I think you have unveiled the right elements: education so that everyone can see how they are being misled, and a common passion - healthcare - to promote unity. Our own universal healthcare is not perfect - free dental care is only available to seniors and lower-income people - but its results are unifying for our society.
We all use roads, we all use internet, we must have computer access to even apply for a job - there are many universal systems we all deserve to have - why roads and no healthcare?
Because us is driven by profit. Hospitals build on numerous charges for everything.... each aspirin, each test ... doctors charge supplements for personal 'conciege' care to do standard superficial exam. Us consumer victim of private equity.
Well, I'll step into it - the same people who do the above to us develop the vaccines. Vaccines is an old, old science and it does work. That's not the issue. It takes time to do good science so we do no harm. And, the same companies getting sued for products that cause cancer (baby powder) did the Texas two step and LLC the companies to not pay the victims - why trust ANY big corporations???
We do not HAVE to be a "profit driven" country - it's a choice to do everything that way.
Americans right now are being misled here in California, for example in response to the issue--Tom Steyer is NOT on right side of the issue despite his real working family background in New York. I'm 68 and a native to the state. Despite his progressive beliefs he won't change, and he is high profile. The level of his wealth at this point is unexcusable to not back single payer and healthcare for all citizens.
I would start and say we should not conflate Indoctrination with education. Progressives are no more or less educated than other groups of people. So I think that should be removed from the discussion first. Secondly on the health care, for one it is not a federal enumerated power. So like the Flemming v Nestor decision, your Social security is really at the whim of congress. But now at the state level, most state do have some kind of state health care system. Had the people of those states so desired, they could have implemented state healthcare systems. Resource rich states I am actually surprised to find they have not done that. As to the comparison to the European countries who do seem to have on the surface, some kind of universal health care system, those countries have not had to spend billions on defense, most of that was done and is being done by Americans, who the Europeans actually dislike. I would say lets get the United states out of NATO and western Europe, bring out troops and weapons home, and maybe that peace dividend can be used to start some kind of basic healthcare system.
Aren’t you forgetting the wars the US started, including the Iran war we’re now in? What peace dividend will we enjoy until we cut defense spending by half?
The Iran war kind of started in 1979 maybe half a year before I went to boot camp. That it is now being ended is a good thing. And I agree the peace dividend would not be enjoyed until we get out of Western Europe and NATO and paying for their defense.
So then America should withdraw all our forces and military equipment from Western Europe and NATO and stop using American tax dollars to provide for defense of Europe.
The consequences of US isolationism in the past left the US unprepared for major conflicts, namely, World War I and World War II. The US diminished its diplomatic leverage when it retreated from international leadership, for example, by declining to join the League of Nations.
In my opinion, there is a middle road between being the world's police as we're doing now and sharing the cost of monitoring aggressive behavior, such as by participating in the UN and NATO.
No one is advocating for isolationism. Just realign our posture with allies ( Western Europe has made it clear they are no longer allies) so A pivot to Asia and south and Central America, and Eastern Europe. To date no global peacekeeping group like the league of nations, or the UN has prevented conflicts. I agree on the world police. Seeing the USA, China, and Russia work together as a team would probably usher in a period of peace the globe has not seen in a very long time
Definitely! Although in fact what has been going on since 1945 has been that "American tax dollars" were cleverly cycled through Europe to boost European demand for US goods and services, with of course a healthy slice of all the money going to US arms manufacturers and their shareholders.
Try changing that now, and... stand back! It'll be like trying to get a whale out of a swimming pool.
I repeat: Europe has not needed any defence since 1991, and hardly since 1945. The "Iron Curtain" was essentially a defensive measure, to keep the potential aggressors at arm's length from Russia. Very much as Russia is now doing in Ukraine.
We can and should stop trading with Western Europe, and no way in hell should we share our Nuclear sub technology with the UK and Australia. We repeat, we are fed up paying for the defense of western Europe for people that hate us. Time for the U.S.A to walk away from Western Europe and Australia. Russians are so much better than Western Europeans
There is an overriding need to get accurate information to people. The businesses that make so much money from for-profit spend as much as they like (they can always just raise prices) to make people believe right is left and up is down. And, just like in elections, they usually succeed.
Perhaps if we can get election funding under real control, something can be done.
And... we're back at education. A good educational system would ensure that by the time children are 6 or 7 they understand the profit motive and deceptive advertising. It's not too hard to teach children such simple ideas - and they would enjoy the challenge of refusing to be fooled.
This all sounds right in principle, but remember that the devil is in the details. Universal healthcare would certainly contrast strongly with the situation in the USA for many decades past. But there are some vitally important lessons to be learned from experience.
In Britain, for example, the National Health Service (NHS) was set up in 1948 after WW2 and while British people were still suffering under "austerity" more severe even that that imposed during the war. (Rationing, including food, continued until 1954).
The theory was that everyone would receive treatment free at the point of contact, without any charges. After one or at most two generations sickness would become far less common, and the huge costs would gradually decrease. And of course the people would all be magnificently healthy.
Reality turned out differently. In every decade the costs steadily rose, along with the number of patients. Early on, dentistry was excepted from the "free at the point of contact" promise. Today there is a two-tier system where patients can choose NHS treatment - basic and utilitarian, but still not free - or "going private" and paying far more. As the number of patients rises remorselessly, more and more compromises must be made. The overall bill goes up every year; "In 2022/3, £181.7 billion was spent by the Department of Health and Social Care on services in England. More than 94% of spend was on salaries and medicines". https://en.wikipedia.org/wiki/National_Health_Service
Glaringly obvious factors reducing effectiveness include the huge and steadily growing number of administrators and managers, many of whom - like Soviet political officers - now dictate diagnoses and treatments to doctors and nurses. Also the government nutrition guidelines which - like the US ones which they closely resemble - are calculated to cause obesity and sickness.
It became clear long ago that the NHS suffers fatally from giantism and bureaucracy, either of which would be enough to render it terrible value for money. Also, of course, those who spend the money do not need to worry about where it comes from; the taxpayer will provide. As elsewhere, Big Pharma obtrudes, pushing its drugs and other products whether appropriate or not. The NHS has become more and more about money, hwich of course is quite wrong.
Universal medical services seem to work better in some countries; I have heard good things about the French system, for example. It seems likely that the typical British dislike of elites and hierarchy doesn't play well with medicine and surgery, where of course you always want excellence.
No universal healthcare system is perfect, but ours is catastrophic for many and their families in ways those in countries with universal healthcare don’t have to endure when they get sick.
I understand and sympathise. As technology advances and more diseases are identified, medicine gets harder to practice.
But while looking for a better system, it’s useful to take account of the various other paths that have been tried - and the ways in which they can go wrong.
I think that ideally a new system would exclude both corporations and government! But I don’t suppose that is remotely possible. It really boils down to excluding money - and that, too, seems like a pipe dream.
Oh, I don't do plans! I leave that to industrious, educated, constructive people. My chosen path in life is to point out what doesn't work. The Internet has been a godsend, without which I might well have been murdered long ago.
To the extent that I have given it any thought, I quite like the status quo ante - before the NHS. Britain had a varied assortment of hospitals (mostly fairly small), medical practices, charities, surgeries, etc. That was a "system" that really was diverse. All treatment had to be paid for by someone, but charities helped a good deal, and most doctors were flexible. They might openly overcharge the rich, using the surplus to subsidise the poor. If the rich objected, they could probably find less socially-conscious doctors. (I have always adored Tom Lehrer, and I recall his aside about the ambitious young doctor who set up a practice "specialising in diseases of the rich").
Of course the prewar British situation (one could hardly call it a system) was far from perfect, but it could be improved at relatively low cost and trouble. Starting with a small system that worked more or less, and incrementally fixing the omissions and weaknesses.
One thing that I believe was critically important - and has been jettisoned - was that medically qualified professionals made the decisions. The bosses were doctors and nurses, and perhaps other specialists. Managers and administrators were employed where necessary, but always reported and answered to the medical staff.
I think it was in his short story "The Man Who Sold the Moon" that Robert A. Heinlein suggested that solution. The story featured a billionaire who sets out to be the first to the Moon, and he hires the best engineer he can find to run the project. Visiting after a while to check on progress, the billionaire finds his engineer frazzled and run ragged by administrative tasks for which he is unsuited. Apologising for his oversight, he immediately brings in a manager whose only job description is to make sure the engineer never has to worry about anything except engineering. (I imagine him as like Jeeves, or the people who sweep the ice in front of a curling stone to give it a perfectly smooth path). Brooks, project manager for the IBM System/360 (now THERE was a project!) explicitly invoked the Heinlein story in his book "The Mythical Man-Month".
This is the question that haunted me over a 25-year career in health care: Why are we, to the best of my knowledge, the ONLY major industrialized country in the whole world that does NOT have a universal health care system?
As a Britisher who knows very little about the US system or US life in general, I would hazard a guess that it's because the USA is the country where money plays the most dominant role in everyone's life - whether they have it or not. It seems to me that everyone in (or even adjacent to) the US healthcare system makes a ton of money - except the patient who pays for it all.
There seems to be a general prejudice in the USA against any kind of mutual help. Socialism and communism are swear words, and it's widely asserted (quite untruly) that such systems always fail. Although they usually fail when the US government decides to make sure they do. Libya, to take one example, had universal free healthcare, free education up to postgraduate level, and even free housing for many. So the USA decided to smash it. Can't have a prosperous, successful socialist country setting a bad example! Better poor and free in the USA.
Unfortunately, China is now setting a similar example of successful socialism... and it's too powerful for the USA to attack, let alone smash. Hence the sneaky attempts to undermine China by cutting off its imports.
It is the wealthy, powerful oligarchs who have taken over our government and use their money to brainwash the gullible. We need fundamental change to turn this situation around.
Yes indeed! But it’s a devil of a puzzle how to do that. Even in ancient Greece and Rome the people were always at daggers drawn with the oligarchs, and that was usually what kept the situation somewhat balanced - the possibility of resort to force, where the people had greater numbers. Nowadays that is impossible without serious organisation.
“Nothing appears more surprising to those, who consider human affairs with a philosophical eye, than the easiness with which the many are governed by the few; and the implicit submission, with which men resign their own sentiments and passions to those of their rulers. When we enquire by what means this wonder is effected, we shall find, that, as Force is always on the side of the governed, the governors have nothing to support them but opinion. It is therefore, on opinion only that government is founded; and this maxim extends to the most despotic and most military governments, as well as to the most free and most popular”.
- David Hume, “Essays, Moral, Political, and Literary. Essay 4 : Of The First Principles of Government” (1741-2)
There is a well-known saying in the computer industry, which may be apocryphal but has been attributed to Frederick Brooks.
"Every large system that works started as a small system that worked".
I think that applies, more or less, to systems of all kinds. Starting small and flexible allows one to learn from experience and make changes quickly and cheaply. Once a small system is working consistently, reliably, and well, it may be time to start thinking about a scaled-up version. Or maybe not; perhaps it's better just to multiply instances of the small systems that we know works.
Of course politicians, bureaucrats, and empire-builders of all kinds detest such caution. But they don't usually have to pick up the costs of failure. Many, many large ambitious systems have been mooted and launched by such people; they always cause immense trouble and expense, and often don't work at all.
Federal govt announced fraud task force against medicare and medicaid. Undoubtedly to punish beneficiaries from getting benefits. Presumably so trump can steal more money for Trump vanity projects.
‘US Health Security’ and ‘Universal Choice Care’ are solid ideas, but we need something instantly clear and broadly appealing. I think ‘Medicare for All who want it’ would do that.
No matter what you come up with, they will always come up with new propaganda against it with their deep pockets and vested interest. Maybe what we need is better educated voters who are knowledgeable enough to ignore the propaganda.
Absolutely right! But that just brings you face to face with another problem: how do we get better educated children and adults? The political establishment prefers ignorant dupes; and government has gradually taken over most of education. It has even managed to obscure the very nature of good education - confounding it with vocational training.
And since vocational training is seen to lead to well-paid jobs, and badly-educated people want money above all...
I think you have unveiled the right elements: education so that everyone can see how they are being misled, and a common passion - healthcare - to promote unity. Our own universal healthcare is not perfect - free dental care is only available to seniors and lower-income people - but its results are unifying for our society.
We all use roads, we all use internet, we must have computer access to even apply for a job - there are many universal systems we all deserve to have - why roads and no healthcare?
Because us is driven by profit. Hospitals build on numerous charges for everything.... each aspirin, each test ... doctors charge supplements for personal 'conciege' care to do standard superficial exam. Us consumer victim of private equity.
Indeed
Well, I'll step into it - the same people who do the above to us develop the vaccines. Vaccines is an old, old science and it does work. That's not the issue. It takes time to do good science so we do no harm. And, the same companies getting sued for products that cause cancer (baby powder) did the Texas two step and LLC the companies to not pay the victims - why trust ANY big corporations???
We do not HAVE to be a "profit driven" country - it's a choice to do everything that way.
Good observation.
Very good point, Janet.
Americans right now are being misled here in California, for example in response to the issue--Tom Steyer is NOT on right side of the issue despite his real working family background in New York. I'm 68 and a native to the state. Despite his progressive beliefs he won't change, and he is high profile. The level of his wealth at this point is unexcusable to not back single payer and healthcare for all citizens.
I would start and say we should not conflate Indoctrination with education. Progressives are no more or less educated than other groups of people. So I think that should be removed from the discussion first. Secondly on the health care, for one it is not a federal enumerated power. So like the Flemming v Nestor decision, your Social security is really at the whim of congress. But now at the state level, most state do have some kind of state health care system. Had the people of those states so desired, they could have implemented state healthcare systems. Resource rich states I am actually surprised to find they have not done that. As to the comparison to the European countries who do seem to have on the surface, some kind of universal health care system, those countries have not had to spend billions on defense, most of that was done and is being done by Americans, who the Europeans actually dislike. I would say lets get the United states out of NATO and western Europe, bring out troops and weapons home, and maybe that peace dividend can be used to start some kind of basic healthcare system.
Aren’t you forgetting the wars the US started, including the Iran war we’re now in? What peace dividend will we enjoy until we cut defense spending by half?
The Iran war kind of started in 1979 maybe half a year before I went to boot camp. That it is now being ended is a good thing. And I agree the peace dividend would not be enjoyed until we get out of Western Europe and NATO and paying for their defense.
It's ironic that Europe does not need to be defended, as no one is threatening it. (Unless perhaps Israel under the Samson Doctrine).
So then America should withdraw all our forces and military equipment from Western Europe and NATO and stop using American tax dollars to provide for defense of Europe.
The consequences of US isolationism in the past left the US unprepared for major conflicts, namely, World War I and World War II. The US diminished its diplomatic leverage when it retreated from international leadership, for example, by declining to join the League of Nations.
In my opinion, there is a middle road between being the world's police as we're doing now and sharing the cost of monitoring aggressive behavior, such as by participating in the UN and NATO.
No one is advocating for isolationism. Just realign our posture with allies ( Western Europe has made it clear they are no longer allies) so A pivot to Asia and south and Central America, and Eastern Europe. To date no global peacekeeping group like the league of nations, or the UN has prevented conflicts. I agree on the world police. Seeing the USA, China, and Russia work together as a team would probably usher in a period of peace the globe has not seen in a very long time
With Trump in charge our country will become “America Last”
Definitely! Although in fact what has been going on since 1945 has been that "American tax dollars" were cleverly cycled through Europe to boost European demand for US goods and services, with of course a healthy slice of all the money going to US arms manufacturers and their shareholders.
Try changing that now, and... stand back! It'll be like trying to get a whale out of a swimming pool.
I repeat: Europe has not needed any defence since 1991, and hardly since 1945. The "Iron Curtain" was essentially a defensive measure, to keep the potential aggressors at arm's length from Russia. Very much as Russia is now doing in Ukraine.
We can and should stop trading with Western Europe, and no way in hell should we share our Nuclear sub technology with the UK and Australia. We repeat, we are fed up paying for the defense of western Europe for people that hate us. Time for the U.S.A to walk away from Western Europe and Australia. Russians are so much better than Western Europeans
There is an overriding need to get accurate information to people. The businesses that make so much money from for-profit spend as much as they like (they can always just raise prices) to make people believe right is left and up is down. And, just like in elections, they usually succeed.
Perhaps if we can get election funding under real control, something can be done.
And... we're back at education. A good educational system would ensure that by the time children are 6 or 7 they understand the profit motive and deceptive advertising. It's not too hard to teach children such simple ideas - and they would enjoy the challenge of refusing to be fooled.
This all sounds right in principle, but remember that the devil is in the details. Universal healthcare would certainly contrast strongly with the situation in the USA for many decades past. But there are some vitally important lessons to be learned from experience.
In Britain, for example, the National Health Service (NHS) was set up in 1948 after WW2 and while British people were still suffering under "austerity" more severe even that that imposed during the war. (Rationing, including food, continued until 1954).
The theory was that everyone would receive treatment free at the point of contact, without any charges. After one or at most two generations sickness would become far less common, and the huge costs would gradually decrease. And of course the people would all be magnificently healthy.
Reality turned out differently. In every decade the costs steadily rose, along with the number of patients. Early on, dentistry was excepted from the "free at the point of contact" promise. Today there is a two-tier system where patients can choose NHS treatment - basic and utilitarian, but still not free - or "going private" and paying far more. As the number of patients rises remorselessly, more and more compromises must be made. The overall bill goes up every year; "In 2022/3, £181.7 billion was spent by the Department of Health and Social Care on services in England. More than 94% of spend was on salaries and medicines". https://en.wikipedia.org/wiki/National_Health_Service
Glaringly obvious factors reducing effectiveness include the huge and steadily growing number of administrators and managers, many of whom - like Soviet political officers - now dictate diagnoses and treatments to doctors and nurses. Also the government nutrition guidelines which - like the US ones which they closely resemble - are calculated to cause obesity and sickness.
It became clear long ago that the NHS suffers fatally from giantism and bureaucracy, either of which would be enough to render it terrible value for money. Also, of course, those who spend the money do not need to worry about where it comes from; the taxpayer will provide. As elsewhere, Big Pharma obtrudes, pushing its drugs and other products whether appropriate or not. The NHS has become more and more about money, hwich of course is quite wrong.
Universal medical services seem to work better in some countries; I have heard good things about the French system, for example. It seems likely that the typical British dislike of elites and hierarchy doesn't play well with medicine and surgery, where of course you always want excellence.
No universal healthcare system is perfect, but ours is catastrophic for many and their families in ways those in countries with universal healthcare don’t have to endure when they get sick.
I understand and sympathise. As technology advances and more diseases are identified, medicine gets harder to practice.
But while looking for a better system, it’s useful to take account of the various other paths that have been tried - and the ways in which they can go wrong.
I think that ideally a new system would exclude both corporations and government! But I don’t suppose that is remotely possible. It really boils down to excluding money - and that, too, seems like a pipe dream.
Big-name insurance companies are corporations. Medicare and Medicaid are government programs. What's your plan?
Oh, I don't do plans! I leave that to industrious, educated, constructive people. My chosen path in life is to point out what doesn't work. The Internet has been a godsend, without which I might well have been murdered long ago.
To the extent that I have given it any thought, I quite like the status quo ante - before the NHS. Britain had a varied assortment of hospitals (mostly fairly small), medical practices, charities, surgeries, etc. That was a "system" that really was diverse. All treatment had to be paid for by someone, but charities helped a good deal, and most doctors were flexible. They might openly overcharge the rich, using the surplus to subsidise the poor. If the rich objected, they could probably find less socially-conscious doctors. (I have always adored Tom Lehrer, and I recall his aside about the ambitious young doctor who set up a practice "specialising in diseases of the rich").
Of course the prewar British situation (one could hardly call it a system) was far from perfect, but it could be improved at relatively low cost and trouble. Starting with a small system that worked more or less, and incrementally fixing the omissions and weaknesses.
One thing that I believe was critically important - and has been jettisoned - was that medically qualified professionals made the decisions. The bosses were doctors and nurses, and perhaps other specialists. Managers and administrators were employed where necessary, but always reported and answered to the medical staff.
I think it was in his short story "The Man Who Sold the Moon" that Robert A. Heinlein suggested that solution. The story featured a billionaire who sets out to be the first to the Moon, and he hires the best engineer he can find to run the project. Visiting after a while to check on progress, the billionaire finds his engineer frazzled and run ragged by administrative tasks for which he is unsuited. Apologising for his oversight, he immediately brings in a manager whose only job description is to make sure the engineer never has to worry about anything except engineering. (I imagine him as like Jeeves, or the people who sweep the ice in front of a curling stone to give it a perfectly smooth path). Brooks, project manager for the IBM System/360 (now THERE was a project!) explicitly invoked the Heinlein story in his book "The Mythical Man-Month".
This is the question that haunted me over a 25-year career in health care: Why are we, to the best of my knowledge, the ONLY major industrialized country in the whole world that does NOT have a universal health care system?
S/Rev. Diane Bagüés, Hospice Chaplain (retired)
As a Britisher who knows very little about the US system or US life in general, I would hazard a guess that it's because the USA is the country where money plays the most dominant role in everyone's life - whether they have it or not. It seems to me that everyone in (or even adjacent to) the US healthcare system makes a ton of money - except the patient who pays for it all.
There seems to be a general prejudice in the USA against any kind of mutual help. Socialism and communism are swear words, and it's widely asserted (quite untruly) that such systems always fail. Although they usually fail when the US government decides to make sure they do. Libya, to take one example, had universal free healthcare, free education up to postgraduate level, and even free housing for many. So the USA decided to smash it. Can't have a prosperous, successful socialist country setting a bad example! Better poor and free in the USA.
Unfortunately, China is now setting a similar example of successful socialism... and it's too powerful for the USA to attack, let alone smash. Hence the sneaky attempts to undermine China by cutting off its imports.
It is the wealthy, powerful oligarchs who have taken over our government and use their money to brainwash the gullible. We need fundamental change to turn this situation around.
Yes indeed! But it’s a devil of a puzzle how to do that. Even in ancient Greece and Rome the people were always at daggers drawn with the oligarchs, and that was usually what kept the situation somewhat balanced - the possibility of resort to force, where the people had greater numbers. Nowadays that is impossible without serious organisation.
“Nothing appears more surprising to those, who consider human affairs with a philosophical eye, than the easiness with which the many are governed by the few; and the implicit submission, with which men resign their own sentiments and passions to those of their rulers. When we enquire by what means this wonder is effected, we shall find, that, as Force is always on the side of the governed, the governors have nothing to support them but opinion. It is therefore, on opinion only that government is founded; and this maxim extends to the most despotic and most military governments, as well as to the most free and most popular”.
- David Hume, “Essays, Moral, Political, and Literary. Essay 4 : Of The First Principles of Government” (1741-2)
There is a well-known saying in the computer industry, which may be apocryphal but has been attributed to Frederick Brooks.
"Every large system that works started as a small system that worked".
I think that applies, more or less, to systems of all kinds. Starting small and flexible allows one to learn from experience and make changes quickly and cheaply. Once a small system is working consistently, reliably, and well, it may be time to start thinking about a scaled-up version. Or maybe not; perhaps it's better just to multiply instances of the small systems that we know works.
Of course politicians, bureaucrats, and empire-builders of all kinds detest such caution. But they don't usually have to pick up the costs of failure. Many, many large ambitious systems have been mooted and launched by such people; they always cause immense trouble and expense, and often don't work at all.
Federal govt announced fraud task force against medicare and medicaid. Undoubtedly to punish beneficiaries from getting benefits. Presumably so trump can steal more money for Trump vanity projects.
Their definition of fraud will be providing necessary coverage for poor and middle class.
‘US Health Security’ and ‘Universal Choice Care’ are solid ideas, but we need something instantly clear and broadly appealing. I think ‘Medicare for All who want it’ would do that.
I like Medicate for All, but there is a lot of propaganda opposed to it after all these years. Maybe repackage.
No matter what you come up with, they will always come up with new propaganda against it with their deep pockets and vested interest. Maybe what we need is better educated voters who are knowledgeable enough to ignore the propaganda.
Absolutely right! But that just brings you face to face with another problem: how do we get better educated children and adults? The political establishment prefers ignorant dupes; and government has gradually taken over most of education. It has even managed to obscure the very nature of good education - confounding it with vocational training.
And since vocational training is seen to lead to well-paid jobs, and badly-educated people want money above all...
That's for sure.
G
Europe... at least England France abd Sc a bdinsvia have 'universal healthcare.' Which works very well. ... another thorough well researched article.
Thank you.