1. Joe S. Says:
   January 27th, 2010 at 12:30 pm

   Very good post. How true!

2. Larry C. Says:
   January 27th, 2010 at 12:32 pm

   Agree totally. This is not about health care. This is about government controlling your life.

3. Linda Gorman Says:
   January 27th, 2010 at 12:33 pm

   Another difference: in the U.S. the private system is large enough that what constitutes good care has, until very recently, been benchmarked by the private system.

   The various commissions and panels in the ObamnaCare bills were set up to change that. It would make the definition of good health care much NICEr.

4. Tom H. Says:
   January 27th, 2010 at 12:36 pm

   Linda: very clever pun! I don’t remember seeing this side of you before.

5. Gertkvist Says:
   January 27th, 2010 at 12:50 pm

   In principle I agree, but I have to point out that

   a) In Switzerland you are free to chose your own health insurance. Yes, it is obligatory to have an insurance, but what it includes is up to you.

   b) In a way the US already votes on other peoples inurances. Both by the federal laws that obliges hospitals to treat people without insurances and by state laws regulating what health insurances must contain (drug reahb, advices from priests and so on).

   c) Comparing the US to other countries is difficult. A better comparison would be between the US and the EU, or between countries and US states.

   d) If the US had the Swedish tax system (where everyone is registered, all the time) I doubt that the US healthcare system would survive for long. The possibilities to create special “healthcare taxes” is irresistable. So it is not only healthcare that determine the system.

6. Don Levit Says:
   January 27th, 2010 at 1:32 pm

   Do we make decisions publicly or privately?
   Well, as long as a third party is involved, be it insurance companies or the government, the dichotomy is not that clear cut.
   I believe the real issue, the bottom line here is one of contrasting values.
   Are they “situational values,” or “sustainable values”?
   Situational values allow the parties to do whatever the situation will allow.
   Thus, we have the patient trying to maximize care, and the insuter trying to minimize care.
   Sustainable values provide guidance to behave in ways that sustains future generations.
   That, we don’t have presently in our health care system.
   Whether public or private, the system is not sustainable.
   And, it won’t be sustainable until we can think ahead, long past our physical survival.
   Don Levit

7. William G. Shipman Says:
   January 27th, 2010 at 1:35 pm

   Because of your efforts, and those of others, we may have avoided this monster. As one of my political friends recently said, “Massachusetts gets
   it right about every 300 years.” Social Security may be next.

8. Mike Says:
   January 27th, 2010 at 2:14 pm

   You seem to forget that the main reason for universal health care is the fact that the employer will no longer have control on YOU. Would you start a company or job of your own if you KNEW that you and your family would have health care? The answer is yes.
   Does your employer control your health care and use this control to keep you working at a job you may not like? The answer is YES. Be honest, you are tied to a job you don’t like because you need the health care and so does your family. Your employer gives you a very narrow choice of health care options.
   You can’t just leave your job and go to another job if you have pre-existing conditions (and who doesn’t) so you stay at a job you don’t like.
   Trying to make this out to be a simple choice is the right wing way, it’s complicated. But we need to have some type of choice in health care so we don’t have to be chained to a job we don’t like.
   More is better than less and health care for all is more.

9. Bruce Says:
   January 27th, 2010 at 2:42 pm

   Of course it’s not about health care. It’s about control, and making people dependent on government. Which means, dependent on politicians.

10. Matt Says:
    January 27th, 2010 at 3:11 pm

    I continue to enjoy the posts. What dollar value do you equate to “almost free”? Particularly in regards to this statement:

    In Canada, when people see a doctor, the visit is free. In the U.S., it’s almost free.

11. John Goodman Says:
    January 27th, 2010 at 3:21 pm

    Matt: We pay 10 cents out of pocket every time we spend a dollar at a doctor’s office. “Almost free” means we get physicians’ care for ten cents on the dollar.

12. Jennifer Siefert Says:
    January 27th, 2010 at 4:03 pm

    Unfortunately, most consumers of health care do not know how much the care actually costs. Any model where people are disconnected from the true cost of care cannot be sustained. Certainly, an attitude of “let the rich pay for it” or “let the people with rich plans pay a high tax on them – except for union members” is not going to improve things. You are not going to bring down the cost of care without changing behavior. I would rather have my employer offer me a lower insurance premium for exercising regularly or not smoking than have the federal government ban smoking or send me to jail if I don’t purchase the “right” level of coverage for my family.

13. Joseph Chiarelli Says:
    January 27th, 2010 at 5:24 pm

    In my opinion, healthcare is very personal and each individual is unique – physically, emotionally, and economically. Private enterprises or government agencies that make healthcare decisions for individuals based on groupings, statistical samples extrapolated to broad populations, or glittering generalities will, by definition, create issues, errors, and mistakes for some individuals. This process creates resentment, resistance, and attempts at retribution on those who made the decisions/created the rules. As these issues, errors, and mistakes become known, the effort to compensate and either correct or avoid these issues, errors, and mistakes in the future increases the cost of providing care. However, the underlying issue – personal choice – is never addressed so the cycle continues. It appears that if a system of options is provided to individuals to make their own choices – with guidance and help to avoid choices that are deleterious either to them or to the population/ country as a whole – the underlying root cause can be addressed.

14. Bobby Morris Says:
    January 27th, 2010 at 11:24 pm

    Mr. Goodman, well put! You are correct about the misleading rhetoric that confuses so many. The problems with our system of health care are indeed numerous. I could not agree more with you and Mr. Chiarelli’s comment about the needs of each individual being different strikes a resounding chord. I am fairly new to your site so I may be beating a dead horse here, but one of the huge problems with the cost factor of health care in our country stems directly from the pharmaceutical manufacturers. Why oh why do we have to foot the bill for advertising of prescription drugs which are obviously only availableby prescription. Why, because these mega corporations need justification for their budgets and write offs on their taxes! It is preposterous to think that advertising these drugs to the general public is a public service. The very notion that because a commercial telling you that a particular prescription drug is what you need and then suggesting that you ask your doctor for it is reprehensible. Health care as we know it need not be this way.

15. hoads Says:
    January 28th, 2010 at 2:05 am

    “I don’t recall a recent example of an American being intellectually honest enough to admit that the real reason for national health insurance is that in matters of health, private decision-making is socially intolerable. If you know of an exception, post it in the comment section.”

    While I haven’t dug up exact sources, I have read either in Congressional testimony or from some liberal think tank statements that individuals should not be allowed to determine individual insurance benefits because of the concept of “everybody in, nobody out” which is prominent within the literature of healthcare reform. Proponents of nationalizing healthcare believe the government should determine the actuarial value of an insurance policy because they believe everyone should be paying for a baseline of healthcare benefits determined by government. And that basket of benefits include maternity and infant child care, drug and alcohol rehab, mental health therapies, preventive screenings on top of treatment and hospitalization for acute and chronic medical care.

    And, there is also the concept of “healthcare equity” that is rampant within liberal circles and promotes the idea that “overutilization” of healthcare needs to be regulated by government in order to spread healthcare resources to all.

    So while there are probably no headlines in mainstream media that read private healthcare decisions are socially intolerable, scratching below the surface reveals an ideology that relies on collectivizing all healthcare decisions.

16. John R. Graham Says:
    January 28th, 2010 at 7:22 pm

    “Mike” (above) states that employers control our access to medical services in the U.S. But his “universal health care” seems to be run by government. If we had (for historical reasons) employer-based housing, so that every employed American lived in a house chosen by his (or his spouse’s employer), would the appropriate reform be to put government in charge of the housing? No, it would be for the government to let families control their own housing dollars, by reforming the tax code.

    Nevertheless, he is right that the employer-based system is idiosyncratic to the U.S. and harmful. In other countries, health insurance is portable (although the Dutch seem to be experiencing a rise in group health benefits: http://tinyurl.com/n9lcrz).

    As to the more philosophical question, I think the drive by the political class to take over Americans’ access to medical services is driven by international class envy. Think about it: If you are the Secretary of Defense, or State, or Treasury, you are the Big Cheese at an international meeting of your peers. If you are the U.S. Secretary of Health & Human Services, you look like kind of a loser when you meet your Canadian or British peers. The same goes for the various bureaucrats at lower levels of the system.

17. OldSailor Says:
    January 29th, 2010 at 3:56 am

    In Obama’s State of The Union address, there was a momentary slip in the so-called Health Care Reform. The President actually said that the administration is pursuing “Health Insurance Reform”. From what I have read, the pending legislation is really about bringing the insurance industry to heel just as the administration has done to the banking/financial sector and the automobile manufacturers. Most people would agree that health care delivery is a patchwork that does not consistently deliver high quality care across the population or even across the country. Throwing billions (Trillions?) of dollars at the problem will never work as long as the politicians are in charge of doling out the money. When the current, pending bills from House and Senate are each 2,000 pages, we all know that each bill is riddled with massive problems and special interest provisions. “War and Peace” is less than 1,500 pages for Pete’s sake! The Obama/Pelosi/Reid troika seems to be blinded by what they see as their legacy being “Universal Health Care” for everyone. What they do not see is the total dissatisfaction with how the bills are going to be punitive to the entire population, with the exception of the unions’ (government unions) of course. This whole process is reminiscent of a line in “Animal Farm” by George Orwell in which the ruling class (pigs) state that: “All animals are equal, but some animals are more equal than others”

18. Why are There Collectivists? | John Goodman | NCPA Says:
    February 8th, 2010 at 11:31 am

    [...] a previous Health Alert I argued that the real issue in health reform is not health care. It is collectivism. The natural [...]

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