Last chance

October 21, 2010

…before the US turns into Denmark or Sweden.  Last chance to tell Nancy Pelosi to go eat a hodgy. A news post from one of the directors of NCPA:

Dear Policy Patriots –

Election Day is Just Two Weeks Away! If ObamaCare is not repealed, you will face lower quality, higher cost health insurance. Your access to care will suffer. The time to act is NOW!

Top 4 Reasons to Repeal ObamaCare. There are dozens of good reasons to repeal ObamaCare but here are the top four:

  • Americans Don’t Want It. People will be required to buy a product whose price will be rising at twice the rate of growth of their incomes and they will be barred from doing many of the things needed to control these costs.
  • Businesses Can’t Afford It. ObamaCare imposes a bizarre system of subsidies which will disrupt the entire labor market – causing massive layoffs and, ultimately, a complete restructuring of industrial organization.
  • Patients Don’t Need It. The health insurance exchange will give health plans perverse incentives to attract the healthy and avoid the sick; and after enrollment, to overprovide to the healthy and underprovide to the sick.
  • The Health Care System Can’t Support It. As is the case in Massachusetts, people will have perverse incentives to game the system – remaining uninsured while healthy and obtaining insurance only after they get sick; choosing limited-benefit plans while healthy and scaling up to richer plans after they get sick.

Change You Can Believe In! The American people deserve better than ObamaCare. You should expect more. Health reform should include higher quality, lower cost and strong protections for the care of senior citizens. Repealing ObamaCare is step one in achieving these important, attainable outcomes.

Walk Your Block This Week! Policy Patriots just like you have distributed more than 350,000 copies of the NCPA’s What Does Health Reform Mean for You? This week, many have committed to walking their neighborhoods, distributing this important educational guide. Do your part today by order 100 pamphlets from http://www.policypatriots.org and committing to walk your block this week.

———–

Okay, it’s a little hysterical-sounding, but he’s on the right track. I’ve been harping on that fourth point for many moons now. The health care system won’t be able to stand the strain. http://wp.me/pzqik-2R, https://shutyoureverlovingpiehole.wordpress.com/2009/07/13/stop-single-payer-health-care-now/

I’m happy that my representative, Frank Kratovil, voted against the thing, mainly on point #2; and dismayed that one of my senators, Ben Cardin, has stated in his publicity literature that he sincerely believes that health care is a right. He’s wrong, of course. If you have to pay for it, it’s a commodity, not a right.

One of the great things about our rights is that, coming from G-d as they do, they’re free. Life? Liberty? Pursuit of happiness? All free. The stuff in the Bill of Rights? Free. You don’t have to pay for the right to free speech. (Please don’t confuse this with the need to pay for devices, such as a printing press or a personal computer, that facilitate your rights. That’s not a need. You can go down to the corner, stand there and yell, “The President is a fink!” without any purchased tools. That’s not only free, but very satisfying.)

The flip side of all this is that if you do have to pay for something, it’s not a right, it’s a good, a commodity. Which is why I’m disappointed, but not one bit surprised, that one of my senators, Ben Cardin, declares access to affordable health care to be a right: http://cardin.senate.gov/news/enews/nov23.cfm

As I’ve said in a prior post, I think Ben Cardin is a pretty smart guy. I know he had a class in Constitutional law as part of his J.D. degree and he knows quite well that health care is not a right, at least not in our Constitution. It’s too bad that he makes it sound like it is. It’s not. Health care is a commodity. In this country, one must pay for it.

It seems that too many people, politicians and others, on the pro-government health care side of the debate are getting two rights confused: the “right” to affordable health care, which is not a right, with the right to not be denied access to a commodity because of intangibles such as the color of your skin, your sex, your native language, or even to which deity you pray. As human beings, we are all equal in human dignity and those G-d-given rights enumerated in the Constitution. That doesn’t mean we are all equally entitled to equal access to the same commodities. If that were the case, I have just as much right to drive a Bentley as Kobe Bryant or Paris Hilton does, and therefore I demand that a Bentley be delivered to my house, tout suite. Can I get it in burgundy?

In my opinion, the best commentators on the monstrosity knows as health-care reform are those elected representatives who also happen to be health care providers. You guessed it, no one “gets” the issue better than Ron Paul:

http://www.house.gov/htbin/blog_inc?BLOG,tx14_paul,blog,999,All,Item not found,ID=100322_3678,TEMPLATE=postingdetail.shtml

Ben Cardin is one of my senators. He’s been one of my elected representatives for fifteen years, either as my U.S. representative or my senator, and been in federal office and state office much longer than that. He’s a smart guy, a nice guy, and has a career of dedication to public service. In other words, he’s pretty much everything that’s wrong with Maryland politics.

I’m not sure how that “red state–blue state” thing got started, unless is was Dr. Seuss’s contribution to the political discourse. But we have it now, so believe me when I tell you Maryland is one of the deepest blue states in the nation. We have a few Repubs in the public eye—Ellen Sauerbrey, Andy Harris, Michael Steele. But as long as I’ve lived in Maryland, we’ve had public officials who’ve made careers out of sincerely believing that government is here to help people. Some of them, like John Sarbanes, are personal acquaintances; others, like Martin O’Malley, Cardin, and Sarbanes’ father, I’ve only had the opportunity to meet and say hello. But they all approach government the same way: the bigger, the better.

In response to an announcement by Spirit Airlines, a mid-range regional carrier, that they would begin charging passengers $45 for each piece of carry-on luggage, Cardin is one of the cosponsors of a particularly meddlesome piece of legislation, S.3195, the Free of Fees for Carry-On Act, which he claims will preserve airline rights but also prevent travelers from being abused with fees. This bill is the essence of government micromanaging our lives.

In my current job, I bet I travel way more often by plane than Cardin does (though he probably travels longer distances). I also bet he doesn’t fly coach, where the overhead bins are a pandemonium dominated by preschool children with their very own wheeled luggage (why? why do four-year-olds need a bag as big as mine?), inconsiderate adults putting their bags in the wrong way and thereby taking up too much space, and still other adults thinking it’s okay for them to put their jackets in the overhead bin so other passengers have no room to put their bags up there. On Southwest, if you don’t have an “A” boarding pass, woe is you; I bet my paycheck there won’t be any room for your bags by the time you board.

Some larger airlines, such as United, are charging for checked luggage. I totally understand the desire to not check luggage, since it may get lost.  However, in this day and age, of overhead bins crammed to the gills, I think it should be the other way around. Make checked luggage free, and pay for carry-ons. I suggest that Spirit has the right idea. Don’t want to pay the $45? Check your bag, and leave room for the rest of us who don’t mind paying. Or, I have an even better idea: Don’t want to pay the $45? Don’t fly on Spirit. No one is forcing you to, after all. An added side benefit of this would be that fewer bags to process would mean fewer tie-ups in the TSA lines. (Now, granted, I do think the best solution for tie-ups at TSA lines is to abolish TSA. But I digress.)

S.3195 could come from no other legislator other than a nanny state type. For a bright guy, Mr. Cardin certainly has lost sight of how much easier and, ultimately, better a free-market solution could be.

A final thought: Would a terrorist pay $45 for the privilege of bringing bomb components onboard? I doubt it.

Consider the following opinion column run last week in The Washington Post:

http://www.washingtonpost.com/wp-dyn/content/article/2010/04/06/AR2010040601010.html

It’s too bad comments are closed for this item, because I have one other thing to say to those statist who applauded the efforts of Big Government to stifle marketing and advertising aimed at children. There was a lot of discussion noise revolving around whether Froot Loops and Twinkies are bad for you. Well, no shit, Sherlock. That’s not the point. The point is: Just because something is bad for you does not mean it’s good for Big Government to prevent you from doing it. This is the flaw of a statist’s thinking.

The same thing is true in reverse. Just because something is good for you does not mean it’s a good idea for Big Government to coerce or force you to do it. As I posted back in the fall, what if the government had declared it mandatory to consume heroin, based on the glowing declarations of physicians of 100 years ago?

Happily, there were many rejoinders from the flip side which basically said: do some parenting. I know my mother certainly did when we were children. To all the moaners and hand-wringers who curse Kellogg’s, Post Cereals, Hostess, Skittles, etc. for daring to advertise on Saturday morning TV, or place their product on the lower shelves of the grocery store, I suggest using some of my mother’s techniques for deflating our hopes. Mom, if you’re reading this, thank you.

“We’re not getting that.”

“You don’t need that.”

“We don’t need that.”

“Forget it, we’re not buying it.”

And my personal favorite: “You got money?”

Though you’d never know it to look at me now, I used to be an avid bicyclist. Since I’m not very fast on a bike, rather than time trials and speed cycling, I concentrated on distance cycling in the 90’s, and completed four centuries in a 26-month timeframe then. In 1990, a bill introduced into the Maryland state legislature by a delegate from Anne Arundel County proposed to ban bicycle helmets.

Let me let you read that statement again and let it sink in: He wanted to ban bicycle helmets.

His rationale? We cyclists can’t hear sirens and other traffic noise.

If you bike, you know that a helmet is your first and sometimes only line of defense against asshole motorists and other bike dangers. As I was hit by a car while biking in 1995, and absorbed the brunt of the impact mainly with my face, I know firsthand the protection bike helmets provide. This jerk wanted to take my only protection away. And yes, we can hear road noise just fine.

This was my first “libertarian moment.” Here is a legislator who is both stupid and powerful. As anyone who lived through the George W. Bush regime administration knows, that’s a dangerous combination.

One of the reasons I left the Democratic Party for the Libertarian Party, and a libertarian point of view in general, is that I saw an increasing reliance by progressives, liberals, Democrats,  the left wing, whatever you want to call them, on government to enforce beneficial behavior. If something’s good for you, pass a law requiring it. If something’s bad for you, pass a law banning it. The latest salvo in this assault on our personal liberties comes to me courtesy of CNN here at UM Hospital, where I’ve been for the past 7 1/2 hours awaiting the outcome of my mother’s brain tumor surgery. (Turns out the channel changer’s locked, so I can’t escape to ESPN.) They’ve carried a news bite about the recent requirement for health care employees of New York state government to be vaccinated against the H1N1 virus (related story here: http://www.newsday.com/long-island/mandatory-flu-vaccination-splits-workers-1.1481242?print=true). Today, a rally against the proposed legislation took place on the steps of the state house in Albany. CNN found a couple of picketers to interview who, honestly, weren’t very articulate. Or, in my cynicism, I suspect their tape editors cut out the good stuff and made those two picketers sound like morons. It’s too bad, because they had a point. Related stories point out the risk of being exposed to impure vaccines or getting sick (or even dying) from the vaccine itself, as some people do.

Getting the vaccine is probably a good thing. The protesters weren’t protesting the vaccination, just the government requirement. Skip the vaccine, lose your job. It was that simple.

Suppose all the states adopted this same requirement. And suppose that the requirement extended to all state employees, not just those with health care-related jobs. There simply wouldn’t be enough vaccine to go around. There is a promise by Kathleen Sebelius that there will be about 75.3 million doses available to the public, which should carry us through the end of December ( http://www.cnn.com/2009/HEALTH/07/09/obama.swine.flu/index.html?iref=newssearch ).  She doesn’t have the power to promise that. Besides like being a promise that it will snow on Christmas, who is to say that that will be enough? Making everyone get the vaccine is a sure way to increase demand artificially without increasing supply. And the vaccine production process can’t be sped up. (Most vaccines are grown on a chicken-egg medium, which means that the rate-limiting step is how fast chickens can lay eggs. No government can speed that process up.)

Another danger of making something good a government mandate is that we can’t always predict what will happen in the future. Consider, for example, this description of a drug from the 19th century: “… dull(s) pain, strengthen(s)the pulse, calm(s) nervousness and help(s) the body heal.” Not only did it do all that, wrote a New England doc in the 1870s, “it invariably contributes to the mental cheerfulness.”  Sounds good, right? Suppose such a drug were mandated by the government to be required therapy for everyone?

We’d have a nation of addicts, because that drug was cocaine. A similar pronouncement was made by late 19th- and early-20th-century doctors of heroin, with the result that thousands of people really did become addicts.

Never mind the religious objections people may have to government-mandated therapies of any kind. Those are too numerous to mention here. What if we just find out later that what the government made us do umpty-ump years ago is bad now? What do we do then?

Another example of this bizarre behavior is occurring now in the state of California. In 2007, California passed a law banning incandescent light bulbs, with a five-year phase-in. Just banned ’em. ALL houses and places of business in California are now required to use CFLs. (http://news.bbc.co.uk/2/hi/business/6316635.stm, among others). Sounds good on the surface, right? CFLs use less electricity and emit less heat than the Edison invention. Using less electricity means less greenhouse gas emission by power plants. All good, right?

A typical CFL manufactured for consumer use contains about 3-5 mg of mercury. Imagine ten or more years from now, when spent CFLs need to be disposed. That mercury goes right back into the biosphere. (Not to mention the millions of incandescent bulbs that suddenly need to be disposed of because they’re now illegal in California. The glass, perhaps, is recycleable. But the rest of the bulb’s anatomy is not.) If all the CFLs in the US were dumped, it would contribute about 104 tons of mercury to the biosphere. And what did the EPA recommend? Double-bagging the bulbs before disposal. I am not shitting you. (http://www.epa.gov/mercury/spills/index.htm#flourescent, and yes, the government spelled “fluorescent” wrong) Someone pointed out that a plastic bag was a piss-poor idea, since plastic could still allow mercury vapor to leach out. I’m saying plastic bags are a piss-poor idea because—hello? McFly?!—plastic bags are made with petroleum derivatives! So much for protecting the environment.

I have a better idea: how about if we decide what’s good for us, and buy and use accordingly?

By the way, although this number is a bit out of date, the site http://www.swinefludeathtoll.com/ puts the total death count from swine flu at 1,154 as of this May…less than 1% of all diagnosed cases worldwide. Not exactly a cause for alarm. And certainly no reason to mandate getting vaccinated.

I’m sitting in a hospital waiting room in Florida while my mother undergoes surgery for a (thankfully, benign) brain tumor. In fact, as soon as I get done typing this, I need to go visit her in her room. The family waiting room, happily, has wireless Internet access, as well as a big-screen TV that’s been permanently tuned in to CNN. I don’t know if that’s because the staff have the remote, or simply because none of us has the stones to get up and change the channel.

So all day, we’ve been subjected to saturation PSA’s from the President about what the “public option” plan he proposes is not: It’s not a slippery slope to a single-payer program. It’s not a method of taking away your choice. “If you have a private plan,” he’s said all day, “you get to keep it.” He’s promised that the plan he proposes will prevent insurance companies from denying applicants coverage based on pre-existing conditions. He promises that this plan will compel the insurance companies to pay for basic preventative measures “such as regular checkups, mammograms, and colonoscopies.”  He’s also saying in this PSA that finally, regular families will be able to get the care they need without going broke.

As my friends at Camden Yards would say: Negro, please.

I know this President is ten tons smarter than his predecessor, so I’m confident he understands what he is saying is simply not true. So I have to wonder: Is he trying to convince himself of what he’s saying, or is he hoping we are too stupid to discern that these things are simply not true?

First and most important: Having coverage does not guarantee access to care. I’ve been saying this for a long time, but I’m by no means unique. Many others have said the same and presented the statistics to back it up, as have I. There is a shortage of providers nationwide. You cannot increase demand artificially without increasing supply. The result is rationing. Ask anyone in Canada or England.

Second, from a liberty-minded viewpoint, government forcing companies to do its bidding is just as bad as, if not worse than, government forcing individuals to do its bidding. Mr. Obama plainly stated in this PSA that insurance companies would be prohibited from denying applicants coverage, dropping sick customers from current coverage, raising premiums when someone got sick, imposing caps on coverage, and raising the patient’s share of required out-of-pocket expenses. So basically, the government is telling the insurance companies how to do business. The above regulations cost these companies money. What will they do? …Pass the increased costs, especially the costs of being forced to accept applicants who are very sick, on to the rest of us. Individuals and employers. To some smaller companies, the added cost may prove to be too much of a burden. Some people will lose their jobs as a result.  Not quite the result he was shooting for, I’m sure. Remember, liberty for businesses is just as important as liberty for individuals, and this is a great laboratory on why.

Third, and this isn’t just a government thing, mammograms and colonoscopies are not really preventative. Mammograms, by definition, detect. Therefore, they work only when there’s something there to detect.In other words, they don’t prevent; they only detect what’s already there.  (I remember being cynical when mammograms were heavily promoted as being the “latest and greatest” in breast cancer care. I was cynical because at that time, about twenty years ago I guess, I felt that research on a true cure for a women’s health issue was being given short shrift. While millions were being spent on cures for men’s health issues, the best they could do for women was early detection.) Colonoscopies, of which I’ve had one, are basically the same thing: they can’t prevent, only detect what’s already there. In the PSA, Mr. Obama promised these services free to low-income folks. My fear is that they will be overutilized and even abused, which costs all of us money, because guess who’s going to be paying for it?!

I’ve been grumpy about this whole issue lately because I feel powerless to do much about it, my Congressman being on the committee that drafted the House bill. So he’s not going to vote against it. Not to mention that his constituency largely favors it. That’s ok; I can live with him representing his constituency. But it would be spitting into the wind to ask him to vote no.

Today, the Senate Finance Committee voted down the “public option” compromise: http://www.cnn.com/2009/POLITICS/09/29/senate.public.option/index.html For now, I breathe a sigh of relief.

There are ways to provide for poor sick people without the government making us all pay for it:

  • In 2007, I did some consulting for two pharmaceutical companies. I won’t name them, but they are two of the biggest players in the industry, and you’d recognize their names. Both of them have “compassionate” programs to make sure poor patients get the drugs they need at little or no cost to them. It’s a good PR move for them, and because the patients are getting proven drugs, not experimental ones, the cost of R&D has long been absorbed and the cost to the companies to provide the drugs is lower than you would think. In fact, the cost can be part of the marketing budget, precisely because it is good PR.
  • In 1998, I worked for a small non-profit that provided advocacy to seriously ill patients. For the indigent, a co-pay of $1 was all they needed to get a prescription filled. In a minimal-government scenario, charitable donations would cover the remainder of the cost. And let’s face it: If you had more in your paycheck because of lower taxes, wouldn’t you contribute more to charity?
  • Looking at the model of the pharmaceutical companies I mention above, I could see insurance companies doing the same. In the name of free-market competition, they could offer similar programs to folks who have trouble paying for simple services like checkups, mammograms, and colonoscopies. Perhaps some companies would ally with teaching hospitals to do patient outreach in low-income areas. (Maybe some do already!)
  • Some doctors accept no insurance. That leaves them free to charge whatever they want. Including $0, if they so choose. I do allow that this is a better strategy for doctors who have paid off their student loans and have established practices than it is for new med school graduates. I currently see a specialist who meets this description for an ongoing condition I have. I pay his full fee because I can. Others may not pay his full fee.

It’s too bad Mr. Obama chose this issue to tackle first in his administration. He’s alienating a lot of people. I understand he wants to demonstrate that he’s a take-charge kind of guy, but he would have won more points with another issue the American people are less divided on, like bringing our troops home from Iraq. As of today, I don’t think it’s too late for him to switch gears. If he continues to beat this almost-dead horse, people will remember in 2012.

I’m sitting here in a hotel room in a Midwest city, listening to Kathleen Sebelius and a few Senators discuss and debate government-run health care with Wolf Blitzer on “State of the Union.” Prior to this segment, Blitzer’s show ran a couple of interviews with ordinary Americans who are out of work and in danger of losing any coverage they may have had. (For those of you who may be unaware, when you are separated from a job in which you were paying for your share of a health insurance plan of any kind, by law the employer must offer you the opportunity to continue to pay for that plan on your own. This is COBRA, the Consolidated Omnibus Budget Reconciliation Act, and it allows the covered to pay 100% of the premiums for up to 18 months to continue the same level of coverage he or she previously had. I’ve participated in it myself a couple of times, having been laid off from jobs four times in my career due to budget shortfalls. It can be expensive, but can also be cheaper in the long run than paying for a catastrophe,  like an auto accident or sudden cancer diagnosis, out of pocket.)  One interviewee said on camera, “We’re the only industrialized nation that doesn’t do this for its citizens….I say, don’t talk about it, do it!

For a couple of years now, I’ve been railing against the prospect of any government-run single-payer plan in this country. If you’re looking for a surefire way to run both the economy and the medical industry in the US right down the shit tubes, this is the best way to do it. Here’s why:

  1. People confuse universal health care coverage with universal health care. To be fair to the politicians and talking heads, for the most part they’re not the ones interchanging the terms. But many citizens are. Just because you have coverage does not mean you will be able to obtain care.  Artificially increasing demand without a concomitant increase in supply increases the value (i.e., the cost) of the item being offered. In both Canada and Britain, the result has been rationing of available medical services. This is tantamount to an increase in cost, the exact opposite of the desired result. The cost increase can sometimes be seen in terms of time rather than money:  Patients wait longer to see a doctor, with sometimes fatal results. (Canada: http://www.patientpowernow.org/2008/03/25/universal-health-care-kills/) (Britain: http://www.dailymail.co.uk/home/you/article-1114446/A-smear-test-saved-life.html, or just do a search on the name “Katie Brickell”) With rationing, because the government is paying for it, the government gets to decide when and what level of care you receive. This, tragically, is how Katie Brickell became famous. Let’s say you’re a 29-year-old female, and you and your doctor know there is a strong history of breast cancer in your family. You want a mammogram, or perhaps even a prophylactic bilateral mastectomy (a scorched-earth solution, but it does happen).  But government guidelines state that women don’t need baseline mammograms until 35. Guess what? You’re shit out of luck. “Oh, but exceptions could be made for compelling circumstances,” you argue. Okay. The compelling circumstance is the knowledge and experience her doctor possesses. This is the way care occurs now. Why do we need an extra layer of bureaucracy to achieve the same end result we now have? Who should decide whether you can have the mammogram: your doctor, you, or some unfireable GS-7  paper-pusher in Washington?
  2. There is already a nationwide shortage of both physicians and nurses.  There were, as of the 2006 census, 800, 547 physicians and 2,417,150 nurses in the U.S. (http://www.census.gov/compendia/statab/cats/health_nutrition/health_care_resources.html) The highest patient-provider ratios, not surprisingly, are in jurisdictions with both large populations and high costs of living, such as Massachusetts, New York, the District of Columbia, and my home state of Maryland, where according to this census there is one doctor for every 415 residents, and one nurse for every 847 residents. This is the third-lowest patient-doctor ratio in the country. On some other message boards I post on, others argue that the solution therefore is to train new doctors. Well, duh! Why didn’t I think of that?! Thinking like that should be in the “No Shit, Sherlock” section of the news. Consider: If there’s already a shortage of doctors, and teaching is one of the lowest-paying, lowest-prestige professions in this country (and it is), does it not also follow that there has been and will continue to be a shortage of medical faculty? (Everything I’m saying about medical education can be extrapolated to osteopathic and nursing education as well, so I’m not mentioning those just in the interest of avoiding redundancy.)  If government takes over all health care, all doctors therefore will be Federal employees.  According to the American Medical Association, in 2007 the average debt a new M.D. graduate emerged from medical school with was $139,517. (http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml) Now, if you’re a shiny new medical school graduate, and you’re looking down the barrel of debts that high, or higher, since that’s an average, would you want to accept a government job to pay that off? My guess is not. Most Federal hirees with first professional degrees go in at a GS-11 level, which currently begins at $49,544 at Step 1. Pretty puny, huh? Let’s say we jack them up to a GS-13. Ooo! They’re now eligible for a biiig $70,615 at Step 1. And that’s assuming the government would hire them straight out of medical school with no residency, which is unlikely. Now, we could bring them in on the separate GS schedule for senior-level, scientific and professional employees, which begins at $117,877.  Not bad. Let’s suppose we dump all the new American doctors, as well as the eventual foreign doctors who immigrate here, into that system at that salary, since that’s the only place they can go. Guess who’s going to pay for that? (see #4 below) So, knowing that you’d emerge from medical school with debts like this, and knowing that under a government-run single-payer system, your only career option was a government job, would you pursue that career path? I wouldn’t. Such a plan would actively contribute to a decrease  in the number of adequately trained physicians in this country. Not what we need right now. Nice going government, you just increased demand and decreased supply at the same time.
  3. The sharp decrease in provider supply will lead to an increase in less qualified providers. Some have suggested importing doctors from foreign countries. Okay, sounds reasonable on the surface. We already have many doctors here who got their medical education elsewhere. Let’s take a look at some of the requirements in foreign medical schools:
    France: Medical education in France comprises 3 years of basic medical science at the undergraduate level, followed by 3 years of hospital rotations and a residency of variable length. ( Ann Emerg Med. 1998 Jan;31(1):116-20)
    India: A medical degree in India is an undergraduate degree comprising  the basic clinical sciences and concomitant practical bedside training (http://www.indiaeducation.net/Medical/undergraduate/). Undergraduate degrees in India are three years in length. Graduate medical training can optionally be pursued.
    Russia: A medical degree in Russia is a five- or six-year program, similar to the duration of a pharmacy degree in the U.S., which could be five years for a bachelor’s degree or six years for a Pharm.D, which is currently the degree of practice. (http://www.medical-education-in-russia.com/medicaleducationinrussia.htm)
    Britain: Like India, a British medical degree is an undergraduate degree. Unlike India, however, study can last five or six years.
    Taiwan: Medical study in Taiwan is generally a seven-year program, with the last year being the bedside rotations.
    And those are just some of the most industrialized nations. That’s not counting the infamous “box top” medical schools, whose home countries I do not wish to mention, but if you’re reading this you probably already know whom I’m talking about (I’m looking at you, Ross University).  Here’s my point: No country in the world, not even the UK, has as rigorous a medical education system as the US. Virtually all of these foreign graduates require additional education and certifications, sometimes needing to repeat clinical courses or hospital rotations, to become licensed to practice in the US. And that’s not including the English language courses some of them would need to take. So, despite coming to this country hoping to ease a burden, they actually would contribute to it by needing at least some of the expensive education we require of our homegrown doctors. As well, here’s an oft-neglected aspect of this scenario: Some, including Mr. Obama and Mrs. Clinton, have suggested that the flip side of a single-payer plan be that everyone is required to carry insurance. (Obama backed off on this by suggesting that not everyone,  just every child, be required to have some kind of coverage.) That means that every immigrant doctor coming here hoping to ease the burden would be required to become part of the burden. Stated another way, they too would become mandatory consumers of the plan, before they gain the remedial education necessary to alleviate the burden. Again, this is a great way to cause an increase in demand while reducing the supply, since these new immigrants cannot help increase the supply of doctors until they get licensed and board-certified.
  4. You’re going to be forced to pay for other people’s insurance before you take care of your own family’s needs. This morning, Sebelius stated, “Well, I think we all bear a share of the burden for paying for this.” When she says “we all bear a share of the burden,” she’s basically talking about collective responsibility. That’s communism, folks. It’s the exact opposite of what this country was founded on. Kathleen, look at me and read my lips: NO, WE DON’T. Yes, bitch, I’m shouting. We don’t all bear the burden. Apparently, though, you would like us to. The only way to pay for a government-run single-payer plan is with taxes. In other words, folks, before you pay for your family’s basic needs with your take-home pay, taxes get taken out and used to pay for total strangers. Strangers who may not take care of themselves the way you do. Perhaps strangers whose health is a result of lifestyle choices you don’t agree with. Personally, I don’t care to pay for the medical care of some fat, chain-smoking teen parent who may have been drinking alcohol when she was pregnant, and her child(ren), in, oh, say, Alaska. Fuck that. I could see a situation where a taxpayer with religious objections to, say, alcohol consumption would resent being forced to pay for the coverage of alcohol-related illness. (Extrapolate that to AIDS or abortion and you can see the shitstorm brew right before your eyes.)
    “But other industrialized nations do it!” Yup.  And their take-home pay is much less than ours. The countries I hear touted the most as models of universal care, Sweden and Denmark, take a much bigger chunk out of paychecks to pay for that universal, single-payer plan they have.  A Danish take-home check is about 45% of gross wages earned. Forty-five percent. Sweden, 52%.  http://blog.canadianbusiness.com/take-home-pay-in-oecd-countries/, also http://www.fool.co.uk/news/Comment/2004/c040224e.htm
  5. Do you still really want a government-run cradle-to-grave health care system? And do you not mind paying for others? If so, fine. Move to Europe. Leave me and my paycheck out of it.

    (Post hoc 9/12/09: A poster to the comment boards at http://www.washingtonpost.com tipped us off to this insightful article in the Atlantic Monthly: http://www.theatlantic.com/doc/200909/health-care And I’m not just saying insightful because he agrees with me. He has the experience and economics chops to back it up.)

This morning on CNN, some talking head was discussing the job situation in Michigan (bleak, we all know that) and how the state has had to find other ways of boosting their local economy rather than rely on the automotive sector. One of the post-industrial sectors they are looking at is the film industry.

It seems to me that the best thing an economy of any size in the U.S. can do is move away from a manufacturing base. The natural progression of any society is agricultural -> industrial -> post-industrial, where post-industrial can be service-based or intellectual-based.  (Look at my home town and my current residence: unlike 40 or even 30 years ago, the biggest employer in Syracuse is Syracuse University, and the biggest employer in Baltimore is the Johns Hopkins University. Both cities left their industry—Allied Chemical, American Can Company—behind.)  Other countries can compete in the manufacturing sector, but almost no other country can compete in the service-based sector—as anyone who’s had to talk to a help desk in India can affirm.

Lou Dobbs has a bully pulpit by virtue of his TV exposure. He continually rails against the putative death of the manufacturing industries in the country. OMG—we’re losing manufacturing jobs!! OMG! Only 4% of our clothing is made in the U.S.!  (http://www.thedailyshow.com/watch/thu-january-10-2008/lou-dobbs)

OK with me.

How many of you have ever said, “I’d love for my daughter (or son) to grow up to be a union garment worker”? Doctor, teacher, astronaut, Nobel Prize-winning scientist, yes, but factory assembly line workers? Not bloody likely. In this day and age, post-industrial skills and post-industrial, service-sector jobs are necessary for the economic health of any nation. It is the natural progression from an industrial economy.

Rather than peeing and moaning about how people aren’t buying American cars any more, and this is coming from a lifelong Chevy owner,  perhaps Michigan should start selling something people will buy. There’s one thing that no one else but Michiganders can sell, and that’s Michigan.