They’re penetrating the bureaucracy!

by John Holbo on July 7, 2007

Matthew Yglesias re: positive responses to Sicko:

The crux of the matter is that ordinary people think that if there’s a sick person, and you’re in a position to help the sick person, that you ought to help the sick person.

Insurance companies strengthen this commonsense moral obligation by actually entering into contracts – you pay them, each and every pay period, so that when you’re sick, they’ll help you. But insurance companies are largely in the business of devising excuses to avoid helping you when you’re in need. They employ people wake up every morning, drive to the office, and work all day denying sick people health care. The labors of these individuals line the pockets of the companies’ executives. Most people find this repugnant. Bloodsucking vampires and flesh-eating zombies have the excuse of being driven by insatiable urges. Insurance companies have free will and just choose to do bad things because they’re greedy.

Well, I haven’t seen it, so I’ll write what I know. I remember reading, at the time, about how The Incredibles was a sneaky, conservative thumb-gouge in Hollywood’s liberal eye. (Conservatives are just desperate about these things. Click to read one of the screenwriters for Transformers trying to set a few people straight.) Mostly it had do with the idea that affirming achievement is a conservative value, ergo the movie is conservative. Mom: “Everyone’s special, Dash.” Dash: “Which is another way of saying no one is.” In short, superhero stories become an allegory of the emptiness of liberal rhetoric. (But of course, Kurt Vonnegut wasn’t a conservative, even though he wrote “Harrison Bergeron”. Well, anyhoo.)

In fact, the film – The Incredibles, not Sicko – seemed to make special effort to take swipes at both sides, by way of making the (not entirely credible) point that superheroes can save us from both (wishy-washy relativist) liberals and (black-hearted capitalist) conservatives. But, perhaps significantly, the representative of ‘conservative’ values, in the film, is Mr. Incredible’s slimy insurance company boss, Gilbert Huph – who fits Yglesias’ profile to a T. And, of course, you don’t remember anyone being offended, at the time, by the portrayal of insurance companies in the film? In a sense, then, Moore’s thesis is utterly mainstream.

Thus, The Incredibles may provide a tiny bit of confirmation for the Lloyd Free and Hadley Cantril thesis that Americans are ‘philosophical conservatives’ but ‘operational liberals’. If you want to show what’s wrong with liberalism, you hold up some threadbare tissue of ‘everyone is special’ rhetoric. If you want to show what’s wrong with conservatives, you point to policy problems, e.g. healthcare out of whack.

It seems there are lessons here for Dems seeking to ‘frame’ more effectively. But I’ll leave it there, for now. Sicko (I gather) is basically one scene from a movie that many viewers found agreeably conservative, fact-checked and stretched to 90 minutes. How far out of the mainstream could that possibly be?

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The Ambrosini Critique » Blog Archive » Health Care, again, but this time real people talking…
07.09.07 at 7:18 am

{ 77 comments }

1

Thomas 07.07.07 at 5:55 am

I’m not going to comment on Moore or on healthcare.

I just think that Zombies need to be used more often as an agent of political rhetoric.

2

lemuel pitkin 07.07.07 at 6:11 am

Somewhat surprisingly, Sicko is really excellent. As is zombie rhetoric.

3

derek 07.07.07 at 8:14 am

Corporations are driven by an insatiable urge: the imperative to maximize return on capital investment. This is not just a good thing to achieve, it’s a requirement, built in to the structure of the corporation like Asimov’s Three Laws of Robotics. And note that it’s not just a need to get a reasonable return; any return, no matter how good, is still not as good as that return plus another 0.1% would be. And no other law trumps it, except in a vague “oh yeah, and don’t kill or steal while you’re doing it, yadda yadda” way, that has nothing like as firm a grip on the corporate gonads.

This isn’t a law of the universe, although right-leaning economists say it is; it’s just a way our society is organized. It’s not the only way a civilization could function.

4

abb1 07.07.07 at 9:26 am

except in a vague “oh yeah, and don’t kill or steal while you’re doing it, yadda yadda”

I suspect that, in fact, kill and steal you must if justified by your cost/benefit analysis.

5

mister z 07.07.07 at 10:35 am

What an outrageous way to impugn intrinsic corporate morals. I believe the correct Chicago-school endorsed formulation is “kill, lie, bribe and steal”.

6

yabonn 07.07.07 at 12:26 pm

just desperate about these things

I don’t know if the link supports very well what you are saying, John.

The Hollywodlibrul, root of all conservative despair, explains there that he outdoes some wingnut in militarism, and that there are some baddies in suit with a plot.

Maybe I missed some irony, or maybe if Rogers post is a speaking-to-the-wingnuts effort ; as it is, I found nothing much there to make a conservative despair.

7

Geoff 07.07.07 at 2:49 pm

Maybe I’m paranoid, but I thought The Incredibles expressed fascist (or quasi-neo-fascist, or something like that) politics. The message about the insurance company seemed to be not so much “black-hearted capitalists are bad” as “humdrum bourgeois life lacks glory.” Add to that message the movie’s sneering attitude toward liberal weakness (I agree with John’s reading there), and then add the idea of superpeople. What do you get? Not “swipes at both sides” in a way that averages out to the political center, but a “third way,” in a sense much older than Tony Giddens’s.

But, as I said: maybe I’m paranoid.

8

Matt Kuzma 07.07.07 at 6:07 pm

Derek,

You’re absolutely right, but I’ll take your statement one step further: It’s not even the way corporations have to function, it’s just a natural outgrowth of their organizational structure. When all your decisions are ultimately decided by shareholders, who only have interest in the continued increase in rate-of-return, you get this kind of behavior. If shareholders weren’t treated as an abstraction of private ownership, but instead as transitive investors, and were given less power of decision-making (less of a presence on the board of directors) and instead corporations were structured to be governed by people who actually “gave a damn” (I’ll leave that deliberately fuzzy) we’d have better operational decisions.

I think the structure of the American corporation needs to be experimented on and ultimately needs to evolve to something less unamerican.

9

Martin Bento 07.07.07 at 6:25 pm

Kuzma, I don’t think the problem is that shareholders have so little voice; in fact, many of them never vote and care little about stocks they flip day to day. The problem is that the legal structure ensures that the intention of the stockholder as a comprehensive being, evolved with some moral need (if not pathological) to take account of the needs of others so as to be capable of functioning as a moral being, is not what has a voice in corporate governence. Rather, the “investor” is reduced from a complex moral being to an abstract maximizer of monetary value. In this sense, the law actualizes the most simplistic model of neoclassical econmics.

The diffuse nature of ownership can serve to strengthen rather than weaken the moral commitments of corporations if the structure and culture gives it a voice. After all, an investor who has but a small stake in a particular company should be more willing to see that company sacrifice something for a broader good, than an executive whose investment in that particular company is much greater.

10

Martin Bento 07.07.07 at 7:13 pm

“functioning as a moral being”

should be

“functioning as a social being”

Gotta’ start proofing these things.

11

s.e. 07.07.07 at 7:34 pm

yabonn,
thank you

12

Quo Vadis 07.07.07 at 8:04 pm

The demands of the shareholders are not unrelated to the corporation’s quality of service to the consumer. The value of the shareholder’s investment is directly related to future profits. For companies whose customers have the option of buying the services elsewhere, future profits depend upon the ability to continue to sell services. Companies that fail to deliver a competitive level of service will not be able to make sales.

13

roy belmont 07.07.07 at 10:12 pm

Here’s one for you. Imagine a corporate entity with the altruism and courage necessary to commit at the level of, say, a firefighter or a search-and-rescue team member. The goal being something higher than mere survival of the self, there.
In those rare and unfortunate times the rescuers don’t make it through, they’re praised unequivocally for their sacrifice.
Imagine a corporation, shareholders CEO’s and all, capable of altruism to the point of sacrifice.

14

abb1 07.07.07 at 10:37 pm

I doubt it’s possible to build a working economic model that relies on shareholders’ and CEOs’ morality, their willingness to sacrifice and stuff like that. It’ll likely turn out to be a sociopath’s paradise. An American corporation represents financial interests of its management and shareholders. A European corporation also represents interests of its workers but, I think, this is as far as it can go; I don’t think any corporation can represent interests of the whole society. This is what the government is for. And when you have corporate-government symbiosis, you know you have a big problem.

15

Quo Vadis 07.07.07 at 10:48 pm

@13, 14

A private charity perhaps? There are a lot of these, a lot of people contribute to them and they do a lot of good work. Some actually compete directly and successfully with for-profit enterprises.

16

J Edgar 07.07.07 at 10:50 pm

“If shareholders … were given less power of decision-making”

By making the voting issues even more incomprehensible?
By making the board candidates even less well-known than my dog groomer’s brother’s daughter’s kindergarten teacher’s middle name?

Speaking of kindergarten and sociopaths, even a kindergarten student can figure out that the corporate (sociopath) kingpins hide behide a fictitious concept of stockholders to rip-off everyone they can. It’s just that no one can figure out how to stop it.
.

17

John Holbo 07.08.07 at 3:05 am

yabonn, much entertainment marketed to a young, male audience is of a distinctly shoot-em-up variety (I trust you have noticed). As the screenwriter notes, it is a fallacy to read these entertainments as intentional attempts to send conservative political messages. So conservatives seem rather over-eager to make out how they have a few secret political allies in the bowels of Hollywood, sending them political messages-in-bottles, past the cordone sanitaire of liberal censorship. Of course they DO have allies in Hollywood. But they shouldn’t just assume anyone who pens a dumb blow-em-up is actually trying to sell the merits of conservatism. (I’m not sure where the ‘despair’ comes in, in your comment.)

You can of course argue that films are idiotic in a way that will warp young minds to Republicanism. I take it this is really your point. But that isn’t what the conservatives are claiming, so no one was denying it (I think). Although I probably would be inclined to deny it – or qualify it, rather.

Bless you, S.E., you are consistent.

18

s.e. 07.08.07 at 3:25 am

“Bless you, S.E., you are consistent.”
but not as consistently foolish as you dear; or matty

19

roy belmont 07.08.07 at 3:54 am

abb1- The professionals who risk their lives for the common good don’t intentionally sacrifice them, they risk them, following a narrowing ledge between cowardice and casualty. The idea is they don’t not do their job because it’s dangerous.
I wasn’t expressing a yearning for corporate altruism, more an allusion to how we’ve allowed these entities to assume the rights of the individual, and more, in our societies, even as they take on what we mostly all agree are the most despicable social attributes, to the point of sociopathy.
john holbo-
I think you’d have a hard time making the case for no rightwing/conservative/whatever intent behind the cop-show dynamic of the three or four decades following the universal adoption of television, at least in the US.
It does seem true that the US public is neither one nor the other in an ideological sense. At some point the liberal v. conservative engagement begins to look like the vocal tall people versus the vocal short people, two minorities in pitched battle while the greater majority keep bewildered silence, or try to fit themselves into one camp or the other for safety. Having only two points on the line makes it easier to construct the graph, but accuracy gets left behind.
But I think there has to be some kind of agenda working in the still-virulent puritanical censoring of materials for the young that lets slip a constant bombardment of kill kill kill for entertainment’s sake. It was my experience when young that sex was even more enticing than blowing things up or killing monstrous villains. So unless I was an anomaly, or things have changed an awful lot, there’s more at work there than the call-and-response of the market and its audience. Something like long-forecast social control I think. Which as abb1 sort of said, when you have corporate-government symbiosis toward a eugenic goal, you’ve got trouble.

20

John Holbo 07.08.07 at 4:24 am

S.E., if you have an argument that “Transformers” was intended by its makers to send a conservative political message I would be happy to entertain it. My distinct impression is that the screenwriter is probably telling the truth: they really did intend to make a blow-em-up, based on a silly show from the 80’s. (Not that they couldn’t have intended both, but I see no evidence that they, indeed, did intend both.)

Roy, I think there IS an argument to be made that violence-saturated media products are substantially market-driven (rather than ideology-pushed). People like the stuff, there doesn’t seem to be any actual conservative cabal of makers you can point to. (This is, of course, consistent with, not contradicted by, the additional possibility that a taste for it then breeds a stronger taste for it. It is also consistent with admitting cases like “24”, where there really does seem to be intention to produce conservative propaganda.)

People like violence. So the market gives it to ’em. The violence-is-ok-not-sex thing is, I admit, all messed up and needing a special explanation. But I don’t see any reason to believe it was pushed by people who actually reasoned sex=liberal=bad, violence=conservative=good. I suppose you could argue that it wasn’t conservatives making the stuff, but conservative censors (largely self-appointed) complaining about sex, not so much violence, who, over time, conditioned corporate makers to avoid the hassle (no money in it) and just focus on violence. It also has to do with the most lucrative markets being younger and younger. We have a highly sexualized media culture that is, at the same time, unusually concerned to insulate children from it.

There is a strong cultural consensus that children shouldn’t see representations of adults of the species mating. I think most other cultures have been less specifically concerned about this. I admit that you could just make this part of your argument: why do we think children should be able to see someone stabbing a breast, but not kissing one? But the point I would make is that concern about children seeing sex is actually pretty bi-partisan. Concern about adults seeing sex, by contrast, may split – with liberals saying it is ok, conservatives saying it isn’t. Anyway, when media products are marketed to children, you would predict an aversion to sex-as-opposed-to-violence, just given cultural attitudes – no need to posit a conservative cabal or long-term plan.

21

s.e. 07.08.07 at 5:20 am

I made a one word comment about a stupid movie written directed, and produced as corporate hackwork. I have my own stories about the people who make this crap. The man who wrote it sounds like an idiot.

Of all the things that annoy me about you Mr H. your fetishizing of intentionality is probably the worst.
Is the movie a consciously ideological construction? No, of course not: it’s simply a product, and judging by the review of my old mate Manohla Dargis, not a very interesting one.

The movie waves the flag equally for Detroit and the military, if to no coherent end. Last year the director of General Motors brand-marketing and advertising clarified how the company’s cars were integral to the movie: “It’s a story of good versus evil. Our cars are the good guys.” And sure enough, most of the Autobots take the shape of GM vehicles, including Ratchet (a Hummer H2) and Ironhide (a TopKick pickup truck). The only Autobot that doesn’t wear that troubled automaker’s logo is the leader, Optimus Prime (a generic 18-wheeler tractor). Maybe that’s because the company didn’t want to be represented by a character that promises to blow itself up for the greater good, as Optimus does, especially one based on a child’s toy.

Shape-shifters of another kind, Hollywood action movies bend this way and that politically in a bid to please as many viewers as possible, but they almost always play out exactly the same, as entertaining violence leads to heroic individualism leads to the restoration of order. “Transformers” is no different, even if it does offer chewy distraction for the bored viewer: the would-be suicide bomber, American soldiers tearing it up in the Middle East while American cars keep up the fight at home, along with plugs for Burger King, Lockheed Martin, Mountain Dew and the Department of Defense. Why there’s even a president who asks for a Ding Dong. He’s wearing red socks like a big old clown, but no one really laughs.”

22

s.e. 07.08.07 at 5:22 am

And fix your software so we don’t have to blockquote every goddamn paragraph.

23

John Holbo 07.08.07 at 7:16 am

S.E., I was making a point about people’s conscious intentions. Why assume I was fetishizing intentionality?

24

Suvi 07.08.07 at 9:58 am

Corporations are driven by an insatiable urge: the imperative to maximize return on capital investment

Corporations don’t have urges. They are inanimate things.

Meanwhile, don’t forget the people driven by
bonuses and options, because they really do have urges, and are usually in a position to change outcomes.

25

yabonn 07.08.07 at 10:24 am

But they shouldn’t just assume anyone who pens a dumb blow-em-up is actually trying to sell the merits of conservatism. (I’m not sure where the ‘despair’ comes in, in your comment.)

It seems I had understood your point, then – your link wants to show that authors, in fact, don’t “mean conservative”?

But over the link the author post seems to be aimed at reassuring his conservative readers : bespite being hollywod hellspawn, he can be as militaristic and “pro freedom” as them (I’m not even touching the weird parts about “professional hate-mongers”)

So my point was that, if is was a conservative, I would not be despaired (as in your “being just desperate”) about a conservative hollywood after reading the linked post.

You can of course argue that films are idiotic in a way that will warp young minds to Republicanism. I take it this is really your point. […] Although I probably would be inclined to deny it – or qualify it, rather.

Nono, it wasn’t my point, see above. But while we’re on it, i’d agree with “I don’t need a Bush/Cheney bumpersticker on it to know where it comes from”.

26

yabonn 07.08.07 at 10:29 am

Ugh.

“if I was a conservative, I would not be despaired… ” etc.

27

abb1 07.08.07 at 10:41 am

As far as Hollywood is concerned, I suspect generally it’s a bit more subtle than partisan/bi-partisan, liberal/conservative. People and entities involved on all levels try to do what’s best for them, by the rules and within the constraints of this socio-economic system – what’s best for their careers, their bank accounts, their social status, etc. – and and the result is what we see on the screen.

On the other hand, I suppose rich and powerful important individuals of the trade (like, say, Bruckheimer) do get a lot of opportunities to advance their personal pet causes and tastes as well.

28

Slocum 07.08.07 at 1:01 pm

As a health care provider, my wife works with both private insurers and state run insurance program for poor children. The state insurance program is by far the worst in terms of delaying and denying coverage. They demand ‘more information’ to justify paying for a particular treatment but won’t specify what information it is that they need (just ‘more’). They resolutely refuse to provide clear guidance as to what is required to approve particular treatments. They are very slow in returning phone calls and emails. Faxes somehow don’t make it through time after time. They hire bureaucrats who don’t understand (or pretend not to understand) the medical issues.

If she is persistent enough for a particular patient, they’ll eventually give in in the end. But she’ll have to jump through exactly the same long, frustrating set of hoops for the next patient. And the next. She doesn’t have the time or energy to do this for every patient, so some inevitably get the cheaper, lower-quality treatment. So the denial of care via frustration and exhaustion actually is quite effective.

Why do they do this? Money, obviously. They’re trying to spend as little as possible and as slowly as possible. Just like the for-profit companies. But why are they even worse than the for-profit companies? Because they have no competition at all and their ‘customers’ have absolutely nowhere else to go (except to get so frustrated as to scrape up the cash to pay out of pocket — which, of course, also saves the program money).

29

abb1 07.08.07 at 1:49 pm

That sounds like one bad insurance program for poor children. Not clear, though, why they should be intrinsically interested in spending as little as possible and as slowly as possible.

30

Slocum 07.08.07 at 4:00 pm

That sounds like one bad insurance program for poor children. Not clear, though, why they should be intrinsically interested in spending as little as possible and as slowly as possible.

Why the interest in spending as little as possible and as slowly as possible? Because they have only so much to spend and they’re trying to stretch it. And there’s nothing uniquely bad about this — both Britain’s NHS and Canada’s health care system also are known for rationing via delay, to the point that the prohibition on private insurance was overturned in Quebec:

The court ruled that the waiting lists had become so long that they violated patients’ “life and personal security, inviolability and freedom” under the Quebec charter of human rights and freedoms, which covers about one-quarter of Canada’s population.

http://www.nytimes.com/2005/06/10/international/americas/10canada.html?ex=1184040000&en=55eb912cc4240679&ei=5070

And I can’t dig up a link at the moment, but it wasn’t many months ago that in Britain the NHS told some centers to slow down their work because they were treating too many patients too quickly (and using up the budget too fast).

The idea that only flinty-eyed capitalists try to deny or delay treatment and that this never happen with government funded health systems is ridiculous.

31

abb1 07.08.07 at 4:29 pm

The idea is that capitalists’ primary incentive dictates that they should deny treatment and that government health systems don’t have this incentive, or at least it’s not (certainly doesn’t have to be) the main one.

32

Slocum 07.08.07 at 5:15 pm

The idea is that capitalists’ primary incentive dictates that they should deny treatment and that government health systems don’t have this incentive, or at least it’s not (certainly doesn’t have to be) the main one.

In both cases, financial considerations apply and lead to similar behaviors. But with the capitalists, they have to attract new customers and retain existing ones. And horror stories about denying coverage are very bad for their reputation and, therefore, for business.

And government systems actually do have a natural incentive to deny and delay because an inability to meet demand with their existing budget is the primary justification for arguing for a larger budget (and a bigger empire). That’s just bureaucracy 101.

33

s.e. 07.08.07 at 5:23 pm

Again, Mr. Holbo,
You mocked the wingnut’s claims for intention by linking to the screenwriter’s own claims of intention.
But I don’t care about intentionality, even or especially[!] authorial intentionality. To the degree that I care about the movie at all I care about what it is and what it represents as a thing that exists, as it is, having been made, and now in the world. That’s how both yabonn and I responded to it, and that’s how Manohla reviewed it.
I’m sorry if this is all to determinist for you freethinking libertarians at CT.

34

abb1 07.08.07 at 5:45 pm

Slocum,
In both cases, financial considerations apply and lead to similar behaviors.

In the for-profit case only financial considerations apply. In the government case financial aspect is one among many.

Your second paragraph sounds contradictory. It seems that a government-run system would have an incentive to serve more people and spend more to justify its expansion – if its primary instinct is, indeed, to expand.

35

Quo Vadis 07.08.07 at 7:27 pm

@34

In the for-profit case only financial considerations apply. In the government case financial aspect is one among many.

By this reasoning, in the government case only political considerations apply. I’m not sure I would count that as an argument in favor of socialized health care.

36

abb1 07.08.07 at 7:37 pm

Why wouldn’t ‘only political considerations apply’ count as an argument in favor? If you watched Sicko, that’s exactly what the British Labour guy with funny pronunciation was talking about.

37

Scott Ahlf 07.08.07 at 8:18 pm

All this mental masturbation is a moot point–
All First World Democracies have Universal Health Care.
And do so a fraction of the cost, with lower infant mortality rates, and usually higher life spans (often by a large margin)–
The question now is how to get the USA to drop it’s superstition based economic model (probably screaming as reality emerges from the darkness (sorry Plato)), and extract itself from the toxic ideology that is hurting the citizens of the USA.

38

nick s 07.08.07 at 9:12 pm

I’ve long suggested that the appropriate strategy is divide-and-conquer. People like doctors. People don’t like fat corporate fuckers in suits who tell doctors what to do. So pay off the doctors in return for putting the corporate fuckers out of business. Stuff their mouths with gold.

(That said, I did get more than a faint whiff of Rand from The Incredibles.)

39

abb1 07.08.07 at 9:18 pm

Why, you have your empirical evidence, but Slocum has his empirical evidence too. Perhaps all other First World Democracies are different in some significant way from the US political system so that Universal Health Care is impossible to implement in the US? In fact, it’s obvious that they’re different since they have it and the US doesn’t.

40

nick s 07.08.07 at 9:22 pm

When all your decisions are ultimately decided by shareholders, who only have interest in the continued increase in rate-of-return, you get this kind of behavior.

Consider the role of institutional investors, who are almost always public corporations. Also, they rule.

41

Quo Vadis 07.08.07 at 9:25 pm

The challenge for proponents of socialized health care in the US is that the 85% of Americans who have health insurance believe that they get better care than they would under any of the socialized systems currently implemented. I myself am in favor of universal health care, but I do have reservations about how it might be implemented.

I insure myself and have a low-end policy with an HMO. I pay $200/month with unlimited full-coverage after a $1200 deductible with free regular checkups. I can get an appointment with my doctor within a day, lab work is available immediately and non-critical minor surgery within 2-3 days (that’s the extent of my needs so far). The entire operation is a model of streamlined efficiency and the staff are always friendly and professional.

Frankly, I can’t imagine anything run by the government coming anywhere near it in terms of bang-for-buck and when it comes to health care where the only limit to how much it costs is how much you are willing to spend, bang-for-buck = level of care.

42

Slocum 07.08.07 at 9:33 pm

Your second paragraph sounds contradictory. It seems that a government-run system would have an incentive to serve more people and spend more to justify its expansion – if its primary instinct is, indeed, to expand.

In the short term, the government-run system must stick to a fixed budget, which means rationing in one form or another. In the long term, it does have the incentive to expand. And waiting lists serve both purposes (to conserve present resources and demonstrate a need for more in the next budget cycle).

All this mental masturbation is a moot point—All First World Democracies have Universal Health Care. And do so a fraction of the cost, with lower infant mortality rates, and usually higher life spans (often by a large margin)

A ‘fraction’? When you compare percentages of GDP, the U.S. spends about 50% more than France and Germany. But I guess 2/3 is a fraction.

But, in general, the idea that the U.S. is going to pass universal health care and soon have the costs and results of France is absurd. We have patients with expectations that the French don’t (with respect to costly end-of-life treatment, for example). And physicians likewise (on average, French doctors really DO make a fraction of what US doctors do — only 1/3 as much). And we have an existing system of health care providers and insurance companies who have a great deal of power and money and who will pull out all the stops to tailor any universal plan to their advantage.

And we have a situation where the majority Americans who have insurance are satisfied with their coverage. Most Americans also do support the idea of universal coverage in the abstract — but support drops to less than half if that means waiting lists or restrictions on choices of doctors. And who thinks a universal plan will both save substantial amounts of money and involve no rationing or restrictions in choice?

43

Scott Ahlf 07.08.07 at 10:07 pm

Slocum–
Not only are we in the USA getting inferior care (just look at the stats), we are also getting shorter (a universal sign of failing health and lifestyle)–
Ideas are great to debate, but observation and reality is what I must base my conclusions-
Europeans are getting taller from a higher quality of life:
see: http://www.spiegel.de/international/zeitgeist/0%2C1518%2C484168%2C00.html

44

Quo Vadis 07.08.07 at 10:26 pm

@43

The US population is changing in a lot of ways, most significantly by race. Birthrate and immigration patterns probably have a much greater impact on average physical characteristics than than changes quality of in health care. Are you seriously suggesting that the quality of health care in the US has decreased significantly since the 70s?

45

Scott Ahlf 07.08.07 at 10:38 pm

@43–
Obviously the stats say so—
Also, you can take race and most social class out of the data, and the same results emerge–
Something is degrading the health and lifestyle of the citizen in the USA.

46

Scott Ahlf 07.08.07 at 10:38 pm

@43–
Obviously the stats say so—
Also, you can take race and most social class out of the data, and the same results emerge–
Something is degrading the health and lifestyle of the citizen in the USA.

47

Scott Ahlf 07.08.07 at 10:42 pm

For a more in-depth look at height and health in the USA, see this excellent article–
It will dispel the race and class argument–
http://www.newyorker.com/archive/2004/04/05/040405fa_fact

48

engels 07.08.07 at 10:44 pm

Are you seriously suggesting that the quality of health care in the US has decreased significantly since the 70s?

Nobody has to claim that, qv. They only need to claim that the improvement in the average level of care in the US (including the poor, as well as the kind ‘high expectations’ people who appear to be at the front of Slocum’s mind) has not kept pace with the improvement in the average level in Europe. Is there a particular reason why that hypothesis doesn’t pass your “smell test”?

49

Quo Vadis 07.08.07 at 10:57 pm

@47

Is that what you consider “in-depth”? Long on narrative and short on substance.

50

Scott Ahlf 07.08.07 at 11:01 pm

@47–
So what are you confused about?
Maybe I can help–

51

Quo Vadis 07.08.07 at 11:02 pm

@48

Nobody has to claim that, qv.

That is the claim that is being made and the only one I have addressed.

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Scott Ahlf 07.08.07 at 11:21 pm

Well @48–
Here in the USA (as pointed out in the data presented) we are shorter, have a shorter life span, higher infant mortality rate, and are getting fatter than Western European Democracies and Japan–
So what are you saying ? This is a good thing? Let’s keep on doing Who has the better model?
Plus, we spend more– Even consideringr basic greed, let’s get the best bang for the buck.

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Slocum 07.08.07 at 11:32 pm

Something is degrading the health and lifestyle of the citizen in the USA.

I’m very skeptical. Why? Well, for example:

However, the Komlos-Lauderdale study does include second-generation Hispanic and Asian immigrants – although the authors didn’t consider those groups to affect national height.

“Admittedly, this does not rule out second-generation immigrants from the data set, but there are several reasons to think that this is not very likely to be the cause of the patterns reported here,” stated the study.

And, it’s not that the U.S. average height is falling, it’s just that it has not increased as much as in some European countries:

http://www.livescience.com/health/041027_america_size.html

Those data do not imply a “degrading” of health.

But even if it were true, to assume there’s a direct cause-and-effect relationship with the lack of socialized health care and height is an enormous stretch (Why not assume the problem is too much time in front of the XBox or too many Chicken McNugget meals or whatever just-so story you can think up?)

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Scott Ahlf 07.09.07 at 12:05 am

The European Economic and Social Model is producing healthier citizens that live longer, have a lower infant mortality rate than the USA.
Obviously, we need to examine why we are losing ground–

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Slocum 07.09.07 at 12:44 am

Obviously, we need to examine why we are losing ground—

We have a pretty good idea what the factors might be. For example:

– Obesity / sedentary lifestyle
– Higher number of motor-vehicle deaths (Americans drive much more)
– Particularly poor results among minorities

Or alternately we could note that even with all that, the differences are fairly minimal:

http://www.swivel.com/data_columns/spreadsheet/2191800?order_by_direction=ASC

And we could collectively decide that if people are willing to trade a year of expected life span in exchange for living life as couch potatoes, well, just let them be.

After all, I could probably increase my own life expectancy by giving up the mildly risky activities I do for fun (biking, hiking, skiing, sailing) and get all my exercise on a nice safe treadmill, but I’m not inclined to do that, and I certainly am not in favor of treating my love of “risky” activities as a public health problem that “we” need to solve.

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John Holbo 07.09.07 at 4:10 am

I can’t resist. S.E. writes:

“You mocked the wingnut’s claims for intention by linking to the screenwriter’s own claims of intention. But I don’t care about intentionality, even or especially[!] authorial intentionality.”

But the thing is: the fact that you don’t care about what I was talking about doesn’t make it be the case that I was actually talking about what you care about. Do you see the distinction?

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Scott Ahlf 07.09.07 at 4:55 am

slocum–
So what is your solution for all these fat, short people with lesser life spans and higher infant mortality that the rest of the Western Industrial Democratic world–
Less fast food and more exercise?
Is just a coincidence that Holland has the greatest equality of wealth, and now the tallest people (also, the greatest number of museums per capita?)–
Is this a condition free divine incident?
Maybe they don’t drive enough motorcycles?

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Elias Cannoli 07.09.07 at 5:14 am

“I can’t resist”

You should have:
But the thing is: the fact that you don’t care about what I was talking about doesn’t make it be the case that I was actually talking about what you care about.

So you weren’t talking about the movie and what it represents in the world but about the dueling fantasies of the author and some right wing critics about what each wants it to represent.

You make your own reality. Where’ve I heard that before?
Since lives aren’t at stake I suppose it doesn’t really matter much.

Goodnight bubble-boy

59

abb1 07.09.07 at 9:29 am

In the short term, the government-run system must stick to a fixed budget, which means rationing in one form or another. In the long term, it does have the incentive to expand. And waiting lists serve both purposes…

I don’t know, I suppose it can be like that and perhaps often is, but I don’t think that’s inevitable. With a government-run system you are free to create pretty much any set of incentives you want. You can make the bureaucrats suffer if there are long lines and complaints, for example. There will be unintended consequences, of course, but I imagine it’s always possible to achieve a reasonable equilibrium.

Not so with a market-driven system. A market-driven system works well for a mass-production; electronic gadgets, for example. A consumer can evaluate prices, features, etc. and make an educated choice; competition works, everybody is happy. But when the product is heavily customized, features and specs unclear and the quality is a matter of life and death – the market can’t find an equilibrium and will collapse.

This is a bit like with those automobile muffler and oil-change shops (Midas, etc). You go to these market-driven places to get a standard out-of-the-box service, but if it’s something more complicated, you need a mechanic you know and trust personally, market doesn’t work here.

Though I think market will work for some healthcare services, corrective eye surgery, for example. That’s because it can be modeled as a case of standard mass-production.

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SG 07.09.07 at 9:38 am

Slocum, Australia has very similar rates of obesity to the US, and is also a multicultural society experiencing similar types of immigration. It has a socialised health care system which costs significantly less than the US system. Australia has longer life spans and better infant mortality than the US. It is expecting lifespans to begin to decline due to obesity in a similar fashion to US lifespans in the next 50 years. Can you explain why we pay less and get better healthcare?

Quo vadis, I pay about $100 a month (in taxes) in Australia for my all-expenses paid, no cost healthcare. I could see a doctor the same day, and the concept of a deductible is completely alien to me. Doctors visits are free no matter how many times I go. Lab-work time frames depend only upon the doctors` rooms, and a trip to a specialist is also free if I get a referral from a GP. The only problem with this system is that elective surgery (our word for the minor non-essential surgery you describe) has a waiting time, often quite long. I can get around this by paying an additional $90 a month for private health insurance, or I can wait. Private health insurance companies in Australia are essentially boutique services to enable rich people to jump the waiting list. Significantly, the cost of my tax contribution depends on my ability to pay, and the cost of my boutique private care doesn`t increase with age. In fact, once I hit 65 and retire, the cost of my tax contributions hits 0. So when I most need healthcare, I don`t pay anything. Similarly, I didn`t pay anything when I was a student living on my own with only state welfare to support me.

I have compared this with the stories of American insurance from a recent thread on pandagon (including, for example, $400 a month insurance, and a woman who cannot get insurance due to a genetic defect) and I am, frankly, horrified.

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Slocum 07.09.07 at 11:12 am

So what is your solution for all these fat, short people with lesser life spans and higher infant mortality that the rest of the Western Industrial Democratic world—Less fast food and more exercise?

The growth in height in height of Americans has leveled off and suddenly we’re shrinking lilliputians? Oh, brother. According to this table (yeah, yeah, I know it’s wiki — but the original sources are listed):

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

Non-Hispanic white males in the U.S. average 5’10”, which is shorter than the Dutch, Norwegians, and Swedes but a bit taller than most of the rest of Europe. Hispanic American males average a couple of inches less. And given the shorter height of Chinese, Koreans, and Japanese, we have to figure that the relatively high number of East Asian immigrants into the U.S. has had some effect as well (it’s not clear if ‘non-Hispanic whites includes asians). So what would I do about the ‘crisis’ of ‘shrinking Americans’? Nothing. We’re not shrinking. There’s no crisis.

In terms of obesity, I’d appoint Michael Bloomberg as nanny-in-chief. He could ban potato chips and Captain Crunch and limit the number of hours people could spend in front of their TVs and game consoles. People who didn’t exercise the prescribed number of hours a week would be fined. And we could come up with a national slogan (although I believe “Arbeit macht frei” is already taken).

Infant mortality is a problem of the underclass and I’m afraid that those who think government health care is going to solve it are going to be disappointed, since the poor already have government-provided health care, but do not use it. My wife treats medicaid patients (not for obstetrics) and many have a habit of not showing up for appointments, of moving without leaving a forwarding address, of having phones disconnected, and so on. Their kids need treatment and the problem is getting them to show up. I understand the same thing happens with pre-natal visits and ‘at risk’ patients and reducing the no-show rate is something that is being worked on. For example:

http://www.jabfm.org/cgi/content/full/16/5/399

What’s it going to take to reduce infant mortality? More and more of this kind of thing, I expect:

http://www.unf.edu/~jwill/Magnolia%20Final%20Report%201999-2001.pdf

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engels 07.09.07 at 1:08 pm

In terms of obesity, I’d appoint Michael Bloomberg as nanny-in-chief … we could come up with a national slogan (although I believe “Arbeit macht frei” is already taken)

Wow. I think that might possibly be one of the most tasteless remarks I have ever seen on this blog.

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seth edenbaum 07.09.07 at 2:15 pm

I shouldn’t have ended with that much snark. So sue me, I was drunk.
I began with a two word sentence agreeing with yabonn; the screenwriter didn’t sound like a progressive to me either.

On the larger point, the question is not the behavior of corporations as such but the behavior of their employees, who one would think should show a divided loyalty, to their employer and their own sense of appropriate moral behavior as social beings.

Strengthen community and you will strengthen individuals’ sense of social obligation, creating a counterforce to the urge to maximize. Obviously, quite obviously, contract and market theory are irrelevant at this level. What is relevant is the context in which they are applied. Arguments that begin from rules of contract begin with individualism and individuals in opposition to one another; but Individualism can not argue against itself. And again of course individualism is the basic element for most of the posts on this site.

The European model is first a social model, not legal and not economical. Those who try to bring scientific clarity to social thought, who are fans of a naturalist epistemology are unwilling or unable to see their logics as anything but foundational. But naturalism is the intellectualism of nerds. And how are nerds not a product of their time?
If you assume freedom, you’ll lose what little of it you have. Individualists are all alike. How many more trusims and taglines can I offer?
But to you they’re not trusims yet.

64

Joshua Holmes 07.09.07 at 3:02 pm

sg@60,

What is the Australian health policy towards people 80+ looking for healthcare? As I understand it, most of the national health services simply refuse most serious treatments for people over the age of 80+, whereas in America, we expect that our Medicare will pay for every last second of life.

65

seth edenbaum 07.09.07 at 4:34 pm

One more comment:
Strengthening community is not strengthening the nanny state.
The nanny state and liberalism generally conflates pity with concern. Pity reproduces power relations, concern lessens them.
To give another example closer to home: the research and professional model of academia imported from the sciences into the humanities (naturalism again) reinforces relations of authority while the fast fading pedagogical model opposes them (big-shots with an elite corps of acolytes don’t cut it).

What’s neoliberal about the liberal arts?

66

yabonn 07.09.07 at 5:49 pm

One day, everybody will agree with me.

One glass at a time.

67

engels 07.09.07 at 7:01 pm

Btw Slocum you’re off-message; nationalised health care causes TERRORISM.

68

Slocum 07.09.07 at 10:34 pm

Wow. I think that might possibly be one of the most tasteless remarks I have ever seen on this blog.

Really? Health Nazi jokes are completely beyond the pale then?

Btw Slocum you’re off-message; nationalised health care causes TERRORISM.

Actually, taking everything into consideration, I’m in favor of universal health insurance. But I think that the benefits are being vastly oversold and the costs and problems seriously underestimated. The U.S. cannot transplant the health system of any other country. The process of putting a deal together is going to involve a lot of horse-trading and result in pork and (successful) rent-seeking. It’s not going to save money any time soon. And there will be no differences in infant mortality or lifespan (or height), since the lack of universal health insurance is just an important causal factor. And there’s going to be a lot of buyer’s remorse (a substantial percentage of people are going to be less satisfied than they are now).

69

Helen 07.10.07 at 12:05 am

As a health care provider, my wife works with both private insurers and state run insurance program for poor children. The state insurance program is by far the worst in terms of delaying and denying coverage. They demand ‘more information’ to justify paying for a particular treatment but won’t specify what information it is that they need (just ‘more’). They resolutely refuse to provide clear guidance as to what is required to approve particular treatments.

Slocum, that just means that wherever you live has a stupid way of arranging their state system. In Australia, the doctor decides what is to be claimed for (Duh!) and each procedure, surgical or whatever, is assigned a number and the hospital or surgery just transmits the number to Medicare to get the rebate.

Of course, this is being steadily dismantled by the Howard government so soon we’ll live in the US nirvana where you can get free heathcare (after a fashion) after you’ve spent $300,000 on your cancer treatment and filed for bankruptcy.

70

hymie 07.10.07 at 3:14 am

Why is it taken as gospel truth that height is the preeminent measure of health?

The top five countries with the longest life expectancies:

Andorra
Macau
San Marino
Japan
Singapore

None of these strike me as having citizens with above average height.

71

SG 07.10.07 at 7:28 am

Joshua, I think your understanding may be wrong. There was a brief flurry of concern about this in NZ when an old alcoholic was denied a liver transplant in favour of a young person, under an explicit policy of rationing. But that`s a special case anyway, livers being rare regardless of our healthcare system (though I imagine libertarians would have some amusing workarounds for that problem).

In Australia you get whatever healthcare you need at whatever age. I don`t think I`ve ever heard of a national health care system which rations treatments by age. My grandfather (who recently died, in case any libertarians were planning on making nasty comments about paying his taxes) received all the necessary care at the ripe old age of 86, and that included major abdominal surgery. That was in the UK.

I think you should go look over your understanding of nationalised health care a little, Joshua. I think it might be slightly overburdened with stories of the evils of socialism.

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phil 07.10.07 at 8:24 pm

Seth: just a guess, but it’s generally rude to attribute Nazi slogans to Jewish politicians.

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seth edenbaum 07.11.07 at 12:15 am

It wasn’t me, that was Slocum.
There were and are Jewish fascists but Bloomberg ain’t one of them. Monarchist maybe, but not fascist.

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abb1 07.11.07 at 7:04 am

He’s a self-made billionaire. Whatever he is, I suspect he’s a technocrat who’s convinced he can fix everything.

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engels 07.11.07 at 11:58 am

Fwiw I think seriously comparing people who want government action on obesity to Nazis is extremely stupid, but not offensive. Explicitly typing up that particular slogan is what I thought was tasteless.

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c.l. ball 07.11.07 at 6:54 pm

Insurance companies have free will and just choose to do bad things because they’re greedy.

Which is why no morally correct person ever uses them.

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seth edenbaum 07.12.07 at 1:10 am

He’s a neoliberal billionaire. He’s in favor of a congestion tax that would charge delivery vans and pick-up trucks with tools and workers [I used to work out of a truck] nearly 3 times the rate for a limousine. He’s a kinder gentler Giuliani: making Manhattan a cleaner safer oasis of wealth.
That being said, kinder and gentler means a lot; but not enough.

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