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The Expansionist
Tuesday, June 16, 2009
Followup. A colleague in northern England offered this emailed comment on my post of yesterday.
Did you know that the troubles of the Big 3 American car manufacturers can be traced back to the lack of single-payer health care in the United States?

Crippling costs for health care (for retired workers as well as current ones) add some $1,500 to the cost of building a car in the United States, compared to Europe or Japan. This meant that the only American-made cars capable of making a profit were very expensive ones (and because American cars are not vastly superior in quality to European and Asian ones, this means oversized gas-guzzlers).

Read more here at Diatribes of Jay.
I replied:
Yes, I thought President Obama made that point, but I didn't listen all that carefully to the news once I realized that the huge problem of "defensive medicine" and worries about malpractice lawsuits, was a function of our insane current healthcare-funding system. I fear we are going to be saddled with some half-assed system that will be plainly unconstitutional in requiring (healthy) people to spend money on a service they don't want as a condition to living in the United States. The only way such insistence on taking health insurance could possibly be legal is if it were put in the form of a Healthcare Tax, and used to fund universal healthcare. But Government cannot require you to buy life insurance, health insurance, homeowners insurance, or anything else you don't want, just as a condition to breathing. And once people realize that there could be a dedicated Healthcare Tax, on a sliding scale that starts at $0 for people in the lowest income brackets, they will also realize that there is no need for an entire industry, the health-insurance industry, and that, indeed, if we continue to permit private health insurance, we set ourselves up for a two-tier system, of deluxe care for the rich, and crappy healthchare for the rest of us.
A healthcare tax need not be created as a separate entity, mind you, and a single-payer system could be funded by general revenues from an income tax restored to actual progressivity, with much higher taxes on the rich, and confiscatory rates on the obscene portion of the income of the obscenely rich. How is the healthcare system funded in Britain? Do you have "co-pays" each time you visit a doctor/hospital?
Britain, in its new role of "best friend" — and/or Canada, our former "best friend" — could do us a big favor in speaking up, in messages directed to Americans, on how it made the transition to a single-payer system, how it works, how it's funded. Such an exposition might even be salutary in finding any flaws that need correcting in Britain's (or Canada's) own system. ALL the industrialized countries with universal healthcare should be speaking up NOW, as friends, saying "You can do it, America. We know you can. Just do it!" (with apologies to Nike). Such encouragement should be in the form of helpful advice from good friends, not sniping criticism and implications of European (or Canadian, or Japanese) superiority: "WE can do it. OUR system works brilliantly. YOURS is contemptible, and the proposals put forward now are the work of idiots, fools, and cowards afraid to challenge the rich. Whatever happened to that 'all men are created equal' thing? It's just hollow words, isn't it? You're just a bunch of mealy-mouthed hypocrites. You don't mean any of it. How come the rich get to live, while the poor have to die because the rich refuse to pay higher taxes so their fellow citizens can get the best care? Walk our streets. Do you see massive numbers of people walking with limps from injuries they couldn't heal from completely because the healthcare system shunted them aside? How many disabilities render how many of your people incapable of work, or incapable of functioning at a high level economically? How many of your hordes of poor ARE poor because of disabilities that your disgraceful healthcare 'system' has permitted to make them permanently incapacitated? How much does that cost you in lost productivity, lost competitiveness, lost tax revenue? Americans think they're so smart when it comes to money, but subverting your economy with a healthcare system that leaves scores of millions of people unable to live up to their best potentiality isn't smart. Your system is just STUPID, which means that YOU are stupid for holding onto it and even DEFENDING it." All that is true, of course, but it's a little hard even for a close friend to say it without raising hackles and causing the jingoists to dig in their heels even more, AGAINST making the reforms that every sane and intelligent person on Earth, looking at our problems, would instantly see as necessary. The U.S. needs an "intervention" to shock it out of its self-destructive healthcare-delivery nitemare.
As I said recently in my Newark fotoblog,
Ever notice how glad the Republicans are to brag about how the United States is the richest country in the history of the world? — until it comes time to pay for things that benefit people other than the rich, such as universal healthcare, whereupon they jump to say we can't afford that! Make up your mind. Are we rich, or are we poor? Republicans can't have it both ways.
Is it possible to use pridefulness on the part of the Republican Right to get them to say:
Of course we can afford universal healthcare. We've got all the money in the world, and it's time to spend it to do the right thing, for all Americans, so we can look the world in the eye and say we have the best healthcare system in the world — the best doctors, the best hospitals, the best equipment and technology — instead of looking away because we won't face the fact that our current system stinks. Money is power, the power to do the right thing. The world doesn't remember Carnegie for his steel company, which doesn't even exist anymore, but for his philanthropy. "You can't take it with you." And if you believe in that "Creator" who made all men equal, how are you going to face Him and explain that you were perfectly willing to have your fellow-citizens die prematurely or suffer painful health problems and lifelong disabilities because you didn't want to pay higher taxes you could EASILY afford. So you could only have five houses and one yacht, instead of ten houses and two yachts. Those houses, those yachts, are not following you to the grave, and even if you buried them, you couldn't use them after death. Wherever you're going, housing will be provided. You might not like the climate, however, even if it is a dry heat. And your yachts wouldn't last long on the Lake of Fire.
We could also institute a separate tax on various categories of people who overburden the healthcare system because of preposterous choices they make that undercut their health — such as smokers of tobacco, the seriously obese, and users of illegal drugs — and would otherwise unfairly victimize the rest of us, who end up effectively subsidizing their self-destructive behavior. Such a tax would "concentrate the mind"* of such people on the negative consequences of bad choices. So simple a thing as a dollar figure that starkly shows an actual economic cost of self-destructive behavior might induce a lot of people to stop killing themselves. It's like the Ted Knight anchorman character ( "Ted Baxter") on the classic sitcom The Mary Tyler Moore Show, who couldn't deal with math — until "Lou Grant" said "Put a dollar sign in front of it", whereupon, magically, he turned into a human calculator.
Abolition of for-profit, private health insurance companies as contrary to public policy will, sooner or later, be understood to be essential to social equity. Some of the executives and clerical employees of such companies would be hired by the new national health service to process payments to providers. Others would be absorbed by other types of insurance companies. Others have skills that other types of businesses entirely can use. Some would be thrown out of work, and the law enacting a single-payer system would, in all fairness, have to provide for extended unemployment benefits, retraining, and job-placement services.
Unfortunately, the United States likes to think itself a "moderate" country, so rather than seeing all this from the outset and just making the leap to universal, publicly funded, single-payer healthcare, we will likely institute some absolutely inadequate and unfair half-measure, then suffer with it for decades before we go the necessary rest of the way. Picture a skydiver whose timidity in exiting the door causes his parachute to get caught on the tail of the plane, so he is dragged for miles before the parachute finally comes loose and he can fall, with the parachute fully deployed, safely to earth. All the while the skydiver is being dragged, the pilot has to fite to keep the plane on course, indeed, even keep from losing control and crashing. Just JUMP, dammit!

* By the way, maybe you knew the quote about death concentrating the mind, but I couldn't find it on Google, which is nowhere near as good as it used to be. Maybe there are just too many webpages now, but I think that if I had put "there is nothing to 'concentrate the mind' death" into Google five years ago, I would have found the quote quickly. Now I had to spend something like 10 minutes and try several different formulations, and read short bits of various webpages for further clues, before I finally came up with it:
"Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully."
from Boswell's Life of Johnson
(The current U.S. military death toll in Iraq, according to the website "Iraq Coalition Casualties", is 4,313 — for Israel.)

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