health care as a human right, part the 58th.

Picture a little town in Flyover Country, U.S.A—let’s call it Liberty Falls.  You know the kind: three stoplights, one gas station, a little corner grocery store, white picket fences, and a covered bridge.

Liberty Falls has 1,000 residents, and one doctor, a kindly old country doc who’s a few years shy of retirement.  Everyone who has an ailment goes to see the doc, and they pay either by presenting their insurance card, or by forking over cash as private patients.

Now, some people in Liberty Falls have neither health insurance, nor the money to pay for a visit to the kindly old country doc.  So the progressive and compassionate people of Liberty Falls pass an ordinance that proclaims the following:


Because health care is a human right, it is now the task of the community to pay for the doctor’s visits of the townsfolk that don’t have health insurance.  In the next annual town budget, local property and sales taxes are raised a few percentage points to get the funds for the health care expenses of the town’s poor folk.  The lines at the kindly old country doc’s office get a little longer, as do the doctor’s hours, but all in all, everything works smoothly, and the citizens of Liberty Falls bask in the knowledge that everyone in their little town has a right to health care, and nobody has to go sick or die for lack of money for the doctor’s visits.

A year or two later, the kindly old country doctor has had enough of the General Medicine business.  His hours have gotten a bit long, and he was ready for retirement anyway, so he closes his office, and takes up gardening instead.

Now the citizens of Liberty Falls have a problem.  Not only do the paying and insured citizens no longer have a doctor to go to, but the uninsured folks are out of luck as well.  What’s worse, the town has made health care a human right, so some of the citizens are considering suing the town for violating their rights as defined by the town bylaws.

Efforts are made to secure a new source of medical care, but there’s no other doctor living in Liberty Falls.  The only college kids currently living in town are all in other fields of study, and the only one who got into medical school is planning to practice in nearby Megalopolis instead, because there’s more money and less stress in the Cosmetic Surgery field than in General Medicine.

What can the town do?  The town council can’t move the sole med student to take over the kindly old country doc’s practice, and nobody else wants to go to med school just to face the sure prospect of being underpaid and overworked as the sole heath care provider in Liberty Falls.

Now the town looks to the outside for a new doctor to come and move in, so the town law of health care for all as a human right can be satisfied.  But the town ordinances are a roadblock in this case once again.  The people of Liberty Falls don’t like outsiders much, and they passed laws a long time ago that require professionals from other towns and cities to get a special temporary license to practice their craft.  (This was done to protect the local professionals from unfair competition from nearby Shady Grove and Potter’s Landing, two towns with which the Liberty Falls folk aren’t on the best of terms.)

What happened to the right to health care now?  What are the options open to the good people of Liberty Falls now?  The out-of-towners face severe hurdles just to get an undesirable job (and don’t want the position for that reason), and the town’s youngsters can’t be forced to become doctors, no matter how much the town tries to convince them.

How, now, does Liberty Falls secure that “human right” they wrote into the town laws…without forcing anyone into the job, and thereby violating their rights?  Do they force the old doc out of retirement?  Do they force the med student into a field of study she doesn’t like, and then push her into a job she doesn’t want?  Do they end up paying out half the town’s tax income to send people to Shady Grove’s doctor instead?  All the coercive and fiscal power of the town government is completely useless when it comes to securing that right, if nobody wants to take the job willingly.

In order for something to be a human right, it cannot and must not be something that requires a good or a service from someone else.  If you make it so, then the person providing that good or service will become a slave to the community, because they no longer have the option to refuse.  That’s why health care cannot ever be a human right: because health care is a commodity, just like flat-screen TVs and sliced bread at the grocery store.  You can’t claim the right to force J.J. Nissen to make bread for you, whether it’s for compensation or for free, and you can’t force Best Buy to keep stocking flat-screen TVs, either.  If you run out of people to provide that commodity, you have no way to claim that so-called human right.

A human right only requires that people leave you alone to exercise it, not that they work for you, whether you give them money for their work or not.  Freedom of speech is a human right.  Freedom of association is a human right.  Free exercise of religion is a human right.  Free band-aids and vaccinations aren’t.

That, friends and neighbors, is why health care, while very desirable and a good thing to have, cannot and will not ever be a human right…and that’s why I have a capillary or two bursting every time I see that bumper sticker.


66 thoughts on “health care as a human right, part the 58th.

  1. perlhaqr says:

    Best of luck. I’ve tried explaining this 50 different ways. In the end, it always turns out that somehow I’m the evil heartless bastard for not wanting to enslave anyone. Funny how that works.

  2. Roberta X says:

    But we can all freeze in the dark together, as we enjoy equal access to health care: none at all. After all, humans are a bane on the planet, right? So why hadn’t we all die soon rather than late?

    –I am entirely convinced that’s the idea at the heart of this madness. We’re gonna have to be eating these ijits after civilization falls and the very thought makes my gorge rise.

  3. Rick R. says:

    But Roberta,

    At least a large percentage of these idjits will be well fed on granola and tofu.

    Herbivores tend to taste better than carnivores, anyway. Less gamey.

  4. You’ve proven that they’re inconsistent by your standards, but by their own they’re perfectly consistent. The health-care-is-a-right believers don’t believe in “negative” rights at all. Your work? Theirs. Your property? Theirs. Problem “solved”.

  5. Brian says:

    Marko – I may be mistaken, again, but I believe you may be well on your way to the the script for “Doc Hollywood II: Electric Boogaloo”.

    There’s just no convincing these people. They collectively think that healthcare (not insurance even) IS a right and it MUST be FREE!

    Remember the children! Do it for the children! It’s their right!

  6. T.Stahl says:

    Amen, Marko!
    (or whatever the atheist equivalent is)

  7. aczarnowski says:

    Wonder Twin powers, activate

    May Job have mercy on them. Go Joe! 😉

  8. daddyquatro says:

    Maybe Shazaam!
    You’ve knocked it out of the park again, Marko.

  9. Storytelling is a great way to make a point!

    Now, it’s not a very popular view, but I’ve always been a bit unsettled by the idea the people “deserve” health care or that the government owes them anything except the services for which they pay taxes; roads, municipal services, schools, etc.

    Thanks for writing it down! 🙂

    • perlhaqr says:

      Funny, I’ve always been a bit unsettled by the fact that the government has the authority to decide they’re going to provide me with a service, and then to mug me to pay for it whether I want it or not.

      Like, say, “health care”.

  10. MarkHB says:

    If you pop a gasket every time you see a complex issue missed by reduction to bumper sticker form, I can recommend lisinopril or ramipril. Or hooch.

    It’s a good point and well made – as ever. The reasons why complex philosophies break down are generally bigger than will fit on a bumper sticker without using *really* small fonts. Sadly, most people seem to have a five or six word frame buffer and anything bigger than that sends ’em into a glazed state.

    I’ve seen a bunch of reasons why Government-provided healthcare will be prone to graft, backhanders, lousy quality, crappy management and a patients-come-last mentality engendered by clipboard-wielding scuzzwads who’d make fine reactor shielding. Hell I’ve made TV programs on the MRSA outbreaks in NHS hospitals.

    That said, private insurance companies have their own problems too. Anything worth charging for is worth overcharging, and they didn’t grow into big healthy companies by writing a bunch of cheques either.

    Universal Healthcare: A lovely dream. Time will tell if it’s practical or not.

    • ibex says:

      One might argue that time has told. Soviet Russia, Cuba, Red China, North Korea…

      • MarkHB says:

        Yus. Also, the UK which has been a socialist country for a decade or so. What hasn’t been tried is a non-socialist country trying the gubment-funded healthcare thing. I know a lot of people seem to be saying the US is a “socialist country” now, but it really ain’t.

        • Rick R. says:

          Could that be because, BY DEFINITION, a government run health care things IS socialism?

          That’s like saying, we can’t be sure Marxist-Leninism doesn’t work, because it’s never been implemented in a capitalist society.

        • MarkHB says:

          Err…. I’m trying to wrap my brain around your statement.

          Most of America pays taxes which are within a half-dozen percentage points of the taxes I pay in the UK.

          So… uh… the last eight years were a socialist government? When was all the shouting about it then?

          Frankly, I just think the US citizenry is getting hugely fucking overcharged and you should demand they pay your medical bills because people paying THAT much tax get ’em paid anyway everywhere else.

        • Rick R. says:

          Tax rates do not “socialism” make.

          Just like shiny boots do not “fascism” make.

  11. karrde says:

    There’s also the niggling little detail that advocacy of Health Care As A Right usually devolves to Health Insurance As A Right.

    I mean, if I had insurance for my car, but couldn’t guarantee repairs for yesterday’s collision anytime in the next 3 months, I wouldn’t call that “guaranteed car care”.

  12. Tim says:

    I have been arguing that point for a while too Mr. Kloos. The sad part is that most of the people I talk to when the idea is broken down, they see my point and agree…then immediately say that we still need it.

  13. robnrun says:

    Nicely summed up there, I don’t think I have encountered quite such a succint description of what a right is before.

  14. Rick R. says:

    What’s particularly revealing is that the people who insist that it isn’t about getting a single-payer government health care service for universal treatment keep claiming the problem is caused by greedy insurance companies with captive markets, greedy doctors with hidden fees and unecessary procedures, and the fear of loss of insurance through job loss due to insurance being “unaffordable” outside an employer-subsidized (paid for via tax breaks to the employer unavailable to the individual employee) plan.

    Yet they scream incoherently at the thought of making three simple legal changes that do not require the government to pick up the bill for coverage:

    1. Drop the state line barriers on purchasing health insurance, so companies are not competing for your business merely in YOUR state, but have to face competition from any insurance company (and any plan) in the country. State by state balkanization of coverage may have had some shred of justification in Ye Olde Times, where you had to wait for the train to carry news back and forth, and investigations into shady business practices were equally hindered. (I don’t agree, but the argument could be made.) But today? No excuse.

    2. Remove most or all state-peculiar mandates on what a policy must cover. If Marko wants a high-deductible, high-copay, “catastrophic only” plan that is truly “insurance” and has correspondingly lower premiums, and I want a gold-plated “health management” plan that covers everything for peanuts out of pocket at the time of treatment, and I’m willing to pay the premiums, fine. If you want to leave “catastrophic” and true “emergency care” mandates in (to avoid people becoming a drain on society by inadequately providing for a car accident and having to use the court-mandated “life saving treatment provided, regardless of ability to pay”), fine. But requiring Marko and I to have EXACTLY the same coverage is ridiculous — we have different medical needs. If he has 20/20 vision and zero family history of colon cancer, maybe he doesn’t WANT a vision plan and regular colonoscopies after he hits a certain age. If I’m blind as a bat without my glasses, and all of my male ancestors died from colon cancer, maybe I’d rather have that stuff covered.

    3. Have doctors state up front what the fees are they plan on charging for specific, predictable items, just like my dentist, car mechanic, and vet do. Yeah, sometimes unforseen issues crop up that require going “over estimate” — but when I ask for an oil change or a cavity filling, I’ve got a fair idea what it’s going to cost, and what each item being charged for is.

    4. Real tort reform so that the legal system is not a Lotto. No, most people do NOT actually win frivolous malpractice suits in court. However, there is no penalty for them to file, little penalty for a lawyer to take on a bad case (as long as he wins enough to offset the losses, like an old time oil wildcatter using one good strike to cover a dozen dry holes), and a GREAT incentive for an insurance company to throw appeasement money at a suit, becuase the perceived cost of appeasement is offset by the risk of a HUGE loss, such as in the silicone breast implant fiasco. Between unbelievably high malpractice rates (ask an OB/GYN what his annual premiums are sometime. . . ), and the fact that the malpractice insurance company insists on a certain level of “extra-super-dooper” diligence on the part of the doctor, often time svery expensive and medically unnecessary procedures get carried out solely so the doctor can show in court that he did all that could be reasonably expected — and then some.

    5. Allow The same tax break to be claimed by individuals who purchase tehir own insurance as businesses get for insurance subsidies they offer. This allows indivuals to de-couple their health insurance from their job. Easily enough done — simply make “insurance costs” a claimable deduction under the same rules as already apply to that same insurance if it is employer-provided.

    Now, once we’ve done these types steps, to make insurance more affordable via private choice, we can take a better look at who STILL doesn’t have insurance and cannot afford it. And then have a discussion about what we want to do about them.

    Of course, the current political climate in Congress and the White House makes this impossible, as all of these ideas have been proposed by Republicans, and are therefor evil.

    Much easier to claim that Republicans have offered NO ideas, and are just standing in the way of any reform so Grandma can die faster.

    • perlhaqr says:

      That was five things. 😉

      That said, I agree with everything you’ve written here.

      I’ve got another one.

      Reduce licensing requirements for lots of procedures, to open up the market by giving Nurse Practitioners and Registered Nurses the ability to do thing that they are perfectly capable of doing, but legally forbidden because they aren’t doctors. Abolish the AMA, if necessary, to accomplish this.

      More competitors == lower prices.

      • Rick R. says:

        Steel on target.

        Given the quite adequate treatment I’ve received from military medics who were NOT “doctors”, or even “nurses”, (MUCH better than my buddies got from the full-fledged doctors in the VA in many cases) I’ll take my chances with a limited-duty medical professional who can do some of the stuff that otherwise would take a full-certified doctor.

        • perlhaqr says:

          Realistically, doctors shouldn’t even object. Other than the AMA being worried it’ll lose prestige or something, letting people who aren’t doctors take care of “high volume but low value” cases frees the doctors themselves up to concentrate on more complicated, higher monetary value procedures. Meaning that far from this scheme cutting into doctor’s wages, doctors might actually make even more money.

        • Windy Wilson says:

          The licensing should be relaxed. The process of becoming a Doctor is analogous to requiring that every airline pilot be astronaut trained.

        • Rick R. says:

          I’m not certain that licensing for an MD should be relaxed. We WANT our “doctors” to be highly qualified, and not just be mere biological mechanics.

          Which is why we should consider expanding the medical authority for those BELOW the level of “doctor”, so they can handle routine procedures and perscriptions.

          Diagnosing, say, strep throat, is NOT something that takes 8+ years of schooling (even if you have to run a culture “just to be sure”). Nor is writing the standard antibiotic perscription to treat it something that takes the breadth of knowledge we expect our doctors to have.

          The more “routine” work we can move from teh doctor’s in-box to another medical professional’s in-box, the more teh doctor can concentrate on teh stuff that DOES take 8+ years of schooling to deal with. Like diagnosing early stage cancer and coming up with a treatment plan.

        • perlhaqr says:

          Rick: ‘zackly. You probably don’t want the 16yo kid who is installing your muffler to rebuild the engine in your car. But you probably don’t want to pay the rate of the guy that can rebuild your engine to install your muffler, either.

      • Rick R. says:

        Oh, I’ll note one helpful area that is somewhat already implemented.

        Military physicians need to be ready for full scale warfare with mass casualties. (FAR in excess of the casualty rates in the current conflicts we’re fighting.) Even the reservists.

        And then there is the inevitable need in a military environment to provide health care for the civilians in the area in which you are operating (which they ARE doing in the current conflict).

        Yet, outside the level of high-intensity warfare, there is not enough for the military doctors, nurses, PAs, and medics to do. So we need to maintain a surge capacity, FAR in exc ess of what we need in time sof less than full-war. And they need to keep current, even if Stateside between deployments “Downrange”.

        That means you need not only more active duty medical types than you actually need most of the time, you also need a nice pool of reservist medical types (all of whom have to be trained and kept current — even if they also work as civilian medics) you can call up when things get really hairy.

        Right now, we really don’t have enough, even with contract civilians to pick up the slack.

        The best training for treating trauma and typical “war zone civilian” non-trauma injuries is to actually treat them on a regular basis.

        Which is why there are programs to stick reservists into the US civilian health system for some of their inactive training periods. “OK, guys, next month, the weekend drill is gonna be in in the ER of Forlorn Hope General Hospital, in the ‘hood. We’ll meet up at the Armory at 0500 Saturday, and head on over together.”

        This oculd be expanded, and include active duty personnel on rotation. Aviation units don’t necessarily do their “weekend” drills on weekends, so reservists (especially the IRR types who aren’t assigned to particular units) could be used to help manning.

        Set up 24/7 clinics in the worst areas, with free emergent care and means-tested non-emergent care. The Constitutional driver is not some mythical “right to health care”, however — it’s “provide for an Army and a Navy”. It’s free or reduced cost to ensure that there’s a nice steady flow of training opportunities.

        We may very well end up expanding the current size of the various medical corps for the military, but that’s a bonus.

        It’s called “cascade benefits” (the opposite of “cascade failure”). The taxpayer gets:

        1. A well trained medical force to adequately take care of our well-trained military force.

        2. (Probably) A much larger medical force, especially as people who would never support expanding the military per se, push to get more medical units so that they can expand these clinics. (I don’t care WHY someone supports a bigger, better medical corps that will take care of troops.)

        3. We can take care of people who really cannot afford good care WITHOUT creating a nationalized health care system or set out some imaginary right.

        Of course, if WWIII breaks out as a conventional war, and we find ourselves facing large ground forces overseas, we’re gonna have to draw down those clinics (close many, reduce hours from 24/7, etc.), as their purpose will have arrived — surge time. Well, I suspect a LOT of the normal customers for such clinics will end up in uniform anyway for one, and for two, there will still be medical units rotated Stateside for recovery and refit.

        It’s at least worth exploring.

        • perlhaqr says:

          This is pretty darn brilliant, I have to say.

          I’m moderately skeptical of this particular president doing anything which benefits the military, though, even if it helps with his goals as well.

        • Rick R. says:

          The beuaty of it (to my mind) is that it has appeals to a wide spectrum:

          1. Pro-military, because it actually has concrete benefits to the forces.

          2. Strict Constitutionalist, because it is an exercise of a specifically enumerated power, not a lame ass extension of an undefined prenumbra.

          3. Bleeding heart liberal, because it helps “the children”.

          4. (Probably) Insurance companies and health care companies — and those that earn income from their success, because it takes some of the burden off their backs.

          I think it’s easy to find a majority that falls into at least one of these categories — and few of those people who would oppose it is ALSO attractive to another of those categories.

          I mean, if we’re gonna piss away an unspecified amount of money on health care for the indigent (and we are, no matter who is in charge), might as well make it a two-fer and get something ELSE in return at the same time.

  15. Anna says:

    Sorry, we’ve already declared it to be a human right.

    Anyone who shows up at an ER must be treated regardless of their ability or willingness to pay.

    Now what the REST of us are concerned with is figuring out a way to pay for the rights we’ve already established without bankrupting the middle class or the doctors.

    So your choice is either to add to the debate by coming up with realistic solutions to the problem of physician reimbursement or moving somewhere that hasn’t already declared health care to be a human right.

    • Gregg says:

      Wow, so I’m guessing that you disagree with both the Women’s suffrage movement and abolition. After all the people of this country had already decided that both women and blacks needed white male caretakers.

      Yes, that statement was likely offensive to you. However, my statement follows the same logic that your statement did. This country was founded on certain ideals and “health care is a Right” is not in line with those ideals. If you wish to live in a nation that espouses that bogus right then please pull up stakes and move.

      • Windy Wilson says:

        No, extending sufferage to blacks and women (and before that to white men without property) was consistent with the original framers’ intent, because the new rights did not cause anyone to be required to deliver goods and services in order for the newly enfranchised blacks and women to vote. It comes back to Marko’s original post about negative rights, (I get to do this and you can’t stop me) and positive rights (I get to make you do something for me), which are a form of slavery.

  16. Tim says:

    Choice Three Anna,
    Over turn the current law that requires anyone to be treated. I am not saying that I support that, but there are always more options move away, or support the status quo.

    • Rick R. says:

      It’s not law, but court fiat, that requires that emergent care be covered, regardless of ability to pay.

      Of course, it’s ONLY supposed to be emergent care — not sniffles and chronic, but not life-threatening, disorders.

      • perlhaqr says:

        Everyone I know who works in emergency medicine (and that’s not a small number of people, my wife works in the ER and I hang out with her colleagues) want there to be a co-pay for their services. Even a dollar co-pay would help weed out some of the stupid bullshit they get at the ED.

        I realize that at the fringes, there are probably people who legitimately need emergency care who don’t even have a dollar. But likewise, none of the people I know in that field are going to let people who are truly in need not receive care for something like that. There is just so much incredible abuse of the emergency medical system, though, that needs to be curtailed in some manner.

        • Rick R. says:

          I agree.

          Hell, we could put a “Need a dollar, take a dollar” jar in the staff lounge, funded by stupidity fines, and cover all the $1 co-pays for the truly indigent.

          I make decent money and have a good plan. MY co-pay is about $25 ($50 for the ER). $1 is nothing.

          You know what?

          If I see someone who truly doesn’t have that damned co-pay dollar for a real problem, I’ll pull it out of MY pocket. By MY choice.

          Here’s a hint, though. if you have done your nails or hair, own an iPod or cell phone, have a pack of smokes in your pocket, or otherwise have an indication that you’ve got four quarters or more in your pocket, tough shit.

        • perlhaqr says:

          Bah. My wife works at the ED, and our ED co-pay is $200.

          I did an ambulance ride-along recently, contemplating a change in careers. Every patient we actually transported, I’d have paid that dollar for if I had to. And I am, as many may tell you, not exactly the most bleeding-heart of individuals. 😉

          But we had a good night, too. No one called the ambulance because they wanted a free taxi ride to somewhere near the hospital. No one called for (57 different things my companions warned me about while we were driving).

          I dunno. Something needs to change. I’m not sure what. I have faith in the ability of 230 million Americans to come up with something that works in the free market far more than I trust 537 Americans to come up with something that works via government fiat.

  17. Jen says:

    Marko, I deeply respect your opinion, so let me throw this out there, though it’s a little OT. I have a kid with CP, fortunately mild. I have met many parents who are not so fortunate, whose kids will need therapy, surgeries, expensive care, often for the rest of their lives. Private insurance, as it is now, will often cover little to none of the therapy services. I have heard of parents filing bankruptcy over their children’s medical bills.

    What is the libertarian answer to this? I posted it over at Reason, and the answers have ranged from useless (“parents pay out of pocket, suck it up”) to reasonable (free market offers policies you buy before the kid is born).

    I like the policy-before-the-kid-is-born idea. But what do you do with those kids whose parents are not as responsible? Leave them to die in the street? Spend no resources to get them to be functional, productive citizens when they reach adulthood? And what of those that will require institutionalized care?

    I didn’t go into this over there so as not to be labelled a troll, I genuinely want some insight into this as I have thought about it. A lot. Like when our HMO told us, in October, that they would not pay for any therapy after the previous July. We, with help from family, handled it. As well as her post-surgical therapy regimen. She’s doing fine. But not all kids (or parents) are as lucky.

    Would this be a legitimate governmental activity? Is there some free market solution I haven’t thought of? I would like nothing more than to see a solution to this that didn’t involve the government.

    • Rick R. says:

      Bad things, even horrible things, happen to good people all the time.

      Where do we draw the line?

      Seriously, the track record of government provided health care is NOT good, ESPECIALLY for chronic illnesses.

      Not surprisingly, given the government track record in running a whole slew of things, from road maintenance, to the actual EXISTING government health care systems.

    • Gregg says:

      Ideally, in a true free market, some of this slack would be taken up by charitable organizations. Historically, most of those organizations have been religious in nature. That is a viable solution. Heck, you can try it now. Start a charitable organization for children with CP, get people to donate money and use the donations to help offset the costs for people with children who have CP.

      That is free market. Having the government extort money from me to pay for someone elses misfortune and/or poor prior planning is IMO evil.

      Basically I see your options, and the options of other families in situations similar to yours, to be as follows:

      1) Take responsibility for your own life and the lives of your family and pay your own way.

      2) Find or start a charitable organization to offset the costs.

      3) Move to a country which already has universal health care.

      You will notice that none of those options include you, or your agent sticking a hand in my pocket.

      • Jen says:

        1. This is exactly what we did. All costs were paid by our private insurance or our family.

        2. I have strongly considered doing this. Right now is not the right time; I hope that in the future I can do so. I support other causes with my time right now.

        3. After my daughter’s surgery last year, we found ourselves at the airport with another family whose son had also had the operation. The family, who were Indian nationals, were moving back to India after several years in the states due to the incredibly lower cost of therapy back home. I don’t believe India has universal health care, but they also don’t have a whole lot of regulation, mandates or trial lawyers.

        None of my post was a stealth endorsement for my or anyone’s hand in anyone else’s pocket. If I had fewer hands in -my- pocket, maybe I could help fund another child’s therapy. But I don’t see the libertarian viewpoint gaining much traction with the general public without a workable idea on topics like these.

        • perlhaqr says:

          The problem there is, the libertarian philosophy is pretty much diametrically opposed to “here is the solution”.

          The entire idea of the free market is that when you leave things open to competition and personal liberty, you’re far more likely to come up with many better solutions, than if you ask just one guy (or a handful of them) for “the answer”.

          When someone says “no one person is smart enough to control all of this”, and then people respond with “ok, but how is it all going to work, according to you”, they’re sort of missing the entire point.

        • Rick R. says:

          Right — if various people throw out various possible solutions, it’s far more likely you’ll get closer to a “universal” solution than if you try and hand the problem off to any ONE group of people.

          Kind of like how the federal system was SUPPOSED to work — “50 laboratories”.

  18. Kevin S says:

    Wow. My only choices are to come up with a healthcare solution or GTFO? Bummer.
    Did you even read this blog post?

  19. Shootin' Buddy says:

    Pffft, the solution is obvious; we simply order that the town drunk is now a physician. This will ensure the town drunk’s right to employment and fulfill our right to health care.

    (This was done throughout Eastern Europe. However, in the DDR, the white lab coat that the town drunk wore was tailored and very clean).

  20. Steve says:

    Well said, Marko. A very eloquent, understandable illustration.

    Now, if only them what’s in DeeCee could read, and actually understand, such a clear and plain explanation.

    I’ll not hold my breath waiting for that to happen though.

  21. Bob says:

    Ah Marko sorry that idea has already been done. If memory serves me wasn’t that the premise for the TV show Northern Exposure? Small town in Alaska hires a doctor from the lower 48. With the doctor hired everyone got health care.
    BTW is what we have is so great why are people in countries with universal health care living longer than we are?

    • Marko Kloos says:

      Oh, come on. Have you ever compared life expectancy rates in all the industrialized nations? They’re all within a year and a half of each other. You folks make it sound like Europeans get to be 120, and we Americans keel over at 65.

    • perlhaqr says:

      BTW is what we have is so great why are people in countries with universal health care living longer than we are?

      Because they don’t count infant mortalities the way we do. If it doesn’t live for a certain length of time, or is under a certain weight, it’s “stillborn”, and not averaged into the life expectancy calculations. Here, if the child draws even one breath, it’s a live birth. Averaging in all those zeroes brings the total down quickly.

      • Rick R. says:

        Somehow, my responce that should have ended up here, ended up attached to ricketyclick’s post below. . .

        • Bob says:

          Longevity is more of a philosophical issue than a statistical one. Just look at the amount of money spent in the last year of life. Roughly 30% of Medicare’s budget is spent in the last year-of-life, 10% in the last month-of-life. The fact is, they live longer than we do, and staying alive as long as possible has value.
          Which brings about the issue of money. The American Journal of Medicine reported that 62 % of bankruptcies medical and 72% of the filers had health insurance. That doesn’t happen in the EU either.

        • Marko Kloos says:

          The fact is, their longevity is statistically indistinguishable from ours.

          Also: you cite Medicare expenses for end-of-life care in an argument for public health care? How would basically expanding Medicare to the entire population alter that expense ratio? (Medicare denies more claims than private insurers do, BTW.)

          Have you ever looked into the costs of a European-style universal coverage system? Do you know how much the average Joe over there pays in payroll taxes, VAT (15-19% in most of Europe), gasoline taxes, and other expenses, only to achieve the same level of longevity as we do?

          I know it sounds simple and awesome: government pays for all health care, and everyone’s covered. Trouble is, government doesn’t pay for jack squat: you do. What good does it do you if you don’t have to pay for your doctor’s visits, but you get half of your paycheck taken every payday, and you need to shell out $5 for a gallon of gas and a 17% VAT on everything you buy with whatever’s left?

        • T.Stahl says:

          I’m an 37-y-o engineer in Germany.
          My health insurance is of the government-regulated statutory type (though I could have changed to a private health insurance starting this year).
          Last year my gross income was ~61,800€. Add to that my employer’s contribution to statutory pension insurance, statutory unemployment insurance, statutory health insurance and compulsory long term care insurance and I actually earned ~72.300€.
          From this I had to pay 6,350€ for statutory health insurance and 900€ for long term care insurance!

          That was for one person, single, no kids. It would have been the same if I had been the only wage earner of a family of 2+x.

          That’s what you’re in for, thanks to Obama: 10% of your gross income, up to 15% for lower incomes.
          Oh, and a 19% VAT to support the statutory health insurances which are in deficit despite the premiums you’re already paying.

          My net income was ~33,700€ – or less than 47% of my actual gross.

          A fine social net is great! 🙂

          Unless you belong to those who have to finance it. 😦

  22. […] Including this from Marko the Munchkin Wrangler: A human right only requires that people leave you alone to exercise it, not that they work for you, whether you give them money for their work or not. Freedom of speech is a human right. Freedom of association is a human right. Free exercise of religion is a human right. Free band-aids and vaccinations aren’t. […]

    • Rick R. says:

      78.67 years in the EU, 78.11 in the US as a whole.

      Hell, GREECE ranks higher than the UK, and the Channel Isles (like Jersey) rank higher than either.

      Bermuda ranks higher than the UK, and the British Virgin Islands rank lower than the US.

      The fact is, at these levels, a year or two’s difference is nearly statistically insigificant.

      And there are other ways the data gets tweaked, which affects the US figures slightly negatively.

      Such as the fact that most nations treat a kid who is born alive but dies in the delivery room as a “still birth” (thus counting towards neither infant mortality nor life expectancy), whereas the US counts that as an infant death (so it is figured into both infant mortality rates and life expectancy).

      Now, by comparison, where do most of the medical drugs, discoveries, and advances come from these days?

      That’s right. . . the place where the profit motive is still alive and well.

      So, the majority of the modern “free” health care provided by other nations ultimately comes from the US health system.

  23. Bob says:

    Marko we are already paying for it. We pay for ER visits & for the 62 % of the folks who go bankrupt (how do you think their creditors stay in business?) And the money you pay in taxes for the uninsured’s hospital visits/stays gets pulled from other parts of the budget, generally the states operating fund. If it doesn’t the public & privet hospitals go bankrupt and shut down, ration services, and jack the rates they charge.

    In the EU health care costs half per capita of what we spend in the US for health care they receive, and no difference in longevity.

    As for the $5 gas and the 17% VAT. Lets see no sales tax. Think of all the things that those support in addition to health care, like a cushie retirement (no old age poverty), good public housing (compared to our public housing), excelent welfare benefits, excelent public transit, etc. Take a lot of the programs we don’t fund out of the gas prices and the VAT and the rates would plummet.

    Stahl, The social net here sucks. If you lost your engineering job here (VA), unemployment would probably pay you around 246€ (taxable income) per week for 12 to 26 weeks, & you would probably get your 1st check in 2 to 3 weeks after filing. After 26 weeks good luck, maybe you might get an extension. Food stamps are available. There is no health safety net, other than the ER and a free clinic if you can get into one.

    • T.Stahl says:

      If I lost my engineering job in the US I could probably stay at home for a year and live off the money I saved by not having to pay unemployment insurance.
      Germany’s mandatory unemployment insurance is an insurance I would never conclude if it were voluntary. The terms of this insurance are just too bad and restricting.

      • Bob says:

        Its still payed but by your employer. As for living off your savings, most Americans only have about 2 months in the bank., many less.

        That’s it for me on this subject. Ta

    • Rick R. says:

      One of the reasons that per-patient care costs less overseas than it does for US patients, even with equivalkent care, is the cold, hard fact that if you want to sell new drugs or machines to, say, Germany, you can ONLY sell them at a price the German government thinks is apprporiate. (Think Canadian drug prices for a more commonly known example.)

      While this sounds like a great idea — “Hey, we’ll just tell those greedy Big Pharma parasites they can’t charge more than strict direct cost-plus!”, there is a HUGE problem.

      The “obscenely” high profit margins they charge in the US on the successful treatment discoveries is how they pay for all the UNsuccessful ones.

      They can afford to charge a direct-cost plus to sales abroad, but only if they can make up the research losses elsewhere.

      If you use the big hammer of government intervention to force them to charge a direct cost-plus on American sales as well, and you’ll see a rapid result.

      This is also why the “up front” charges for hospital services is so absurdly high, and the “negotiated insurance price” is ususally so much lower. Hospitals end up trying to use the high asking price to recoup losses elsewhere, by trying to get these inflated fees paid by anyone who isn’t insured but DOES have money.

      No more medical advances, unless they are pure serendipity.

      In other words, WE in the US are already paying for universal health care — health care in Canada, the UK, Germany, etc.

      Just like we paid a disproportionate share of European and Japanese defences for many decades.

      It’s easy to give government handouts when you charge your own people 50%+ total tax burden AND some third party is picking up large parts of the tab on top of that.

  24. Schmidt says:


    In my country, doctors are invariably paid badly(compared to engineers, bankers, programmers and people who did similarily tough schools..). The hours are long, the pay so-so at best, and still a lot of people line up to study and practice medicine. It’s far harder to get to medical school than to start C.S. ..

    Guess what? They’re not doing it for the money. Apparently, they want to heal people, and that the job is not cushy or badly paid doesn’t really matter.

    Though they don’t have any lawyers bothering them, they don’t have to practice CYA medicine like the hapless US doctors.

    @Rick R.
    You sure on the regulated prices? My family works in healthcare, and I don’t know anything about that arrangment. Only restriction on drugs is, that they have to be in the so called drug register, meaning, my mother if she wants to give her patients drugs that haven’t been approved has to go to Austria to get those. Funnily enough, the insurance covers it..

    Same goes for medical machinery. Flipping expensive, I hear, certainly not “regulated prices”..

    I’d say American problem is the fucking lawyers. Defensive medicine is expensive and dangerous, as it subjects patients to too many procedures. At least, all the M.D.’s I know say so, and are all glad they don’t practice in the USA.
    Here, there’s only court and lawsuits if it was gross negligence.
    Doctors tend to be careful though. Most of them don’t want dead people weighing on their consciences.

    ..BTW, you know Big Pharma blows more on marketing than on R&D? Why is that? One would have thought it’d be enough to have impartial studies showing efficacy or particular drug to have doctors use it..

    ..apparently, you need astroturfing and fake science journals too.

    • Rick R. says:


      By and large, the prices on American drugs sold overseas are negotiated with the pharmaceutical companies. By “negotiated” I mean they are told by the government, “You’ll charge this much or less, or you will be prohibited from selling your drug here. Or, you can license it to a local company for a pittance.”

      That’s why American drugs are available for a bare “cost-plus” right across the border in Canada, for instance.

      Generally speaking, that “negotiated” price is (marginally) profitable for that particular drug, if one overlooks all the drugs that don’t make it to market.

      Yes, top end medical equipment is expensive. That’s becuase cutting edge computerized equipemnt, ESPECIALLY if you toss in imaging systems that not too long ago were applications used by spy satellites and NASA. Hell, look at the “basic” (today) medical tools that are PURE deriviatives (we’ll just ignore indirect derivatives, like the explosion of the micro electronics field) of the US manned space program. They were pretty damned expensive when they first came out.

      Why do American drug companies spend so much on marketing? It’s because a LOT of new drugs are either alternatives (often better) to older drugs, or are drugs for NON-life threatening conditions. (Of coure, most drugs have multiple uses — but if the “essential life saving” aspect of a particular drug are limited to a sliver of cases, while the “elective” use of it comprise a HUGE market segment, they are going to market to the more profitable segment. The “essential” category patients generally don’t need to be marketed to in order to find out about it. . . if they are already aware of the drug in a wider context.)

      What do you think pays for the new heart, AIDS, and cancer drugs? In large part, stuff like Botox for vain rich people.

      As for doctors doing it only for the money — we HAVE real-world case studies on this, right in the US. Places where the legistlatures have made things so unpalatable for particular fields of medicine, that it is now damned difficult to find a practicioner of those fields. Likewise, the huge amount of immigrant doctors, who come here becuase the talent follows the money. Including a certain amount of German doctors. . . although most Western European doctors prefer to live where they grew up, rather than in a foreign land. (That’s OK — I have no intention of moving outside my home state. Even though I’ve lived and visited elsewhere, many of those places are nice, and I could even perhaps get paid more money, this is my home, and is more important to me than mere money. But not everyone thinks like that.)

      If it’s JUST pure greed on the part of “Big Pharma” in the US, please explain to me the WIDE disparity between the size of the US market, the size of the rest of the world’s medical market, and the breakdown of new advances that require original development, rather than novel applications of OTS equipment and drugs?

      Original R&D isn’t cheap. Remove the profit incentive, and you will see a RAPID slow down of truly new medial products. Of course, if you want to avoid this, you’ll need to factor in replacement tax dollars to cover that R&D. Plus some, as government agencies are generally inefficient at making breakthroughs and applying them to practical matters — the red tape that accompanies govenment programs has a tendancy to get people doing things the same way, not novel ways. (Study the phenomenon known as “Beltway Bandits” — Uncle Sam figured out we get better results in many cases farming out research to contractors. Minimizing red tape is why.)

      Don’t forget to replace the independant research companies (profit based) that do a LOT of the R&D, and then sell the developed tech to Big Pharma, and thus are not included in the R&D budget of the drug comanies directly. If there is no payoff, there will be no research, because there will be no investors willing to fund it.

      Oh, and don’t neglect funding the “useless” R&D in cosmetic procedures and the like. Scientific discovery is more often serendipity than not.

  25. Jumblerant says:

    I explain it slightly differently as my friends are slightly ‘different’!

    Surely more basic rights than healthcare is food, shelter and fire – the three neccessities of mankind?

    The government provides food-stamps but we all know that they are minimal and do no help in the long run. It is going to be difficult to get steak, let alone caviar with food stamps. Cheese, bread and milk are what you are going to end up on as a staple diet.

    Government housing is not where anyone wants to live, its where they end up when everything else goes wrong – as is getting unemployment benefit.

    I don’t want my visit to the hospital, and especially not have my kid visit there, to be at the most basic, ‘underfed’ and ‘badly housed’ level. I’m willing to pay for that – surely everyone else should be too?

  26. Dan F says:

    I’ve brought up my own poorly articulated understanding of this real/invented rights issue elsewhere- got a response of “since you need a gunsmith to make a gun, the 2nd amendment doesn’t count as a right”

    In a free market, this would be false because the gunsmith WANTS to build guns, wouldn’t it? Not sure I understand this.

    • Rick R. says:

      Precisely. Additionally, you may make your OWN gun.

      The proper corollary between teh 2nd Amendment and “health care is a right” would be:

      The gunsmith is forced by law to make guns, which the taxpayers pay for, which all residents are forced to accept and personally use. Even if neither the gunsmith nor the end user resident wants to have anything to do with guns.

      Rights are permissive — not coercive.

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