A Personal Note on Today’s News …

My decision in 2005 to leave the USA had many motives.  But whenever I’ve contemplated returning permanently, the single strongest reason not to has been the nation’s barbaric, anti-competitive, and stupendously inefficient approach to health care.

The plight of the uninsured and underinsured was bad enough; more than one relative has told me that the great thing about turning 65 in America is that you can finally go to the doctor.  I couldn’t contemplate living in a place where I could be trapped in a toxic job for fear of losing my health care, or where the appalling burden the system places on employers would prevent me from starting a small business, should I want to do that.  I have always been amazed that Americans tell themselves they value entrepreneurship.  Taking on your first employees is a much easier decision in Canada or Australia, where you’re not taking on their health care needs as well.

I have few illusions about health care in Australia, where I live now.  Here, the central government is considering seizing control of public hospitals from the states, in order to address long-term problems of underfunding and incompetence that have made years of lurid news.  Health care is an emotional issue everywhere, an issue that has us all by the throat, much like the issue of “home” that lies at the heart of NIMBYism.   People will never be entirely rational about health care, any more than they are about “home.”

I also have few illusions about the complex and compromised bill that President Obama is about to sign, but I do know this is about more than health care.  Apart from the election day of 2008, no other day in recent history has made me feel as hopeful about the US’s ability to reform despite its toxic politics and archaic systems of governance.  If a reform of this magnitude can survive all the fear-mongering and confusion and somehow get to the president’s desk, reforming transportation policy may not be such a crazy dream.  When I’m feeling really dreamy, I can almost imagine a world where California could put together a constitutional convention to fix its dysfunctional budget system, so that it wouldn’t have to continue wrecking its great universities, or its magnificent and diverse experiments in urbanism.

I hope, wherever you live and whatever your views on the issue, that you too feel a sense of a release and opportunity, in the fact that reform on this scale can still get done.

25 Responses to A Personal Note on Today’s News …

  1. Teresa March 22, 2010 at 7:09 am #

    Well said. And, yes, I do.

  2. EngineerScotty March 22, 2010 at 8:45 am #

    With that in mind… I propose a trade.
    Australia sends Jarrett back to the US. The US sends Rupert Murdoch back to Oz.
    As part of the deal, Australia gets Murdoch’s multi-billion-dollar fortune–if appropriately taxed, quite a bit of transit infrastructure could be built. The US would, in return, get Jarrett’s fortune, whatever it happens to amount to. Given that media tycoons make a lot more money than do transit planning consultants, I suspect the land down under comes out ahead (financially) in this transaction; though the intangibles probably benefit the US.
    Whaddya think? 🙂

  3. Teresa March 22, 2010 at 10:12 am #

    Sounds like Australia’d be getting ripped off bigtime. 😉

  4. Mike Fogel March 22, 2010 at 11:39 am #

    Good post. I have a somewhat similar situation – I’m a dual canadian/american living in the US. My partner has a dreaded “pre-existing condition” making getting health insurance an extremely difficult process. We’d been considering moving to Canada – it seems after 6 months residency, she’d be covered, pre-existing condition and all. But with the health bill passing, it appears that we have another option – just wait it out here till 2014 (by my reading).
    Anyway, I for one am certainly as stoked as you that the US seems to be taking steps to recognize basic health care as a right, not a privilege.

  5. Art Busman March 22, 2010 at 1:54 pm #

    I’m not a big fan of US healthcare, not so much the fact that it is not universal as much as the fact that there are monopolies, unfair markets, incredible waste and corruption. Is that enough to push me out of America? I can name countless things worse in Europe or any British Commonwealth or ex, namely persistent and institutionalized racism that far exceeds that in the US. Just watch TV in NZ, Aussie, Canada, England, or Europe and everyone is white despite the fact that there are now huge minority populations. Check out your parliaments and count the minorities, on one hand, perhaps a finger? As for entrepreneurial advantages the US has most of them and that’s why there’s more free enterprise here than anywhere else in the world. Try jumping through all the red tape and paying the exorbitant taxes in Europe or paying much higher wages and fuel costs. Creativity, innovation, technology, America has it all. And don’t get me started on the snobbery, elite, smug, condescending governments of Europe and the British Commonwealth. And I’m not entirely convinced healthcare is more competitive and free market in Europe or the British Commonwealth. I’d much rather live in America thank you and as an American fulfill my obligation to fight to improve my country instead of running away from it and its problems.

  6. David March 22, 2010 at 3:55 pm #

    Heh, I guess we can’t use that “at least we have Health Care” joke anymore? Congratulations, though.
    Anyhow rant follows:
    Art, of all the ironic things, an American lecturing the rest of the world on racism. But wait, I forgot now that Obama is President I guess all American problems with racism have been dealt with! That’s why Obama’s Tea Party/Republican protesters/opponents have never questioned Obama’s “Americaness” (seriously, they only want to see his Birth Certificate), they never suggested he “go back to Africa” (that’s never racist, tis only a mere suggestion), nor have they ever questioned his commitment to Christianity (he spent so much time with Muslims growing up and his black family is Muslim, so who knows… also his religion is clearly relevant to his ability to run a country). Then again, many Americans (not all though!) have difficulty with irony, so I apologize if you don’t understand what I’ve just written. Granted Europe has some of the most significant problems with racism I’ve seen in the western world, nor are the settler societies you’ve listed including Canada much better on these matters even if we don’t elect British National Party, Front National or National Democratic Party MP’s, but your view is extremely myopic.
    I’m only going to speak to Canada as a Canadian, specifically English-speaking Canada. As a relative comparison between population and representation visible minorities are underrepresented in parliament, yes. Almost all minorities that aren’t a plurality are underrepresented in First Past the Post electoral systems. The only reason they wouldn’t be in the US is because districts in the House of Representative are gerrymandered to be “majority minority” as minorities have difficulty getting elected in majority white districts. Take a look at the US Senate; how many non-white Senators are there? I bet you could count them on one finger. Jon Stewart’s “America the Book” (circa 2004) had a hilarious colouring exercise where you where supposed to colour in the skin colours of US Senators (hint they were all white!).
    As for TV, English-Canadian TV is relatively representative of diversity. Almost to a point of unbelievability (ever heard of a show called Little Mosque on the Prairie?… I’ve been to Saskatchewan, it isn’t that diverse). Besides, about half of our TV/Movies come from the states anyways, so again, the irony pops up.
    Anyways, I’ve found this entire episode really interesting. There are some really interesting and dynamic cities in the US that are a real draw to anyone looking to make a future for themselves, provided they have a job with good health care lined up. Though I’m a proud Canadian, I’m honest enough to admit that we have nothing that compete with the vitality of a place like New York, or even Chicago, or even god forbid Los Angeles (despite its history of awful land use and transit planning). That being said, the utter ridiculousness of the American political system in passing this half-assed, albeit improvement on the status-quo is astounding. These places succeed despite of a slavish insistence that America is already perfect and anyone who questions it is an idiot.
    The fact that ideology, ie. a belief that government “red tape” is worse than private sector “red tape” even if the former is less than the latter and gets rid of the latter’s excesses is myopia at a level that makes one believe the lie that America has “the best” Health Care system in the world. By any stretch of the imagination it does not and probably still won’t. That and the fact that the Democrats clearly won a majority mandate to do this, and took as long as they did, is astounding to those of us who live in parliamentary systems. If the last point is snobbery, so be it. Canada’s health care system isn’t perfect, but at least I know two things A) I won’t go bankrupt getting the health care I need and B) I won’t be caught up in red tape should I need help now. The same couldn’t be said for the US and I’m not sure if it can now, though perhaps, you’re on your way.

  7. EngineerScotty March 22, 2010 at 4:21 pm #

    Many, many societies and countries have histories and legacies of racism and discrimination–and most places are still dealing with these to this very day.
    Arguments over which country, especially among the Western democracies, is the “most racist” are pointless.
    And yes, racism is alive and well in the US, despite the fact that we have a black President. The fact that Obama is of part African ancestry (which, in the minds of many, makes him “black”) has brought some of this out in public.
    The GOP, sadly, is about two steps away from becoming the equivalent of the BNP or the Front national–and some may argue that I’m giving them too much credit at this stage. Which is a shame; US politics functions best when there’s more than one vibrant, intellectually capable political party out there.

  8. Watson March 22, 2010 at 4:47 pm #

    For some individuals, health care reform will have a significant positive impact. But in the aggregate, I don’t think it will have any significant positive effect on either the health or the economic security of the U.S. population. I don’t expect we’ll see any significant changes in the trendlines of health indicators like life expectancy and infant mortality, or in the rate of health-related bankruptcies. And I think the proponents of health reform have greatly underestimated its long-term costs. It doesn’t make any fundamental changes in the way health care is funded or delivered. In fact, it entrenches the existing system based on private insurers and employment-based coverage.

  9. Mad Park March 22, 2010 at 8:14 pm #

    Thanks for a clear and concise analysis of this 14 month long reign of nonsense. Little if anything has changed for the vast majority in the US; the rich will continue to get richer, now it’ll be insurance company executives instead of banking executives.
    I have a tonne of respect for you, your career and most especially your ideas on transport. However, on this one I must disagree. There is only one way: single payer – everything else is frosting on Big Medicine’s, Big Pharma’s and the Big Insurance Company’s cakes.

  10. Spokker March 22, 2010 at 9:27 pm #

    I consider myself a capitalist, but I think world experience has proven that those countries with socialized medicine not only spend less on health care as a percentage of GDP, but get better results. It makes no sense to continue to support a broken system in light of superior alternatives, which aren’t perfect, simply better.
    The arguments that hinge on creating fear, uncertainty and doubt are quite easily dismissed. One example is rationing? Death panels are going to kill grandma and grandpa. Rationing happens in a private as well as in a public system. Pre-existing condition? That’s rationing, dummy. Private insurers kill grandma and grandpa just as well as any government plan, if not better.
    Of course, I would hope that preventive care is a part of any health care reform bill. It’s far better to nip conditions in the bud and promote health lifestyles than encouraging people to develop conditions that cost $100,000 per year to treat (which is what our current system does now). Blood in the stool is no cause for alarm, not under America’s health care system. Drink two whiskeys and call no one in the morning.

  11. doctorwho March 22, 2010 at 10:13 pm #

    @Watson – “For some individuals..’ Would that be around 25-30 million?

  12. Watson March 22, 2010 at 11:11 pm #

    Would that be around 25-30 million?
    No. It be the number of people whose health and/or economic status is significantly improved as a result of this bill. I think that number is likely to be quite small.
    I think world experience has proven that those countries with socialized medicine not only spend less on health care as a percentage of GDP, but get better results.
    I don’t think they do get better results. Critics of the U.S. health care system frequently point to the relatively poor ranking of the U.S. on average life expectancy. But life expectancy is not a meaningful indicator of the performance of the health care system, because life expectancy is so strongly influenced by other variables that differ greatly between countries, like diet, exercise, smoking rates, drug use, crime, accidents, etc. If you look at statistics that actually measure the outcomes of health care interventions specifically, like cancer survival rates, the U.S. tends to do better than other countries.

  13. Paul C March 23, 2010 at 2:12 am #

    As a Canadian
    All I can do is laugh and laugh and laugh and laugh.

  14. Dave March 23, 2010 at 2:20 am #

    Not sure I agree with that last one Watson; the cancer survival rates may only include those that were treated, not those that died from it (which are included in life expectancy outcomes. So, if you can afford treatment, your prognosis is good; if not, well, you don’t tarnish the cancer treatment figures with your passing… which does get included in life expectancy figures.
    I don’t see in the US any ‘competition’ effect in driving down healthcare costs, but maybe I’m missing something? When the Government is the provider, at least it can also set the payment- not always the most efficient, but seems like most ‘single payer’ systems work out cheaper.

  15. Guy March 23, 2010 at 5:48 am #

    “I have always been amazed that Americans tell themselves they value entrepreneurship. Taking on your first employees is a much easier decision in Canada or Australia, where you’re not taking on their health care needs as well.”
    And yet, there is virtually nothing entrepreneurial that emerges from Canada, the UK, or Australia. Nothing.

  16. anonymouse March 23, 2010 at 9:13 am #

    Canada has a population of 30 million. Australia has 22 million. Compare that to the 300 million that the US has. (And the comparison to California is not valid… CA attracts entrepreneurs from the entire US, so an arbitrary 10% slice of the US would be much less entrepreneurial than California). That and I bet there are plenty of UK, Aussie, and Canadian companies that you assume are American, because they’re english-speaking and you just kind of assume that if they speak english they’re American.

  17. anonymouse March 23, 2010 at 9:19 am #

    Also, I think there’s an interesting parallel between health care and transportation, in terms of the difference between existing reality and perceptions. In both cases, the existing system is viewed as a product of the free market despite massive government subsidies, both by those who love the free market and those who hate it. In the case of transportation, it’s things like government highway funding (while railroads are taxed) that make driving cheaper than taking the train, while for health care it’s the employer health care tax deduction that created the current employer-centered system.

  18. MB March 23, 2010 at 1:35 pm #

    Per capita costs (US$) of healthcare in selected Western nations (2007 data or more recent):
    Australia: $3,137
    Sweden: 3,323
    Denmark: 3,512
    France: 3,601
    Austria: 3,763
    Canada: 3,895
    Switzerland: 4,417
    US: 7,290
    “The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.”
    I would add that the US, with the highest health care costs in the world, also has an infant morality rate (which most definitely IS a meaningful healthcare indicator) above 14 other western countries, and there are 45,000,000 US citizens without any health coverage. Moreover, the standard tactics used by private health insurance companies to deny and cap coverage beggars belief, as does thier power and sway over elected officials.
    Given the above information, approving Obama’s heathcare initative will prove to be a watershed and seminal event toward improving American society.
    I would add that I grew up with Canada’s public healthcare system. I’m not saying its quality of care is any better than the US (when you have adequate coverage, that is), just far more efficient WRT especially the insurance bureaucracy and legislation.
    Moreover, Tommy Douglas, late premier of Saskatchewan, headed the first government in North America to introduce public healthcare, and built the system from the late 50s onward under 21 successive balanced annual budgets. Public healthcare will not bankrupt the system, but given the numbers above, private care will.
    The Canadian deferal government took Douglas’ lead and implemented the national healthcare program under Lester Pearson in the mid 60s. After a half century it could use some additional leadership using Australian prime minister Rudd’s example to wrestle control back into federal hands, and to achieve the original 50/50 federal/provincial balance of funding and to elevate and protect national standards.
    My wife, who has several serious respiratory tract and other maladies, commented last Sunday after Obama’s accomplishment that we likely would have lost the house or she would have died (or both!) under a private system after maxing out the insurance coverage. To an average Canadian that is an inconceivable tragedy.

  19. anonymouse March 23, 2010 at 4:41 pm #

    Okay, since we’re talking about health care: true, there are 45 million americans with no health insurance, but there is in fact a system of universal healthcare, in the sense that someone who is sick and has no insurance or money to pay for treatment won’t just get left on the street to die. They’d go to an emergency room, which is obligated to provide treatment regardless of ability to pay. But this system is rather inefficient and expensive, and a really bad idea to have as the default, or only, health care option for so much of the population. This is definitely a part of why health care is so expensive in the US, but not the only one. Other factors include the much longer and more expensive education requirements for doctors (as well as regulations that prevent immigrants from competing effectively), the culture of suing everyone for any perceived mistake, and so on.

  20. Chris March 23, 2010 at 4:55 pm #

    anonymouse – Not only will that be expensive but also fairly ineffective and cruel. If you can’t get medical treatment until you are ‘sick’ then your complaint is likely to have progressed further than it would have had you had the ability to visit a doctor when you first began feeling unwell.

  21. Nathanael March 23, 2010 at 6:39 pm #

    Unfortunately, the bill passed will entrench the private insurance companies, making them even harder to get rid of.
    However, it *will* eliminate the employer-based system bit by bit. There is a scheduled date after which pretty much all employers can choose to participate in the “exchange”, paying premiums for their employees individually, instead of providing health insurance directly — I think it’s 2017 or 2018. That will tear the employment linkage out as many will choose to do exactly this as it will be cheaper.

  22. Nathanael March 23, 2010 at 6:48 pm #

    “Apart from the election day of 2008, no other day in recent history has made me feel as hopeful about the US’s ability to reform despite its toxic politics and archaic systems of governance. ”
    I really hope we can. What makes me pessimistic is that we haven’t even gotten rid of the filibuster yet (and that should be considered a *first* step).

  23. cmorgan March 24, 2010 at 2:12 am #

    James Howard Kunstler reliably puts the events in much more drastic terms.
    “It was amusing to see the Republican party inveigh against health insurance reform as if they were a synod of Presbyterian necromancers girding the nation for a takeover by the spawn of hell. […]
    At least this once a workable majority in the government has stood up to the forces of cruelty and injustice, and whatever else happens to us in the course of this long emergency, it will be a good thing if the party of fairness and justice identifies its adversaries for what they are: not “partners in governing,” or any such academical-therapeutic bullshit, but enemies of every generous impulse in the national character.”

  24. al m April 4, 2010 at 9:20 am #

    The root of the problem is the monetary system, a false creation by the elite of the world.
    “Profit” can only exist if there is scarcity, not abundance.
    As long as humans exist within a monetary system, there will never be a just world.
    The “winner and loser” pathology will continue to plague the world of mankind until evolution enables the mind of men to realize that everybody is a loser when even one human is a loser.
    Probably a million years away from today.

  25. BettieHENRY34 August 11, 2011 at 2:12 am #

    I think that to get the home loans from creditors you ought to have a good motivation. But, one time I have got a term loan, because I was willing to buy a car.