right-wing tomfoolery, The Daily Show, Uncategorized

Get ye to The Daily Show

Last night (July 27) on The Daily Show, Jon Stewart got Bill Kristol to admit that the federal government *can* provide better health care than the private sector.

What is it that Jon Stewart v Bill Kristol reminds me of? Oh yeah:

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15 thoughts on “Get ye to The Daily Show

  1. Actually, considering Bill Krystal’s track record for being egressiously wrong, I’d find that more worrisome than anything….

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  2. Before talking up this point, some data is needed.

    1) Is U.S. military health care really that good? Maybe it’s crap.

    2) How expensive is U.S. military health care? Maybe it’s more expensive.

    Better be prepared with facts, numbers, etc. before wading into this issue.

    If that system is good and cheap, then perhaps it should become a model for the public reform.

    If that system is good but not cheap, it could support the Republican view.

    If that system is not good but cheap, it could support the Republican view. How many servicemen go outside that system to purchase better care for them or their families?

    If that system is neither good nor cheap, it could support the Republican view, and may need reform too.

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  3. A quick look at wikipedia suggests the Military Health System might be good but not cheap.

    http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

    The U.S. government also runs the Military Health System. In Fiscal Year 2007, the MHS had total budget authority of $39.4 billion and served approximately 9.1 million beneficiaries, including Active Duty personnel and their families and retirees and their families. The MHS includes 133,000 personnel, 86,000 military and 47,000 civilian, working at more than 1,000 locations worldwide, including 70 inpatient facilities and 1,085 medical, dental, and veterinary clinics.

    But I never trust wikipedia as a sole source. More investigation is needed.

    That’s about $4,300 USD/beneficiary. If this is true, then using the MHS as a model probably won’t help control health care costs and the U.S. will still have financial troubles in their future. But I’ll defer to better experts than me, this is just speculation.

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  4. “Cheap” and “expensive” are relative terms – relative to who is paying. I’d be quite sure that the military system relies more on federal dollars than the existing system, but that doesn’t mean the system itself is more expensive as a whole, only that the government is directly paying more of the shot. In the current (more) privatize system, users pay either out of pocket or via insurance companies and HMO’s. This makes the system cheaper for the government to operate by downloading most of the costs to the users. However, having the hands of the insurance companies and HMO’s between the stethescope and the patient raises the overall price quite dramatically.

    Hence, a government-operated system like the VA would be more expensive for the government, but less overall owing to the efficiencies attained by removing insurance company vultures, er, middle men.

    For numbers, the US costs far more per person than ours. According to the UN, nearly double (in 2007, $6,096 to $3,173). I got these numbers here.

    The root of the problem of course has nothing to do with efficiency, nor really directly with ideology; it’s money. The politicians are paid handsomely by medical, insurance, and pharmaceutical lobbies to keep the status quo, and so they oversimplify the debate to scare the electorate to believe what they want them to. Ideology becomes the tool, nationalized healthcare is socialism, and this becomes the talking point, not the actual strengths and weaknesses of the proposed or existing systems.

    This is speculation, too.

    edit: I just found the original source from the numbers above, from the UN. You can see the original report here.

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  5. TR#,
    You make a good point about the costs of the military system being higher than the existing privatized system available to the US public, but that only considers the cost to the government. According to the UN numbers, the US pays more per capita than we do, that it’s coming from the pockets of users directly rather than from taxes is irrelevant, it’s the amount that they spend that’s the real economic problem. (I remember a speech by Obama earlier in the year indicating his concern that if the cost of healthcare doesn’t come down it will drown the federal government and the US economy.) Note, here I’m sticking to the economic argument and will set aside compassion or the fact that medical requirements have become the leading cause of bankrupcies in the US, a fact which appals me.

    Naturally, a nationalized, public, socialized system would be more expensive for the government and require higher taxes, but healthcare is an expense already being borne by the taxpayer. Hell, it’s being doubled and then borne by the taxpayer.

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  6. More than anything, I was interested in two things specifically in regard to the interview:

    1. Kristol was surprisingly competent in spouting several facts in a row, all of which were demonstrably false – it was stunning in its ineptitude. I wanted to head over to Kevvy’s to watch it in HD to see if he was covered in lint – he is so clearly in somebody’s pocket.

    2. The particularly interesting part was Kristol’s admission that the government could run the health care system, and a good one at that – regardless of whether or not that is true, it is emblematic of how poorly thought out the dogmatic opposition to health care reform is, to indicate that “what I say is true, except when it’s not.”

    The facts in the case for health care reform are well-known to all of us (who seem to be of a generally like mind on the subject), and can be referenced effectively and authoritatively as above. It’s the danger inherent in the continuation of the rhetoric of fear and class/race division that troubles me more than the numbers.

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  7. @kevvyd: I don’t mean to argue against U.S. health care reform, I think they need it; if not, their higher costs will eat them alive. I think when employers share or support the cost of their employees health care it must get bundled into the price of that companies’ goods & services. So a health care system paid for by individuals (whether directly or through taxes or some combination) make a country more competitive internationally – this is an advantage of our (partially?) socialized system.

    I’m trying to anticipate Republicans’ objections, spin and counter-attack and try to separate fact from fiction. I understand it’s very, very difficult to compare different health care systems.

    I agree more and more with Bill Maher re: the profit motive in health care. If you remove the profit motive from insurance by changing to a national single payer system, then how will the private health care providers increase their profit? They’ll likely try to optimize around providing the most profitable services… does that open the possibility that some less profitable services will be underserved or neglected? I see no evidence of this in Canada, but I’m not really looking either. However, lack of service capacity can lead to longer wait times for those services.

    I think it’s just a matter of either a) paying more for those services to attract more providers (e.g. doctors, machines, whatever) or b) legislating minimum standards (e.g. if you operate a hospital you must live up to these metrics, else you won’t qualify). If you do too much of b) then you risk running providers out of business. If you too much of a) you’re just transferring money to the providers bottom line (this makes me wonder about Nova Scotia Power).

    @flash – in short, most Republicans (like Kristol) have no credibility and I doubt and double check everything they say. Occasionally they tell the truth, just to keep me off guard 😉 Did I mention I support Palin for pres in 2012?

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  8. I’m absolutely supporting Palin for 2012, as Nate Silver’s pointed out on 538, Obama could pull out a victory over Palin even if his numbers drop down to the low 40s – if the Republican’s want to shot themselves in the foot by nominating Alaska’s answer to Paris Hilton, who am I to stop them?

    I’ll agree with TR#, if you think what’s being proposed by the Dems is a national, socialized med system, you need to stop taking Bill Krystal’s word for stuff – as far as I can tell, the proposed system has a public option on the table, but only as one part of the whole, no-one’s talking about doing away with private practice.

    Finally, while I agree that the vast majority of the Republican’s (at least the ones arguing for the status quo) don’t have any credibility when it comes to health care, I don’t really see that Bill Maher does either:

    http://aetiology.blogspot.com/2005/12/bill-maher-and-his-anti-vaccination.html

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  9. I loved Maher’s comments the other night – he’s great. However, everyone working in the medical field, like other fields, does so with the expectation of some kind of pay/reward. As noble as doctors and nurses are, most of them wouldn’t do it on a volunteer basis.

    That said, there is a reasonable way to reduce the profiteers in the industry, and that is reduce the number of leeches. In this case, the first step is to get rid of that entire foolish insurance layer that serves only to (very efficiently) suck funds from the system. This is pretty much what we have done in Canada.

    TR#, you make a very interesting point, one which I hadn’t really considered properly: how does a private caregiver increase profit if not by high-grading to more profitable services? That the Democrats aren’t proposing nationalizing the hospitals, let alone the insurance system, I don’t think that any changes they make will actually reduce the costs without in fact cutting services. They are just dabbling around the edges of a bad system with a paint brush.

    Healthcare must be fully nationalized, and I know that there is no chance that they will do this. (I see now that Dan has pointed out the hash I’ve made of the discussion by not specifically pointing out the Democrats’ intentions. In my defense, I will offer that they themselves don’t appear to have much of an idea as to what they are doing or why as well.)

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  10. @dan: you got me on Bill Maher’s credibility I’ll admit. I’ve just started following him recently. He tends to exaggerate (not unlike some on the right wing) and I just automatically filter it out because I find him entertaining.

    @dan: Yeah I think they’re not proposing a single payer system (monopsony?). It’ll be interesting to compare their new system to ours. Personally I wouldn’t propose a live experiment on our Canadian system, but we can learn by watching their results.

    @kevvyd & @dan: Maher said not everything has to make a profit. There is a difference between breaking even after paying employees a living wage, more for doctors and specialists in recognition of their own higher personal investment in both money and time, and making a profit on top of that. A for-profit health care provider should be compensated for the use of the capital invested in the corporation – but how much? I’d argue this profit should be monitored similar to a utility, to provide a lower profit for a correspondingly lower risk. There shouldn’t be much risk in running a health care provider; am I missing something? So expectation for profit should be lower. I wonder if the risk/reward disconnect is crossing over from wall street? Just speculating.

    @kevvyd: The chief difference between the dem’s proposal and Canada is public competition vs. single payer. It’ll be interesting to see how well it works for them. I’ve lost faith in fair competition lately, looking at other industries (fin. services? auto? wireless?). I think the health ins. bus. is more like an oligopoly like wireless, so competition won’t work that well. Won’t lobby groups just push for a less-efficient public option to make their insurance more attractive? How is that kind of un-competition really going to help them? I’ll stick with single payer, thanks.

    OTOH I think single payer allows for some fair competition because if 1 provider can provide more efficiently than another they keep the reward (although there are issues of market size and barriers to entry which keep the number of competitors low). Also, if 1 provider gives better service they can attract more customers, etc. I don’t think the for-profit model is that bad if it is restrained. My main concern is the possible optimization I stated earlier.

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  11. Actually, I was thinking further. Perhaps the lobby groups will find a way to sabotage any option, even single payer. There may be no solution. Canada should really, REALLY step up its efforts to diversify its international trade partners in case America collapses.

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  12. Bill Maher is entertaining, but so is his BFF, Ann Coulter (or she wouldn’t sell as many books as she does). On Maher, I agree with the columnist at the Globe and Mail, he’s too smug and his act aims solely for ‘low-lying fruit’ – it’s basically shallow opinions with very little depth.

    Some better sources for medicine would be the various blogs at http://scienceblogs.com/channel/medicine/ or Discovery Magazine: http://discovermagazine.com/topics/health-medicine

    For the political side of things you can try Matthew Yglesias’s blog:

    http://yglesias.thinkprogress.org/

    And because it’s important sometimes to get a differing viewpoint:

    http://meganmcardle.theatlantic.com/

    I don’t agree with anything that Megan McCardle says on healthcare, but she is a good example of the kind of person that the idea needs to be sold to.

    Speaking of Yglesias, and sequeing into the subject of for profit vs. national healthcare, he had a very good post relating to innovation in healthcare:

    http://yglesias.thinkprogress.org/archives/2009/07/health-care-dollars-well-spent.php

    The telling paragraph being this one:

    “This gets back to some of the perversities of fee-for-service medicine. The current market creates strong incentives for people to develop “better and more expensive” methods of treatment, but almost no incentive to develop “as good but cheaper” methods of treatment. Both kinds of innovation, however, are extremely valuable. The world’s resources are limited, and the development of cheaper methods of treatment would allow for more overall treatment and thus better outcomes.”

    As he points out *both* kinds of innovation are needed – the present system doesn’t give incentive for the second, but the completely nationalized system kevvyd seems to be advocating (although I may be wrong) doesn’t give much incentive for the first.

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  13. My thought, and this is probably way behind the rest of you (vacation, doncha know – purposefully not using all brain cells at once), is that there are some services, such as the maintenance of health and well-being on a societal scale, that are nearly immoral for private enterprise to be involved in. Again, I know the same point has been made over and over again, with the most absurd examples (the Fire Dept. charging to put out fires – Maher’s example, I think)used to illustrate it. The Canada Health Act was created to ensure that portability and consistency of care across the country would be guaranteed everywhere for every one. Nevertheless, health care remains a provincial responsibility, as does education (another hands-off zone, at least in K-12). What role would the states play in a ‘socialized’ public option? Just wondering.

    Blended systems such as Australia are interesting phenomena – the existing public system was opened to private providers, with the intention of reducing waits for the public option and freeing those who could pay to choose that option. Did it work?

    Not so much – never underestimate the public’s ability to create demand that fills a void. Australia now has both public and private systems working at capacity. Not necessarily relevant, but interesting.

    If anyone has not seen “The Corporation”, shame be upon thee – it examines corporations, persons under the law, as if they were persons, and decided that, according to diagnostic procedures, corporations are by their nature psychopathic. CEOs have been fired because they tried to ‘do the right thing’ rather than maximizing profit for shareholders, the stated goal of any corporation. Public good and maximizing profit can only leave the public shortchanged as the corporate structure is by definition designed to do the exact opposite.

    Anybody remember “Four on the Floor” with The Frantics? As I was writing this, I thought to myself, “Hello, I’m Mr. Interesting. Here’s something I find extremely interesting…”

    Let’s hope someone else does, too. 🙂

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  14. @Flash – love the Frantics! (also The Great Eastern 🙂

    Thanks for the tip, I’ll read up on Australia, and I work with some Australians so I’ll pick their brains next time we have lunch or something.

    There is room for capitalist, for-profit ventures. I tend to categorize goods and services as either necessary or discretionary. Discretionary things are well suited to for-profit concerns; necessary things not so much (but it depends on the details). For example, take a house. If it’s basic shelter for my family, it could be a necessity. If it’s got too many bedrooms, multiple garages and pool, maybe it’s discretionary. It’s hard to see health care as discretionary. Banking and retirement investing have necessary and discretionary components, too.

    As a liberal I want to protect people and ensure their access to necessary things, and leave discretionary things up to the market. I’m not convinced that leaving necessary things up to the market protects everyone.

    However, I agree with @dan that the market delivers innovation. You just have to direct the market by telling it what you want. Better? Cheaper? etc.

    You can control demand (like a single payer monopsony) or supply (like a fully socialized monopoly). Single payer isn’t perfect but it leaves room for innovation and I’m not sure a monopoly would. The single payer system unites the purchasers, where a monopoly unites the suppliers.

    I think the states role would be similar to the provinces, in that each state could go further with their plans as long as they meet the minimum. Like California clean air standards, which are now adopted by 6 other states I think? (not sure)

    Obama needs to study up on Tae Kwon Boot 😉

    @dan – I like that Maher isn’t afraid to speak up, even if he lacks detail. Certainly some on the right aren’t afraid to speak up whether they have detail or not. I used to listen to Sean Hannity before my subscription ran out, I found him almost as entertaining as Stephen Colbert.

    BTW, thanks to you both I’m really enjoying this back-and-forth.

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