Yes, there are problems now, e.g.,
"how many people have nothing else to rely on.".
But, really, the existing system has faced
such problems for a long time and put in place
a complicated, disorganized, collection of
pieces, patchwork, to respond to it. E.g., there is the
Hill-Burton hospital act where to build a
hospital can get Federal money but then
can't turn away patients who can't pay.
So, do 'cost shifting' and charge more for
patients who can pay. Or have a city run
and funded hospital. Patchwork.
Could we improve it? To borrow from Cheney, no doubt. Could
we make it worse? No doubt.
To me, the 'sausage making' process
of Obamacare promises a poorly designed
product. And the origins and motivations
of Obamacare concern me: As I recall,
really Obamacare was in its first drafts
(did anyone read the 2000 pages enough
to do a second draft?) was basically pulled
off the shelf from where it had been
stored by a health care team under Senator
Ted Kennedy. There the dream, Ted did
like the "dream", was simple --
socialized medicine.
I suspect that 'socialized medicine'
can be made to work well; maybe it does
in Switzerland. But I don't trust
the results of the people who want 'socialized medicine'
in the US mostly just as I don't trust
the people who just want socialism in the US.
My guess is that too soon we will be
paying too much (yes, we are now, also)
or screaming about bad medicine like
people do in the UK and Canada.
In a sense Medicare and Medicaid
have an advantage because they are mostly
just payment mechanisms placed on top
of what is roughly, very roughly,
a 'free-enterprise' system. But if just
socialize the whole thing, then
can end up with a bad version of the
USPS.
I'm not against the Federal Government
doing some things: In places what the
Federal Government does works out
great -- Hoover Dam, Bonneville Dam,
TVA, Los Alamos, NSF, NIH, DARPA,
funding of the top three dozen or so
US research universities, the Interstate
highway system, the FAA (the safety
and engineering parts; some of the
air traffic control parts), in the
end most aspects of the USPS,
the Agriculture Extension Service of
the USDA, the FDA (pretty good on
safety, a bit slow on efficacy),
and more. For the VA, I don't know:
There are complaints about the
access and quality, but I know no
details.
So, for Obamacare, I'm
concerned that in the US
'socialized medicine' is just super
tough to get right and that the
Nancy, etc. efforts are not even
10% as serious as needed. Then,
from the structure of the 'board'
or 'panel' appointed by the president,
I'm concerned that Obamacare
will become a
'political football'
that results in low quality health
care at high prices.
"Political
footbal"? For an example, that's my view of 'climate
change' and 'clean energy': For
fossil fuels, use 'climate change'
as an excuse to tax them and throttle
them. E.g., in his 2008 interview
at the SF Chron., Obama explained
his intention to raise carbon taxes
enough to "bankrupt" our coal fired
plants -- then 49% of our electric
energy and, as I recall, ~23% of all
our energy. I suspect he was just
posturing, but it was dangerous.
Then supposedly about $92 billion of
the various 'stimulus' and TARP
(I and II) funds went for 'clean
energy' but turned out to be
make-work jobs and campaign
contribution kickbacks. Supposedly
since then we've thrown another
$45 billion at 'clean energy' --
to me, 99 44/100% about politics,
e.g., campaign contribution kickbacks,
and the rest water and not at all
about energy or the even the climate
(in my view, there's no very good
evidence that the climate is at risk).
So, with US socialized medicine,
I fear 'waste, fraud, abuse' from a
political football.
E.g., now we've got NSA: Politics?
Sure: No politician wants to get
blamed for "being soft on terrorism".
So, NSA suspends good judgment and
goes overboard -- 'over reaches', e.g.,
data on calls of 120 million or so
Verizon customers, maybe all the
US e-mail traffic, maybe all the
US phone voice data.
E.g.? Sure: Snowden was a GED,
contract, bottom level employee in
Hawaii but apparently had his fingers
directly on huge volumes of data,
all at the NSA supposedly just
terrific at 'computer security'.
Why? Poor oversight. Poor
execution. From the White House,
don't give a sh!t about the details
and otherwise a political football.
I fear the same for a US national
health care system. Yes, what
we have could be better, but it could
also be worse, and for having it
worse Nancy is just the person to
lead us there.
Maybe in an honest moment Nancy
would have said, "We will just
pass it. That's all we can do.
Then we will leave the details
up to the execution of the Executive
branch, in some big office buildings
somewhere within 100 miles of the
Washington Monument, and pass more
bills if really necessary. So, we
will just get it started and then
let others make it work well."
But they don't have to make it
work well -- they might just make
a mess. I'm thinking, re-engineer
and rebuild a Boeing 747 in flight,
with people who just started learning
about sheet metal.
Well I think I agree in principle that the implementation of healthcare should be left to a free market-esque system, with oversight and resourcing provided by the government.
It could even be much like those "basic income" schemes being floated around here; the government pays out up to a certain cap to cover basic preventative and "major life function" care. If people want fancier doctors that's fine, but they have to pony up the excess themselves.
I think the best examples of government interaction with the business sector have come when the government says this is what needs to happen without enforcing how it has to be done, and then letting entrepreneurial types figure out how to do it best. I see no reason why healthcare has to be fully nationalized, or why ObamaCare can't be the first step toward a system like that.
More generally, you are correct because
you are trying actually to think about
it. If we think about it carefully,
we might actually get something both
better and quite good. E.g., along the
lines you said, if some Hollywood actress
wants her nose again to look like it
did when she was five years old, then
she can pay a top Beverly Hills plastic
surgeon. If some poor guy in a ghetto
has a badly swollen foot and can't
even pay taxi fare to the hospital,
then he gets the basic work on his
foot for free. Fine. That's like
a 20 second, free hand, rough sketch
of a Boeing 747 -- making it fly
like a real 747 is a lot of
hard work yet to do.
I wish we'd done that work. I
can't believe we did.
But, really, the existing system has faced such problems for a long time and put in place a complicated, disorganized, collection of pieces, patchwork, to respond to it. E.g., there is the Hill-Burton hospital act where to build a hospital can get Federal money but then can't turn away patients who can't pay. So, do 'cost shifting' and charge more for patients who can pay. Or have a city run and funded hospital. Patchwork.
Could we improve it? To borrow from Cheney, no doubt. Could we make it worse? No doubt.
To me, the 'sausage making' process of Obamacare promises a poorly designed product. And the origins and motivations of Obamacare concern me: As I recall, really Obamacare was in its first drafts (did anyone read the 2000 pages enough to do a second draft?) was basically pulled off the shelf from where it had been stored by a health care team under Senator Ted Kennedy. There the dream, Ted did like the "dream", was simple -- socialized medicine.
I suspect that 'socialized medicine' can be made to work well; maybe it does in Switzerland. But I don't trust the results of the people who want 'socialized medicine' in the US mostly just as I don't trust the people who just want socialism in the US. My guess is that too soon we will be paying too much (yes, we are now, also) or screaming about bad medicine like people do in the UK and Canada.
In a sense Medicare and Medicaid have an advantage because they are mostly just payment mechanisms placed on top of what is roughly, very roughly, a 'free-enterprise' system. But if just socialize the whole thing, then can end up with a bad version of the USPS.
I'm not against the Federal Government doing some things: In places what the Federal Government does works out great -- Hoover Dam, Bonneville Dam, TVA, Los Alamos, NSF, NIH, DARPA, funding of the top three dozen or so US research universities, the Interstate highway system, the FAA (the safety and engineering parts; some of the air traffic control parts), in the end most aspects of the USPS, the Agriculture Extension Service of the USDA, the FDA (pretty good on safety, a bit slow on efficacy), and more. For the VA, I don't know: There are complaints about the access and quality, but I know no details.
So, for Obamacare, I'm concerned that in the US 'socialized medicine' is just super tough to get right and that the Nancy, etc. efforts are not even 10% as serious as needed. Then, from the structure of the 'board' or 'panel' appointed by the president, I'm concerned that Obamacare will become a 'political football' that results in low quality health care at high prices.
"Political footbal"? For an example, that's my view of 'climate change' and 'clean energy': For fossil fuels, use 'climate change' as an excuse to tax them and throttle them. E.g., in his 2008 interview at the SF Chron., Obama explained his intention to raise carbon taxes enough to "bankrupt" our coal fired plants -- then 49% of our electric energy and, as I recall, ~23% of all our energy. I suspect he was just posturing, but it was dangerous. Then supposedly about $92 billion of the various 'stimulus' and TARP (I and II) funds went for 'clean energy' but turned out to be make-work jobs and campaign contribution kickbacks. Supposedly since then we've thrown another $45 billion at 'clean energy' -- to me, 99 44/100% about politics, e.g., campaign contribution kickbacks, and the rest water and not at all about energy or the even the climate (in my view, there's no very good evidence that the climate is at risk).
So, with US socialized medicine, I fear 'waste, fraud, abuse' from a political football.
E.g., now we've got NSA: Politics? Sure: No politician wants to get blamed for "being soft on terrorism". So, NSA suspends good judgment and goes overboard -- 'over reaches', e.g., data on calls of 120 million or so Verizon customers, maybe all the US e-mail traffic, maybe all the US phone voice data.
E.g.? Sure: Snowden was a GED, contract, bottom level employee in Hawaii but apparently had his fingers directly on huge volumes of data, all at the NSA supposedly just terrific at 'computer security'. Why? Poor oversight. Poor execution. From the White House, don't give a sh!t about the details and otherwise a political football.
I fear the same for a US national health care system. Yes, what we have could be better, but it could also be worse, and for having it worse Nancy is just the person to lead us there.
Maybe in an honest moment Nancy would have said, "We will just pass it. That's all we can do. Then we will leave the details up to the execution of the Executive branch, in some big office buildings somewhere within 100 miles of the Washington Monument, and pass more bills if really necessary. So, we will just get it started and then let others make it work well." But they don't have to make it work well -- they might just make a mess. I'm thinking, re-engineer and rebuild a Boeing 747 in flight, with people who just started learning about sheet metal.