In response to comments on my post on health care -

Note: This entry is in response to a comment on my June 2009 posting ( ). Since my answer was too long for the space allotted for responses, I have posted it here.  To follow the discussion in its entirety, you may wish to revisit that post ( link ) and see the anonymous comment, which is the eighth from the top, signed Bryan.  The original entry cites 2006 Total expendit. on health % gross domestic product which was then the most recently available data. My response, citing the same source and statistic ( link to Excel file ) uses the 2008 data, which is now the most recent data available.

Hi Bryan,

First of all, you leave me with some vague impression that you are really upset about something - wow. Not sure where that impression comes from. Perhaps it was the typo in the subject heading that probably was intended to read "Leave it in Europe." Well, that could just be carelessness - something that always shows up in my typing. (Edit: after re-reading my facebook reply to your post, I found some seriously mangled sentences of my own. Some were so carelessly written as to be unintelligible.  Thats what I get for not proofreading!) So I am left wondering, where does all this anger come from?

I am afraid that, to begin with, I have more questions then answers - but they are fundamental to the discussion. I am sure that they can be characterized in terms of "liberal" and "conservative," but that is not what I want to achieve by posing them. No, my questions are an attempt to understand what really motivates such arguments against universal health care - which is what I have been arguing for. Unless I misunderstand you, you are arguing against universal health care.

(My thought experiment below will generally reflect on pre health care reform, because I am guessing that it more closely relates to your preferred societal state and because I am not up to date enough on American health care reform to accurately represent it in my discussion.)

The most fundamental question is: What kind of society do you want to live in?

I will get back to this question later.

A subset of the first question is: Should everyone have equal access to quality health care in that society (or a certain minimum standard that everyone has access to)?

If your answer to the second question is "yes," then you agree with universal health care. Based on your arguments in the comments to my previous post and elsewhere, I suspect that your answer to this question is "no." That leads to more questions:

Under what conditions should someone have access to health care? Should quality of care be limited to those who can pay outright or obtain insurance? What happens to those who can't pay?

One example, someone very close to me (real life example) has a chronic illness and has to take medication that would require an out of pocket copayment of >$20,000 US per year. Having a preexisting condition would prevent this person from getting any kind of health insurance in the US, (keep in mind: pre-reform). In Germany, the copayment is €10 per quarter. In my example, the person is employed and is insured (actually, this person would have the exact same quality of insurance, regardless of being employed - or regardless of the conditions of employment (pay, full time, part time, employer, direct or temp ...).

So ...

What about a person with an inherited chronic illness who can not work to support his or herself - should this person have access to medical care?
What about someone with a physical or mental disability?
What about someone with a mental disorder, such as schizophrenia - and is not able to support himself or herself?
What about someone who ends up with a serious (i.e. expensive) disease, like cancer?
How about someone whose health has been impacted by some act of god (ex. struck by lightning)?

What about someone who does something arguably stupid like extreme sports who ends up having a life changing injury?
How about someone who does not take care of his or herself properly - poor diet, inactive, other forms of neglect or abuse?

I am sure that there are more cases in point, but I think that the examples I listed in two categories are enough to make my point. The first group are those needing health care with a condition that can not reasonably be seen as being the result of any action that they have taken - and for the most part could not generally be seen as being able to pay for that health care directly themselves or, for the most part, obtain health insurance in the United States on the open market - at least not with a preexisting condition. The second group of people have made some conscious or unconscious decision that would generate (additional) medical expenses. Should a distinction be made between the two groups? Is it possible to effectively do so? Would something be gained in the grand scheme of things by making such a distinction?

My whole discussion leads (among other places) back to my original question: what kind of society do you want to live in?

Reflecting on America, I often ponder two seemingly conflicting aspects of American Culture. On the one hand, there seems to be this pioneer spirit that is founded on self reliance, the sense of "what I have is mine, and keep your hands off it!" It also seems to assert that everyone gets what they deserve - those who don't take care of themselves, or aren't able to take care of themselves, well, thats their problem, not mine.

On the other hand, America tends to be a much more religious place, particularly Christian, than most of Europe. Now, I am certainly no big time Christian, and certainly don't want to pull any "holier than thou" arguments - and don't want do get bogged down into a religious discussion, and I agree that religion has many negative aspects. Still, when thinking about Christian values, Bible passages spring to mind, like "And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye did it unto one of these my brethren, even these least, ye did it unto me." Or, the golden rule "Do unto others as you would have them do unto you."

I tend to prefer the latter sentiment to the former. But, I never cease to be amazed about how Americans can reconcile the two philosophies so well.

As for me, I believe that at some point in our lives, we will all be dependent on others in society. We are all dependent on our parents when we are young, and many of us will be dependent on others when we get old. There is a lot that happens in life in between. Some of us will make lots of money, and never have to worry about the many 'what ifs' that I mentioned above. Many will have medical conditions that are completely out of their control - and won't have the independent means to take care of them. Others will do something stupid and will also need help. I think that the later group is small enough that it should not be differentiated from the former group both because it would not be economically expedient to do so, and it would also run too great a risk of wrongly categorizing members of the first group into the second one. I think that the most equitable way to take care of everyone's needs is the most just. I don't believe that the poor, or chronically ill should be precluded from care. And, I believe the only way to achieve this - or come close to it, since universal health care is only achievable in theory - is through a single payer system, at least for those earning from zero to very comfortably.

To come back to your person A and person B, the analogy does not hold up. I am not directly causing a debit for you: in my societal system, I pay more than you do because I earn more than you do. Currently, I consume less in health care services than I pay in because I am healthy. That is likely to be true for you, as well, as you are young and healthy. But that could change any time when one of us gets sick or injured. Since we all pay into the pool, the risk is spread spread among the entire population. The whole system works more efficiently since everyone pays in, and those managing the system have a better economies of scale and less unexpected costs (ex. uninsured people showing up in emergency rooms, people in hospitals who suddenly find their insurance canceled or maxed out). And, to get back to my original post, in the United States, you pay 16% of your GDP and in Germany, we pay 10.6% of our GDP, btw, Slovakia - which has comparable quality of health care to the USA, spends 8.0% of their GDP, based on 2008 data, the most recent available data. (Edit: actually, it is Slovenia that has been reported to have similar quality of care to the United States, which spends 8.3% of their GDP. Slovakia does considerably worse,  ranking 62nd, compared to the USA being in 37th place.) I'd rather be person B living in a society where everyone has health care and the net cost divided among the population is less, than person A who may or may not have health care - and could loose it if he does have. And, the whole system costs the American people in total of $794 Billion annually MORE out of a $14.72 Trillion GDP, then it would cost if they were ONLY paying 10.6% of GDP. Who would not want to take care of their neighbor while saving so much money?

Something else occurred to me after I finished writing this.  Why is it that you are person A and I am person B?  Why don't we imagine you as person B for a moment? Or, is that something not fathomable in the universe of the plausible?  What would your expectations be as person B? Somehow, I get the impression that you have this image of person B as some possibly Muslim guy on welfare with dark skin and ten kids, who spends his time playing Nintendo and smoking pot when he is not out cheating on his wife or plotting Jihad.  Worse yet, there is this nagging question as to wether or not he is really an American (we know that his father is from Kenya). (Edit: no, I don't really believe that you think this. The illustration uses ironic exaggeration.) The truth is, we are all person B at some point in our lives.  It is true, some of us will never be person A - but that is an inevitable minority.  The rest of us will be person A for either longer or shorter periods of time, depending both on our effort and our good fortune.  Some of us might opt out of being person A to raise a family - that causes an immediate transfer to person B-dom.  The point is, why all the animosity?  You are person B, just as much as I am. We are all person B.

Back from Vacation: First set of Pictures

 We have been back from our summer vacation for several weeks and are still sorting pictures. *sigh*  I have managed to post pictures from the first leg of our trip, when we stayed in the Julian Alp region of Slovenia.

Here is a link to the slide show in flickr:

P.S. If you are one of my "flickr" friends, view the slide show from flickr to also see pictures of us ;-)

Health Care Debate Marathon

During my travels last week, I caught little snippets in the news about the health care marathon debate. Two arguments stuck in my mind, one from the Republicans and one from a woman who was protesting in the street.

Arguments from Republicans: we can’t afford an all inclusive reform; it would break the bank. That made me wonder where these guys were when it came to tax breaks for the rich and paying for the war in Iraq, but I am getting off point.

Two points about cost:

First: From what I understood, the congressional budget office rated the reforms as being paid for. That was at least until the tax on the most expensive "Cadillac policies" fell victim to the negotiations. I am all for a pay as you go measure. The answer has to be figure out how to pay for this and don’t use this argument to kill the measure.

Second: the United States pays more for health care by far than any other country in the western world AND is virtually alone among the leading industrial nations in not having comprehensive health care coverage for all legal residents. Based on 2006 data, the United States pays 16% of GDP. Compare that with the countries ranked place two to five: France with 11%, Switzerland with 10.8%, Germany with 10.4% and Austria with 10.1% of GDP. That means that the United States spends over a half trillion dollars more on health care per year per than the French. What’s different is that the French and all others in the top five have universal health care, and the United States has 40 Million uninsured. Worse than that, according to a Harvard study, there are 45,000 excess deaths for lack of health insurance in the United States.  ( link )

Imagine the potential. If Americans could implement the cost structure and complete coverage that the French system has, there is the potential to save half a trillion dollars a year AND 45,000 lives a year. I have written more about the cost of health care in a previous entry ( link ).

But no, Universal Health Insurance, much less MANDATED Health Insurance, much less a SINGLE PAYER health insurance system has no chance in the American political landscape. That, would be SOCIALISM. That brings me to the second tidbit I heard in the news.

I didn’t commit the comment exactly to memory, but it was typical to much of the public opposition and went something like this: "we don’t want the Government controlling our health care system" and "we don’t want a socialist system."

First of all, where is the public outcry to eliminate Medicare and Medicaid? Medicare and Medicaid are not only government controlled, but also enjoy among the highest customer satisfaction and is a perfect example that quality health coverage can be administered at a much lower cost.

More than that, this Government Control Socialist argument is a red herring, albeit one deeply embedded in the American Psyche. For generations, and particularly during the cold war, the idea of socialism was something that was villainized not only in political circles, but also in the school system, and in popular media as well. Common themes in Social Studies classes included a) "The United States is the greatest and most free country in the world" (we never discussed by which measure, nor did we do a comparative analysis with other countries) and b) "Socialism does not really exist in practice, it is really just a buzzword for Communism, which only exists in combination with a totalitarian regime."

You can’t have a lucid conversation about health care reform without this understanding about the premises that it’s opponents believe the system is predicated on.

I don’t think that it will be possible to have a real discussion about whether or not universal health care is something that should be treated as a human right – or even something that just makes financial sense until the stigma is removed about government being in charge of and providing for such services. And, you can’t do that without reprogramming the American Psyche ... or better put, deprogramming the American Public after so much cold war propaganda.


Seneator Bayh's article in the NY Times

Dear Senator Bayh,

Thank you for your article in the NY Times (link) about reforming congress. I share your beliefs and salute your commitment to and focus on this most pressing issue.  I have become increasingly frustrated by the corrosive impact of big money, big business and special interests in the political process in the United States.

I was uplifted by candidate Obama’s initiative to create a new political reality based on consensus and cooperation. It is saddening to see how difficult it is to turn this vision into reality.

I share your belief that any reform of congress needs to start with the personal interactions between members of both parties.  Over the past several years, members of both parties have expressed regret about the deteriorating state of affairs in this regard.

I also agree that there needs to be an amendment to the constitution in regards to campaign finance reform, particularly in light of the recent Supreme Court decision. There needs to be a more immediate legislative response as well, to insure that the interests of judicial persons do not trump those of natural persons.

Finally, I agree that there must be reform to the filibuster.  I think that gridlock via filibuster is a symptom and not the root cause.  If members of congress functioned with each other in a personal level as you described and there was more focus on problem solving than political positioning, then the temptation to abuse the filibuster would not be so great.  Still, in the absence of real progress on the root causes, the power of the filibuster to keep government from functioning correctly needs to be limited.  You are right to note that the minority needs to have its voice heard, but should not permanently derail the will of the majority.

I wish you success in your pursuit of these goals and hope that you continue to work toward them even after you leave the senate at the end of your term.

Thank you for shining a light on these issues.

Kind regards,


First overnight business trip at my new job ... to Zagreb

Next week, I will be spending two nights in Zagreb on a business trip to visit a supplier, part of a project I am working on.  Since five of us will be traveling … and since it would have cost EUR 700 per person to fly, we will be DRIVING to Zagreb and back.


Actually, it won’t take us all that much longer to drive than to fly.  According to all knowing google, it will take us pretty much exactly seven hours to drive to Zagreb … without breaks, providing we don’t have winter driving conditions or traffic jams along the way.  The flight would take a little more than an hour.  Add to that, two hours for the drive to Munich (including a comfortable margin), getting to the airport two hours before takeoff, ¾ hours to pick up checked baggage and get through the airport in Zagreb and perhaps a half hour to get to the hotel from the airport, and flying wouldn’t save that much time.


This way, we will also get to see the countryside along the way.  It will probably be dark by the time we get to the Slovenian border.


I have traveled this route before, by bus.  I am looking forward to this trip!