Monday, August 24, 2009

More Conversation With a Liberal

(...a conversation begun earlier today and recorded below)

It should be noted that Hussein gassed thousands of his own people with gas that we (America) sold him and with our tacit approval. Secondly, it is against international law to attack a sovereign nation without provocation. Iraq was in no way involved in 911. Most of the terrorists on those flights were Saudis. Why didn’t we attack Saudi Arabia?

You are the umpteenth conservative that has said there are better ways to solve the health care crisis but none have forwarded a proposal that does so.

I am one of the millions of people that is essentially without health care and I am anything but indigent. I am self employed and in an industry that has been hammered by the economic mess created by the conservatives. I can’t afford health insurance for my family with a deductable of anything less than $10,000. So, the hernia surgery and the skin cancer surgery that I had in the last three years came out of my pocket. The health care system is designed to do one thing well, make money for insurance companies. I have had better health care in Mexico, New Zealand and Chile while on assignments for National Geographic and Sports Illustrated. I, a tourist, was covered by their national system. I couldn’t have paid if I wanted to, I was seen, the problem taken care of quickly and efficiently and I went on my way. America is the only non-third world country without a universal health care system. The scare tactics used by the insurance companies and their friends in congress are lies. Yes certain coverage is denied some people in some cases in those systems but I have news for you: ALL coverage is DENIED to MILLIONS of Americans due to lack of or insufficient health insurance because the costs have gotten out of hand.

Mark Gamba

Well, Mark, can you please document that Saddam Hussein had "the tacit approval" of the US in gassing thousands of his citizens? Or do you mean, we did nothing to prevent or punish it, which, I'm afraid, fits your definition of deferring to a sovereign state.

As to reforming health care insurance...many sensible proposals to do so have been widely circulated on the internet, even popping into the main stream press occasionally. Here's a few:

1. Allow individuals to receive the same tax credit for the cost of individually purchased health care as businesses receive for employer provided care, thus severing health care insurance from employment and solving the "portability" problem.

2. Allow individuals to purchase the policy they want across state lines (at present individuals are limited to purchasing plans that may be inefficient or not what the individual wants because he must purchase health care in state).

3. Expand the number of plans available so that individuals are not required to purchase services that they do not want (perhaps, for example, IVF treatments or breast implants).

4. Work on the problem of "pre-existing conditions" so that an uninsured individual has options for covering a sudden diagnosis of, say, cancer. I'm not sure if this should be accomplished by requiring everyone to carry at least some health insurance (thus lowering the risk factor for insurance companies) or by creating state pools for such individuals.

5. Provide vouchers to the genuinely indigent to purchase insurance.

6. Initiate tort reform to limit rewards to actual damage in order to reduce the practice of "defensive medicine" and the cost of malpractice insurance that has become prohibitive for many doctors.

Now, I don't know the particulars of your situation, although you do not sound indigent. However, there are many millions of Americans who choose not to purchase health insurance because they are young and healthy; they take their chances. Others, I'm sure, face a definite budget strain when confronting the cost of health care, but their decision nevertheless involves choice. Personally, my husband and I spend almost 10 percent of our income on the cost of our share of the health insurance we carry.

I have no personal experience with health care in other countries. However, my son, who lives in London, has been shocked by brief contacts with the NHS there. His wait time for an antibiotic prescription was 6 weeks. His wife, who is Spanish, purchases private insurance from her employer. Nevertheless, when admitted for day surgery for a cyst, she was sent to a recovery room in which there were at least 40 others lying, separated by curtains. She has also lived in Denmark, where, she reports, satisfaction with public care is higher (but Denmark is a very small country).

I have a brother-in-law who has lived in China on a number of occasions, during one of which he had surgery (I believe for a hernia). He was delighted to be charged only the equivalent of some 90 dollars. However, at the time, 90 dollars was about three months' salary for the average Chinese.

I might point out also that emergency room treatment in the US is available to everyone; I imagine many problems are taken care of there "quickly and efficiently." Overall, satisfaction with the quality of care received in this country is very high. It's that quality which conservatives want to protect, and we believe this is possible while extending private coverage to the most needy.


Here is my issue with all of this, both your suggestions and the current plans wending their way through congress: Why not create a system by which we all pay one entity (the government for example) exactly what we pay for our health insurance (in your case 10% of your income) and that entity provides health care for everyone - period. No enormous profits for soulless corporations (insurance companies, hospitals etc). The profits made off of health care in this country are massive. That money could easily cover (the now reduced) costs of providing health care to all Americans. Simple, logical and workable.

I can answer that question easily: Because some very rich people want to continue getting richer.


Hi Mark,

I'm not sure how your system would work. Honestly, were my income to increase, would I want to continue to spend 10% on health care? If I were indigent and receiving care, would I want to contribute anything at all should I acquire assets? I think the fact is that most everyone is interested in becoming richer. We're not frozen in our circumstances.

And then, about that one entity... imagine its power. I realize you believe government is benign, but that's hard to support given any historical knowledge. You, yourself, obviously have greatly mistrusted the administration of George Bush. It's not inappropriate here to recall the words of Lord Acton: "Power tends to corrupt, and absolute power corrupts absolutely." This is a lesson played out again and again throughout history.

The advantage of power in the hands of corporations, soulless or not, is their plurality and consequently the competition between them. I've read that health insurance companies reap an average profit of 3 percent. This hardly seems outrageous even though, considering the sums involved, that must be a very large absolute figure. Were there only one health insurer, I suspect profit would be a great deal higher. And there would be little incentive to improve service beyond the goodness of the corporation's soulless heart. (Please note here that a non-profit is equally soulless except its excess is paid out more exclusively in executive salaries rather than stockholder dividends.)

I don't think there is an easy answer to solving problems in health care, and this is all the more reason to proceed cautiously and responsively (i.e. with fiscal restraint) rather than rush in pell mell with good intentions lacking sound judgment and ladened with hubris. Health care is after all a life and death proposition.


Profits are easy to disguise, anyone who has ever done their own taxes will attest to that, the facts on the ground are this: the current US Insurance industry estimates that 18% of every dollar paid by the insured is used towards “administration”, In France the health care system there spends about 6%, Germany – even less. So there is another 12% (at least) of the money available towards actual care of our health. 10% does seem high when you say it that way, but I spend more than that for insurance and don’t really get anything for it. At least if I was part of a system where all my health care was covered I would be getting something.

I do not believe that governments are benign but I also believe that most of the evil they do is at the bequest of corporations. Had not the tobacco industry spent millions and millions through their lobbyists for the reelection of certain congressmen I doubt the government would choose to subsidize the tobacco industry.

I know that you conservatives hate and fear Michael Moore and he is (like all good showmen) over the top, but he is none the less relatively accurate and his portrayal of the health care system in foreign countries is very similar to my own experiences. I would suggest that you have a glass of wine and sit down and try to watch Sicko even with a grain of salt, he makes it very clear that we do not have a health care system befitting the status of our country. Indeed most people from even decently developed countries enjoy better health care than most Americans do.

It’s a very broken system now and the rest of the world is aware of that. China is watching how and whether we deal with it and whether they continue to loan us money or call in their loans may well depend on our decision.



Hi Mark,

Let's take a look at this piece by piece:

1. "Profits are easy to disguise." I'll agree with you here with the caveat that it may not be all that easy for corporations that face much closer regulatory scrutiny than, say, the average small business. However, what this exposes, I think, is the total chaos, or if you prefer, corruption of our tax system that allows Congress to provide sticks and carrots according to the pleasure and often self-interest of particular members of Congress, their constituents, or whichever lobbyists grab their ears. This is certainly an argument for the reform of the IRS tax code, which the Obama administration has not made. In fact, we have a secretary of the treasury who successfully avoided paying his own tax bill until discovered to have done so in the confirmation process.

2. I'll accept the figure of 18% of health insurance benefits going toward administration. I'd even up your figure and say I suspect that a doctor might say that more than 18% of his staff time goes to complying with various insurance regulations (including federal or state Medicare and Medicaid regulations). I don't find the 18% figure totally outrageous. For example, have you ever investigated a charity to which you consider contributing? There's ratings for these. One group that rates is the American Institute of Philanthropy, and here's what it says on its website about its criteria: the "percent spent on charitable purpose" is "the portion of total expenses that is spent on charitable programs. In AIP's view, 60 % or greater is reasonable for most charities. The remaining percentage is spent on fundraising and general administration. Note: A 60% program percentage typically indicates a 'satisfactory' or 'C range' rating. Most highly efficient charities are able to spend 75% or more on programs."

Now, honestly, I'd rather not contribute to a charity that spends more than 15% on administration, but that's my choice.

As far as the lower administration expenses of government medical service in France and Germany, I think it is worth considering that funding is fungible and health services may benefit from sharing administrative costs with other government agencies... say accounting services. The charge has been made that in this country Medicare benefits in this way to achieve a supposed superior administrative efficiency over private health insurance.

3. I agree: a pox on government subsidy for tobacco, corn, ethanol, organic agriculture, etc.

4. This conservative neither hates nor fears Michael Moore; I look at him as a buffoon. However, I have not watched Sicko, but I am willing to submit myself to this agony... fortified perhaps not by a glass of wine, but a good shot of single malt scotch.

5. As to health care in "decently developed" countries, this concept is hard to categorize. I imagine many countries have adequate health care for the reasonably healthy. The U.S. has far superior healthcare for those who are seriously ill. We have five times the survival rate for cancer, for example, than does the U.K., which is a great deal more than "decently developed." On the other hand, the growing phenomenon of "medical tourism" indicates that very good health care is available more inexpensively than in the U.S. in some surprising places. I'm guessing that many of the techniques used were developed here. And this is a factor to consider when judging our health system: its innovation in creating new treatments... which, of course, is a costly proposition. Factoring it out is not quite cricket.

6. Finally, you betcha China is watching, but China is watching our fiscal integrity which is plummeting. It's no wonder China doesn't want to loan us any more money when we are heading to a 9 trillion dollar deficit (without adding a costly remake of health care). We are hell bent on pairing our first world health care with third world financing.



  1. Mr Gamba claims he had a good healthcare experience in NZ, Mexico and Chile because he was seeing in E&A. Emergency action in my view is top notch in Europe too, the problem is when you are actually in the system and become part of a process because you have to be scheduled for a treatment. That is horrendous.

  2. Mark wants a freebee. There is NO freebee! Somebody pays!

    If Mark did not have a health insurance plan that he contributed to monthly he should have at least put the money in the bank for a rainy day. A shoe store owner in Berlin Germany with a wife and two children is required to pay 2,200 Euros per month for health insurance. His wife develops cancer so she gets a part-time job in government and is now covered but the rest of the family is not. When they see a doctor they pay cash.

    Now it is illegal NOT to be insured in Germany so the shoe store owner and an estimated 250,000 thousand other uninsured business people in Germany are taking a chance on a fine. Should they need hospitalization the government will garnish wages, bank accounts and if you have adult children make them pay.

    The only people who do not pay can earn up to 700 Euros a month. That was my mother.

    After the second world war the German government made a contract with its citizens such as work 60 hours a week, no overtime pay and build up the nation and the government will take care of you from cradle to grave.

    When she started her pension everything was paid for. Then came co-pay for this and that. Co-pay became higher and higher. This is a woman who was really never sick but started having problems after she was run over by a negligent car driver while riding in the bike lane. She was 85.

    By the time she was 88 she received a note from the government that she had to list her assets and that they would garnish them. This woman was the most frugal person and had saved about 20,000 Euros that she occasionally took money from for co-pays, for special things such as train travel to see her grandchildren, sisters in East Germany and small gifts and also this money was to provide for her funeral. She had her financial life totally organized.

    My mother was so very upset with this new law that she died the day she was to meet my brother and sister who were to take her to the bank to take out her last Euros to stick under her mattress. You see Mark, she wanted control over her last years. Her own mother lived to be 98.

    Since once dead body is also controlled by government rules and funeral home monopoly it was enough to bury her.

    The German government killed my mother. So pay up Mark until your assets are depleted and then I would be willing to help you.