less artilery, less mechanized infantry. The American and English governments saw this, and took greater control over their economies. But could any of this have happened without government control of economies in the first place? A charismatic, psychopathic Austrian-Prussian Lance Corporal took over leadership of the National Socialist Worker's Party (Nationalsozialistische, shorthand "Nazi"), and they already had large control over the nation's factories, food, banking, education, medicine, media, and so on. The "trusting the government" culture lets the inevitable bad government run by a psychopath run amok. You could take North Korea as another example - they have the fourth largest army in the world (fourth! despite being #47 in total population!). All they produce effectively is military, but they do a pretty good job of it. So a bit of a tangent there - I'm with your analysis completely about why the costs are high in the United States. I just also point out the very real dangers of state control of the economy. More government power leads to an easier path to totalitarianism and aggressive war. That's one of the reasons Bismarck, a real expansionary conquerer type himself, introduced the culture of social services to Prussian Austria. It builds national loyalty, especially with government-run education. It endears the people to the government and makes them reliant on it. And it lets them flip into "war mode" easily when the political leadership wants to. There can be some advantages, but there's quite real dangers. I share the take as a casually interested historian, and would be very happy to hear some other people's replies and analysis.

lionhearted 17y ago

I completely agree with you analysis of all the problems with the American system, though I'd suggest a different way to address the problem because there's some very real downsides to Austria's system as well. For fixing America's medical and insurance - in lieu of of free higher education, it'd be simple to drastically reduce requirements to practice medicine. To practice medicine in the United States, doctors have to go through crazy rites of passage, including years of their lives and hundreds of thousands of dollars. Groups like the American Medical Association have intentionally tried to keep the requirements very high, as that keeps doctors' fees and wages up by restricting supply. Undergraduate + medical school + residency is way more than necessary to become a competent doctor. Could anyone really claim with a straight face that 4 years of intense study, plus 2-4 years of hands-on apprenticeship wouldn't far more than enough to practice a specific kind of medicine? People pick up many skillsets as difficult as medicine to a competent degree in a lot less than 10 years and hundreds of thousands of dollars of costs. As for Austria, it's an interesting case, huh? Austria has one of the longest traditions of social services in Europe - Otto von Bismarck, Prussian Chancellor, was huge on it. Austria has lots of practice and does a pretty good job of offering a number of services. There's a few downsides, though. Of course, most people have probably heard the argument about how it slows growth and innovation, and there's some truth in that. Typically people counterargue, "Yes, but it's a worthy tradeoff to improve quality of life in the present." And there's merit in that too. But using Austria as a specific example - one of the real dangers of socialization of important elements of an economy is that it makes it much easier for the government to go totalitarian, as was seen under the Nationalsozialistische Deutsche Arbeiterpartei, the National Socialist German Workers' Party. Limited socialism can work with a very strong constitution to limit governmental powers. But without that, politicians become in control of the courts, military, and economy. That's a very dangerous combination. One of the tricky parts about socialism is that it can't adjust fast enough to fill diverse wants and needs. Governments are rock-and-hard-placed: A fast moving, fast changing government makes lots of mistakes. A slow moving, slow changing government doesn't adapt very fast. But one thing socialism is really, really, realy good at is making what Clauswitz (another Austrian-Prussian, genius military scholar) called "total war". That's where your entire economy, culture, and civilization is focused on conquering or destroying another civilization. Every major combatant during World War II went to a more socialized economy, including the United States and England. Government assumed control of much of the production and media. The Allies needed to, because the Germans and Japanese were that focused. One of the reasons that France fell is because it was severely overwhelmed in terms of technology: Less aircraft, less artilery, less mechanized infantry. The American and English governments saw this, and took greater control over their economies. But could any of this have happened without government control of economies in the first place? A charismatic, psychopathic Austrian-Prussian Lance Corporal took over leadership of the National Socialist Worker's Party (Nationalsozialistische, shorthand "Nazi"), and they already had large control over the nation's factories, food, banking, education, medicine, media, and so on. The "trusting the government" culture lets the inevitable bad government run by a psychopath run amok. You could take North Korea as another example - they have the fourth largest army in the world (fourth! despite being #47 in total population!). All they produce effectively is military, but they do a pretty good job of it. So a bit of a tangent there - I'm with your analysis completely about why the costs are high in the United States. I just also point out the very real dangers of state control of the economy. More government power leads to an easier path to totalitarianism and aggressive war. That's one of the reasons Bismarck, a real expansionary conquerer type himself, introduced the culture of social services to Prussian Austria. It builds national loyalty, especially with government-run education. It endears the people to the government and makes them reliant on it. And it lets them flip into "war mode" easily when the political leadership wants to. There can be some advantages, but there's quite real dangers. I share the take as a casually interested historian, and would be very happy to hear some other people's replies and analysis.