Sign the Social Contract

Roger,

I have libertarian leanings and want the same ends that you do--better healthcare, more access, less waste. I find it paradoxical that you're telling me I should trust the government with something as important to me as the health of my family. The best way to make the case would be to point to government programs that have succeeded in the past and therefore earned that trust. In my view, Social Security and Medicare are poor examples, but I respect your disagreement on this issue.

In my lifetime, market competition has done my family far more good than has the government. Just look at the university system in the United States compared to our public schools. If I can't trust the government to educate, why should I trust it to provide healthcare? In my view, the government will not solve this problem, and I should not trust an institution with so little accountability to make choices that will benefit my family. I trust the profit-motive more than the political-motive even if both are flawed.

Also, you attribute lobbying costs to the free market, but lobbying only exists because a) someone wants to defend themselves against government force or b) someone wants to use government force to threaten others. Both wastes are government related, not market-related. We can expect these lobbying costs to increase as the government takes a larger role in healthcare.

Ebert: Why should I trust private insurance companies more than the U.S. government? What accountability do they have? Baseball and insurance are the only industries exempt from trust laws.

I believe lobbying is mostly financed to advance special interests. I think your "a" and "b" are unrealistically idealist.

I work for the federal government and have what is considered to be great insurance. I pay $70 every two weeks for it, and the government pays $210 (premiums go up some 9% next year while inflation is trivial). That's $7,280 a year. When I do have to go to the doctors, more often than not I still receive an invoice requesting for more money. This is the system that people are trying to defend?

I think this whole debate shows that many conservatives lack a fundamental understanding of pooled risk. The whole point of ANY insurance, public or private, consists of different people at different moments in their lives pooling their resources so that there will be money available for healthcare when needed. It seems like a lot of people think their health insurance premiums go into a separate pile designated specifically for their use, when that idea is preposterous considering the cost of medical procedures. If you don't feel like it is your responsibility to help out other people in more need, and you're currently covered in a health plan--even if it is private and profit-driven--you're a hypocrite.

I think that the need for available and reliable public healthcare in what we hastily refer to as the greatest country in the world goes beyond a moral imperative, as the positive externalities would benefit even those who spent the most taxes to support the system. The irony about libertarians, who are often well-read and financially stable, is that they are awarded the luxury of stating their egocentric viewpoints precisely because government eliminates the state of nature. In a true state of nature, where life is "solitary, poor, nasty, brutish, and short," these libertarians would lose everything as the desperate poor would simply kill them.

Thank you, Roger.

I have been unemployed for fifteen months, no health insurance due to pre-existing conditions. The last two employers I have had over the last five years couldn't afford to offer health insurance to employees.

I recently had a serious health scare. For two doctor visits and one lab test I had to pay, upfront, $2K. The hospital which performed the test said I had to pay at least 50% at the time of service or no test would be done. Balance to be paid in full within 30 days.

Sadly, I do not qualify for Medicaid because I was one of the idiots who actually saved money for a rainy day. I am worth just enough over the amount to get any assistance for health coverage.

I am more than happy to pay a reasonable amount to obtain insurance. Just make it available to me. I can't afford $1800 per month for catastrophic coverage and hope to be able to pay rent and other expenses for however long it takes to find a job in the current economy.

Comes down to rent and food.

Something has got to give.

It seems we're asking for trouble again...and so soon after the hit and quitters got done hitting and quitting.

I'm all for public health care. In fact, health care is one of the reasons I voted for and worked on the behalf of President Obama during the election. The phone banks I participated in were held in homes that belonged to people far better off than an unemployed college student and son of a college student with a part-time job, and they all seemed to agree: solving the health care problem was just the right thing to do.

I have health care, but it hangs by a thread. My mom, the college student, is a college student because she took the buyout at Ford Motor Company, who had long suffered before G.M. and Chrysler and thus sounded the alarm years ago. She, of the last group of pre-economic-crisis buyout takers, was given a generous package: A yearly salary, a stipend to go to school, pension in 15 years and, above all else, health care for her and her two kids.

That somebody who went through three work-related surgeries would walk away from the job is not surprising. But that she would only do it on the condition that her kids were covered says something about the issue: The ability to afford health care in many cases supersedes health risks, personal discomfort, or personal life. I got so mad when the media took the Big 3 to task over how much people are paid on the line, and I've been reduced to shouting at people who launch into that diatribe. There were days when my mother would be physically and emotionally incapable of movement, such are the joys of working on the line, but she did it because she could provide health care to her family.

This might be the last year I'm covered by Ford Motor, though my mom has, I think, a year or two left on her buyout agreement. I'm covered as long as I'm in school and can provide transcripts and such. Every year, there are stretches of four to six weeks when I'm not covered because my transcript is at the bottom of a pile of paper on a desk somewhere. And if I don't get into grad school, my health care is kaput. I've been fortunate enough in my 21-years to have visited the emergency room only a twice that I can remember (once for cluster headaches, which they gave me Tylenol for, and once for being the middle driver in a three car accident), and I don't often get sick. But to ape Yogi Berra, you don't need it till you need it. What will I do when I need it, but couldn't afford it?

Beyond any and all of that, what really kills me, still, is the argument that universal health care in places like Canada and England is garbage. Plenty of Canadians come here and say otherwise, and I've met and spoken to many Brits who say the same. The most popular meme is always the old chestnut about the friend of a friend's cousin's mother's aunt's uncle's best friend's best friend having cancer and being told that they'd...gasp...have to wait for treatment. There are all of these stories and statistics about how grim the outlook is for those poor Canadians who have to wait three months for hip surgery or the English woman who had to wait 22 or so days (or more!) before their first outpatient appointment, but never any data on how long it takes in America, and at what cost.

I'm not familiar with how things work at hospitals. When you're diagnosed with cancer, do they immediately whisk you away to the cancer ward for surgery, radiation, and everything else?

And if there is, how would the public option destroy that?

I simply haven't read a convincing case against the public option, and I consider myself as Libertarian as they come. But to argue that people who can't afford health care shouldn't receive it is, to put it bluntly, asinine, and the logic of the people decrying it ranges from illogical to down right disgusting. Yours is the most eloquent defense of the public option that I've yet seen and, in an ideal world, would help bring about the necessary change. But we live in a world where money overrides human interest each and every time. I'm no fan of our current President, but if he manages to fix this disgraceful system and make it fair for everyone, not just those with a steady income and steady job, then it will be the most valuable thing anyone has contributed to this country in a long, long time.

Thank you for this, Mr. Ebert. It speaks volume about the level of intelligent discourse on this matter when the most eloquent defense of universal health care comes from a film critic. That's not meant to be a knock at you in any way, but rather a knock at all our cultural gatekeepers keeping America divided and stupid.

Ebert: Aw, now you've gone and made me regret being hard on you Libertarians.

I feel something different in the air. I sense that Americans are finally focused on the actual issues around universal health care and articles like this confirm that feeling. It seems like such a hard battle for you guys, but little by little your pushing that boulder up the hill. I think you are going to get this done and when you do, you'll wonder how you managed to live without something so obviously right.

The best way to make the case would be to point to government programs that have succeeded in the past and therefore earned that trust.

How about the Army, Navy, Air Force, Marines and National Guard. Or the National Parks. Or National Laboratories (NREL, NOAA, etc). Or NASA. Or Bureau of Reclamation. Or the FAA.

Or how about the VA, a government health organization that provides some of the best health care in the world (including currently treating my father for cancer), on the Government's dime, to our military veterans.

When I was a grad student, I needed reconstructive knee surgery. I spent 4 hours in the hospital, and the procedure cost $27,000. Luckily, I had opted to participate in the university's health plan. Still, the amount of money the hospital wanted me to pay would have dragged me well below the poverty line, as they wanted $3,000 of the $9,000 I made that year in stipends. They still took enough money to drag me below the poverty line, but because my income hadn't changed, I was ineligible to receive food stamps and other government aid. It's not a matter of capitalism versus socialism, it's a matter of decency.

You demand that I 'sign the social contract' at the point of a gun.

No thanks. You can keep your force. Ebert, how much of your money have you donated to health care for others? Oh, what's that? You just want to point guns instead.

You aren't part of the problem; you are the problem.

Ebert: I've donated more, I suspect, than you have.

I'm not pointing any guns. I support gun control.

A shockingly simplistic "argument" based on emotions, conjecture, and a patent lack of understanding of the issue. Mr. Ebert has, like Michael Moore, been overtaken by ideas he doesn't fully grasp. It is admittedly humorous to watch them both try to illuminate a concept for others that is so clearly beyond them both.

Ebert: I was counting the comments until someone brought up Michael Moore.

I suggest the argumentum ad Moorum be classified with the argumentum ad Hitlerum.

http://j.mp/40TvOk

The government has earned its right not to be trusted. But unfortunately so have private insurance companies. In a free market system you have the right to make profit. If you want to become rich selling "jeans" at $400.00 a pair, and people buy them good for you. But, and it's a big BUT, you should not be allowed to become rich out of the illnesses of others.

In a democracy we need equal opportunity, and that means security, education and health. The US has many good public schools and very good public universities, but its healthcare sucks. Plain and Simple.

We can have a system in which people have to pay a premium for certain coverages, that should be no problem. But there are many basic services (covered in preventive medicine) that would reduce the costs of healthcare by half.

The sad thing is how many people are against some form of universal healthcare.

This might sound cruel and sadistic, but the only way they will learn is if something terrible happens to a close family member and they cannot do anything about it. When tragedies like these happen, things get done.

Ebert: Very few people who have had that experience are opposed to universl health care.

I went to your blog and found this, which is useful coming as it does from a practicing dentist:

http://j.mp/37xiHx

Once again, you are right on the money.

I love that you always frame this debate the way it ought to be framed: as a moral issue. Universal health insurance is simply right. Making profits at the expense of the sick and dying is simply wrong.

There are people who are so morally wrong, so evil, so greedy, that they refuse to see the issue in this way. To them, it is about dollars and sense. Kicking people off the rolls because of "pre-existing conditions" or because they have cost the company too much is justified by them as a savvy piece of business. In short, people are treated like commodities. It is shameful.

These people often treat "the market" as a sort of deity; we are never to challenge the market. Government regulation is interference, and that can never happen. We have heard people blame the current depression on government policy!

There are others, the libertarians, who are so fixated on their own idea of rights that they simply overlook the idea of right. Universal health care is seen as a bad thing just because it would call for government intervention, which is never justified. It is a case of missing the forest for the trees. And while libertarians often take a sort of idealistic high road, their motivation is rather base: greed. Plain and simple.

They always claim that government cannot be trusted. In some instances, they are right. But if those people use that logic to justify the deregulation of guns, militias, and so on, as they usually do, they are just simple. What will all of the M16s and militias in the country do against one nuclear bomb? I bring this up to point out the fact that all of us, even the most jaded, do not beleive there is any chance of our government turning a nuclar weapon on us. In some ways, we do trust our government, and we trust it completely.

I love the inclusion of those lovely Rockwell paintings. They are so wonderful, so inspiring.

As I write this, the Yankees are collapsing against the Angels. I can see this turning into a (near) repeat of the disastrous 2004 ALCS. I think I know what Sox fans felt all those years, and what Cubs fans feel like today. And I also happen to hate Joe Girardi. Why leave Burnett in when he has looked so shaky all game. Sure, 5 shut out innings were nice, but he was throwing all over the place and never looked sharp. And why not walk Abreu to load the bases and set up the double play? Sorry for the digression, but I am furious right now!

Ryan Hargraves wrote, A shockingly simplistic "argument" based on emotions, conjecture, and a patent lack of understanding of the issue. Mr. Ebert has, like Michael Moore, been overtaken by ideas he doesn't fully grasp. It is admittedly humorous to watch them both try to illuminate a concept for others that is so clearly beyond them both.

And your "rebuttal" is based on nothing but generalities and personal attacks.
I'd be interested in your analysis of the question, though, given that I imagine you put yourself in the group that "fully grasp[s]" the problem.

Roger, why don't you ask people like Ryan Hargraves to enlighten us?

People like you, Michael Moore, and I just can't warp our head around these complicated issues. Perhaps Ryan, who did not write a single word concerning the issue itself, could take a chance at sharing his ideas, rather than just attack two of our finest social commentators?

Please.

Speaking as a college student about to lose all insurance converge, I am waiting for people to actually think how the market works completely before I end up needing serious care. People say the market will fix things because the government can't do it. In terms of products that are not necessary, yes that is exactly how it works. The market is really an elaborate voting system, you vote with your dollars. If you don't like a product, if you think it's shoddy or too expensive you don't buy it. Our present health insurance system is shoddy and expensive. There is a problem, it isn’t an unnecessary thing, and it is vital. People have no choice, but to buy it if they can. The other option is pain, bankruptcy at the ER, or death. Food is the same way, but it is regulated so the prices will not inflate. Food prices have inflated over the years and people have had no choice but to buy them, the cheapest being the unhealthiest, because you need to eat to live. Health insurance is the same.

I hear arguments that our health care system is the best in the world. I agree. We do have the best heath care system in the world that being doctors, nurses, tests, training and procedures. We have the worst health coverage system in the western world. The debate is not over care. It has never been over care; the debate was always how to pay for it. The government would not control doctors or procedures, only how to pay for it. In fact the simpler the method for payment, the cheaper it is, because it cuts out middlemen who need their share.

As for the first poster's comment saying we have the best Universities in the world. Again I have to disagree. I'm tuition has gone up three times since I've been at BU and they've had to cut print quotas, meals, transportation, and have up the prices of campus run establishments. So I pay more and get less. I wont go into all the problems I've faced trying to get anything done in the campus bureaucracy. What they have done is redone the sidewalks, planted new trees and spruced up the surface layer, because that is all prospective students and parents see when making a choice where to spend their money. Our Universities are run by the profit motive just like every other company. And like every other company, it's not the product that they're selling, it's the advertising. The advertising says we have the best universities in the world and maybe for the very top schools we are in the running, but state sponsored, not run, schools do a very good job in other countries and keep pace in this one. Other countries have a higher percentage of college graduates, so that has to say something.

One argument, in my opinion good and useful, in favor of universal care which I have yet to hear: it lowers one of entrepreneurship's barriers to entry. People who quit their jobs to launch a small business immediately shoulder the burden of providing for their own healthcare. Individual policies are harder to get and more expensive than group policies. Universal care is thus a safety net for entrepreneurs.

The Entrepreneur and the Small Business receive worshipful lip service in America as a kind of humanized capitalist ideal; why is this argument not heard more frequently?

Libertarians, quite frankly, are stupid. They believe things that are unarguably false. Conservatives add a tinge of fascism, but libertarians take it one step further. They argue that the free market will solve all problems if left to its own devices, but that is simply untrue. How many people bought harmful and tainted food before the FDA, despite safe alternatives? How many of the elderly were denied care in their final days before Medicare? How many of our natural wonders were caged off and exploited before the National Parks? And yet to them, less government is the answer. It's a travesty that ideas so foolish prosper.

Roger, do you read Reason Magazine or the blog at the Cato's Institute's website? I ask this because I wouldn't have any idea why health insurance is so costly if it weren't for those sources of information. Many of the arguments I've heard from the "left" (I hate using those simplistic labels, because as a libertarian I'm stretched like Plastic Man across the left-right spectrum) have boiled down to "the insurance companies are evil and greedy" and many of the arguments from the "right" have been essentially silly episodes of shouting about death panels.

But let me play devil's advocate. Let's take the "public option" or any other government program out of the equation. How would you fix health care if a government-run plan was not available?

Ebert: I don't know. Universal health care is the only system that seems to be working elsewhere in the world, although it takes various forms.

Any ideas?

The "government" cares ONLY about their wars in the Middle East and how they will be funded and NOTHING else. Funny, we have to repeal the social security cost of living increases, cancel medicare for the elderly and put the disabled before death panels - yet the compassionate and well meaning federal government of Obama can find $320,000,000 A DAY just for the fuel expenditures of the Marine expeditions in Iraq and Afghanistan.

Could the Health Care “Reform” legislation be a ploy to force the Unemployed and Uninsured into the military? I think this could be the case for several reasons. First, the unemployed/uninsured with be primarily young, white, American males, who are also the preferable cannon fodder for the imperial wars. Second, as you failed to mention, the uninsured/unemployed will not be able to afford the REQUIRED health care premiums for a "public option" nor would they get tax credits on non-existent taxes based on non-existent income. Third, this would make being unemployed and uninsured a felony – punishable with severe fines and I’m sure, imprisonment. What choice would the young, unemployed and uninsured resident-felon, white, American male have other than joining the military?

Maybe some of the preferred guests in Dick Cheney’s Haliburton-built gulags will be the unemployed/uninsured who refuse to fight in our imperial wars for women and minority rights democracies?

Great piece. It's good to know there is at least one human left with a heart made out of something other than coal.

We tried the private market. The "Invisible Hand" is without an ethics or a morality. It often leads us to outcomes that are not morally acceptable. I don't trust anything invisible when it comes to human lives. That doesn't work, so let's try something else. I, for one, am glad I had the opportunity to get an education, benefit from fire and police protection, drive on paved roads, attend a state university, enjoy national parks, and have recourse to a court of justice. I am pleased to have these services, and I would be just tickled pink if I could also have health care.

Greed is not the only morality left in this country. Thanks, Roger, for reminding us.

Personally, I think on this subject our country is doomed. I've given the American health care system a lot of thought.

My sister recently died of a horrible, painful, unpreventable disease. She lost her job, could no longer work, and basically until she died, she lived a life waiting for relapse, knowing should couldn't have a normal life ever again because of huge medical debt and knowing she couldn't get employer based health insurance again.

Millions of people win the reverse lotto each year. You can, like my sister, do everything the supposedly right and responsible way, but if you get a catastrophic disease or accident, you are screwed.

My sister spent the last years of her life scrambling to pay for COBRA insurance...worrying she was going to hit the limits...scrambling to find replacement insurance and paying for that when COBRA ran out...figuring out how to pay for medications...being called by bill collectors all the time...having to move to her parents house at age 40. It's hard enough to get healthy without worrying every day about the money and insurance part.

She wrote about all of this stuff in her blog that she kept until her body failed around her: www.debutaunt.com Heartbreaking. She talks about some of her frustrations, but it was always worse in reality than she could ever write--she was just such a positive person that it hurt her to talk about how grim things really were.

I love the idea of universal health care. But I worry even the smartest thinkers on this subject can't fix what is going on. It's so huge and complex.

That even if you had a room of the smartest, most benevolent people in the country, they could not come up with a system that delivers high quality, health care to everyone in the country. It would be hard enough to do if the country was doing well, but spending money on overseas wars and dealing with a recession, I have a hard time picturing any fix.

Most people see that American health care is totally screwed up. It is just hard to envision how to fix it, how to pay for the fix, and not make things substantially worse while trying to fix something this big and awful.

It is hard not to feel doomed on this subject but I very much appreciate someone like yourself who can eloquently put a human face on this problem and champion it. Be well and thanks again.

Ebert: She is so brave in that blog.

Colin - We're clearly coming at this from a different perspective, but I think if you look at the track record of NASA, the FAA, and the Department of Defense by comparing their stated promises to the public and their results, you'll find a lot of references to exceeded budgets and missed expectations. I am happy that your father receives the care he needs. That's a success, and I admit that the government is relatively good at serving special interests. Universal care, like universal education, is another matter.

I'll trust the private health-care insurers when I can vote for or against them.
There is another factor to health-care insurance and that is the way it affects the bottom line of large corporations. One reason the Detroit car companies are in trouble is the enormous overhead they carry on the health care of long-retired union workers. The unions fought for these provisions because the nation didn't provide any other health-care options.

Roger, when you say "The fallacy of the free enterprise argument is that it assumes corporations are motivated to bring about the public good" you are dead wrong. The free enterprise argument is based on no such assumption - in fact, it is based on what you present in your next sentence: "Corporations are motivated to maximize profits for shareholders." It is that motivation that has brought about the very existence of health insurance, not to mention the invention and production of the medicines and medical devices that we have now.

You also seem to be confuse universal health care with regulation of the health insurance industry. The one does not necessarily require the other. I don't think you'll find many conservatives who don't believe that there needs to be some regulation of the insurance industry, if only to insure that consumers are properly informed about the insurance product being sold.

But universal health care mandated by the government is a different thing. It will inevitably result in rationing, whether by committee or by simply limiting accessibility by using wait periods. Look to England, look to Canada, and you will see precisely that. Providing health care for everyone costs less BECAUSE LESS IS PROVIDED.

Take a look at the health insurance disaster that is happening in Massachusetts. That is what you get when utopian schemes are imposed on the marketplace by sort sighted and economically illiterate politicians.

I work for a large federal agency usually regarded as fairly efficient, but which shall remain nameless for my own protection. We are currently operating under the continuing resolution passed by Congress due to its yearly inability to come up with a budget on a timely basis. As a result, we are caught in a fiscal trap that in effect, gives us a 10 percent budget cut until Congress gets its act together, probably not until Christmas, or even later. What this means is that unless we lay off personnel, we will not have money to do much more than pay the salaries of the people we employ. No money for travel, which is critical to our work. No money for training. No money for furniture, computers or machinery. And this is NORMAL for the first quarter or more of every fiscal year. Care to think how government health care will be handled during that period? Do you really want to try to justify to someone why YOUR operation can't wait, when the answer is that we don't have the money budgeted for this quarter? I shudder to think of it. Cook County Hospital for everyone.

I think that the real problem you are concerned about is that the free market system does not deliver equal service to all people. That much is true. But the answer to that problem is not to dumb down health care so that everyone gets the same level of inadequate care.

Part of the answer is to eliminate the government-created distortions caused by the tax system in subsidizing employer based health insurance. Another part of the answer is to require our representatives in Congress to address issues of safety, transparency, and fraud - matters which the government is best suited to handle. A large part of the answer is to let the states try different systems, and to learn from the failures of states like Massachusetts, and the successes of states like...umm...well, no successes, fancy that.

The answer is NOT to be blinded by emotions. My mother died of cancer in the 1950s. Today, thanks to the advances in medical care resulting from our current health care system, she would have survived. My father, in fact, later survived a cancer that probably would have killed him had he had it at the same time my mother was ill.

I'm sure that if you think about it, you can come up with similar instances where medical care has greatly improved in our lifetime - or even in the last 20 years. Let's not kill the goose that is laying so many golden eggs in search of a false and unattainable goal of "universal" health care.

Ebert: The goose is laying her eggs in fewer and fewer baskets.

But about corporations, you are correct, and I've changed the sentence to read; "The fallacy of the free enterprise argument is that there is a faith that corporations are motivated to bring about the public good.

I lost three jobs since 2006. From the first one I lost all my benefits, and the built up sick time. But I did not lose health care because I was already covered under my husband's plans. I stayed with the same doctors, except for vision care. So I am one of the lucky ones.

I spoke with a former coworker the other day. He had heart surgery last year. His copay for the $350k bill was $25. Neither of us knew what he would have done if he did not have health insurance. I told him I don't know why the protest against universal health care is so great. We pay millions for foreign aid, schools, parks, fish, roads, wild horses. Where is that money coming from?

OK, I want my $2 to go to health care. And another $2 to domestic farms. Vegetable farms. And lean air and water.

Ebert: I want to ask, naively, why does heart surgery cost so much more here than in Canada?

http://j.mp/394hC5

All this comes down to is a question of values and priorities. What's more important to you: freedom (and I mean TRUE freedom, not the freedom Republicans espouse when promoting war and not the freedom Democrats espouse when promoting regulations) or happiness? Freedom or safety? Freedom or convenience?

It doesn't matter if I can't afford health care, it doesn't matter if a family member needs it. I don't have a natural right to force other people to pay for it. It's that simple. Universal health care is based on force, as is a "public option" which, at the very least, will be founded through tax dollars. Proponents can talk all day about the negative consequences of NOT having universal health care, but that doesn't mean they have a right to it.

Ebert: You offer a false choice.

I don't say I have a right to it. I say I feel obligated to help my fellow citizens, and be helped, for the general benefit.

I'm not positive but I am fairly certain that my mother is opposed to universal health care. Yet she continues to call me and insist that I get health care and that if I can't afford it (which I can't and that's why I don't have it) then she'll pay for it. Why can't she see that everyone else matters just as much as me? I'm willing to sacrifice part of my pay check to go to health care for the masses. They're all someone's sons or daughters.

Eric Swain:"Speaking as a college student about to lose all insurance converge, I am waiting for people to actually think how the market works completely before I end up needing serious care."

When my son was in the same situation as you are now, we went to Blue Cross and bought him a high deductible insurance policy which cost 80 dollars per month. It has a 5000 dollar deductible, so basically, it's insurance against major medical expenses, plus the ability to get medications and routine treatment at negotiated discounts. That's all you really need at this point in your life.

If you want something more than that, check to see if your university provides bridge insurance to cover you till you get on your feet financially. If your university doesn't, your parents/sibling's university might, and these policies are frequently extended to relatives of the graduate.

With all due respect to yourself, my experience with the decision made by the baby boomer generation -- my parent's generation -- has not been very favorable. For the last thirty years, baby boomers have drained the social security and medicare trust funds for their pet projects while undercutting the taxes that would replenish them. Now Medicare faces insolvency by 2019. Social Security is in better shape; payments will begin exceeding collections by the middle of the decade, with insolvency looming at some point in the 2040's. I pay a tenth of my salary to programs that either won't exist or will be sharply curtailed when I'm finally of age to collect.

In their twenties, thirties and forties, boomers benefited from paying low premiums befitting their low risk to insurers. Now that they've aged and are becoming high risk (and therefore high cost) to insure, Congress rushes to put a cap on the how much more insurers can charge the old than the young. When boomers were young, they paid a tenth of what the old (but too young for Medicare) paid for health coverage. If Congress limits that number to twice as much, I will have to pay five times as much so they can pay a fifth. At that point price, it'd be more fiscally feasible to just take my chances sans insurance. But of course, they know that. So they'll pass a mandate that will fine me if I don't play along.

I'm not an uncharitable person, but I'm sick of paying for the consequences of a generation obsessed with instant gratification. My generation, which was after all raised with this mentality, is poised to be even worse. The nation's debt now exceeds its GDP.

All of these are reasons I support universal health care. I'm sick of paying for promises of what I'm supposed to get down the road, because I have no confidence it'll be there once I've paid my dues. I also don't think it'd be as politically feasible to rob a national health service if the entire electorate was benefiting from it. True, the same percentage would be withdrawn from my paycheck as a fifty year old that costs the system ten or twenty times as much. But I'd feel part of a larger social framework; I'd be able to have faith that the system would still be there for me when /I/ was the expensive one.

The watered down nonsense before Congress is nothing like what I've described, however. It's just the latest attempt by the baby boomer generation to game the system and push the consequences of its low-tax, high-spend mentality further down the line.

Dear Ebert,
Why do you assume that the government is a charitable organization? I agree that corporations are only out to get out our money and I do not think our health care should be in their hands. But the government is no more charitable then the corporations. Governments are set up to keep the masses in line and keep people from killing each other. And that is all ANY government is good at doing.

We do need a health care reform.
The corporations are ridiculous. But at least in theory I can sue their asses when they screw me over. How often does anyone succeed at suing the government?

There must be a better solution then this one.

Ebert I sincerely respect you and think that you are an intelligent, creative, wise, old man but I regret that you do not have any better ideas then this.

Ebert: If you agree it's a problem, do you have better ideas?

I don't consider health care a charity, but a solution.

Mr. Ebert:

Stimulating as always. I have already signed a few social contracts.

Good health is not a right; never has been since time-out-of-mind.

That said, I think that an enhancement/retooling of the public options that already exist is a good place to start a discussion. It is ingenuous for people to go on about nationalized public insurance as if it is a novel idea. It's not.

Why aren't the powers-that-be refining Medicare, etc.?

How can costs be controlled for a 'public, universal' health care system? Could such a system end up being actually *worse* for the nation, economically? Why isn't the discussion more nuanced?

Hmm.

I think you'd agree with me that "No Child Left Behind," while a noble ideal, is pragmatically stupid. Education cannot be compelled; only *access* to education. Children are going to be left behind.

Ditto 'universal' health care. Making it universal is asking to break the bank. The marginal costs of insuring 'the next percentage' of citizens are not equal all the way up the ladder.

I think an intelligent place to begin might be, "what percentage of uninsured can be covered at reasonable cost to their fellow citizens?" The answer is neither 0% nor 100%.

Thanks again for posting!

I recently had a bicycle accident and broke my elbow. It required surgery and an extensive rehab period. I thank my lucky stars that this accident happened on the very first day that my university health care coverage kicked in. Had the accident happened one day earlier, I would have declared bankruptcy, received care that was not nearly as thorough, and all of you would have paid for my care.

For all the screams about free markets and socialized medicine, a public option is really only creating additional competition--something us capitalists should desire. If the private providers really are so great, people will choose them over the public option.

Ebert writes: "The question becomes, to what degree are we willing to trade personal liberty for the good of the general community?"

I think this concedes too much to libertarian framing. Libertarians, as noted in the article, adopt what the philosopher Isaiah Berlin termed "negative liberty"; for them freedom is the absence of conscious, human interference. Inasmuch as others leave us alone, we are free to pursue our own ends; your liberty to swing your fist ends where my nose begins. In addition to negative freedom -- not contrary to it -- there is positive freedom, which in many ways is a richer, more robust vision of liberty: the ability to effectively pursue one's own goals. Libertarians can offer only formal liberty: you will have top-notch healthcare... provided you can afford it.

Any definition of freedom is humbug unless it says something like this: a life ought to be largely determined by personal choices rather than arbitrary circumstances. Babies (and even parents) did not choose to be too "fat" or "thin" and it's crazy they lack coverage. "General community" reasoning too often suggests, especially to libertarian opponents, that we favor supporting the blob. The general community is made up of individuals, and in our society individuals need access to certain primary goods -- resources such as healthcare and education -- in order to engage in the self-shaping behavior any freedom-loving person treasures.

One of the main problems with the style of libertarian thinking that animates a lot of mainstream conservatism is the notion that almost any tax that involving "redistribution" -- so-called "transfers" from the wealthy to the poor -- is automatically immoral (transfers from the poor to the rich are OK on account of the fact that poor are getting services in return: Halliburton secures our borders from invading Iraqi warplanes; and besides, if not for the uber-productive John Galts of the world, the poor would be living in mud huts). Wealth is created socially, not in a vacuum. Investments in public infrastructure -- education, roads, sewers, courts, police services etc -- are directly responsible for the creation of whatever we own. Our standard of living is not higher than our grandparents' on account of our greater efforts.

The problem with arguing against libertarians is that their beliefs in private property are axiomatic. Even if you did convince them that universal health-care generated superior outcomes, they would still insist it's wrong to "steal" from Peter in order to pay Paul, even where Peter is an heiress in the mold of Paris Hilton and Paul is a small boy in a Charles Dickens novel.

What egalitarian-minded liberals must do is retake the language of liberty. When Democrats want to expand -- not guarantee, but merely expand -- health coverage to poor children, what do they call it? SCHIP. What in the hell is SCHIP? The Democrats have SCHIP and the Republicans have "Death Tax"??

Wikipedi: The State Children's Health Insurance Program (SCHIP) is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. The program was designed with the intent to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

The bill was co-sponsored by senators Ted Kennedy and Orrin Hatch.

The voters of every first world democracy, except for here, have figured out a way to pull together a medical system that gets better health outcomes than we get, for about half of what we pay. Give or take, they average something like $3,000 per person every year, while we shell out about double. For worse outcomes, we pay about double.

Feels good.

We're the only voters in the advanced world who can't seem to overcome health industry political muscle.

Perhaps I am a masochist. Your blog is beyond infuriating, yet I still read it from time to time.

I loathe your backhanded robbery and forced enrollment of myself and all other people who want nothing to do with your system. If a system is worthwhile, people will join of their own accord. If people have to be forced into doing something then its not worth doing. (With the caveat that there are certain exceptions namely those in which the following are not true: the costs and benefits are personal, rivalrous in consumption, and non-exponential as they are accrued across the strata of society, e.g. National Defense, the system of justice and law, tragedy of the commons situations, etc. Healthcare however is not among these.)

That said this bickering among citizens with little to no experience in economics, healthcare, or business is pointless and probably filled with illogical opinions based on emotion rather than reasoned rhetoric, behavioral economics and psychology, and the mathematics of the situation.

I must be an intellectual masochist. Perhaps we all are at heart.

I don't think the moral case for universal health care is made strongly enough. Not even in this post, which is quite good.

An analogy is appropriate. Say you have a group of people with enough food to feed every member. But some people have more of it than others, and they want it to trade for trinkets - things they don't need and can live without - and don't much care if some of those without food don't have the trinkets to trade (they were too busy trying to find food to make trinkets, naturally). They don't need to give trinkets up entirely, just one or two, and everyone would have enough to eat.

Now, you're the chief of this group of people, and it's within your power to decree that everyone has to put extra food into the kitty, to be doled out to those whose crops or hunting expeditions failed. Some of those people who dearly love their trinkets don't want to give the food up. If you're a moral person, you don't worry about the trinkets. You simply decide that everyone eats, period. You deal with the consequences later, and if some people have to give up a couple of trinkets, that's just the price you pay for living in a group where you're able to acquire trinkets in the first place, rather than being forced to always live or die by your own luck at finding food. Because the unsaid thing is, the ones with enough spare food to trade for trinkets aren't the same people from one month to the next. Sometimes your luck runs out, and you have to depend on the good will of others to survive long enough for luck to return.

This is a "lesson" that natural selection learned aeons ago, and can be found in animals as distasteful (to some) as vampire bats, which have a brisk trade in reciprocal altruism, where the currency is blood.

We're supposed to be the supremely morals animals on this planet. It's rather ironic that those most vocally claiming that title are vastly more likely to be those who oppose such obviously moral policies, though exceptions must be made for the special case of Libertarians, who combine social liberalism with economic conservatism. That group is composed of selfish people who lack morality, and moral people who are confused about what a Libertarian actually is (if a person talks about politics for half an hour without making you vomit, and claims to be a Libertarian, that person is not actually a Libertarian).

More to the point, money is worthless. You can't eat it, and even the wealthiest person alive, with all cash converted to singles, couldn't survive one winter by burning it. It has value only in a society, and if you live in a society which allows you to acquire wealth beyond being able to feed yourself daily, it is your obligation to support the continued existence of that society. That includes providing for the basic survival of everyone born into it. If you do not agree with that sentiment, then you are not a moral person.

Mahatma Gandhi said that a nation's greatness can be judged by the way it treats its animals. Certainly a nation's greatness can also be judged by the way it treats its people. America is undeniably a great nation, but it cannot remain one if it remains the only western democracy that turns a blind eye on the medical needs of a vast segment of its population. We are one nation, indivisible – and, yes, we owe universal health care to ourselves, all of ourselves.

Life is a basic human right. The preservation of that right is not a choice, but a fundamental human need. It's not like deciding between buying a car and taking public transit. The preservation of life is not a luxury and should not be weighted against the margin of profitability. I think most people would agree with this, right?

Why should you care if someone else who can't afford health insurance is sick, even though you're not? Because you live with that person. Because you go to the same supermarket, the same schools, the same church, the same movie theaters. You sit beside each other. And the person who can't afford health insurance on his/her own for whatever reason will unfortunately remain that way, and because YOU weren't willing to participate in a universal plan they will remain sick, and will continue to share the public space and breathe the same air as you, and maybe, will touch the same fruit or seat handle as you, and maybe, you will receive his/her sickness. Most people would agree that they don't want this, right?

So you see, libertarian or not, it always does, and will, come down to YOUR OWN HEALTH. We actually all agree on the objective. It's just a matter of how to get there. When more people get treatment for their illnesses - less the chance that those who are healthy will get sick, the faster they will recover and the less chance of reinfection. Yes. That applies to you and you and you.

Unless you are completely antisocial or live far away from civilization, the maintenance of your own health is intimately related to the maintenance of others' health. Believing otherwise is not only foolish, but dangerous and downright near-sighted.

I'm throwing in my two cents as an outsider. I don't claim to know the answer. I don't know exactly how best to get there either. It is a monster job. But I think it has to be done, and attempts should be made, because universal health means individual health, and we ALL WANT THAT.

Ebert: This is an important sentence:

Unless you are completely antisocial or live far away from civilization, the maintenance of your own health is intimately related to the maintenance of others' health.

Honestly, Mr. Ebert, as someone who could be classified as a Libertarian and as a staunch Capitalist, I’m still on the fence with nationalized healthcare. The argument for compassion is strong and appealing, but I don’t think that necessarily justifies such a program. If it could be reasoned that a free market could provide the cheapest, highest quality healthcare to the market, wouldn’t its advocacy be the voice of compassion? Compassion, or selfishness, isn’t at issue, pragmatics are.

Do you remember reviewing I.O.U.S.A.? It highlighted that starting this year, the total expenses of Social Security, Medicaid and Medicare will exceed their respective net revenues, and from then on, never recover. In a previous blog, you posited that all of those complaining about Medicare should give it a try, as it worked so well for you. Well, at 28, there’s a good chance that by the time I need it, it will be a defunct program. I’m sure you can appreciate my hesitation, and the hesitation of others, who keep hearing this new nationalized healthcare program is like Medicare for everybody. There is certainly room for skepticism.

Had there been universal health care in this country back when Roger had cancer, he'd probably wouldn't be alive today.

Ebert: Look at it this way. I probably would be.

Roger,

Did you get your cancer treated in Cuba? Allegedly, it has the best health care system in the world!

This country doesn't need another trillion dollar boondoggle. The Dems keep throwing more and more money into the wind. Obama was wrong on the stimulus bill, he was wrong on Iraq (he predicted the surge would fail)... so what makes us want to believe he's right on universal health care?

Fixing the economy should be a bigger priority than universal health care. Obama's 'war on prosperity' is turning this country into a banana republic.

Time to bring back the "misery index"!

Oh well... so much for "hope" and "change"....

Ebert: Ah, yes, the argumentum de Cubam.

It is my opinion that you are manifestly correct in your assertion that this country needs public health care.

Your analysis of the untrustworthiness of insurance companies is dead on. I would have gone further, mentioning the untrustworthiness of corporate health service providers. There was a time in this country when institutions such as hospitals were run as non-profit charities. Those times are over, hospitals, nursing homes, and even most doctors offices are now run by profit seeking corporations, and the direct result is that the quality of health care has decreased while the costs to the patients have skyrocketed.

I am troubled, however, by your attack on libertarianism. I can only assume your opinion has been colored by exposure to individuals not typical of the movement as a whole. Roger, true libertarians are just as mistrusful of greedy corporations as you are. They are also big believers in compassion and human rights. They simply believe that compassion and rights originate with individuals, not organizations.

I don't see why Libertarians would be opposed to treating their neighbors, or strangers, decently. There is a tangible difference between volunteering time and money to make a measurable impact in your local community, and sending money to grease an inefficient and compromised Washington machine. There is also a difference between volunteering money toward a cause you deem worthy and having it taken from you on threat of prison, leaving you with no direct say in how it will be used- unless, of course, you want to contribute to nationally subsidized political coffers.

I'm fine with a public option- sure, it'll become an overburdened, government-bankrupting mess before the last of the baby boomers manage to reach retirement age, but by then the whole damn system will be down the tubes, along with Social Security and everything else. However, I can't say I like your argument, Roger, which seems to be the equivalent of those Dateline specials on murdered children- anecdotal situations with a heavy dose of "It could happen to you! Be afraid!" Well, Roger, I suppose I could suffer an accident that drives me to bankruptcy. I suppose a crazed killer could also break into my house and murder my family. But should I let my fear of unlikely hypotheticals determine my ideology? Or should my ideology be the result of measured risk and personal principle?

Dear Mr. Ebert. This is the first time that I post a reply to your blog, although I have been visiting your website for years. I'm writing from a Canadian perspective, where most people still believe that a society is only as strong as the weakest of its members. After the 1930s, during which Canadians increasingly looked to the south with the wistfulness that their own government would embrace the ideas of social justice and equal opportunity espoused by FDR and his New Deal, Canadians - as individuals, as a society, as a state, as Christians (for example J. S. Woodsworth or Tommy Douglas), as Jews, as Atheists, as conservatives and liberals and socialists all - recognized that in the end we all sink or swim together, that only by caring about the common good can we succeed as a society and as human beings.

Part and parcel of that was the recognition that we cannot claim to be moral or ethical human beings when we allow people to suffer and die because they did not have access to health care. All too often my fellow Canadians give a self-deprecating laugh at the thought that our universal health care is part of what defines Canadian identity. Yet, if we look beneath the immediate surface, universal health care is a symptom - a symptom of abiding caring and morality, not just in Canada but any place where the society and the state commit to public health care.

I often hear in the American news the pooh-poohing of the Canadian health care system. It is not perfect, but it works despite the waiting lines being longer for some services than others. I've had a joy of waiting in emergency room for 8 hours first-hand. I will give just a couple of examples I'm personally familiar with. My wife had to have a CAT scan done, for a non-life-threatening condition. Despite her grumbling at the length of the wait (2 months), she had the scan done. She paid 120 dollars on the spot for administrative fees, and that amount was then refunded back to her by the provincial ministry of health. A friend of mine is a single mother of two. She had injured her knee, which required surgery she did not have any private insurance. Because it was non-life threatening, she went on a waiting list for the surgery (also about 2 months) and collected disability because she couldn't work due to the injury. The surgery was successful. She contemplated at first getting it done in the U.S. in order to have the surgery done faster. It would've cost her 21.000 USD. She is a single mother and if she lived in the U.S. it would've bankrupted her, put her on social assistance and vastly decreased the success chances of her two boys in the future.

Now the question for the critics. Which is better? An imperfect system that nonetheless provides adequate service for all, or a system that excludes a significant percentage of population from any services, limits the availability of services to another chunk of the population (those with private insurance that covers only some of the services, and might eventually run out), and provides excellent service to either a relatively tiny group that can afford the services or those willing to bankrupt themselves or go into debt? Which system is more moral? Which system is more humanistic? Which system is more just?

Libertarianism might be good in a world of infinite resources and opportunities. In the world we have, it is better to work together and pool our resources, because that is the only way to solve certain big problems, such as World War II. Unfortunately, the sort of problems we are facing now aren't as obvious as WWII, and are much easier to ignore.

On bureaucracy - I worked at General Electric for the whole of the Jack Welch reign; in several of those years GE was selected as the best-managed company in the country by Forbes Magazine. As many of us said during those years and is generally known now, Welch turned us from a world-class industrial and technology company, with one of the best R&D departments in the world, into a financial-services company in which R&D was almost a pejorative term - just in time for the financial crisis. Welch spend half his time as CEO playing golf and retired a billionaire. (Not now if he kept his money in GE stock though.)

I'll take government management over big business management any day. They don't retire as billionaires, don't brag about "how much blood they can squeeze out of a lemon" or how all their decisions come "straight from the gut" (correct in JW's case, but mostly from the wrong end), and I can relieve my feelings a little by voting against them if I don't like the job they are doing - although some libertarian or conservative will probably cancel my vote.

Ever hear of a steam boiler exploding and killing lots of people? It used to happen a lot in the 19th century. Then government made it a legal requirement to design boilers according to the ASME Code for Boilers and Pressure Vessels. The nerve of government, telling private industries what to do. (Yes, there are still lots of steam boilers. Chances are about 50% that the electricity powering your computer came from the heat energy produced in a boiler.)

Oh yeah, on health insurance: what Roger said.

Roger,

I would much rather find a way to pay for my family and their needs than saddle my children and their children's children (and all children for that matter) with this insane debt and more reckless spending by some faceless beaurocracy. I love how people hate insurance companies but think the DMV-like department will be some paragon of concerned virtue. You think insurance company meddling was bad? You ain't seen nothing yet. Government has the power of force behind them to tell you to do anything they want as a parent. I'm a father. I don't need a nanny. I'll find a way. I consider that far more humanitarian than passing the buck and responsibility. Bush was bad with reckless spending. Obama has quadroupled down on stupid. More government control over all our lives, more spending on the credit card, and a bill for the kiddies. How charitable. The CBO figures don't lie. Obamacare will lead us to trillion dollar deficits for over a decade. When the dollar collapses and hyperinflation sets in, tell me, how humanitarian will that be on middle class families? We're so bad now communist China is warning us to stop government spending. They've just about had it with our insane addictions. Obama now wants a second stimulus because the first failed. They've already brought medicare and social security to the brink of insolvency, why the hell should I trust them with 1/6 of the economy.

And to your point that universal healthcare works abroad. It won't soon. The fast approaching demographics of 6 people retired for every one person working in Europe will collapse the system all too soon. You know it. I know it. They know it. No one wants to face reality. Just more handing out of loot at future generation's expense. No thanks.

I am libertarian/conservative and so am knee-jerk opposed to the government meddling in healthcare.

But why? Well:

1> Once it is established that "we the people" are footing the bill for your illnesses, it becomes the business of "we the people" to "encourage" you to be healthy. This is offensive to the extreme to my (and one would hope most) sensibilities. It is a road that, grated in some extreme future, leads to jail-time for refusing to exercise. In the short-term, just try to get away with driving without a seat-belt and not paying the subsequent tickets.

2> "You can't fight city hall" Ebert, if you think corporations are generally speaking soulless, merciless entities driven by the profit motive, you are right. We need protection from them. That is the role of the government. We need a way to set one corporation against the other, to undercut each other, outperform each other, and fight for your business. That is the role of the free market. But the system falls apart in the cases of monopolies, or when the interests of the government agents are set against the well being of the people. By making the government take the role of a health insurance company, you are breaking the system. You are creating the ideal conditions for corruption of the government.

3> And no, we don't think that those without health insurance should die. This is the classic case of blaming the messenger. Ebert, we don't want to deny health services to some people. We are pointing out that there is a limited amount of resources. Some people WILL be denied health services one way or another because, again, there aren't enough to go around. Theory and practice has shown us time and time again that by adding bureaucrats to the system, we end up with even LESS of the resource than we would otherwise.

4> "Give unto Ceasar what is Ceasar's and unto God what is God's" It is not a virtue to pay your taxes. Yes it is wrong to let your fellow human suffer. But YOU should do something about it. Give to charity, and in giving, become a charitable person. Taxing for good deeds eliminates opportunities for human ennoblement.

5> Poisons the public discourse well: Now we will have fights over abortions, over defining the meaning of the phrase "elective surgery", over euthanasia, over etc. and another gazillion etc.'s If you think things are bad now, just you wait.

I simply wish that your readers who are against universal coverage wouldn't give "re-fried sentences" over and over but valid and thoughtful ideas like you do Mr. Ebert. If that was the case I would have no trouble listening to them.
And by the way, I wonder why most of them don't lose any sleep over the US goverment bailing out Wall St with their greedy CEOs and never ending fat bonuses. Is that a more moral and/or valid form of goverment intervention ?
I live in Mexico and we live with a system not unlike yours. I consider myself a conservative but I also believe:
a) No one who has dealt with an insurance company in difficult health times can be in favor of them exclusively deciding what becomes of your life and....
b) I am a conservative but you have to be rather ignorant to decide on important subjects based on "a team you belong to", as opposed to analyzing and deciding subject by subject.
Best wishes and thank you for your thoughts.

I find Charles Krauthammer's suggestion a viable option. Though I must point out, I feel it should only be considered as more of a "transition" proposal than anything else. A public option is more financially sustainable, and it decreases costs in the long run. Still, it's good to know there are conservatives out there who are rational enough to understand that regardless of any final decision, universal coverage is to be included as a must.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/27/AR2009082703262.html

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html

One thing I wholeheartedly agree with is that neither party is tackling the big elephant in the room: rising health care costs.

I also want to say that there are several governmental organizations that have "fail" written all over them, as well as some that we as a nation should take pride on. That's to be expected. Take any high school government class and they will teach you that some industries need to be left in the hands of the private sector, while others are better off being regulated by the State. Whether we should let the government handle an institution or not is always a subject of heated debate, and we always strive to make the right choice. Our Medicare, and our health care programs for the veterans are just a handful of examples of the government doing a good job. The postal service's copious amount of red tape (and the fact that companies like FedEx and UPS seem to be doing a better job) tells us that the government has also done it's fair share of wrongs. There are two things though, that let us know that health care should be handled by the State, and they are the fact that it affects all of us and that it tampers with (what should undeniably be)a birth right. Denying coverage is simply amoral. When someone goes to a hospital, finance should never be the focus of any talk between a patient and a doctor. That a doctor and the hospitals incur expenses is obvious, and that's why we should subsidize them and reduce the education costs to obtain a doctorate. The United Kingdom does it. Several other countries do as well, and the best part is that we have the power to do it too. It only takes a bill that taxes churches, then.....
I'm going to stop here. Moving forward with that argument is almost as bad as stating "I'm a communist" (which by the way I'm not).

Roger-

You have put a lot of thought into this essay but missed integral points in the Health Care debate that many others are missing too.

Government is the number one barrier obstructing people from obtaining health care on their own terms. Taxes (Income, Sales, Property, and Corporate) are the biggest obstacles preventing people from buying health care on their own. For example in Illinois the average person spends 103 days a year, 28.2% of the year, just in paying the costs of government taxation, not to mention regulatory costs. Taxes contribute much more heavily to bankruptcies than health care ever will. This will get much worse as taxes are increased to pay for bigger government health care plans.

Also, think about the taxes the Health Care industry has to pay to provide us their services. It's a very labor intensive and many doctors pay the highest income taxes rates in the country. Obama is already planning on allowing tax increases on this population in 2011. This makes health care more expensive for everyone.

Why not support the Fair Tax that eliminates the income tax, corporate tax and eliminates all taxes on health care services and providers, and replaces it with a sales tax on all goods except health care and education. The Fair Tax is the most progressive tax policy that would not only make health care insurance more accessible for millions but dramatically reduce the costs for everyone else who already has health care insurance.

Government also prevents people from buying insurance across state lines. By eliminating the artificial insurance company competition barriers that government has created free-market competition would lower cost and improve service on a dramatic scale. In some states it is estimated that premiums would go down 40-50% if they were allowed go to their neighboring state to buy health insurance.

Government also requires many mandates on insurance increasing the cost of Health Insurance up to 50% depending on the state and number of mandates. In Illinois we have over 40 mandates and it grows almost every year. Shouldn't people be free to buy the health care policies they choose instead of the policies the politicians choose?

Government also arbitrarily restricts the number of medical facilities through medical facilities boards. There are tens of thousands of potential medical school students who are highly qualified that are turned away each year because government has artificially restricted the number of medical schools through punitive licensing procedures in setting up new medical and nursing schools. Allowing more medical schools means more doctors & nurses to provide the services we need at a lower cost.

There are many more ways that government restricts access to medical care, but one thing I noticed is that you attack the profit motive and selfishness. But I ask you how many doctors would be doctors & nurses if there was no opportunity for profit, and all doctors were impoverished through government rationing and taxation? Being a doctor or nurse is hard work and should be rewarded through individual or corporate profits.

Another question what is more selfish voluntary mutually-beneficial transactions in the free-marketplace and the abundance of charity that comes from a prosperous capitalist system or the brute force of government who resorts to violently taking away the liberty, property, and prosperity of our citizens so the government Apparatchiks can turn around, give us back a small portion of the money they took from us and pretend that somehow theft on a mass scale is a sort of philanthropic activity to be applauded. Government redistribution of wealth is infinitely more selfish than the free-market libertarian system you criticize.

Remember government cannot create wealth; it can only redistribute what it has taken away from others.

There are so many low and no cost solutions to dramatically improve access to health care & health insurance that are being completely ignored in the health care debate in the rush for power and control over the billions of dollars in new spending that a public option or government health care expansion would bring.

We are poorer as a country for overlooking the most essential tool individuals must have to solve our health care problems on our own. The most powerful tool in reforming our health care system is economic freedom.

I myself have actually come to the conclusion that privatized healthcare is a violation of the fundamental rights this country guarantees us. All citizens of the United States are guaranteed the inalienable right to life, liberty and the pursuit of happiness. Let's consider these under the privatized health care system:

Life: Tens of thousands of people die in this country every year either because they can't afford health insurance or the insurance they do have refuses to pay for life-saving operations.

Liberty: Tens of thousands more are burdened by crushing medical debts that ruin their lives and rob them of their ability to lead their lives as they see fit.

The Pursuit of Happiness: A still further tens of thousands are not able to live their lives to the fullest because they lack the kind of medical care that would, for example, give them the prosthetic limbs they need to lead normal lives or undergo surgeries that would correct debilitating conditions.

I am going to be so audacious as to say that anyone who truly believes in the ideals of this country will at the very least oppose privatized health care even if they have doubts about our current plans to fix it. There are those who cling to the ignorant notion that private health care should be supported because it is a capitalist endeavor, but the problem with that is that capitalism and insurance do not go together well. Under the ideals of a capitalist system, the restaurant that provides the best food and the best service winds up at the top of the heap. If the restaurant were to suddenly refuse to serve people the food they ordered because, for example, they were too fat, or turned away anyone who looked too hungry, the restaurant would go out of business and would deserve the fate it got. The problem with running insurance under a capitalist system is that it is the one industry that rewards that kind of behavior. The more a restaurant screws over its customers, the more money it loses. The more an insurance company screws over its customers, the more money it makes. For less vital matters, like auto insurance, we're most likely going to have to continue to take it up the ass, though I admit I have been generally pleased with my car insurance and I've never heard of anyone going bankrupt from car insurance anyway. For something as vital as our health though, it is imperative that we take the insurance out of the hands of those who profit from letting us suffer and die. Our government may not be perfect, but a government does not profit from citizens who suffer and die, a government profits from citizens who are healthy, happy and active and I am confident that a government-run healthcare system, though it will most likely have flaws of its own, will at least operate off of those ideals and will be vastly superior to the system we have now.

"How would you fix health care if a government-run plan was not available?"

How about mandatory standardized practices for billing and patient data across both the hospital and insurance industries along with yearly reviews and evaluations to change inefficiencies and update new procedures, discoveries, information, etc.? The amount of waste due to inefficient administrative and billing practices is enormous. Every hospital and every insurance company has their own way of handling all of these processes.

The way I see it, this is not about health CARE, but about health INSURANCE. If insurance companies were subject to the same regulations that Las Vegas casinos are, they wouldn't be able to manipulate the odds and deny people the payouts they are due. Insurance is about spreading risk. But for-profit insurance companies have shown they can't be trusted to accept the actual risks associated with doing business. They are under pressure to provide profits for the company -- not to provide a risk pool that covers those who are in need with people's premiums. Nobody -- NOBODY -- should be forced to rely upon an unregulated profit-maximizing corporation to cover their health care costs. We've tried it. It doesn't work -- because the duty of these corporations is to their executives and stockholders, not their customers who are paying for insurance. The only way insurance works is if the risk and the premiums are spread evenly and fairly. The odds guarantee that it's still a profitable business, but that has not been enough for some companies. That's why we need health insurance reform.

There seems to be quite a bit of stereotyping here when it comes to libertarians, and it reminds me of the charge leveled by Christians at atheists that there can be no morality outside of religion or without a belief in God. There can be and is charity and compassion outside of authoritarian institutions, and it is insulting for commenters here to write otherwise.

Ebert: Fair enough.

Everybody hates lawyers till they need one. And almost everybody does not care much about others who don't have insurance, till they loose their own. Public or Private, health care costs are and should be the debate.

"Joy, beautiful divine spark,
Daughter of Elysium,
We enter, drunk with fire,
O heavenly one, your holy shrine.
Your magic once again bonds together
What custom strictly divided,
All Mankind become brothers
Where your gentle wings hold sway."

Schiller's Ode to Joy
http://bhabha.name/

It's obvious that under a true, libertarian free market, most of our problems would completely vanish. First off, a free market assumes no barriers to entry, and this holds up particularly well in the case of medicine, where anyone can start up a local business providing healthcare (insurance markets do not require a lot of capital, and practicing medicine takes little or no experience). All of this competition means lower prices for you (and lower profits for the industry). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around for bargains (it's not like they're dying). Third, indivisible benefits and costs: when other people get sick and die, it's on them -- perfectly self-contained. Some people -- yes, I'm talking about Reagan-hating communists -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive at first... and if it does sound counter-intuitive, then you suffer from low intelligence and need to get your "duh-face" checked out... assuming you can afford to do so. Fifth: a free market means no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows more than your doctor (oh, but he does: the algorithms and profit margins prove it!).

Ebert: You write:

"It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive at first... and if it does sound counter-intuitive, then you suffer from low intelligence and need to get your "duh-face" checked out... assuming you can afford to do so."

I just wanted to be sure nobody missed that.

First; love the Norman Rockwell paintings! This one is my all-time favorite. :)

http://susanpogorzelski.com/wp-content/uploads/2009/08/norman_rockwell-school_fight.jpg

As for Health Care...

Do unto others, as you would have done unto you. That's the universal golden rule. Don't be a selfish @sshole.

Words to live by. And I try every day to do just that, to be a decent human being. To that end, I'm willing to compromise and share the planet and meet folks on the 50 yard line. And for thinking the world wouldn't be a very nice place if people were constantly just looking out just for themselves. And so by example, I don't.

I follow the golden rule.

And that includes empathizing with the plight of others and thus contributing to a medical system for all, not just one. This way, people are more likely to get the help they need.

The alternative is akin to a level of callous indifference and cruelty that not even a dog would show. Seriously, a so-called "mere animal" is capable of greater compassion and grace than some Americans, it would seem.

Lilly, a black Labrador who adopted a batch of orphaned kitties!

http://www.youtube.com/watch?v=T0OCqGFM_mo

Maybe this is why Dog spelled backwards is "God." :)

And while you can chalk it up to genetic programming, it still amounts to a degree of compassion sorely missing these days in the United States.

You guys could learn a thing or two, from these Moms.

Ebert: Awwwwwww...

To love our neighbor as ourselves is such a truth for human society, that by that alone one might determine all cases of social morality.

John Locke

Roger, applause for this. Beautiful. Beautiful.

Yes we must trust our government to promote the general welfare. You bring up the horror story of what Chevron did to the rainforest and the innocent people who live there. I haven't checked lately, but Chevron was Texaco as you say, which was commandeered by Pennzoil in a suspect Supreme Court coup; the chief shareholders of Pennzoil and its morphings are George Herbert Walker Bush and his family. So our presidents and their families don't mind sending innocent people to death and ruin for their own profit one bit. Never mind their interests in the Carlyle group, which profits from the mass murders of war technology and various media outlets which, unsurprisingly, find these various wars inevitable. Odd there's been no mention of a change of weapons contractors since Obama took office. But it's been that odd since 1917.

This one story is hardly an anomaly. Lift a rock and you'll find a vested interest posing as a democratic representative under it. Lift another and you'll find a popular religious leader of one stripe or another stealing, lying, and trysting with whores or minors or children. Another and you'll find a doctor addicted to the pills he prescribes. A psychological counselor sexually victimizing his patients. A scientist fudging his experiments for fame and fortune. And so on and so on, news services too (Prescott Bush bought a 30-something percent interest in the Associated Press in the 1930s, for instance, while handling the account funding the Nazi war machine).

I'll repeat until somebody acknowledges it -- none so far -- we are in the unenviable position where people, en masse, have grown remote from the institutions meant to serve them. It's not entirely wise to trust someone you don't know, much less love. But you're right, we must trust a government if we're going to have government programs that promote the general welfare, which certainly would include universal healthcare.

How to, then?

It's not a rhetorical question. But I'd suggest that a people taught not to trust themselves in so many ways can't be relied on to trust anyone else either.

An odd thing in my recent correspondence. A southern gentleman recently put me in his will, certain he was going to die of cancer any day. E-mail after e-mail. When one set of doctors pronounced him clean of it, he was very angry. He went to another and got the same diagnosis -- no cancer. He was angry again, e-mail after e-mail. Finally he accepted the fact he didn't have cancer. Taxpayers paid for the tests.

How odd. I now know a hypochondriac, personally. But just the one. Then, however, a correspondent in Vermont wrote me the same story about a friend of hers. Doctors are hardly ever firm about a thing like that, she wrote me -- she's in the medical profession herself -- but her friend was very angry about their certainty that she had nothing to worry about. She just knows cancer will get her and those doctors are simpletons. Triumphantly, this friend has now gone on a self-diagnosed program of meticulously picking out health foods supposed to prevent cancer. It reminds me of the famous epitaph, "I told you I was sick."

These are not people who've ever been taught to trust themselves. In what institution is there a course on how to trust oneself? Only the "noble savage" seems to know how to do that. Once upon a time that archetypal creation was very popular in America. During that time, America produced an array of brilliant, independent achievers. And did we have a nation of sick people dropping dead? We did not, even though where the main ingredients of patent medicines weren't bird poop or crude oil, they were heroin (LIFE ON MAN by Theodore Rosebury a must-read).

Months ago on a related thread, Gary in Phoenix weighed in -- his opinion ought to bear some weight, as he works in medical billing and "sees it all," on paper. What he doesn't see, he said, is a solution.

I don't see a solution to the problem either, not in the haphazard way it has been set up; I do see that the proposed solution is bringing people to these various expressed boiling points -- for which the present idea of universal health care is only one symptom.

I'll have to review Rousseau to comment on giving up one's "savage" freedoms for a social contract. It's been too long. I did, however, find a quite effective solution for myself, as mentioned too often, and so far, receiving one acknowledgment and one single, stupid sarcasm. My solution has done nothing to curtail my personal freedom in any way at all. It's expanded it very considerably.

But I have a little dilemma. I know what I know and do what I do and don't need so much as a vitamin pill for it. Are these news reports true, that I will be forced to buy insurance I don't need or want? Will I be forced by law to take vaccinations I believe for fact do more damage than good? This latter is now being considered in two States.

One thing I will not be forced into is accepting notions that "any day now, I could get sick." Sorry, that would be like believing in demons or Carl Sagan again. There are millions and millions of people already mesmerized by that unfortunate meme. Most of the posters are, very clearly. Most of the posters show the symptoms of believing that the longer they live, the sicker they're going to get, or the sooner the event of some personal calamity.

Taxes are problem enough, with or without health care -- which I'd gladly pay, so long as I'm paying, if I could choose on what my share is spent. I'm not real fond of the idea that I'm unwillingly paying a nickel to kill some villager in a far-off land for trumped up and paranoid reasons. On the same token, though, I doubt I'd be a lot happier knowing my nickel's going specifically to a medical institution that kills hundreds of thousands of Americans a year according to its own official journal.

Keith Carrizosa, in the previous related threads, was also drowned out in his attempts to present the issue of "alternative health care," or Integrative Medicine, championed by the very popular Andrew Weill -- popular enough so that spell-check here just now corrected the spelling of his last name. He's more popular than Roger, I see, as it sees "Ebert" as a misspelling.

The war between our major institutes of Allopathic medicine and other means of healing is a quiet one so far as "MSM" is concerned, but it too ought be of concern. If book sales on self-healing and the like are any indication, we have many millions of U.S. citizens, whatever their political ideologies, who want everything to do with alternative healing and nothing to do with a government-enforced allopathic industry. Is there any provision in this 1500 page bill allowing for treatment by alternate healing? Has anyone here even yet read the first, 1000 page version? Has any reputed wise thinker ever been quoted that it's a good idea to support something one hasn't read? Somebody check Bartlett's, eh? 'cuz I don't think even the bible suggests it.

"Giving up" freedom to choose is an issue one considers independently for his own putatively free reasons, but having it forced out from under one for supposedly good reason is not only dangerous, it's an insult to the "noble savage" Americans yet have the right -- and often the need -- to be. This noble savage has been too healthy for too long to pretend health care is the sole province of doctors.

Ebert: I think you know more or less, uh, everyone.

The corporations are ridiculous. But at least in theory I can sue their asses when they screw me over.

In theory maybe. In real life, concerning employment-based insurance, not so much.

Roger I think in 90% of what you say you are preaching to the choir. While anyone's poll questions can be phrased in such a way as to illicit results favorable to the pollster I don't think it's fair to simply blanket the topic by saying a majority of Americans are opposed to Universal Health Care. Left at that, I would be opposed to, because what I've heard described as Universal Health Care is too vague. It is sad but true that the overwhelming majority of working Americans do not trust the government to run anything effectively. We stare in disbelief at how much money the Post Office bleeds, recoil in horror at the amount of money the military spends on a wrench, stare with jaws dropped when we hear that some esteemed House member added something to a bill that gives his district $50 million, and stare in disbelief when we pass road construction that is in it's third week while at least five people on the crew stand around doing nothing at any given time.

Government is wasteful and completely and thoroughly unable to balance a checkbook. Perhaps we can look the other way in the other areas because arguably they don't affect our lives directly. There are those among us, myself included, that fear universal health care if it were to be run by the U.S. government. I know many veterans who have free health care, run by the government, who's only positive remarks on the system are it's cost. I would rather have good health care than free health care. Now that's not to say we can't do something, because obviously we have to.

The first good idea I heard is allowing people to buy insurance across state lines. Before this all emerged I did not know you couldn't. The free market really does work in this country, and would help in this situation. If you have only two choices for coverage in Wisconsin obviously you're over a barrel. If, however, you could get a health policy from any company in the country, then you would be better off. Also limit the amount of money doctor's can be sued for. While there are certainly cases where high awards are warranted, too many are in excess and cause doctors to pay huge amounts of money in malpractice insurance which in turn causes them to offset that by charging patients more. There are other options before us than universal care is all I'm saying, and trying to fix health care at the speed of a Japanese bullet train will hardly yield positive results.

As for your statement 'I say we should implement it and regulate it as well as we can, and improve it through our votes and our legislature', all I can say is God Bless your faith. When pondering the ratification of the Constitution, the most radical investment this country ever made, Benjamin Franklin effectively ended the stalemate by saying that he didn't think it was a very good idea either, but that at his age he wasn't sure he was right to feel that way. He suggested they trust in providence, vote the thing through, and work on it until it got better. That argument works when you are surrounded by Washington, Hamilton, Madison, Adams, Jay, King, Jefferson, Monroe, and countless others. I would give them universal health care in a second and trust that good would come of it. Nancy Pelosi I would not trust to house sit my cat.

On a separate note I will not be seeing Antichrist, it looks like one of those movies where all the funniest bits are in the trailer.

Ebert: Latest stats on public support for universal health care:

http://j.mp/2aOciJ

I appreciate your insight on the subject Roger. This piece was enjoyable to read and I admittedly share your view on the subject. I think factually speaking statistics regarding bankruptcies, quality of health, and international comparisons have already been covered a million times by a million sources. So I figured I might commit my own personal experience with two health-care systems for idiosyncratic sake. In my own personal experience I can testify to the validity of your article. I’m 18 and have spent 10 years of my life in America with the other 8 in Canada (non-consecutively.) With the advent of my disabled sisters’ birth she required three heart surgeries as a means of saving her life. All three were covered by Canadian Medicare and she is still alive today because of this. Now living in America I’ve had the ability of experiencing a handful of different insurance companies. And it is notable to remark that I live very comfortably in a high income household.
Insurance cost were colossal and only manageable because of my parents income.
My sister would rack up insurance bills large enough for a 5 person family with no ‘pre-existing conditions.’ (But then again I doubt that this family exists outside of some commercial fantasy.) And before I start to list the ludicrous and frankly grotesque things considered pre-existing conditions in our current system I’d like to stop myself. Because regardless of the supposed validity of what is or isn’t a pre-existing condition, I think its a violation of what a civilized society considers human rights for there to even be such a concept. This horrendous assertion that those who face financial, physical, or mental distress are to be blamed for their own misfortune is repulsive and downright idiotic. It is to me a disgusting side effect from our societies inflating ego and the so called ‘American Dream.’ Where the only thing a person needs to have a perfect bill of health and a heavy paycheck is ‘will and hard-work.’ The dismissal of luck or circumstance as meaning anything in our world is pure ignorance. And the resulting punishment of a huge number of people surpasses misanthropy.

Wow it's been a long time since I've posted a comment on this blog (I think it was August 2008), but I felt compelled.

I'd like to attack this healthcare argument from another angle, and use my own experience to bolster my point. Instead of comparing the U.S. system to other western democracies, let's compare it to a nominally Communist nation.

I currently live in Beijing, and I've lived in China for the last three years. I also grew up in Canada and the U.S. for ten years apiece, so I've experienced single-payer healthcare, HMO healthcare, and free-market healthcare.

Despite what your readers may think, Chinese healthcare is NO LONGER socialist, but almost purely capitalist. From 1949 to the 1970s, the system was established by the central government as a "cradle-to-the-grave" protection, which was called the Iron Rice Bowl. In the late 1970s, Deng Xiaopeng began dismantling state-run businesses and encouraged competitive capitalism. At the same time, he also dismantled the Chinese healthcare system but provided no direction as to how the system should move forward in the future. I don't believe the government intentionally destroyed healthcare; it appears they simply "freed" the system and then neglected it over the years.

Fast forward to today, and the Chinese healthcare system is essentially a free-market one. There is open competition in this market, far more than the U.S. and there is also far less government protection of its citizens' health. In other words, you and your readers are already experiencing a more "socialist" healthcare system than the people in this "Communist" country. The U.S. government protects your health more than the Chinese government protects its citizens' health.

So what does this system look like? Well, I was sick a few weeks ago with something that felt like bronchitis, and here's what I had to do:

1. Go to the hospital. Nobody goes to the general practitioner in Beijing. They're expensive, and compete mainly for the money of the rich upper-middle class. There are also very few of them; most doctors end up working at the hospital. So if you want to speak to a doctor, you are forced to go there.

2. Once at the hospital, I had to self-diagnose. First I had to stand in one line to get a "personal health journal," which is a small notebook that stores the comments of every doctor you see. Then I had to stand in another line to get a "membership card" for the hospital. This card is scanned at each point, and any outstanding balances must be paid immediately. After this, I stood in a third line and had to take a number. However, I had to announce my illness to the woman at the desk. I told her I had a heavy cough in my chest/lung area; she told me I could go to the respiratory division, the flu division, or even several other divisions, and gave me the option to choose. In other words, while I was standing there coughing prodigiously, I had to diagnose myself and decide which division to go to. In the event that I chose the wrong division, the doctor would send me back down to the entrance hall, where I would have to stand in line again and repeat.

3. Take my number and see the doctor. This is harder than it looks. First I had to go to the respiratory division and get assigned to a doctor. Then I stood in line outside her door. However, multiple people tried to cut in front of me, and I actually had to fight an old man to keep my spot. Neither the doctor nor the secretary cared about people cutting in line, because Chinese people cut all the time and also because there's no monetary incentive. See, doctors get paid more money if the patients buy medicine, but if they recommend x-rays, the money goes to the machine technicians. The old people cutting in line just needed a prescription, so the doctor has an incentive to see them first, since she can fill out a prescription in 30 seconds and that's money in the bank. On the other hand, since I have not even been diagnosed yet, it will take much longer for me to get to that payment stage for medicine. Thus, I am less of a priority.

4. Talk to the doctor. Her name was Doctor Liu. She had been there since 8 in the morning with a 90-minute lunch break, and I saw her around 2 p.m. During the 15 minutes I waited for her, she had already seen three patients. In other words, her rate was about 10-12 patients an hour. This is completely normal for a Chinese hospital. There's barely time to remember names and conditions before the next person comes in. I spoke to her briefly and described my symptoms. She took my health journal, scribbled illegibly inside (Chinese doctors have awful handwriting as well), and filled out a form for me. I had to get a blood test and an x-ray. Four minutes and twelve seconds after I met her, Doctor Liu was shooing me out the door.

5. Pay for my blood test and x-ray. All payment is done beforehand at Chinese hospitals. I stood in line to pay for the services. Cost of seeing the doctor? 3.68 RMB, or 54 U.S. cents. The Communist government locks wages at a certain rate, which is why talking to a doctor is cheap. However, the x-ray was 136.98 RMB ($20) and the blood test was 20 RMB ($3). While looking at my bill, someone cut in front of me in line. Sigh.

6. Get pricked for a blood test. It took 30 seconds for me to roll up my sleeve and have the nurse clean my arm, prick it with the needle, and send me on my way. It will take 30 minutes for results to come in, and I will have to pick them up at a separate location.

7. Get my lungs x-rayed. This took 60 seconds. Once again, wait 30 minutes for results.

8. Take the blood test and the x-rays back to Doctor Liu. This time, I had become the old man, and was forced to cut in line. Now I understood the dilemma: people who have not been diagnosed are given a number, but people who have used other services are NOT given any number. This means that we have to jostle with other people to get the same doctor to see us. A middle-aged woman takes pity on me and allows me to go in front of her.

9. Talk to Doctor Liu. She didn't really remember me. After looking at the x-rays, she recommended antibiotics. We discussed possible bronchitis, and I asked for amoxicillin. She refused and prescribed azithromycin, along with some Chinese throat lozenges.

10. Pay for my medicine. Azithromycin is 20.99 RMB ($3) but the traditional Chinese lozenges are 40.44 RMB ($6). Yes, Chinese medicine costs more at a Chinese hospital than Western medicine does.

11. Stand in line and get the medicine. There are separate sections for Western and Chinese medicine. At the line for the Western medicine, I hand my prescription to the nurse, who promptly yells at me that I need to go to the Chinese medicine department. I point to the azithromycin on the paper, and insist that I should be served here. He relents and gets the antibiotics for me. At no point in this conversation has he looked at my face. The traditional Chinese medicine area is more relaxed. The nurse looks at my face briefly and hands me the lozenges.

This entire procedure took something like 2 hours, which is quite fast compared to the U.S. However, at no point did I feel like anything more than a sheep being herded into a pen, examined, then sheared and spit out the other end.

The healthcare system in China has had astonishing cultural effects, things that you can see easily once you learn what to look for. For instance:

A). A free market creates a system where nobody really trusts the doctors as individuals. Sure Chinese people will trust the diagnosis of the doctor, but nobody here really trusts their recommendations. Because the government locks their wages, their only way of making money is by prescribing expensive medicines or procedures, and receiving kickbacks from those. Economically, their incentive is to give you things you don't need, and ordinary people know this. However, it is still a good idea for doctors to properly diagnose you, so we at least give them credit for that.

B). Hospitals are profit-making enterprises. That means the hospitals with better doctors eventually earn a reputation that people are aware of, which allows them to make more money. I went to Chaoyang hospital, which is good but not as good as Xiehe hospital. This means more people will go to Xiehe than will go to Chaoyang, which puts a strain on Xiehe's resources. No matter, however, as Xiehe encourages more people to come, since that makes more money but means less time per patient.

C). Hospitals are segmented worms. The person who takes your blood has no idea who took your x-ray. The person looking at the x-ray has no idea who will give you the medicine. The person behind you in line does not even live in the same community as you. And none of these people is the one who takes your money. Departments do not really communicate with each other; they just kind of inhabit the same general area. Henry Ford’s assembly line, as applied to hospitals.

D). The system is ruthlessly efficient but frequently wrong. By segmenting the hospital, it allows each division to focus on increasing specialization. That's why if you check out the titles of Chinese doctors or technicians, they all say "specialist." This is also why there's nobody with the title "general practitioner" in China: specialization is viewed as a goal in and of itself. People focus on their own zone and leave the rest to others. If you've got an issue with your throat and your hand, you need to get in line two different lines and see two different doctors. And pay twice.

E). The system shuts down from noon to 1:30 p.m. for lunch. Different divisions will sometimes even push the clock 20 minutes ahead. The x-ray division is particularly infamous for this. Watch as you pay for an x-ray, then walk to the correct section, wait in line, at get turned away at 11:50 a.m. Why won't they help you? Because you already paid for the x-ray, so they've got no incentive to help you.

F). The system is unproductive for working people. I went to the hospital by myself, but every Chinese person will go with at least one or two family members. This is to help with the self-diagnosis part, and also because the family members will grill the doctor about medicine. In other words, if you run a company and one of your workers goes sick, then you're probably out two workers for the day as the second guy is needed to accompany the first guy to deal with the healthcare system.

G). Ordinary middle-class Chinese people know a lot about medicine because they have to. Self-reliance? You got it. Go to work and tell your coworker you have a cough, and ten people will descend on you with recommendations about what you should eat and drink for the next few days, as well as recommendations for medicine. Unfortunately, you'll probably get four different recommendations from the ten people, with no clue as to which is better. In a system with more "choice," people frequently have to choose between trusting a doctor and trusting a friend. But doctors have perverse incentives so that means you turn to your friends for medical advice more often than the doctor. Expertise has now become meaningless.

H). The poor are completely untreated. Since hospital are for-profit and you pay before you get treated, the poor don't even go to the hospital. Not only that, but the for-profit system means city hospitals have tons more resources than country hospitals. The hospitals in say, rural Shanxi province, haven't improved much since the 1970s, while the hospitals in Beijing have improved immensely. However, their primary improvement has been in getting modern technology, like MRIs and CAT scans, while the level of care hasn't really changed much. I wish I could emphasize this more: the poor are marginalized, have more chronic conditions (like lung cancer from cigarettes), and are effectively treated as irrelevant.

I). The savings rate for Chinese families is absurdly high because we fear a family member's illness. Costs are enormous later in life, so we keep it all out of fear. A lot of the country's money is basically out of the local economy as people sit on it for a rainy day. This isn't just a minor cultural difference, but has widespread effects on the world economy. Chinese peoples' savings allow the Chinese government to lend more to Americans, whose rate of savings go lower. In other words, the Chinese healthcare system is indirectly responsible for the massive debt & trade deficit between the two nations.

J). The system has a mediocre track record with epidemics. Remember SARS? Well they locked down swine flu decently this year, but public health information is also segmented and difficult to trust. When an epidemic does break out, you see a lot of masks on the street. In a system where every man pays for himself, and nobody is required to pay for anything, epidemics become MUCH more dangerous: how do I know if the guy next to me on the bus has basic healthcare? If he coughs, does that mean he's already seen a doctor and knows it's nothing? Or does it mean he's never seen a doctor because he has no money?

K). The ONLY thing, as far as I can tell, that the Chinese healthcare system is good for, is a situation where you know exactly what you want, exactly which doctor you should see, exactly when to go, and exactly why you should get this treatment. So if you want to get your wisdom teeth pulled (as I did six months ago), the Chinese hospital is a perfect place to do it. For less than 400 RMB ($59), I got x-rays on my teeth, then got two wisdom teeth knocked out (localized anaesthetic, I didn't go into surgery). No safety video, no guidelines, no pamphlet. Whole thing took an hour and a half. The only hitch was that the girl who knocked my teeth out was an intern, which nobody realized until she got my first tooth out and exclaimed "Wow that was easy for my first time." The look on my mother's face was priceless.

-------

I apologize for the length of this comment but it really needs to get across to people: if you support less government intervention in healthcare, the system I have meticulously described is the most likely result.

I do not know a single American in China who goes to a Chinese hospital. I know plenty of Chinese people who go to American (United Family) facilities.

When I check CNN or the New York Times or even NPR, I hear libertarians, Republicans, Democrats, even people from think tanks (I believe it's called The Heritage Foundation) stating that they do not want the government to intervene in healthcare because they want a system that "does not get between you and your doctor."

Well I live in the system they are describing. I live in a system that allows me pure freedom of choice. I am not restricted by my employer or my insurance. My hospital is also allowed freedom of choice. My doctors are, too. And I can testify that there is nothing that gets between you and your doctor more nefariously than the free market. I support capitalism quite a bit, but not in healthcare. It doesn't work, and it cannot work, because of this simple reason: I can declare bankruptcy if I have no money, but I can't declare anything if I have no health. I'm just dead. There's no such thing as Chapter 11 Mortality.

If any of your staunch libertarian readers want to come to China, I'll gladly show them the healthcare system here. And I'll take a picture of their faces when they see the system of their dreams.

Mike wrote on October 22, 2009 11:44 PM:
I loathe your backhanded robbery and forced enrollment of myself and all other people who want nothing to do with your system.
If it makes you feel any better Mike, I and the many other people who support universal coverage feel much the same way about the current system.

I agree with some of the earlier posters that the real source of the high costs here aren't being addressed on any side. The high bureaucratic costs associated with dealing with different insurance companies is a big part, but even that is only ~20%. A big part that's ignored is procedures and medications that are wholly unnecessary, that are either demanded by patients or provided by doctors without discussion of cost or need. I've seen a lot of these show up in itemized invoices of my own medical bills and been shocked at how they manage to nickel-and-dime the system, adding up a lot of small-ticket items.

Doctors have an incentive to do more because it makes them more money. Patients (those who are insured) don't care or even know about the true cost because they don't pay it directly, just a small copay. Insurers can't keep track of millions of small procedures and don't have much incentive to cut costs anyway since they can increase premiums ad infinitum; when they do cut benefits it's on larger, rarer things like surgeries that actually are more necessary.

The radio show This American Life (produced in Chicago) had extremely good programs this past week and the week before on the cost of health care; very interesting stuff.

Roger -

One thing that strikes me the most about these discussion in American politics is the almost total lack of perspective. On the one hand, opponents of health care reform act as though the slightest amount of government interference will lead inevitably to death camps, forced atheism, marks of the beast, and mind-control chips. It is as if the entire rest of the world -- much of which has had socialized medicine of one form or another for decades -- doesn't exist and whatever experiences they might or might not have are completely irrelevant and totally inapplicable to what we are doing, which, as noted above, will obviously lead to mind-control chips. On the other hand, I feel as though proponents of health care reform are woefully ignorant of the very tangible benefits of universal health care that are on display in almost any country you look.

When confronted with the idiocy of, "the free market knows best" or -- worse -- "bureaucrats will do a horrible job! look at the DMV!" proponents of universal health care should point calmly and firmly at the undeniable fact that Americans pay nearly TWICE what most socialized, bureaucratic European citizens pay and receive no better a product. How is it that this bureaucratic, socialist, communist, fascist, inept, DMV-esque, Postal-system-mimicking bunch of euro trash manages to out perform our ingenious champions of the free market, and at better than half the cost?

The system is broken. It does not work and it costs to much. The free market has had it's chance and it has not shown itself capable. Time to look at the dozens of experiments being run elsewhere and pick a better candidate. Even if it means bureaucrats.

I'm a little tired of the younger generation blaming the baby boomers for the problems with social security. It shows a profound lack of understanding of history. We paid in. Our payments went to support our parents and grandparents generation that had not worked long enough under social security to pay for all the benefits they received. When the social security system was set up (well before we were born)it was designed for immediate payouts to those of retirement age. Money that we paid in that could have gone into an invested trust which would have provided an on-going endowment was used to pay for the older generation, which is probably the only generation that will ever receive the classic retirement.

As for the libertarian argument (oh my goodness we require seat belts that impinges on my freedom) and when it is that you are in an accident and injured for your lack of seat belt should we let you die on the side of the road because that was the choice you made. Oh no, wait you want the government ambulance service to pick you up and rush you to the hospital. Whoops there went your libertarian principles. Sort of like there are no atheists in a fox hole.

Having dealt with my husband's leukemia for four years I am eternally grateful that I have life-long good health insurance in my retirement. I can't begin to imagine the agony of an uninsured family watching a loved one not get treatment. It is highly disingenuous to in effect argue we should let some folks die because they don't have health insurance in order to make sure that those who do don't have to wait two moths for a non-life threatening knee surgery.

There is a reason that the goose "is laying fewer golden eggs in fewer baskets." It's because of that government that you now entrust to give us "universal health care."

We already have a $39 trillion unfunded liability looming in Medicare, to say nothing of what Social Security is going to cost. And yet you propose to add 50 million dependents? And that it will end up costing less?

To be honest, you need to stick to reviewing movies. You are clearly out of your depth here and the wise course would be for you play to your strengths, and not your ignorance of economics, politics, and yes, even basic mathematics.

I am responding directly to the points made by Roberto J. Delgado:

1> Yes it would be offensive if that is the reality of what happens. Universal health care exists in other countries (including the one I live in) and "future road" that you describe sounds extreme to the point of ridiculousness.

2> Health care is not a commodity like a car or a hamburger. Allowing multiple companies to compete for your health-care dollar sounds cumbersome. Think of it less like a consumer item and more like a public utility such as roads. If several private companies laid out their own roads (all charging a toll of course) it would create more choice, yes, but it would also create a lot of wasted space where one single road would do the job more effectively.

3> The reality is that in most countries with Universal health-care there isn't a scarcity issue. There are waiting lists, true, but that is because the most life-threatening serious illnesses and injuries get first priority. But no one is ultimately denied health-care by the government because there is no incentive to not pay out claims like an insurance company does.

4> Giving people opportunity to behave nobly sounds like a terrible thing to wish on the world. Should we eliminate all laws so that everyone has the opportunity to behave nobly rather than by the "laws" that the government forces upon them? Would it be a good thing to give half of the world's population cancer so the other half can learn to treat them with compassion and thus create further ennoblement opportunities? Also that quotation from the bible has been taken out of its context and is not supposed to be a commentary on taxation and charity.

5> As far as I can tell these are already big arguments in the USA. A lot of these discussions are around ethical and moral issues. Would UHC actually have much of an impact here?

One more comment: Anyone who has studied economics (formally or otherwise) will be aware that with any type of insurance system if more people sign up the overall costs drop. If there was one single insurance provider, however, you run the risk of this monopoly setting prices regardless of how many have singed up. Universal health-care takes care of both these issues: costs are down because everyone is signed up and, because the government isn't trying to turn a profit, there is no danger of price gouging.

There is a strange irony that in the US the same citizens who trust their government implicit when it comes to sending their troops away to fight and die are so distrustful of the same organization running hospitals.

My fear is that the Health Care Bill will never pass because Republicans vote as a block and are afraid that if Universal Health Care is successful the Democrats will get all the credit for it. They would rather disseminate all kinds of horror stories instead of face the fact that we need to take care of everyone and it should be a right not a privilege to get help when you are sick. By the way here in Massachusetts no one can be denied emergency health care because they do not have money.

Ebert: Looks like it's going to pass, and if it works the Republicans will be long remembered as the ones who opposed it.

Mr. Ebert, very well said. I hope universal health care comes to pass eventually. I might add: don't forget the mentally ill, who usually end up at the bottom of the heap of unisured. My bipolar, uninsured adult daughter has a $30K hospital debt from multiple hospitalizations that may or may not ever be paid. After more than 12 hospitalizations over the last five years, I believe she received the most effective treatment from the state hospitals, Chicago Read and Tinley Park. Those people know what they are doing.

I wonder if all of the people who say they don't trust "the government" realize that we are "the government".

We are the people who vote to put other people in political office to represent us. We are the people who determine what amendments are made to our state and federal constitutions. We are the people who pay taxes and, directly and indirectly, benefit from the services provided by the government that collects those taxes.

And yet there is an obscene amount of distrust in "the government" as if "the government" is either some unknown 'other' or not of our own making.

Ebert: Some of those people talk like they're living in an occupied country.

Good luck America... from what I've seen in the news so far, you're gonna need it.

Roger (and others from the US),

I live in the UK and have suffered from a varied collection of illnesses all of my life, ranging from the easily curable to the currently incurable.

My friends and I find this health care debate terrifically idiotic. And I truly feel for you, I do. You see, here, in the UK, since I was very young, I've needed to be admitted to hospital on many, many occasions. I've undergone hundreds of different treatments. My dad suffered a brain haemorrhage and had his brain operated upon. My mum has had double as much treatment for her various ailments as I have, and a couple of years ago had life-saving surgery on her gall bladder. Both my sisters have each needed several different treatments, ranging from simply x-rays to surgery. A friend of mine had serious heart surgery. Another needed mouth surgery. Another has had endless meetings with medical professionals who have all helped to diagnose her obscure condition... etc.

Did any of these people need to worry about money when they got ill?

No.

Are all of these people alive and well?

Yes.

As I say, this health care debate seems idiotic to us. Thing is, people get ill. You could have saved your entire life -- and, by the way, I can't imagine doing anything more tedious -- yet you will never be able to predict in which ways you will need medical help. And how often.

The stress of money with regards to illness is completely foreign to us here. The most we need to worry about monetarily when ill is prescriptions, but there is one standard rate for these (£7.20 in England, £4 in Scotland, £3 in Northern Ireland and completely free in Wales).

I understand the whole socialism, evil government angle. And, perhaps, were I born in a different time and place with universal health care only now becoming a national consideration, I might feel similarly scared. Maybe.

I've suffered enough illness to be quite confident on this matter, and I know many more people who have suffered far worse than me. But, luckily, we were born in the UK. Born in NHS hospitals with NHS medical treatment.

It's by no means perfect, but I simply cannot imagine the scenario being faced by many in the US. The whole process of being ill and procuring treatment is awful enough without having worries of massive medical bills on top. Or fears that the insurance company might discover a 'pre-existing condition'.

Or that, finally, a national health service of your very own is seriously on the cards and a vastly significant number of your nation mates are dead set on it being rejected WHILE you are ill, trying to procure treatment and worrying about medical bills or insurance company small print.

Sometimes, I feel pretty lucky to have been born here. It doesn't happen often, but this ridiculous debate certainly makes me feel very lucky indeed.

Kudos to Mr. Ebert for his scrutiny and answers after the entry was posted. It's rare to see such follow up with such well known figures, especially when it comes to the best practices of blogging. Usually the MSM just ignore or accept comments without meaningful discussion and interaction. Refreshing and worth engaging for.

It's interesting to see how often the philosophy of liberty is so earnestly countered with this particular issue. The idea that the motivation of libertarianism is based on selfishness is as misconstrued as the notion that the 'social contract' is voluntary. While subsequent philosophers like John Rawls have espoused such equality behind notions like the 'veil of ignorance' in his social justice theory, moderns like Crispin Sartwell have been quite successful in countering these ancient and quaint notions. Most likely the hard edge of Rand is at fault when the mantra of selfishness is presented. It's certainly harder to read Mises who simply concluded that self interest is the basis of all things economic.

If the issue is a partisan political one, then rest assured that Libertarians have no stake in this power. As a Libertarian Congressional candidate in the past, my motivation was to advocate peace and decry debt. Qualities I find lacking in either GOP or Democrat camp that currently holds power. Things like Medicare Part D are creatures of the GOP has much as any, and the moral obligation that imposed on my own kids, I find horrendous and irresponsible.

The HMO's are corporatist creatures of seventies legislation (HMO Act of 1973). The advance of medical technology and the abuse of tort theory have all contributed to the high costs. Intellectual property rights and licensing are also part of these costs (ie. drug patents and state sanctioned certifications). Add the inability to seek coverage with companies outside one's own state and costs continue to rise. It's hard to show the example of the free market when confronted with these combinations of state and corporatist interests. Ron Paul does as an excellent of a job and speaks from the experience of being a doctor, not a lawyer.

Would we ask a farmer or carpenter to suborn their services and products to a government imposed system based on the perceived utility of lower costs ? Would universal food and shelter ever take on this dimension ? Basing the appeal on similar programs abroad is also not sufficient in a libertarians mindset. Because one society imposes a regime on all delivery and claims success does not offer a clear moral perspective.

Libertarians do very much care about their fellow human beings. But they know that appeal to emotions is what starts wars, creates false monetary structures and otherwise oppresses human freedom with imposed collective structures which can only reduce choice and freedom.

Ebert: Well argued.

I've been noticing that on the whole libertarians are incomparably more civil and intelligent than their opposite number on the Festering Fringe thread.

I'm an Australian. If I live in a Nanny State it's not because I get free health care.

If I want to skip waiting lists (which, along with hospital standards, etc, are always election topics, and as such have a downward pressure which will fluctuate in intensity according to public attention/action) the private healthcare industry is still there, and doing very well. If I happened to be wealthy (instead of a student) I might get upset about 'paying twice', but, a) there's heaps of tax rebates for private insurance holders, and b) I would be wealthy precisely because I live in a capitalist democracy which depends upon the health of people like students and other consumers. Surely not all the wealthy people are in the meds business?

Looking in on the debate it's scary how one side can garner so much support on the basis of fear. Since when did Americans get so afraid of America? "But America thrives on free markets/freedom of the individual - we don't think that should change." Yeah, well, at the bottom of free markets/individuals are people. If they're dying or dead their individual liberties won't save them, and they certainly won't make for a flourishing free market (apart from the health industry, of course).

Boy, you sure know how to spark people. I had a quad bypass in 2003 - $150,000.00 ... I needed a heart ablation in 2006 ... $18,000.00. a few more various procedures followed and currently I am currently in good health. I was lucky to have good insurance through all this. Without it I would not be here to write this. I have 9 grand kids to frolic with. Who would deny me this time I have? Everyone deserves as much time as they can get and those opposed to that concept are truly a sad lot. You are a courageous, righteous man Roger.

Your argument about the oil company doing whatever it thinks it can get away with seems to me to call for vigilant government regulation rather than a complete takeover. Similarly, if goverment regulators hadn't been asleep at the wheel, perhaps Wall St. wouldn't have gotten away with making bets on bad mortgages. But no one is suggesting that the government take over Wall St. or the oil industry.

I believe we have a moral obligation to help our fellow man--and that means no one's life is more important than another, and we all should have access to quality health care.

But all of our history suggests that government-run programs, on the whole, become bureaucratic and inefficient. Too much money gets wasted. Whereas free enterprise (for-profit) programs, unchecked, tend to look to maximize profit above all else. Moral obligations fall by the wayside and people lose out on services because the CEO is worried about the profit margin.

So why can't we find a middle ground--allow private companies to minimize waste and inefficiency while being strictly overseen by the government, to make sure our citizens are treated fairly?

I feel that the biggest issue facing the country right now is the massive national debt. And the thought of adding a new government-run program that will cost hundreds of billions of dollars in a time when we are in the greatest debt of our history is frightening to me. I know that proponents of the plan claim it will be debt-neutral, but I am skeptical. The government is notoriously bad at estimating future costs, and tends to count its chickens (i.e. new taxes and revenues) well before they're hatched. I strongly believe we need to be attacking our debt problem first.

Full disclosure: I am a moderate with conservative leanings, and a Christian. I don't always agree with you, Roger, but I appreciate your writing, your ability to provoke thought, and your often elegant explanations of your positions on serious issues. Thank you for providing this forum and for promoting a civil atmosphere.

So, let me sum up: The government has earned our trust...so long as that government is lead by a progressive/socialist. When conservatives have the wheel, all dissent is genuine, even patriotic.

Most illuminating, Roger.

Ebert: No, no. You're being too kind. It's your summary that's illuminating.

I'm currently living in Australia, though I'm originally from the UK. Both of these countries have universal health care.

Growing up in the UK, I just assumed that universal health care was a basic human right. It shocked and saddened me when I learnt that people in other poorer countries didn't have the same rights that I took for granted.

It further saddens me that a country like the US could deny any individual citizen the right to long term life saving treatment.

I just don't see why your economic status should relate to the standard of health treatment that you receive.

Ignoring all the rhetoric, the facts are fairly simple.

Health care costs as a percentage of GDP (2007)

Australia 8.7%
UK 8.4%
US 16%

As far as I can see from my research, the US is getting no appreciable added benefit for this doubling of costs.

I'm also a bit hazy on how the proposed new system could possibly cost more, work less efficiently or damage people in any way.

The only possible negative effect that I could see would be on people with an economic interest in a private health insurer.

To those people I would say, get a conscience and help out someone less fortunate once in a while. Chances are, it won't cost you anything, and you may actually reap the benefits if you get ill.
Win. Win.

Sad to say but I think the U.S. is at a dangerous crossroad in its short history - perhaps akin to Rome prior to the fall of the Roman Empire. Internationally it faces disgrace for much of its foreign policy of the past and at home it has somewhat ignored its beautiful land, its native population, its poor and its middle class that carry most of the cost of its economic decisions. Capitalism and corporate greed are at the basis of this downfall. The current battle over health coverage for all is just the next example of a nation at odds with doing what's profitable rather than doing what's right. One problem is that neither the political system which is indebted to financial support from corporations and self interest nor the judicial system which is bogged down by never ending legal battles is capable of dealing with ethical decision making.

Six years ago when I started a small film festival we screened a film called The Corporation which clearly predicted then where we would be now. In a few days we are screening Food Inc which shows how corporations are destroying our national food system which continues to lead to many of our health problems.

Obama was elected on the hope that he could bring an integrity and a social consciousness back to government. Almost one year in it is looking pretty dim.

Ebert: "The Corporation" is devastating.

http://rogerebert.suntimes.com/apps/pbcs.dll/article?AID=/20040716/REVIEWS/407160302/1023

I have a steady job, and I have health insurance that I'm provided through that job. I'm not in the same boat as many, many other Americans in this country, and yet I am desperately hoping for a public option. Why? Because I am tired of the constant fear that comes with having private health insurance.

My wife and I had a baby this year. After we received the hospital statements, I was billed for roughly 10% of the cost, the other 90% was covered by my health insurance company. However, over time, the health insurance company decided they had paid for too much. For the next six months, they sent me another bill almost every week. They decided time and time again that procedures that had been done or medicines administered shouldn't have been covered (as if it were our choice what the hospital did, as if doctors didn't tell us what needed to be done, and as if we didn't listen because that's what people do--listen to their doctors). All in all, I ended up paying more than 25% of the original hospital bill, way more than I ever should have. And this was a case where everything had gone right: the labor was quick, there were no complications, my daughter was perfectly healthy.

I know for a fact I will never be able to afford a real medical problem. I know that if I ever get sick, really sick, I'm probably going to die. But maybe before I die, my health insurance company will bleed me and my family dry, take every penny out of my bank account they can.

What scares me most is what might happen to my daughter. We live in arguably the richest country in the world. We live in a country where people can buy $65 million homes and $2 million diamond rings. We live in a country, where there's so much wealth that a lot of people have no idea what to do with it. And yet, we also live in a country where children--babies--aren't guaranteed a safe, comfortable life, where children might die from something as inane as a cavity because his/her parents could not afford dental care, where children could be denied health care for being too thin or too overweight, where children can go to bed hungry each night, where children can lose their parents or their homes to medical illness and medical bankruptcies.

I am so tired of our country, a country where the rich control everything and fight tooth and nail to hold on to every single penny, who actually have the audacity to hide behind the veil of freedom as they horde every dollar.

Freedom is NOT having money. Freedom is NOT living in luxury.

Freedom is knowing your kids will be all right.

Sometimes people say "the free market is democratic". And it is, except that instead of one man, one vote, it's one dollar, one vote. That's why the richest five percent of the country have majority rule, based on the "democracy" of the market.

Thank you for this wonderful post. Every time I hear conservatives, most of whom allege to be Christian, voice their opposition to universal health care I think of this: whatever you do unto the least of these you do unto me.

I've been reading some of these posts and I have to say, what is it with people comparing a national healthcare with Cuba?!?! with Hitler?!?!

Is it really so bad trying to help the people of our nation? Let's make it clear... National Healthcare is not for the poor, it is for everybody. It should be a system where one should not worry about going bankrupt for getting sick.

In fact, it is in the governments and the country's interest for the citizens to stay healthy because they can be more productive. (Does this make sense to anyone?)

We can still have a free market, it does not mean we are going to become a communist country.

I don't want government in the health care. I think that as terrible as it is that some folks don't have health insurance the government cure may be worse than the disease. I agree that there are problems with the health care industry but I noticed that no one has asked the question, how are governemnt laws already screwing up the industry? My experience has been that's always the first place you should look when a market is messed up. The answer to problems caused by government interference is not more government interference. Some people don't like the profit motive in heath care but I submit that in all other industries the profit motive and competition is what gets us the best products at the least cost.

Excellent (if a little long) article on a second option:

http://www.theatlantic.com/doc/200909/health-care

From the article, an interesting side-point that often goes unsaid:

The author doesn't say this directly, but the dark implication is that there are worse problems in the health care system than lack of coverage. Like the annual 100,000 deaths caused/influenced by infections received in hospitals. e.g., double car crashes

When did it become popular to denigrate and demean people who believe in personal responsibility as selfish? As "noble savages".

I don't personally know any savages. Does anyone in America? I do know people who don't agree with the liberal solutions for what's wrong with health cost coverage. I guess, in Obama's/Pelosi's America, that it's open season on our character.

The irony, Roger, is that people opposing Federal Government involvement in health care consider you (liberals) to be selfish! You want a right to services handed to you without cost using other people's money. Is that not the definition of selfish?

You argue a very eloquent, educated, and impassioned case for a change in the status quo in health costs. I don't think at this point that anyone in America - liberal, conservative, libertarian - disagrees with the need for some level of reform. We certainly don't agree entirely on what exactly is broken, let alone the proper reform is.

I say that you hinder your eloquent argument when you:

- dispagarage your critics as "selfish". Not helpful. Many of us were raised on the idea that we had a responsibility to be a contributing citizen who wasn't a burden on our neighbors if we could at all help it. Yes, a safety net! No to a broad entitlement.

- disparage insurance companies as greedy. Not helpful. Why do we have insurance companies in the first place? Because we wanted them! We want a way to mitigate our risk through a risk pool. We all have stories about insurance. Me personally, I am extremely grateful for my insurance company right now. One short story: within the last month I picked up a prescription for a sick child. The price: $1080! My insurer picked up $1030. I paid $50. I couldn't have gotten it without them. I'm grateful to them.

- imply that the Social Contract does not have a personal responsibility component. The Social Contract, the Civil Society, etc. can't function without personal responsibility at the heart of it.

- Argue that we are worse than other Western Democracies. That only carries weight with elite liberals! We are not worse, just different. I don't particularly care what other countries have or do. They don't have our history, we don't have theirs. Let's solve our problems our way.

You, and the Democrats now in power, could easily win this debate if you approach it in a different way. Instead of saying, in effect, "We know what's both "right" and good for you, and we're going to cram it down your throat whether it violates your basic principles or not!", why don't you do this:

Have a national dialogue on what's wrong with the system first. Have town hall meetings, but not to sell your boondoggle. Have town halls to have Congressmen listen and compile lists. What's wrong with the system. Here are some possibilities:

- portability: our employer-based system is a problem. My employer doesn't buy my car insurance or pay my rent. If I bought health insurance like I bought car insurance, I would have it when I changed jobs, or even lost my job.

- safety net: some need it routinely. We all need it when health costs are catastrophic

- pre-existing conditions

etc.

What are possible fixes without going to "single-payer" government run health care - which is where we are headed whether you admit it or not, starting with the government option?

- buy health insurance outside of our employer. (with a corresponding raise in pay)

- provide temporary health insurance as part of unemployment insurance when you lose your job

- anyone undergoing catastrophic expenses would qualify for Medicare

etc.

We certainly don't all agree on what the fixes are. But a national dialogue on just what is wrong would help get over the rancor.

Just my opinion.

Ebert: You write:

"The irony, Roger, is that people opposing Federal Government involvement in health care consider you (liberals) to be selfish! You want a right to services handed to you without cost using other people's money. Is that not the definition of selfish?"

Actually, we would like to see health care provided for everyone, including you, using everyone's money.

Coincidentally enough, I'm in a Social and Political Philosophy class that addresses these very issues you bought up, Mr. Ebert, about political justice and distributive justice.

Have you read anything by John Rawls? I recommend his paper "Distributive Justice". It's a fascinating take on what type of justice would be beneficial to the most, although it isn't quite perfect, just like the idea of contractionalism. Robert Wolff wrote an interesting piece for anarchy, although it too has flaws (possibly too deep to recommend, in my opinion). His paper is entitled "In Defense of Anarchism". You ought to read both, as it will illuminate the political debate occurring right now.

I find the phrase "the government" to be moronic, and I'll tell you why. It's used as if there is such a thing, and there is not. The government is a changing collection of people with no special motive or mindset, until their actions prove they have one. The same can be said for a corp. The people who are running the aforementioned oil company decided to do what they did. If all new employees replaced the old, and they had a certain character, then it would not, could not, happen again.

Humans and their brains run everything on the planet and companies and countries are hypothetical fantasies.

That's a fact.

So, a high quality ethical brain that is employed by the government can achieve the same level as one working for private industry. There is no difference in answering to that brain versus it's private industry counterpart. So the whole idea of "the government" controlling "my healthcare" is part of a nonsensical fantasy. Humans control everything in the human world.

What drives the fantasy is the profit motive, as mentioned in the article. The idea that the government human is somehow different from the corp human, must be installed in the mind for the fantasy to work. That's why broad statements like "the government" are tossed around. It's a heuristic with little real meaning. There's so many in the media that i can't count them.

As much as I hate it, it's pretty powerful rhetoric, because how in the hell does anyone trust people making profit off of your health? If we saw that same story in a sci-fi movie, we'd know who the bad guys were instantly.

Practice thinking.

Libertarians:

There's some good stuff in the philosophy, but about social programs, it's royalist, and so not American.

Rationale:

Libertarians believe that everyone should be responsible and take care of their own affairs. If they don't, then it's their fault, because they should have planned their life out.

I can agree with that, if I stop there.

However, many "losers" have children and why should they suffer because mom and dad are addicts, poor planners, or general goofballs? The kid could be a genius.

That's the UnAmerican part. Ben Franklin believed in the "natural born genius," as opposed to one bred via royalty, and the US was supposed to be a level playing field to foster the growth of the genius. Libertarians assume the old royal model that a "loser's" kid is a junior loser and not worth taking care of, so why waste money on social programs? Meanwhile, the child of a "successful" person is like a royal shinning being.

Sinister.

It is and it's why we had our near communist revolution.

Don't believe that the US was a proto-communist movement, then look up what Jefferson wanted to do with land. He wanted to continuously take it off of rich people to make sure that citizens had a means of production. Thomas Paine wanted National Healthcare back in the 1700s! He believed that healthcare is a right. All of that was to make sure that each person had the same initial advantages, so that they could prove themselves through work and intellect.

I'm rating this movie "One star" and would like someone to turn on the lights.

Please.

I'd argue that a public option would increase competition. People would no longer need to seek a job that provides health insurance for their family. Instead they would be free to pursue the job they are better suited for or better enjoy. More people could go into business for themselves or go to work for a small business if health insurance was no longer the deciding factor. Large corporations would have to take steps to retain their valuable workers, increased wages, more vacation time, etc.

Mr Ebert,

Excellent piece as usual.

@Grace Wang : Madam, you have captured the essence of what Mr. Ebert was saying and framed it in a wonderful manner. Kudos.

Roger, I think you misrepresent the ideals you oppose, forming them into easily defeatable arguments. First, libertarians do not believe that companies that go for profit will do so for the common good. However, they do argue that the profit motive will lead to a higher quality of life. They reference that America has had great gains in economy and standard of living during the least regulated times. Further, no libertarian is going to state that Chevron is in the right. You actually used an example that counters what you are arguing. You displayed an example where a government provided right to drill on other people's property has caused catastrophe. Libertarians would have it so that Chevron would have had to have secured the property rights from the people who control that property (the natives), and any damages to the property would be recoverable.

Further, libertarians are not against universal health care. They are against federally mandated universal health care. The difference is important. In one case, people want all to have access to affordable health care, and when they can't afford it, want the good nature of man to afford it for them (charity institutions of all shapes, sizes, and beliefs). And if those institutions aren't available, we hope that the good nature of medical professionals will ensure that the person is property treated. Though we understand that extremely pricey treatments may not be available equally to all (though often they are, such as experimental cancer medical treatment [which will not exist as it does today in 5 years if the Democrats get their way].).They also want this health care to be of high quality.

On the other side, others, such as yourself, want some quality of health care (decided by non-medical professionals who have had no personal contact with the person needing treatment, and who are provided a strict budget and must make decisions that prevent them from doing so) to be provided to all by forcibly obtaining the moneys of others. So in one case, people have a choice of insurance groups, and when an insurance group won't provide coverage to too small of a baby, and news hits, people are free to change from that provider to providers that their ethical beliefs better fit. However, under a government provided universal health care system you would have no choice. You either take the governments decision on the treatment that they decide you are to have, or you don't. Maybe you have some supplemental insurance. Maybe not. Maybe you can get charity, but less likely, as there's less charity money available the more people are taxed.

I believe you really want to help people - but what if you were actually making it much worse? Socialism has been tried everywhere, and has always failed.

The cure for poverty is production. We need more skills, more education, more technology. Health care will continue to improve over time, as long as too many regulations don't kill it. Remember, the government does not produce anything. More government intervention means more fraud and more corruption. Insurance companies can only be evil if they work with cohorts in government. We need more competition to keep the insurance companies honest. Even now there are too many regulations, and it's too hard for new companies to enter the field and provide a better product.

All these stories about people with huge debts forget one thing - how is it even possible to run up huge medical bills? It's because we have so many amazing technologies to help people, but they are not free. If we kill our health care system and drive doctors away, existing technologies will no longer be available, and we will lose out on new ones.

It makes no sense to focus on health care as a primary issue. You have to go down to the root - if everyone was more free to produce and innovate, every aspect of society would improve.

Ebert: You write: "Socialism has been tried everywhere, and has always failed."

Universal health care has been tried in every other Western democracy, and it has always worked.

I'm for "fixing the system", but unfortunately, the snippets that have come out about the evolving and expanding bill make me suspect this is more about "gaming the system" to move more power to the government and away from the free market or capitalism.

Originally, the plan had very large penalties assessed (and unfortunately collected by and retained for when it should go to the companies providing the service) the government, to "force" you to "buy" insurance (subsidized or otherwise, not an AWFUL idea), and this got the insurance companies on board because they'd have a ton of new customers buying into their risk pools. Then, the bill I believe changed, and they've reduced the prohibitive penalties so they're more manageable (and more likely to be collected). The problem with this is they've given the public an incentive to NOT buy into the risk pools when healthy, especially since they will no longer allow insurance companies to deny coverage for pre-existing conditions. So what this does is people will go without coverage until a catastrophic illness occurs, then pay the small fine to the government and get coverage to pay for it.

This is akin to not having auto insurance, then waiting until AFTER you've wrapped your car around a tree (or school bus), THEN dialing State Farm or Geico from the roadside and demanding coverage after you've paid your ticket.

Oh, and locking conservatives out of the debate isn't a way to build a comprehensive solution either.

As far as tort reform is concerned, it'll happen, AFTER the government runs the health care system (the end game after the insurance companies go bankrupt for this lousy plan they're going to railroad through), and decide they don't like being sued for malpractice.

My problem isn't with the IDEA of universal coverage. It's wonderful. My problem is with the practicality. We cannot vote ourselves rich. There is not enough money to pay for everything we would all like to have, even if we are being relatively modest. Every nation that provides a social safety net also runs debts and deficits. A single glance at the IMF website will satisfy any doubters.

Government optioned health care will increase our national deficits. Privately paid health care will increase our personal deficits. The problem is this:

Healthcare is expensive. It costs about $200,000 to go to medical school. It costs millions to build an MRI machine. In order to recoup the costs of the infrastruture of health delivery systems, medical care must be more expensive than the average person can afford. And if the average person cannot afford it, then people will have to go without, eventually. Because by definition, it is not possible to provide for all that which the average person cannot afford. There is not enough money.

The cost of medical school keeps going up because the government subsidises it with student loans, and universities do not care how much debt they heap upon their students. So they raise tuition, the government pays it, and huge numbers of physicians default on the payments of their loans.

We will go without universal health care, as a society. We may beable to put it on the credit card for a while, maybe even a century. But eventually, there will be no one left to buy our debt. And it will all end.

What is it about the fundamental nature of a politician that makes them more trustworthy than a businessman? Whatever their motivations, be it profit, power, what-have-you, they're all humans, and humans are self-interested. There are corrupt businessmen and there are corrupt politicians, yes, though I side with libertarians because I think the power of the State is greater than the power of a corporation, and hence more dangerous. In your story about the Ecuadorian Indians, you fault Texaco; I would place greater blame on the Ecuadorian government for granting Texaco the power to destroy the Ecuadorian Indians' community.

That's not to say that Texaco is at fault, because it is, and it seems a lot of people are quick to assume that libertarians champion businesses no matter what they do. I don't think that's the case with most libertarians. On the contrary, most libertarians would likely be against the collusion of business and the State--that's corporatism, and that's a very bad thing.

But I think at the heart of the issue is concern for others. One of the other commenters posted something to the effect of "We agree on the ends, but we disagree on the means," that's a good point, and to that end we can all agree that concern for others is a good thing, but a lot of people, myself included, draw a line between an individual choosing to help someone and an individual voting on a law that would relinquish that freedom of choice for everyone else.

--Nat

Hi Roger,

Although your appeals to compassion strike a chord with me, I think you're arguing this the wrong way. We don't need compassion in order to defend universal health care. The plain, simple, economic truth is that the selfish person should support health care reform. It's flatly in his best economic interest.

Here are a few arguments, based on bedrock economic principles, that should appeal to the rationally self-interested utility-maximizer:

1) Insurance pooling. A lot of people talk about insurance without ever thinking about what it really is. Insurance is simply a system whereby people pool their resources to protect against costly bad fortune. As long as there are more lucky people paying into the pool than unlucky people drawing from it, the system works, and everyone can go about their day without fearing the future. That enables people to take risks, which is a very good thing for the economy.

And here's the thing: the bigger the pool, the easier it is to maximize efficiency. Because bigger pools diversify risk. If three people are in an insurance scheme together and one of them gets sick, that's a pretty big burden for the other two to bear. But if 1,000 people are in the pool? No big deal, right? So it is categorically less efficient to have a dozen small insurance schemes than to have one big insurance scheme. Much to the chagrin of health-care opponents, government supplied health insurance would be an efficiency-maximizing intervention in the market, if it broadened the insurance pool. Everyone, from the people drawing on the policies to the people paying into the policies, would be less exposed to risk, and would bear less of a financial burden. This is part of what makes single-payer systems more cost-effective.

Are you listening to this you selfish bastards??

2) Maximizing public goods. The free market is generally the most efficient way of allocating resources, because it allows people to trade things they don't want for things they do, without any planning or oversight involved. It's the simplest possible utility-maximizing strategy. It is extremely powerful. This can't be denied.

However, the market is not always an efficiency maximizer. A "market failure" occurs when the market fails to promote what we call "public goods" - simply put, things everyone values. To solve market failures, we create institutions (like governments) that can coordinate people in ways the free market doesn't.

Consider education. The private market sets prices much higher than most people can afford (for good reason: that's the price at which they can maximize revenues). But society benefits as a whole when we have an educated population (we're more productive, more innovative, more wealthy, etc.). So the government quite rightly intervenes to subsidize your education. And this is positive sum, because after the governments done paying for you to go to school, you go out and earn better money than you would have. Thus, the government is able to earn its investment back from you several times over in higher taxes - and does the same for the next person. And everyone's a winner. Ta-da!

Also consider insurance pooling, as mentioned above. Theoretically, we don't need government to make this work - we just need everyone to realize the gains they can reap from a larger insurance pool, and then pour their smaller pools into one larger one. Then everyone wins. But there are two problems to doing this: first, not everyone realizes that they can maximize efficiency by pooling their policies (an "information problem"); second, no one is coordinating this activity, so people wouldn't know where to start (a "collective action problem"). So we need an institution (government) to coordinate this activity - to everyone's benefit.

(Yes, this comes at the price of some freedom: the freedom to pay more for less. Do you really care?)

In the case of health care, there are enormous public goods associated with a healthy society, but the free market is not producing as much of these goods as intervention could. To name a few:

a) Competition between health insurers is not presently controlling costs (for many, many reasons). Introducing a public option would introduce more competition and make prices lower. This means that billions of dollars currntly being allocated to health care costs could be re-allocated to other (more innovative?) areas of the economy.

b) Providing universal insurance would change people's behaviour: it would allow them to visit the doctor more often. This is a good thing - it would contribute to preventative medicine, catch illnesses early, and generally keep costs down (it's way more expensive to treat an illness than to prevent one). In other words, people will be drawing less from the pool. Again, everyone benefits.

c) Controlling costs will make it cheaper for businesses (who pay for insurance) to hire new people, and possibly pay higher wages to their workers. Thus contributing to a wealthier, more productive economy.

...And on and on and on.

Listen, I speak the language of the free market. I understand why people defend it. But I'm not so crazy as to suggest that it's infallible - no serious person could be. And when it fails to maximize efficiency, it's perfectly appropriate for the government to intervene, to your benefit, my benefit, that rich bastard's benefit - everyone's benefit! (We call this "pareto optimality".)

So there you have it, you selfish jerks. If you can't find it in yourself to care about others, at least think about yourself. You - yes you! - will be richer, healthier, and less exposed to risk by allowing the government to intervene in the health sector. So stop being so damn stupid.

"I.O.U.S.A. [...] highlighted that starting this year, the total expenses of Social Security, Medicaid and Medicare will exceed their respective net revenues, and from then on, never recover."

Then again...

At first I wanted to approach my advocacy for universal healthcare from a legal standpoint: Why it is constitutional, why rule of law is the better regular, etc..

I understand the Libertarian position. It is an earnest position that looks good on paper when written by someone like John Stossel. Their argument is that charities will provide for the needs of the unfortunate. But here’s the problem: They don’t.

The first reason I support the public option is that it will strengthen the middle class.
Our history has shown that deregulation results in consequences like sharecropping, strip mining next to private property, the global economic crisis, fourteen-hour hour days in a sweatshop, undue burdens on the least of us

The second reason I support the public option is pure and simple: Its shameful that the most powerful country in the world allows its citizens to experience this. People make money from cancer here. I can't understand why people aren't outraged by this.

Consider the free medical teams that people wait in long lines to see. These triage teams also operate in developing countries, for heaven’s sake. The patients waiting for medical care would not get in line at 4:30 a.m. if charities provided for them.

If I didn’t have insurance coverage when my kid got really, really sick we would be living in my father’s basement now. It was just a matter of trimming: I had to teach for six months before our insurance kicked in. Had Jake’s unfortunate circumstances happened in 1999, I'd have declared bankruptcy.

Ebert: This is rather off-topic, but I really enjoyed your live music on the South Bend radio yesterday. I was going to call in, but...

I've read all the comments to this post and have a few thoughts to share:

First:

The problem I have with the libertarian concept of "True Freedom" is that it is a practical impossibility. In a real society (even a totally anarchistic one) we are all inextricably linked to one another through a complex series of interrelationships.

Unless one lives their entire existence in a "Biosphere 2"-like enclosure, everything one buys, everything thing one consumes, every bit of waste one produces, every bit of air that one breathes, every plot of land that one inhabits, etc,. has an impact on others. The simple act of, say, putting gas in my car, and driving it around: 1) consumes fuel that requires a complex industrial system to acquire, 2) creates pollution that affects other people 3) puts wear and tear on roads that others use 4) puts other road users in potential danger 5) employs an agreed upon medium of currency 5) puts me in close contact with other humans with potential transmission of communicable diseases (don't touch that pump handle!) 6) affects the future availability of a finite resources, etc,.

How do these things I do have an impact on other people? Let's take, for instance, the pollution angle. Clearly, when I burn gasoline in my car, it puts pollution into the "public" air that others breathe (we aren't all allocated a "box" of air that is ours alone). "But wait" the Libertarian says "the system will take care of that if people simply buy from companies that produce cleaner gasoline and better cars. The cleaner companies will win out." True, but how do you get me to do that when there is a conflict between what is good as a collective choice vs. what is hardship to me as an individual. To explain: Any one individual must, under this system make a choice to endure some greater cost from the system make a very small change for the better in the overall system. I might, say, buy a cleaner brand of gas for, say, 20 cents more a gallon to effect a 0.00001% change in the overall amount of pollution in my cities air. The problem with the system is that it is probably not rational for to me to make the choice of paying an additional 20 cents per gallon to achieve that tiny benefit... that is, unless all other people do it as well. However, a "free" system cannot ensure that others make this choice, and, while altruism certainly exists, we all tend to pick an choose our battles and many problems do not solve themselves in this way.

Also, even if we wish to altruistically opt for doing what is in the common interest, a "free" system assumes we have perfect knowledge of what is good for us. However, in a "free" system, that is far from the case. Lacking regulation, it extremely easy for private entities to collude with each other (create trusts), muddy the informational waters (i.e. suppress the truth, fund misleading "science") or use their greater individual resources to combat challenges their system (i.e. sue the hell out of anyone who challenges them). Moreover, since we must live within the system as it is, we cannot simply do without.

So, all of these different interactions require some agreed-upon system to maintain coherency. A "true" libertarian would argue that that system would best be a private system. However the complexity of any such a system were it to be efficient, all encompassing, and, most importantly powerful enough to enforce collective decisions against its charges, would amount to a de-facto government itself but would not be accountable to the public through the ballot box.

Second:

Regarding the following: "I don't have a natural right to force other people to pay for it. It's that simple. Universal health care is based on force, as is a "public option" which, at the very least, will be founded through tax dollars." It strikes me that the founders of this nation wisely did not protest taxation itself, but, you'll recall from your primary school days taxation without representation ... something very different. We as a society collectively agree, through the power of the vote, to tax ourselves. Our system is not "at the point of gun" (as one libertarian poster called it above) so much as "at the mercy of the ballot box." I regularly vote for and against tax levies in my area, just as I vote for and against politicians who adhere to various taxation philosophies- I do this because I enjoy the rights and services granted to me by the system. Don't want to pay taxes? Don't do anything that affects another person. (see above)

Third:

Most of the posters expressing opposition to "Obamacare" phrase their opposition in the form "I don't want the government to make decisions affecting my health care." (as at least two posters stated above) This statement is akin to complaining that governments not build roads because "I don't want the government to choose where I drive." In other words, its a non-sequitur. The vast majority of the real debate that is going on right now is over a system of payment for health care, not that health care itself (which, ironically, I think we should be having, in an effort to control increasing costs.) The opposition would have you believe that, under the proposed "public option", there will exist some government entity that would decide which care you could get and which you could not. But for a proposed grant of money to study which means of health care are more cost effective, there is nothing in the bill that comes even remotely close to proposing such an entity. What it does do is create a self funding (through premiums) government-based insurance company that would allow people who are somehow denied private insurance (through preexisting conditions etc,.) an outlet for buying a health-plan. That this is not understood confuses me to no end- how again is having an insurance plan that you can opt to buy into restricting your freedom of choice?

Sorry this is so long. There's an old saying "when you've got a hammer everything looks like a nail." The libertarian often falls into the trap of "when you've got the libertarian philosophy, every problem looks like it can be fixed by removing government from the equation". The libertarian philosphy is very appealing because it seems (superficially) so neatly to diagnose and solve a huge host of problems. However, I think this is very misleading.

Interesting. The only thing I kind of object to is this: "The arguments against it come disguised in ideology designed to conceal their common motivation: Selfishness."

True for several people/corporations, and they should be called out on it. However, several of the arguments against government policy in this and other fields are not veils to hide greed, but a very real belief that allowing others as much individual liberty as possible is the most compassionate system. It doesn't stretch just from a want of myself to be left alone, but a want for my fellow man to be left alone. I've no capitalist agenda behind that wish. It's for the general welfare, as I see it. If I become rich, I will give alot of money back. But I wouldn't feel it's my place to make another rich man do the same.

That's more about libertarianism in general-- but on this particular topic, I have mixed feelings, and am skeptical of the hard-core libertarian arguments about health-care. I understand where you're coming from, and wish many others would try to as well; they'd be doing themselves a favor by reading your entry.

Also, a favorite:

"The invisible hand of Adam Smith seems to be giving the middle finger to an awful lot of people."
-George Carlin

Dennis Eddlemon wrote, Some people don't like the profit motive in heath care but I submit that in all other industries the profit motive and competition is what gets us the best products at the least cost.

You mean like in the food industry, where the profit motive and competition get us the worst products at the lowest costs (which, in turns, indirectly contributes to the rise in health costs)?
The profit motive in health insurance is what leads to people with "pre-existing conditions" being denied coverage. It gets really funny (or depressing) when you realize that insurance companies are more than happy to collect money from those people until it becomes obvious that they may have to pay for their medical bills.

As a 30 year old DINK who's getting ready to look at insurance again (it's "Open Enrollment" time for both my wife and I), a quick glance through our company plans shows the following:

My company - Co-pays are staying the same, but the deductible is going up and the lifetime max just got cut by $200K

Wife's company - Co-pays are going up to $35 from $30 (from $20 the year before), the deductible that they added last year is increasing, but the lifetime max stayed the same.

Did I mention that our health care "choices" are a PPO and an EPO, and that's it? After looking at what friends in Canada, Austrailia, and the UK have, I'm begging the government for socialized medicine. I'm young, healthy, and we don't have childern (yet), and I would love to pay a little extra to help everyone else. I know I'm going to need it some day, and would definitely prefer to "pay it forward" right now. It may not be a legally/constitutionally binding document, but people need to remember these lines from the Declaration of Independence:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

Roger, here's an idea: abolish all insurance. The insurance companies are the main force driving up costs. If a free market based on what people could actually pay was allowed to exist, the cost of healthcare would come down dramatically.

It can also be argued that the free market healthcare system of the United States is the engine of medical innovation that other countries with socialized medicine have been parasitizing. Where do the new drugs come from? Not Canada or France, but the enormous pharmaceutical companies.

Thanks for this article and your journal.

How can people be for Democracy, and Freedom but be against 'the government' that a democratic community has elected to protect those freedoms?

Substitute 'our democratically elected representatives' for the word 'government' in all the "how can we trust the government' arguments.

In a democracy, the government, or 'our democratically elected representatives' exist to protect the weak from the abuse of the strong, to protect the minority from the abuse of a majority who would like to take away rights or exploit a powerful position. We only have freedom because we have good government.

Guns and less government don't lead to freedom, not here or in Iraq or Afghanistan. See Clint Eastwood's movie Grand Torino, where the freedom of one man to own a gun did not protect him or his neighbors for a gang of armed evil people. It was the government, or 'our democratically elected representatives' that was able to bring justice and freedom to the neighborhood. Clint's character sacrificed himself so there would be plenty of witnesses who could turn to a good local government. Guns didn't bring safety, good government did.

Other countries like France and the Netherlands insure every single citizen for half the money we spend on health care.

America may have great health care for the rich and lucky few, but it has the worst health care delivery system of the western democracies.

Everyone does it better, England, France, Germany, Canada, the Netherlands, etc.

Why can't America elect good people to our governments that can make a good health care delivery system? Other countries can elect good governments who can solve this problem, why not America?

You can't love Democracy and Freedom and not want good governments who can solve problems.

We don't turn to the 'free market' (which isn't really free at all) to provide roads, universal free education, clean air, safety in the air we breathe or the planes we fly in, safety in the food we eat or drugs we take.

I wish I could make every person who loves the libertarian philosophy could live a year, even two weeks in third world countries. I spent time in Egypt, though many other countires are similar.

The freedoms we enjoy in America come not from guns or less government but because most people most of the time obey the laws the government, or 'our democratically elected representatives' have put in place.

Most people obey traffic laws, obey building codes, most police and judges aren't corrupt, most people do their jobs without demanding kick backs or bribes.

If you love democracy and freeeom, why not ask for better government instead of less government?

Why not ask for a government that can fix our broken health care system?

Wait, we just did. We had an election to get better government and a better health care system.

That is Democracy and Freedom at work. Free elections to elect a better government to protect the vulnerable, the un and under insured, from the abuse of the powerful health insurance industry that can deny life saving coverage at all or deny life saving coverage of one illness.

Democracy has produced better health care delivery systems around the world. Let us hope we can have the freedom of good government and good health care here.

Roger,You certainly openned a can of worms with this entry.Some of the comments are funny but many sad.The gentleman who says he is a Dad and will "find a way" must be watching alot of westerns.This is 2009 Bud.The fact that the US is losing jobs because it does not have universal health care is significant.Companies downsizing and or not rehiring because they cant afford the healthcare premiums should be a major concern to Dad.You cant move for a better job if there are preexisting conditions in your family for fear a new companys plan wont cover you..sheesh.I am a recruiter and I am in the process of moving a candidate with a new baby from Vancouver to Halifax.
In the past month a good friend was diagnosed with a cancerous eye tumor,had 2 specialist vists,eye removed and followup care.The cost was the cab home from the hospital.
It is an astonishing that universal health care is even an argument.

Roger,
Universal Health Care would cost America less money, prevent any number of financial crisis, and raise the quality and quantity of the years Americans spend on this earth. I don't understand how this is a debate outside of Insurance companies desperate to remain cash cows.

Also, further to my above post:

I would wager that a universal health care movement in the US would probably be not only as good as ours here in the UK but even better. I mean, the US is the leader in most cultural movements here these days. Just look at what our cinemas and music outlets stock, as well as the most critically acclaimed shows on television. Is there any way that our government would have led the party into Iraq? No, but they would absolutely follow the US government.

I'm excited at the prospect of a US national health service, because it would probably teach our government a thing or two about how to do it better.

That is, of course, unless your scare mongers successfully shoot themselves in the foot.

I would love a public option that worked. Here's the problem: we already have a "social contract" and it's called Medicare. That program was the right thing to do, it's benefits are many. Why is it referred to as a "looming train wreck?" Because it is currently nearly completely insolvent and cannot continue to operate due to underfunding and a complete mismanagement of expectations, benefits, etc... and NO ONE is seriously trying to fix it or has the political nerve to fix it. Another IOU to the next generation.
Why not resolve the current "social contract," thus proving to all that it can be done and is fiscally reasonable to create a broader public option? Is prudence completely old-fashioned?
Is universal healthcare doable? Probably. Would many Americans be willing to pay additional taxes to pay for a program like this that actually worked? Probably.
But... Has anyone been willing to propose how to even resolve our current "social contracts" (Social Security and Medicare) saving them from complete fiscal meltdown. No. Is it unreasonable then, to be opposed to a public universal health care option until the rest of the "social contract" house is at least near to being in order? No.
It's great to wax rhetorical about the moral duty of providing health care, but wouldn't actual work on existing programs and accounting principles that make it feasible move more to support such an option?

One thing that I have missed in this entire debate...

WHY does the coverage offered by the Feds have to be all encompassing ie a Medicare or something that resembles 'full' coverage? Why not simply provide catastrophic coverage 'only' as a base and then people can purchase bigger plans on top of the base if they choose?

Through regulation, the 'base' plan would have not carry preexisting limitations. Everyone would be covered and provided by the government. Employers would not have to offer any coverage beyond that; only more if they chose to as a part of a benefit package. If the government provided the safety net, then the free market could be used to build from that.

Government would not be in the 'business' of providing total health case; simply the equivalent of Social Security's safety net to avoid catastrophic losses from an illness. Perhaps even using the free market to buy policies from existing companies.

For me, I am self employed, 41 with no preexisting conditions. Anything that might resemble 'traditional' employer based coverage, costs at least $400 a month for anything.

Instead, I have chosen a $5,000 deductible HSA plan. It provides me nothing until I pay out the first 5K. After that, it's 100% coverage. I am fine with that as the policy provides the 'oh God, I've got cancer' coverage but no 'well' care. I am perfectly willing to self insure the first 5K and pay as I go. But I won't lose my home or my car if I become horribly sick. And it costs me about $140 a month. Not dirt cheap, but it gives me piece of mind.

I realize this isn't the panacea that the pro health coverage people want, but I expect it would be a more palatable to the right to cover a baseline and then let the free market would offer supplements like Medicare offerings do now.

It's not perfect, but it 'could' satisfy both sides. The left gets catastrophic coverage to protect everybody and the right still has the free market providing better options.

Am I missing something here?

Ebert,

Much of the complaining against universal health care stems from a misunderstanding of how a single payer system would work. It is assumed that it works like an insurance company where you go to the doctor and then have to check if you are covered for a given condition and then basically ask permission for treatment. This is not how a single payer system works. You go to a doctor, get treated, and then don't get a bill because the gvmt pays for it. That's all. So called rationing occurs only in cases where triage is necessary. There aren't enough doctors to provide every service all the time, so we have to decide which cases are more necessary. Heart surgery before sewing stiches - that sort of thing. The gvmt does not decide the rationing. The hospital does. After all, the gvmt has no profit motive to turn away services.

Also of note on the rationing debate - of course we are being rationed now, just by money instead of threat of illness.

this is not as simple as people would have you believe. the causes of the inequalities are several. those who are happy with their insurance and don't want change probably have never had to use their insurance beyond basic issues. those of us who have had large claims or even not so large ($30,000.00) have had to face ineligibility or high rates with recurrence not covered (put two bullets in the gun and spin the cylinder). If you don't want change, you are being selfish because you have your coverage (temporarily) and you don't care about those of us without coverage or expensive coverage that is inadequate. One shouldn't have to lose one's life to illness because you lose your job and/or your insurance.

Gary writes:

"...there is an obscene amount of distrust in "the government" as if "the government" is either some unknown 'other' or not of our own making."

I think this is well said.

I hope that some of our best libertarian scholars, like Kevin Carson and Walter Block, will respond to this, but I will try to speak for them, and the most radical of libertarian radicals.

First off, the notion of corporations and the "public good" as a motivation. We are all motivated by exactly the same thing -- our own self-interest. There are no selfless and selfish acts. Everything we do, even things that appear on the surface as selfless, are actually selfish. If I were to jump in the water and try to save a drowning man, some would say I have just done something totally selfless. But I expect something in return -- I expect to have an elevated sense of self-satisfaction rather than guilt at not trying. No one ever does anything for the public good. The example presented in "Crude" is exactly the kind of thing a libertarian would use to show how the state can be bought by the rich and well-connected and used to commit institutionalized crimes. Ebert wrote it himself -- "Chevron, moved in with the permission of the national government, which had previously ignored them." As I will note later, a megacorporation like Chevron, or whatever it calls itself now, could not exist without the state subsidizing its transaction costs.

I'll believe in the "Social Contract", which sounds like slavery to me, when I see the document and can evaluate it. I know what Lysander Spooner, one of the great 19th century liberals, thought of the Constitution, a contract which I didn't sign, and nobody alive signed.

Hobbes said that in a state of nature, ie. anarchism, the strongest will dominate the weakest so we have to create a leviathan state to stop this undesirable activity, or to stop "war of all against all". The trouble is that in creating a state, we have the strong -- the state's allies, dominating the weak -- all the rest of us. In short, the conditions Hobbes wanted to prevent come about when his solution is implemented.

I hate it when Ebert uses the term "free enterprise" to describe American State Capitalist activity. There is nothing "free" about business conditions in America. Actually most of the First World has been transformed by the state into rigidly structured cartels, including certainly health care. There's no real price competition in any industry, including health care. Big Pharma is granted patents by the state, which allow for high margins on prescription drugs, hospitals are granted monopolies over treatment of the sick in a given territory. "Universal health care" is merely the further subsidizing of already state-privileged insurance companies. That doesn't solve the problem. The state is incapable and unwilling to solve problems it created.

Regarding corporations, Kevin Carson, in Organization Theory, suggests convincingly that mega-corporations would not be possible in an anarchistic society because their transaction costs would cause them to be unprofitable if the state were not subsidizing those and other costs.

Imagine a society where we all live peacefully trading with one another, running small businesses that serve local communities, no large corporations, no state-run funny-money system, no patents, cost of living so low anyone can afford a comfortable existence on a 20-hour work week, and you can imagine what a libertarian sees happening without the state. State planners cannot bring this about, because as F. A. Hayek pointed out, they do not have all of the information they would need to implement the plans. They would need to know everything about everything.

I want to make another point about the notion of man in a state of nature. It is not our state, or our laws that stop us from committing crimes, it is our culture. It is our core beliefs, given to us by our caregivers as children. If murder were suddenly legalized, only criminals and not the rest of us would carry out murders, which happens anyway of course.

I've been all over the political spectrum in my life, because I'm not afraid to challenge my beliefs. I arrived at libertarianism after reading Murray Rothbard's masterful and brilliant work. I cannot believe anyone could stand up against the relentless pounding of Rothbard's logic. Kevin Carson has gone a step further, and as far as I'm concerned is Rothbard's heir apparent.

Here are some good places to start:

Rothbard's essay "Anatomy of the State": http://mises.org/easaran/chap3.asp
Kevin Carson's blog "free-market anti-capitalism": http://mutualist.blogspot.com/
Lysander Spooner's "No Treason", published in 1870, which argues the Constitution is an illegal contract: http://lysanderspooner.org/node/44
Rothbard's Libertarian Manifesto: http://mises.org/rothbard/newlibertywhole.asp
All books and articles by Rothbard: http://mises.org/literature.aspx?action=author&Id=299

Ebert: Rescued from spam.Too many URLs.

With you Roger I’d tend to agree on this topic. That certainly isn’t the case with your praise of “Zombieland,” but that’s a topic for another day.

The Declaration of Independence is quite the document for speaking to what existence means to a human being. It reads, “all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” There is no caveat on any of the three mentioned. Further, it reads, “That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed.” It’s the next damn sentence and an important one with respect to health care.

Forget about distrust of the government or whether we agree with the government. We should be able to ask the question, “is the government doing its job on the topic of health care,” and I would argue if a significant portion of those who provide the power to the government do not have a secure right to Life it means the government is not doing its job. “Life, Liberty and the pursuit of Happiness” isn’t about political leanings or even nationality. It’s a humankind type of thing, and right to Life seems to be pretty important as it’s the first one mentioned. It’s shameful to think humankind was given such a statement by a nation that lives up to its ideals only if it's convenient or in step with our political beliefs. Universal health care is hardly a revolutionary idea, but securing the unalienable right of Life is and we would do well to remember it.

For the civics lesson and for the soapbox I apologize, but either we believe in what we are, unconditionally, or we’re a pretty awful posterity to those who eloquently said a person has worth by the simple fact that person exists.

Dear Mr. Ebert,

I love your journal. It seems one of the few places left in the world to find thoughtful debate on important issues instead of sound bytes. Ok, so I'm a conservative Texan who has become convinced that universal healthcare is the right thing to do. Let's vote over enough power to Uncle Sam to actually end this cycle of uninsured-ness and waste that the private system is perpetuating. That's all fine and dandy.

I agree with you especially when you say: "I am told we cannot trust the government. I believe we must trust it, and work to make it trustworthy. We are told the free enterprise system will sort things out, but it has not. When insurance companies direct millions toward lobbying and advertising against a health care system, every dollar is being withheld from sick people. When it goes to salaries, executive jets, corporate edifices and legislative manipulation, it isn't going to Amy Caudle."

The Caudle story is one I found deeply moving, and one I'll not forget. But there's a "but" coming, and here it is:

Say healthcare wins, and wins big, public options and all. From then on, the government has the power to help. Great. But doesn't it also then have the power to re-define what necessary help is? I'm talking about conscience protection. We give Uncle Sam the ability to treat everyone's cancer and diabetes in the whole country, but doesn't that also give Uncle Sam the right to use taxpayer money to fund abortion, euthanasia, cloning, and organ harvesting? Can we honestly give over that much power to the government and then trust that there will be rock-solid, credible, and permanent conscience protection for people (both voters and doctors) who agree with documents like John Paul II's encyclical "Evangelium Vitae"? I'd love to give healthcare my vote and fix a corrupt and bloated system that is leaving tens of millions in desperate circumstances, but can you convince me that ten years from now, the enhanced powers of the government won't be used to fire OB-GYN's who won't provide abortions, or to force taxpayer money to fund abortions and "mercy"-killiings? There's the rub. I think the whole "death panel" debate was overblown and terribly harmful to public and private discussion on these issues, but come on, you've got to agree that there are a lot of people in this country who think that after universal healthcare should come governmental re-defining of medical ethics, and the brushing aside of millions of people who adopt an uncompromising line on the dignity and inviolability of every human life from conception until natural death. So, what am I to do?

Brother Augustine, Cistercian monk in Texas

p.s. "Evangelium Vitae" is John Paul II's 1995 Encyclical on "The Gospel of Life", pro-life ethical issues, human dignity, and what he dubbed the "culture of death." For a MUCH more colorful body of reading on the mysterious value and dignity of each individual human life, I recommend the short stories of Flannery O'Connor and the "Divine Comedy" of Dante Alighieri.

p.p.s. Was Gene Siskel as political as you are? If so, did he leave us any interesting writings on American politics? I figure he was at least as smart as you, so maybe I should read some of his work from time to time, too, if, that is, it is available somewhere on the net.

p.p.p.s. "My Dinner with Andre" is one of several amazing movies that I would never have discovered without you. Thanks, Mr. Ebert!

The "veil of ignorance" espoused by Rawls is an excellent philosophical framework to view this type problem. By stripping away all knowledge of one's personal position in the healthcare world, any discussion among reasonable people would clearly gravitate to a public option, as health care would rightly be considered a human rights issue (not a quality of life of issue or an economic ideological issue). In other words, behind a veil of ignorance one develops policies and ethical stances without the knowledge of one's position in the healthcare landscape -- you wouldn't know if you were to be healthy or sick, rich or poor, old or young, citizen or immigrant, employed or unemployed, insured or uninsured, etc. Very quickly, there becomes no rational argument that excludes healthcare for a large group of people if the one making the argument cannot predict with any certainty into which category they may fall. To conclude otherwise is to say that you are willing to gamble that you would never fall into a category of uninsured and sick.

The the Realist:

And to your point that universal healthcare works abroad. It won't soon. The fast approaching demographics of 6 people retired for every one person working in Europe will collapse the system all too soon. You know it. I know it. They know it. No one wants to face reality. Just more handing out of loot at future generation's expense. No thanks.

What the hell is your source for that? I sure didn't know it and I'm pretty sure I'm not the only one here. These numbers would suggest that approximately 86% of Europe's population is over the age of 65 and I don't have to do much research to know there isn't a single country on earth whose demographics break down that way. The only possible basis I can think of for this claim is that some countries in Europe have seen a slight decline in population due to lower birth rates, but not anywhere near at the rate that would be needed to create that kind of discrepancy. I suspect, like many people, you are grossly exaggerating the facts to serve your own ends. Unless you can produce a reliable, impartial source that backs up your claim, I'm officially declaring shenanigans on your info.

Mr. Ebert,

You've already done so much, but will you consider one more thing?

Go on TV.

I realize you can no longer talk but go on TV.

Oprah? CNN? Maddow? I'm sure they would have you.

Better yet go to the belly of the beast and appear on O'Reilly.

I can think of no more eloquent voice on this topic or a more striking visual image than Roger Ebert speaking on health care.

Please.

Incidentally, there is a fantastic pair of hour-long episodes of the Radio Program "This American Life" dealing with the reasons that health care cots are going up. As normal for the show, the reasons are quite surprising for those with only a cable-news influenced view of the issue.

Anyone interested in the health care debate would find this program fascinating and distressing:

http://www.thisamericanlife.org/Radio_Episode.aspx?episode=391

http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321

I bet you'll come away from listening two these two hours looking at the insurance industry in a more sympathetic light.

As a Christain who leans towards conservatism, I do share your opinion that everyone should have access to health care. The problem I have is that the whole system, from insurance and malpractice cases and infastructure reform (I'm sure I'm missing more) in order for this not to greatly increase an already crushing debt. There are so many competing interests that point to others as the source of the problem that I don't see this getting solved in an effective way unless everyone (health care providers, insurance companies, drug companies, lawyers, et al) works together and I'm just not optimistic about that.

If you are an idealist, Mr. Ebert, it is certainly preferable to the furrowed-brow suspicion that seems to be the default mode that many of us operate in. If it isn't the government, it's the layabouts and lazy that want to break down our walls and cross our moats to reach into our pockets. What an unfortunate point of view - not entirely without supporting evidence, but not an attitude conducive to caring about one another.

Not that pragmatism should be tossed aside - we don't want to reap ruin while we sow good intentions. But I've read some good arguments here and elsewhere regarding the practicality of universal health care, many of them from our Canadian neighbors.

Will we get it right the very first time? Perhaps not. My father was a minister for many years, and would often quote that one should "err on the side of grace". That is a statement that can be applied from a humanistic standpoint as well as a religious one. And what a world it would be if it was the way we lived. Is that idealistic? Certainly, but I prefer it to the battened-down hatches of seclusion and exclusiveness.

I feel saddened, watching this debate from the North. I simply cannot imagine not having universal health care. Once you live with universal health care, as we do here in Canada, trust me when I say that you will never go back.

Please, please do not listen to right-wingers who speak about Canada or the UK as having a "terrible" health care system - it simply is not true.

Mr. Ebert,

Health care is not a right. It is an individual responsibility. That is not subject to opinion. It is fact, whether we want to disagree with it or not. The United States does not have a "health care system." Never had one. We're supposed to have a free market economy. The error here is not that we don't have socialized medicine, it's that we allowed our government to get into the health care business in the first place back in 1965. That is where the trouble began. I'm afraid you're all too quick to foster the liberal sense of entitlement that is dragging this once great nation down. Government needs to get out of our lives in order for the system our forefathers set up to work. The more government gets involved in our lives the more we lose.

Here in the United States, we're all free to pursue happiness. It's not guaranteed. And when we try to be all things to all people, we end up accomplishing nothing. Majority rule has NEVER worked in the history of the world. That's why our forefathers established a representative republic. Please quit helping to incrementally dismantle it.

Mr. Ebert,

Thanks for a compelling case which makes one (well, having read some of the prior responses, most) reconsider his or her own views if they are different from yours. What a welcome treat from what passes as discourse in America today.

I'm 36 and have been under the aegis of government health care my whole life and, surprise to the rabid right, everyone has been paying for me (including me) the whole time. I am a military "brat" who joined the military at 17 1/2, and have never taken breath when I couldn't be seen, no charge, by a government health care employee.

When my daughter was born, she went to the Neonatal ICU and had surgery on her second day of life. Our total cost for the whole experience was just under $4, and that only because the cafeteria charged me for a dinner I ate in the room. The care was exceptional, the nurses and doctors enthusiastic, professional, and satisfied, beyond the typical complaints of so-and-so being late or so-and-so never making coffee... I don't think, given these circumstances, I can accept the pictures of doom and gloom the anti-health care reformers paint. The system CAN work!

For the record I'm something of a liberal conservative, but it worries me when we as a people insist that the invisible hand control every aspect of our lives. When it comes to life and health, shouldn't curing the sick and easing the pain of the dying be profit a-plenty? Some don't think so, and I at 22 didn't think so, but now I'm not so sure... If, for a little bit each month, I can help my neighbors when they sorely need a hand up, can I call myself a Christian or even a human if I'm unwilling to do it? We don't complain about sales taxes but we shirk at helping people stay alive and well?

I doubt, sir, that you and I would agree on the specifics of any plan, but I think your support of reform is laudable, and hopefully your wishes in some form will come to pass.

Also, I very much appreciate your movie reviews!

I am a Canadian, who, if not for universal health care, would not be around to discuss this issue. In 2004 I was diagnosed with Esophageal Cancer. I underwnet extensive surgery, radiation therapy and chemotherapy. Aside from parking fees at the hospital I did not have to pay a single penny towards my treatments. However I know several people who have had to sell their homes in the US to pay for the surgery alone!!!! Surgery for this type of cancer can run upwards of $220,000. This is not right - people deserve an opportunity to fight their disease, any disease without having to worry about how to pay for it. The emotional burden of a possibly fatal diagnosis is stressful enough and even with health care paid for there are still financial issues that have to be dealt with. Universal health care does not include the mortgage/rent payment every month. It does not include the grocery bill, the electric bill or the car insurance premium.
I truly hope that President Obama get's the ball rolling toward providing UHC in the US. There is too much to lose if it doesn't happen.
From where I sit north of the border, it seems to me that there needs to be less "business", thus the bottom line, for the corporations involved and more caring and compassion as prescibed by the Hypocratic Oath.

I live in Canada... to those who argue that Universal health care is to expensive, I cannot help but point out that Canada has higher recovery rates from most major illnesses, and a longer average live expectancy, while spending half as much on health care.

As for the argument that its very existence is a forceful act- that can be applied to a huge portion of human action- the pollution by Texaco mentioned in the article, or indeed, on a lesser scale, the pollution caused by driving a car. The act of removing essential resources from the environment. There are myriad examples- our very existence, regardless of how much me might care to isolate ourselves, is an imposition on others. Health care funded through taxation, especially given its benefits, is a minor imposition.

Roger, I don't know if you are still reading these, but have you seen a documentary called "The Corporation"? It puts forth the argument that corporations are, by their very nature, sociopathic. It traces the history of corporations from their invention in the 1800's through the present day.

It's certainly worth a rental, and even if it comes across as propaganda, everything in it is easily verifiable fact. The facts are just presented in a way that makes you wonder why we have been putting up with this crap for so long.

Highly recommended!

-Ralphie, (not a libertarian, just a good Democrat)

Thank you so much for writing this, Roger. This is one of the clearest and most eloquent arguments in favor of universal health care that I've seen.

I'm not a Communist, but there are some industries that are so critical to the rest of the economy that it's simply irresponsible to leave them to the free market. Health insurance is one of these. The private health insurance industry is so drunk on their massive profits that they have completely blinded themselves to their original purpose (much like the financial industry, come to think of it). They have failed us, and there's no sign that they will ever reform themselves without massive regulation.

Have you seen this story about women losing health coverage because they've been sexually assaulted, leading to health risks (such as PTSD or having to take precautionary AIDS drugs) that their insurers consider to be preexisting conditions?

As far as I'm concerned, any industry that could act with this level of utter, inhuman callousness has lost its right to exist and to do business. I want them destroyed. I'll accept the public option for now, but only if it eventually leads to single-payer.

b.

Check out this Boston Globe article about how the Founding Fathers dealt with (or rather, didn't deal with) healthcare in colonial America and the early days of the republic.

I love how society crams our young heads full of stories about goodness and charity and sharing - take the teachings of Jesus and Dickens' "A Christmas Carol", if you will - only to shun them so completely by the time we're being seriously jabbed in the back of the head with a pitchfork to pick a career. Help others and obey the golden rule, but, don't forget your American duty to get ahead by doing what it takes, regardless of who you step on or cast aside in the process.

Socialism (or anything that can be compared to it, rightly or not) is about the welfare of all. Capitalism is about personal gain above all else. If it isn't crystal clear which one of these skews closer to supporting, nay, justifying, behavior that's outright evil, then maybe the people who can't see it are too far gone to help.

If the freedom to not help your fellow man is so important, what say we allow these misanthropes to not partake in universal health care? They can pay for it out of pocket when the time comes that they need an iron lung or replaced hip, and maybe when it reaches the point that they can't afford the anesthetics for their latest round of surgery, they'll reconsider just how important their charity-depended happiness really was.

Roger, you said we must trust the government and you have written many articles to promote the government agenda since Obama becomes president. However, you didn't trust government when Bush was in office. Do you know how the govenment socialized plan will work? Blindly promoting the govenment's agenda without knowing the details is a bi-partisan politics. I don't trust the govenment will solve the problem unless they know the root cause of the problem instead of just throwing money in it (remind you about the stimulation packages that Obama implemented). I understand the political belief is just like religion. It is difficult to change someone's political belief. I was belong to Democratic party for 25 years and just left the party and become independent.

Ebert: It wasn't government I didn't trust. It was Bush.

Roger, as a citizen of one of the other Western democracies, I simply can't believe that half of the comments above are so mean-spirited and illogical. I have had medical incidents in other countries, most notably in France and in the U.S. In France they treated my for a broken arm. I was just plain admitted and once I was all x-rayed, slung up and about to be released, they asked me if I had any insurance. I told them that I had my Québec Health card and a supplementary foreign travel policy.policy, but that both were back at the hotel. The nurse told me that I should take the next day or two easy, but that she could drop by the hotel after work and get the necessary information from me. In the U.S. it was a horror story. No one at the hospital would talk to me until I'd demonstrated "financial responsibility." Were my provincial insurance and Blue Cross foreign-travel coverage enough? Hardly! They wanted the numbers of all my credit cards as well. They didn't get them and I drove seven hundred miles to the Canadian border where the officials summoned an ambulance. I woke up the next day having barely survived a ruptured appendix. They kept me in the hospital for the next five or six days, politely enquired about my insurance when I was well enough to deal with it and sent me home with a number of handshakes and one lovely hug.

And you Yanks can't understand why the rest of the developed world considers you the poorest excuse for a Western democracy imaginable.

Why should we be skeptical about universal health care? I think your review of I.O.U.S.A. set out a very persuasive case.

"Let me explain. There is something called the "national debt." In [I.O.U.S.A.]'s interviews with ordinary people, it has a hard time finding anyone who knows exactly what that is. Well, I've never exactly known, either. I thought I knew, but it never came up in conversation, and it became a meaningless abstraction, even though in 2009, the debt will pass $9 trillion. You might think of those as dollars our nation has spent without having them.

What will this mean to you? It will mean you will live in a country no longer able to pay for many of the services and guarantees we take for granted. In 40 years, when you are still less than my age, it looks like the government will only be able to pay for three things: Interest on the national debt, "some" Social Security and "some" Medicare. It will not be able to afford any of the other functions it now performs."

(FYI, that $9 trillion dollar debt we were so worried about last year, is about to pass $12 trillion.)

"So here's the bottom line, kids. The United States is probably going to go broke during your lifetimes. Actually, it's already broke, but getting deeper into debt allows it to keep running on thin air, like the Road Runner. My advice? Learn Chinese. Start savings accounts. Don't buy what you can't afford."

Good advice, Roger.

Roger, I just looked up your review of "The Corporation". Nevermind.

-Ralphie

I have to ask what you intend as a result of a post like this. Do you simply want your opinion heard or do you wish to persuade others to agree? In this post you present an eloquent and well reasoned argument that, I have to say, is virtually destroyed in one fell swoop by statements like "this is a matter of simple human compassion" and "The arguments against it come disguised in ideology designed to conceal their common motivation: Selfishness."

I was raised in a vehemently conservative family, I live in a very liberal city with liberal friends, and I work in the actuarial department of an insurance company (though not a health insurer). I have heard arguments from many ideologies about health care. Some I agree with, some I don't, some are more sound than others, but every single one of them comes from a moral, intelligent person that simply wants the best for our country. Of course few of those people ever change their opinion, and to persuade them takes hard work and patience, but absolutely no one will ever be convinced they are wrong through an attack on their character.

I left a post on one of your prior threads about insuring those with pre-exiting conditions. The short version of my argument was essentially that insurers can't cover such people profitably and hence are forced to subsidize care through higher rates for the healthy. I have since, more or less, reversed my opinion. After a lengthy conversation with a friend, he persuaded me that, as long as the program also requires everyone to carry coverage, that the risk of fraudulently purchased insurance by the sick was minimized and that insurers were prevented from retroactively defining an undiagnosed condition as pre-existing. But here's the important part: my friend acknowledged that I had a valid concern and addressed it. He did not say I was wrong because I was heartless.

You said "I am naive enough to think that universal care is obviously good." Perhaps that is an over-simplification, but I count myself among those who agree with you. I think we can create a nation where everyone is insured against financial catastrophe through illness, and I am naive enough to think we can do it by rationally discussing with those who disagree.

Again, Roger - Bravo!

It's all fun and games until you or a loved one winds up with cancer and can't pay for treatment.

There is no empathy
There is no sympathy
There is no decency

All there is, is: tough shit. And it 's been that way forever for this nation's poor, tired, and huddled masses merely trying to take their next breath.

Well guess what? People who cannot afford/do not have access to health insurance go the the ER anyway! They call the F.D. I know that for a fact because I drove an ambulance for years!!!

Been there, done that!

Guess who pays for their treatment??
Guess how much more expensive that is as opposed to the public option??

I applaud your for your logic, for your reason and for your humanity. I applaud all of those things, Roger.

But it is time we all move forward and just pass a bill that takes care of the people of this nation - lunatics and sociopaths be damned.

It's time.

I don't claim to be a libertarian, specifically, but I suppose I am one more than I am anything else. As such I have philosophical problems with the government providing health care.

Having said that, I live in Canada, where that's just what happens. (I read somewhere that Canada is one of only three places in the world where there's no private health care, along with Cuba and North Korea. (Nice club to be in, no?) I'm sure that the reason for that is that any mention of allowing private health care in Canada immediately brings accusations that the mentioner wants Canada to adopt the American health-care "system", which is a nasty thing to accuse someone of up here.) I've had occasion to access the Canadian health care system many times in my life, and here's the thing: it works.

It's not perfect. It can be criticized on a lot of grounds. But it's basically a stable, functioning system.

I'm confident that it's possible to come up with a libertarian-friendly health-care system with no government involvement, that, by the standards of (let's say) everyone posting on this thread, works. No, I am! Really! But America doesn't seem to have one of those at the moment. So, until such an efficient, admirable laissez-faire free-market health-care system is achieved, isn't it better to have a mixed-economy system that works than it is to have... whatever it is you call what you've currently got? I mean, we're on the clock here and people get sick all the time.

I'm sorry, but to say that government shouldn't be trusted with health care, is plainly another among a very long line of reasons in why those saying it shouldn't be trusted with any major decisions. Why? Because, if you follow that logic, then the government shouldn't be trusted to protect your sovereignty..oh wait..you've already tried that, to disastrous effects one might add. Privatise the fire department too and while you're at it, take away education also. Why trust the police either? Everyone become vigilantes, that's what Republicans want, they want "the every man for himself - armed to the teeth - everyone else be damned - wild west" back, this is why they won't let go of their guns.

To those that cite bureacracy as the reason why universal health care is bound to fail, I suggest you go and look up Max Weber, read what he had to say on bureacracy and then ferment those thoughts for a few decades and then come back and accuse bureacracy of failing you. In case, you haven't the time for that, here's a practical example - without bureacracy, the military would simply fall apart. There's a time and a place for individualism and clearly those who have been made accustomed to eating strawberries in winter, are going to have a hard time understanding this.

Just remember, what goes around often comes around and if you end up blocking health care reform, you might be the ones who have to one day look into the eyes of your son, daughter, or other loved ones suffer in agony at your missteps and admit that you chose to go the wrong way.

To - Randy Masters

What Republicans are suggesting is savagery and without a hint of nobility at that. If someone is hurling insults at you, let's say someone is saying - "you've got crap on your shoulder" before bristling with misplaced pride you might be well served to spare your shoulder and your reaon a glance and then think, is that really an insult, or ought I wipe my shoulder?

On a sidenote, I've recently found out that many Christian organisations, both directly and indirectly, fund and support hardcore pornography through investment houses for profit, which not only debases women by objectifying them, but also inflicts real physical and mental suffering, not only on the men and women in them, but also on men, women and children as far afield as the mud-shacks of Africa. Those Christians and other religioso right wingers who speak of the selfishness of universal health care, while the pimps of god pump church money into the porn industry to fatten the pensions of the self-righteous, might want to examine their faces for egg..

Try and occasionally alight from that fallaciously lofty perch of yours, down to the level of mere mortals and realise that in this world, there are few things that you can be assured of, good health is foremost among those which you cannot be assured of.

Jim Emerson, if you're still around, I just read your post at "Scanners" on Bill Maher and is one of the many reasons I think he's an self-inflating punching bag for the sensible. I must say I disagree with a thing or two you wrote on Von Trier, but then there were other things you wrote on him, which were quite right.

Roger, a fine piece of writing on Antichrist, but then that's hardly unusual :)

Roger:

Government-provided health care works -- not perfectly, but neither does private health care. I was drafted into the Army and had comprehensive health care coverage. On my discharge from service, I had Veterans' Administration health care. Inexpensive, although not comprehensive, but with broad coverage. When I turned 65, I had medicare. All of the above worked well, and so more than one precedent has been set illustrating the efficacy of government health care.

Evan wrote:

Had there been universal health care in this country back when Roger had cancer, he'd probably wouldn't be alive today.

I live in Canada. My wife had thyroid cancer much like Mr. Ebert did, hers diagnosed in January 2007 and her thyroidectomy in June 2007 (they did one other surgery prior to that in late April, when they thought it might be a tumor on a major artery). She is still alive, doing very well, thank you, and all covered by a publicly funded universal system.

Do you anti-universal types just sort of make things up as you go along? None of what you people say or write seems to have the vaguest relationship to reality.

Politicians find it so en vouge to express their love for "Main Street." Let us picture, please, a small "mom-and-pop" street. We find three groups of people. There are the mom-and-pop stores themselves, offering their goods and services to their customers. There is a local boy scout troup helping people across the street.

And then there's a group of thugs with bats demanding payment before anyone is actually allowed on the street to begin with. They pay off any cops who deign to drive past. And they promise to raze the neighborhood if anyone tries to run them off.

Wall Street and the insurance industry like to present themselves as boy scouts, brokers connecting people and their capital with businesses and services. They may have even started out as such. But they've degenerated into useless punks with shiny bling paid from money extorted from us, one hand out for our money and the other with a bat at the ready. They're now full-on impediments, ineffectual if not actually detrimental to society. Yet simply because they are part of the current status quo, they consider their existence axiomatic, self-justifying. There's not even a capitalistic component that justifies their worth anymore, merely their stranglehold on the current structure.

And they aren't going to go away until we crack down on the politicans by threating the only thing that matters to them: their regualar popularity contests they call elections. Right now our government is full of the corrupt, the complacent or the weak -- if we were a third-world country, any proclamations of governmental integrity would be as much of a joke as Iran's or Afghanistan's are.

If we want these thugs run off our streets, we need someone willing to go "Charles Bronson" on them. But, and here's where we've been falling short, that will require us to be as forceful and involved with our representatives as they are supposed to be with the society we entrusted to them.

“It is weakness rather than wickedness which renders men unfit to be trusted with unlimited power.” John Adams, 1788

“The abuse of buying and selling votes crept in and money began to play an important part in determining elections. Later on, this process of corruption spread to the law courts. And then to the army, and finally the Republic was subjected to the rule of emperors.” Plutarch, Historian of the Roman Republic

“The most common way people give up their power is by thinking they don’t have any.” Alice Walker

"Sick and Wrong" by Matt Taibbi, Rolling Stone magazine
http://www.rollingstone.com/politics/story/29988909/sick_and_wrong

"The fallacy of the free enterprise argument is that there is a faith that corporations are motivated to bring about the public good."–Ebert
-No. No, I can assure you that we are quite aware that “It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest.” We’ve been quite aware of that for a while.

“I say I feel obligated to help my fellow citizens, and be helped, for the general benefit.”-Ebert
-That is excellent. I commend you on your connection to humanity. But you ignore the part brought up by the poster where you are forcing us (what happens to someone if they refuse to pay their taxes?) to join your new “contract” whether we believe it is just or not.

“I just wanted to be sure nobody missed that.”–Ebert
–Didn’t. Also didn’t miss the fact that you didn't miss the opportunity promoted the Evil Clown View as the This What Libertarians Actually Believe.

Eric Sundwall said above what I wanted to say, much more thoughtfully and kindly than I would have, so I should leave it at that, but I want to add that I am actually just a dishwasher (at the moment) and that I have no health insurance.

If you look at the modern history of health care, I believe that you can clearly demonstrate that the exponential rise of health care costs is in direct response to government “helping” with health care costs, and that it is particularly telling when you compare those rising cost to the falling costs in technologically similar areas where the government never “helped.” I am aware that you and many of your readers won’t believe this has anything to do with the discussion. In a way, you’re right: if I still don’t have insurance by the time one of public “options,” comes in – screw personal integrity, I want to stay alive - I’ll take the plan. Gratitude won’t be a part of it though.

If government hadn’t “helped” in the first place, a dishwasher could afford health care as easily as he could a new desktop and the internet connection that allows him to comment on the blog of the man that taught him about great movies.

Roger, can we get you to run for office? I'd vote for ya. And I'm in Chitown, so I'd probably be able to vote for you twice.

Your writing of late has never been better or so expressive. It's rare when a blog post leaves me nodding and saying, "Amen" in agreement, but you seem to achieve it on a nearly daily basis. Cheers!

SFB: Libertarians would have it so that Chevron would have had to have secured the property rights from the people who control that property (the natives), and any damages to the property would be recoverable.

Uh. So let's see, a billion dollar international company on one side, a few hundred/thousand uneducated individuals who live in primitive conditions in the middle, and billions and billions of wealth and profits on the other side, and you really believe that the company will do the "right thing" and politely negotiate with the individuals in the middle, and heartily retreat from the billions and billions of dollars on the other side if the answer is "no"?

Are you seriously telling me that this is what help you sleep at night?

SFB: Further, libertarians are not against universal health care. They are against federally mandated universal health care. The difference is important. In one case, people want all to have access to affordable health care, and when they can't afford it, want the good nature of man to afford it for them (charity institutions of all shapes, sizes, and beliefs). And if those institutions aren't available, we hope that the good nature of medical professionals will ensure that the person is property treated. Though we understand that extremely pricey treatments may not be available equally to all (though often they are, such as experimental cancer medical treatment [which will not exist as it does today in 5 years if the Democrats get their way].).They also want this health care to be of high quality.

"good nature" x 2, hollow laugh, turn to someone you know that have cancer (1 in 3, we all know someone) and is struggling to pay for treatment and tell that to their face, looking them in the eye. Are you kidding me? People save money for vacations and you are asking them to bank their LIVES on the "good nature" of men?

Libertarians is just a label, just like liberals or conservatives, or partisan, so many freaking labels that siphon the effort from solving the problem to defining lines within the problem.

Can people stop talking about what they believe is right, and talk about what they WANT for themselves, and for their fellow human beings? This is a case where the end actually matters more than the means, no? Whoever ends up providing competent universal health for all can call themselves whatever they like in my books. Instead of starting with individual desires and eliminating public options based on that, isn't it better, in the long run, to start from universal health for all - and work backwards to figure out what personal sacrifices individual citizens of society will need to make to bring that into a reality? I realize that any kind of "personal sacrifice" sounds scary and cult-like. But something has got to give, and eventually it will come from the individuals, either directly or through taxes, so why not be proactive and decide to contribute to something that is worth giving for?

Am I the only one that is not baffled at this thought process?

I remember being fascinated by the philosophy of Ayn Rand as she spoke on the Phil Donahue show. When the audience got a chance to question her, one woman stood and told Ms. Rand that she used to adore objecivism but came to realize that her selfish philosophy was irresponsibe.

Ayn responded wih anger saying something like "How dare you come on my show and try to blast me!" Basically saying that she didn't have time to debunk an audience member on "her" show. I agreed with her there. I also agree with her position against altruism.

My main problem with her, and other liberatarian philosophers, is that her moral and metaphysical philosophy does not translate well in politics and social matters.

I see the opposition to universal healthcare debate as an attempt use ideas individual responsibility and the hand of the free market as an attempt to create consistency in all aspects of life. Hence, since goverments are not allowed to interfere in my private life, especially when I don't hurt anyone else, it should be the same for the public.

But what is private and belongs to only the individual? Did Texaco have a right to the rainforest more than the indigenous people? In the eyes of a liberatarian or conservative, self-centered legal actions can never be detrimental. The funny thing is, when they limit the general welfare of the public, they infringe on individual liberties.

If one way of life meant a healthier one, why not take that route? If universal healthcare meant a better country, why accept the opposing ideas? Why? Because some people's ideas have no foundation and are built on faulty justification. They goal of most opposers is to impose their way of thinking just because they're in love with their own tradition. I no longer think that conservatives beleive their social and economic stance is pragmatic. And I thought practicality and improvement was the goal!

In the state of universal healthcare, I can still tend to my garden, read at the library, meet up with freinds at the cafe, see a movie, and sleep when I wish. I'm happier to not have the uncertain burden of bad health. I see more freedom in than that of a completely privatized society.

Ah! It is nice that this is finally not being disguised as a question of whether a government or a corporation is better suited to run our lives. Because frankly, neither will do it as well as any of us would like.

But the idea that either has more force or less force and one points guns while the other doesn't is simply ridiculous. The government has the authority to make laws and compel obeyance. Corporations have the ability to make us buy their products on their terms and simply have the advantage of creating an illusion of choice.

By that I mean, food producers determine the ingredients of their foods; you can't tell Campbell's what to put in their soup. You can make your own soup, but you can't control what Perdue feeds the chicken you'll use. You can raise the chicken, but can't tell the feed company what to do. I can go on until I'm a farmer providing only my own food and food chain from the bottom up. I don't know how I'd grow a car or an HD TV. Or what I'd watch if the networks didn't decide what's on.

It comes back to people feeling like the government is telling them what to do and forcing them to do things and the idea that we should all help our fellow man.

Its hard to defend against helping others, other than to say "I expect no help in return". Conversly its an easy position to attack, usually involving "selfish" and sometimes "bastard".

You can't attack helping others; and its an easy defend because its typically an act of sacrifice, which happens to be one of those "ultimate good" type things. How do you not sound idiotic trashing someone who helped someone?

But the issue of health care is slightly more complex than all that. Its true the current system is horrid and broken, and everyday it seems the numbers grow of people who can't get insurance and can't afford the doctors/surgery/medications. The insurance companies are profit-driven, but their product actually gets worse the more profit it makes, unlike a car or phone service. The companies can't increase profits every year by covering more health costs...its not possible to make more money by giving more out.

And so the health insurance corporations tell us what they will and won't pay for, how much for how long, which effectively tells us what health care we can and can't receive. If a doctor wants you to take drug #1, but drug #2 is the only thing covered for that, which can you afford to take? If the uncovered price is $500/month for Drug #1 and the co-pay is $15 for Drug #2, isn't that choice being made for you on a practical level?

The government at least has one fail-safe in that we elect the bums. And if they screw up, we elect different bums. I have yet to see names for the election of the management team of Blue Cross or AIG or GM or Kraft or Sony on a November ballot.

But the government is far from perfect too. And even the best government programs can get bogged down in bad budgeting and bureaucratic nightmares. And because of the law thing they do, often we don't even get illusory choices from Uncle Sam. Its generally "our way or the highway...and we own the highway...".

The reality is that we submit ourselves to others' control every day. In a way, its a willing reliance on others in some instances and a necessary evil in other instances. There is no true self-sufficience and most of our choices in life are illusory.

The only real control, REAL FREEDOM we have is to choose how you will treat other people. Even the ones you don't know and will never meet.

From the Russ Karlberg post:

"Ebert: You write: "Socialism has been tried everywhere, and has always failed."

Universal health care has been tried in every other Western democracy, and it has always worked."

That's the truth, but why do so many Americans believe what Russ said. The answer is in my previous post. Our minds are filled with all of these heuristics (sound bites) and are istantly believed without critical analysis, and that goes for the left and right, who both produced overly generous amounts.

I recall reading an interview with the famous science fiction author William Gibson where he stated that he was tired of writing futuristic stories and wanted to write a Sci-fi story about now, but was having trouble. What more science fiction do you need than a nation of people who are easily programmed and speak without thinking, while acting against thier own survival? Meanwhile, "overlords" know that this is going on, because they giggled while they wrote the program.

He can use that idea free of charge, by the way.

Here are three points I seldom see raised:

First point: People keep talking about the free market. What kind of a free market is it when I cannot find out in advance how much what I am buying will cost? I have on several occasions been unable to get even estimates from hospitals. (Example: If there are no complications, how much will it cost to have my baby here?)

Second point: Examine your medical bills. Look at the insurance write-downs. Contrast what the hospital/doctors/labs/pharmacy have billed with what they have accepted as payment. In my experience, except for primary care physicians, the bill is two- to four- times higher than what the hospital/physician/lab/pharmacy will finally accept from insurance. If you have no insurance, you are liable for the inflated bill. If you have no insurance, you probably are not financially healthy. But you get the inflated bill. You don't have to be seriously ill to be hit with huge costs.

Third point: Universal Health Care is not the same as Universal Insurance. People often talk about them interchangeably. Insurance means that some of what you pay goes to overhead, to the profits of insurance companies. It seems to me that insurance itself drives up the cost of health care. Doctors must pay for staff to prepare and submit claims, to argue about claims, to resubmit claims, etc. Insurance companies must pay for overhead and generate profit.

I am dubious of universal *insurance* because I think it will make care more expensive. On the other hand, see my second point. Are medical bills inflated so the insurance companies will think they are getting a good deal? Or are the insurance companies keeping costs from getting even worse?

Insurance disclosure:
My family has health insurance through work. For now. Our premiums now top $10,000 a year, with a $1500/person deductable, plus co-pays. Our annual out-of-pocket medical expenses often exceed 30% of our gross income. We are sinking under the weight of this financial burden.

It is true as the saying goes that beauty is in the eye of the beholder, but those who think Ann Coulter is beautiful, maybe ought to visit the opthalmologist for a revised prescription; that is, unless they are evolutionary archaelogists, because she does look like a fine specimen of a fossil. I'd heard of size zero, but she's a size negative 5 and every time I look at her, she looks more like a matchstick, both literally and figuratively. Why a woman would choose to look like that is beyond comeprehension.

"No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend's or of thine own were. Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee..."..John Donne

I initially was concerned the government was the wrong entity to "fix" health insurance. I still hold to that belief and am alrmed that is exactly what they hope to do. As best as I can tell, this health plan before our elected heroes IS NOT universal health care. I'm not sure what it is, but I am fairly certain of what it is not.

I agree with Roger that pure, unalderated Universal Health Care is the best way to go.

Ebert: I think you know more or less, uh, everyone.

---Trying to; can't talk to 'em intimately if you don't understand 'em. It doesn't take me out of my way. I even know 3 people who died of leukemia; Catt's late husband was one, leaving a $500,000 medical bill for 2 years of daily agony and flat broke... also talk to people who are deciding very consciously whether to die of what they've got. Old folks especially can do this. You mature, you accept that knowing who and what you are is more important than the show you're supposed to put on. My friend Merci is 103, a few years ago she told me she needed to live to 104, family business. So far, so good.

---I'll tell you out loud if I ever do get ill again. So far a minor cold in January '08, first one in at least 10 years, and a horse tromped on my bare foot a few months ago -- didn't leave even a mark. I see posting after posting of healthy people who are dead certain they're going to come down with one serious thing or the other and so will their kids. The only evidence they have is medical salespeople telling them they will... over and over and over and over and over, a mass meditation on how weak and defenseless your body is supposed to be without their needless nostrums.

---Trying to sort out in specifics why people don't just try this. Even the "dull spark of non-comprehension" as my brother put it, is instructive. I love reading, but get more out of reading the reality around me. Meantime, studying you, too, Rodge. Sounds like you're going to be okay.

Forgive me, please allow an Englishman to intervene.Universal Health Care paid for out of general taxation, free at the point of delivery with need assessed by Medical Practitioners. What's wrong with that? I have never spent a day of my long life worrying about how I or any member of my family might receive any necessary health care,and we have needed it.In that statement lies the answer to the debate.The debate has nothing to do with freedom of choice,the state versus the freedom of the individual, it is about what works for the health of the individual and the nation.The "freedom" debate is a complete red herring,promoted by special interests.Just look up the comparative stat's across nations of health outcomes and see where the US comes out. If they are great leave well alone,if they are poor the system needs changing-end of.

The invisible hand is often wearing a velvet glove, and picking your pocket.
Free markets don't actually exist outside a several square block area on the south side of Chicago.
Aristotle was probably right about everything, but the devil is in the details of applying principles to real conditions. In a world economy the US is just another business competing with others. A business cannot survive with 40 million liabilities,without education, nutrition, health care,income,shelter,faith, hope, and caritas. Since Hitler,Stalin, Mao, etc, despite their best efforts, have not proven that you can simply "evacuate"( in Heydrich's term)30 or 40 million liabilities, the wise and prudent, as well as moral, thing is to use every means possible to help people be assets. It's not personal. It's business.
Health care is not going to get cheaper, ever. Further revolutions in technology, information-processing, wellness,lifestyle modification,allopathic, osteopathic, neuropathic, homeopathic, and every other-pathic will continue to expand human life and human possibilities, and there will be a lot more of us. We can slow the rate of growth, a lot, but we need a paradigm that is summed up by "L'chaim!

Rowan - move to England.. You guys should have seen the outrage over here when the pro-private healthcare Americans started slandering the NHS. I know ours is a smaller and perhaps more manageable country, but I cannot even begin to tell you how well the NHS works. Yes, we moan sometimes about our system, but in reality, its been phenomenally successful. The most damning evidence in favour of a national health service is that despite a large, seperate private system, the vast majority of people choose the NHS because its cheaper and just as good. And if you want to pay for private medical insurance, go right ahead, feel free. You will just feel silly when your poorer friend has the same condition, and has it dealt with just as effectively, for free.

I dont know what the issue is. Get up to date..

Having read another few comments, I have something else to add- until the fairly recent election of the present Conservative government, Canada was not running an annual budget deficit, while still providing universal health care, as well as other social assistance programs. While it is true that most provinces did run deficits (and still do... rather more so), it is simple wrong to suggest that the wealth of the country is not sufficient. And the US is somewhat wealthier than Canada. It also spends more on health care, per capita, in spite of inferior results.

Ebert: Why should I trust private insurance companies more than the U.S. government? What accountability do they have? Baseball and insurance are the only industries exempt from trust laws.

Thanks for the article, Roger. I would like to point out that this "baseball and insurance companies" statement was evaluated by Politifact and is actually false. They cite agricultural cooperatives, fishing cooperatives and maritime shipping as other industries exempt from trust laws, and point out that the antitrust granted to insurance is more limited than the antitrust granted to baseball.

I agree with your sentiment, and also do not feel that our current system works well, but I thought I would share this knowledge since I think it is a common misconception (carried on through false TV ads).

Several posters, including Mr. Ebert have suggested that universal healthcare does not come about through the “pointing of guns”. I would argue that this is incorrect. Everything the government does, from bylaw enforcement, milk production quotas to taxation, is done at the barrel of a gun by virtue of the state’s monopoly on the use of force. Simply put, the state cannot exist without this monopoly. One comment suggested that they were pointing ballot boxes rather than guns. Voting is simply arguing about who gets to point the gun, and what they get to do with it. As long as the state remains, the gun remains.

We accept that we have individual liberties, such as freedom of speech and freedom of religion. What is important about these rights is that it takes no effort to maintain them. You need nobody’s permission to speak or pray. Nobody provides speech or beliefs to you. We accept that these rights always exist, regardless of what the state, or the public thinks. This reasoning cannot be applied to the idea that healthcare is a “right”. For healthcare to exist, you need doctors, nurses, technicians etc… So when you say healthcare is a right, you are explicitly arguing that you have a right to doctors, nurses and lab technicians. You cannot claim the labour of others as a right. To claim that others must provide you with their labour because you have a “right” to it is akin to slavery. If there were no doctors, would you still have a right to healthcare? If you say “no”, then healthcare cannot properly be considered a “right”. If you way “yes”, then you must argue that by some people not being doctors, they are violating your rights.

Just because this “right” can be made into law does not guarantee that it is inherently just. Fifty percent plus one of the population does not have the “right” to dictate to the other fifty percent less one of the population what they can or cannot do. My freedom is not subject to your whims (and the same is true of you, or anyone else).

I would argue that your characterization of libertarianism is incomplete. I believe that the fundamental essence of libertarianism is liberty. I consider liberty to be the absence of coercion. I, nor anyone else, may initiate the use of force against anybody. People should deal with each other voluntarily, or not at all. If they disagree, then they disagree. Ideally, the market will prove to be an efficient solution for solving problems. It would be dishonest of me to suggest that this is always the case. We are after all, human; there is no guarantee that the market will efficiently deal with problems. However, if we argue that problems should be solved according to whatever is in the public interest, then we face the problem of balancing the public interest with individual rights. In many cases, it must be one or the other. Something cannot be considered an inviolable individual right one day, then taken away because the public believes it to be in their interest the following day.

When we refer to "socialism" as an evil, are we also referring to fire departments, police stations, roads, bridges, and public schools? I don't understand how our local fire department is any more or less evil than "socialized medicine". I'm guessing that many people who believe socialism is always evil would like to take their kids out of public schools. Yet when their house catches fire, they'll no doubt be thankful for socialized firefighting. So they'll detest socialism until they need it. Maybe afterward, too.

"Ebert: Why should I trust private insurance companies more than the U.S. government? What accountability do they have? Baseball and insurance are the only industries exempt from trust laws."

Well government is exempt from *all* laws Roger. At least the insurance companies have to follow GAAP accounting rules and at least not run at a loss (yes, the profit motive is better than the "we can always spend more of the taxpayers' money and worry about it later" motive). If the US government did, we'd have to declare bankruptcy and all 435 congressmen would be indicted. Instead, they just print more money.

And I am all for lifting the anti-trust exemption if you agree to allow interstate competition between insurance companies. State law (i.e., liberals) are the ones who ended competition, not the companies. Want to see more insurers and lower premiums? Let them compete state-to-state.

Even if everything you said is true about your arguments above about *why* we should do this (I disagree, but just arguendo), what the hell does government actually do well Roger? Medicare (which only pays 70-80% of actual bills, and is 10 times more expensive than originally projected) is bankrupt, and so is Social Security. We are already running deficits three times of Bush's. Where does the money come from Roger? Even if we tax our entire $14T GDP at 100% rate, we can't pay for Medicare and Social Security when the Boomers all retire. How could we possibly extend coverage to everyone with our bills? Go talk to an accountant and have him explain how bad our fiscal situation is.

And no country in the world provides care as well as we do to people who get it, which is about 85% of the country. There simply isn't enough money to go around to keep the 85% where they are, so their coverage will have to be rationed, just like in UK and France and Canada. I can't wait to see big Hollywood celebs (and movie critics) standing in a DMV-like line with the huddled masses for their health care! or maybe you VIPs will get special treatment like Michael Moore in Cuba. Or maybe you will go to Canada and get a black market doctor like rich Canadians do.

Ebert: Good going! You worked in Hollywood, Michael Moore and Cuba!

Funny thing. Out of all the Candians and British who have posted in this thread, not one has complained about rationing.

Mr. Ebert,

You make an excellent point that convincingly refutes the argument that we shouldn't trust government bureaucrats with our health care. Why is trusting a corporate bureaucrat preferable when approved health services go on the cost side of his ledger that reduces the profits of his employer? It seems that seniors have done a much better job of preserving popular services in Medicare with their votes than consumers have with their wallets in private health care.

Part of the reason is that health care doesn't abide by traditional market forces in any case. Consumers have very little leverage on costs when they are seriously ill. Comparison shopping on price isn't even easily available. I was once given a list by my doctor of potential providers to get an X-ray. When I called the providers to inquire about relative costs, they told me that they could not give me a quote, though they had no problem in coming up with a number for my insurance provider after providing the X-ray. Some free market.

My 9-year-old daughter is hearing impaired and requires hearing aids in both ears. Not a big deal, right? Insurance will cover it. Wrong. What most people don’t realize is that almost all insurance companies (including ours) don’t cover hearing aids. They refuse to treat hearing aids as any other prosthesis and claim that these medically necessary devices are “elective” or “cosmetic”.

Another wrinkle in this story is that I fought with the school district for them to pay for my daughter's next set of hearing aids. With strong legislation (IDEA) and Supreme Court decisions (most recently Forest Grove School District v T.A.), I was able to support my contention that it is ultimately the school district's responsibility to pay for them. After battling throughout the summer and into the fall, I finally won and the school district will be providing my daughter new hearing aids (it's actually a different FM system which are hearing aids with the FM built in, but the outcome is the same).

I wrote to all of my elected officials at the state & federal levels with my dilemma (this was before the quarrel with the school was resolved). I don't feel that the burden of paying for medical devices should lie with the schools - they have enough budget problems. However, with my husband out of work for almost a year now, a deep-pocketed insurance company that won't cover the costs, and a potential bill of $2400-$4000, I'm left with 2 very bad options. I'm not proud of it, but I'm choosing to have my tax dollars pay for the hearing aids (even though I know there are several other important programs that need the money and would benefit more than a single student) rather than face a serious financial problem for my family.

I never received a response from any official. I was, however, able to pose my problem to my state senator and representative at a Town Hall meeting the same night I received the news from the school district. When I asked why they weren't supporting the bills currently in our state legislature (Illinois - SB0068 & HB4043) which mandate that hearing aids are covered by insurance companies (with limitations like $2500 per hearing aid every 36 months), I was told that they opposed any mandates to force insurance companies pay for medical services because it would "make premiums too high for small businesses to continue to provide insurance to their employees" and "drive away any new businesses that might want to come to Illinois".

I'm not exactly sure what my point is with this long post. I suppose it's that we don't have any entity (corporate or government) that is willing to solve this problem. Or maybe it's that everyone is already paying for at least some health care of others via their tax money, but they weren't aware of just how much.

My son Tony was diagnosed with type 1 diabetes this past Summer. I firmly believe that this disease will be cured within his lifetime, and I can only hope that cure will be widely available while he is still covered by my insurance. It's not so much the matter of who will pay for the cure when it is ready. It's more the matter of whether or not my son will be able to get health insurance when he goes out into the world. Gallstones? Car accident? Slipping in the bathtub? There are plenty of misfortunes that could befall him, all requiring medical attention and none of which are related to his diabetes. But under the current system, with that pre-existing condition, I worry that nothing will be covered.

I think you hit the nail on the head when you put the blame on the profit motive. I'm a great fan of capitalism, but when you run matters of life and death through a purely-capitalistic machine, ground-up people come out the other side.

With apologies to Jack Benny, if you have a system where you say to an insurance company, "Your money or my life," will they even stop to say, "I'm thinking. I'm thinking."

MP, your first commenter, makes an odd comparison to public education. He says the free market "has done my family far more good than has the government," cites the university system as doing, I guess, a better job than public schools, and then asks, "If I can't trust the government to educate, why should I trust it to provide healthcare?"

Does he not understand that many universities are public institutions? That the system of public and private universities is analogous to how a public health care option would work as a less expensive version of private health insurance? That this is the very essence of the free market? The last time I checked, Harvard and Yale weren't hurting, despite the thousands of students who choose to go to a public university. Why should we believe it would be any different for healthcare?

Months into this discussion, and I still can't figure out why so many people don't understand that the public option is – wait for it – only an option. Providing the public with a less expensive choice does not equal a government takeover, no matter how much the Right wants to spin it that way.

Roger, insightful commentary as always. I was surprised to find little mention in the comments of Conservatives, or those with like viewpoints, of waiting in lines for treatment. In most "universal" health care systems some folks will have to weight in line for non-life threatening treatments. What most who argue this point fail to mention is that there is no one stopping folks from pursuing treatment through supplemental insurance, or supplemental care providers.

In the UK for example (correct me if I am wrong) supplemental insurance provided by corporations can be purchased to cover treatments that fall under quality of life (such as rehabs to increase freedom of movement). Everyone receives the same based coverage, and those who are more fortunate can continue to proceed with more health care and their own dime.

Anyway, just my 2 cents.

Thank you Mr. Ebert for voicing your opinion. (And for being the best darn film critic ever)
As a Canadian, I look at you, my American neighbours (yes, we spell that with an "ou" ;-) as living in some Twilight Zone-ish parallel universe. But I also feel deeply sorry for you.
I NEVER have to worry about "pre-existing conditions", filling any insurance forms, paying anything upfront, or receiving any type of invoice after for that matter, going bankrupt, or being outright refused care because I cannot afford medical treatment. Whether I've just survived a serious car accident with broken bones and a concussion and was rushed to the ER, or I just think I might have an acute (but hardly deadly) case of sinusitis, my universal healthcare card will be all that is asked of me.
As a society, we accept that our taxes will often subsidize less than essential treatments (hence the long waits, the biggest drawback to our system) but if it means peace of mind and a proactive approach to one's health, both of which contribute to better health overall and thus costs less for the government, combined with a more egalitarian treatment of the poorest and most vulnerable members of society, and a dozen other benefits, I don't really know anyone who would trade it for any other system. And my total income taxes are less than the average U.S. healthcare premium paid to an insurance company by someone of similar means to me. And to think we Canadians are overtaxed? Seriously?
I am truly appalled that anyone would put in the position of having to forgo medical treatment for financial reasons. It's a cost/benefit analysis no one should have to make.
I sincerely hope my like-minded neighbours to the south will succeed in convincing their own fellow citizens the rest of Western Civilization hasn't gotten it wrong. We are still free societies. You deserve what we have too.
And God Bless Tommy Douglas.

Ebert: I've spent a good deal of time in Canada and know many Canadians of political persuasions both left and right quite well. It's my impression that Tommy Douglas, a socialist who passed the national health legislation, is the only prime minister of any party that allof them like.

For all the libertarians who believe they are self-sufficient and owe no debt to society as a whole, consider this quote regarding his fellow rich people from the well-known socialist, Warren Buffet: "Let's see how high they rise in society by their own bootstraps if you make them one of six children of a frightened single mother in Equatorial Guinea, then sell them into slavery as a cocoa plantation worker in Gambia." Buffet's point is that rich Americans need to acknowledge their success is made possible by our system of laws and government, and they have a responsibility to give back to the society that enabled their success.

Roger,

Let me start by saying that I am a Canadian, and I have to say that I am shocked at the amount of objection there is in America to universal health care. I agree with you completely that health care is a pretty basic 'good' and I can't imagine why someone would argue against it.

Something that I find very interesting is the way Americans tend to label themselves and each other with these blanket terms and these labels take on an identity of their own. Whether it's Democrat or Republican, liberatiran or conservative, Red or Blue (and ass or elephant?) or whatever it may be, these words draw lines in the sand and create to opposing camps that seem to refuse to agree. Why paint yourselves into these ideological corners by declaring yourself one or the other?

In Canada we have 5 major national political parties, red and blue yes, but also orange and purple and Green. We have the socialist party, the center-left liberals, the center-right conservatives, the environmental party, the separatists; there is even a marijana party on the ballot. We don't have to accept a one or another situation (in theory at least)

Our system of politics, and more to the point our system of universal health care, is far from perfect, but then again when they found a lump in my Dad's lung we got to keep the house after the surgery. You can label me what you want, but I'll never stop supporting a system that protects me and my loved ones; it even protects those who might hate it.

Another fantastic post, Roger.

Tom Dark writes: That would be like believing in demons or Carl Sagan again. There are millions and millions of people already mesmerized by that unfortunate meme... and this time I have no idea what the hell he's talking about. I've been practicing Tom's "body, heal thyself" mantra for a month now and I'm healthy as an ox, so nothing's changed [knocks on wooden head]. Gotta wonder, though, if it would have helped my beloved uncle a few months ago when he had a stroke at the top of his basement stairs, crashed to the bottom, and never really regained consciousness. Doctors did all they could but he had a DNR living will type thing and passed away when his feeding tube was removed. I'm just relieved that this happened in a VA hospital and his family didn't get billed for those final agonizing days of heathcare.

DC Geek and David Van Dyke are spot-on in their arguments. I doubt we'll see any real progress on healthcare until we rid ourselves of the entire notion that health insurance companies should be profit motivated. "What shall it profit a man if he shall gain the whole world and lose his own soul?"

Oh, and Marie Haws, the Golden Rule is swell, but let's not forget the Diamond Rule from one of Roger's previous blogs, "Do unto others as they would have you do unto them." If insurance companies could manage this I'm sure they would realize that dropping a person's coverage because of a preexisting condition (and "for the sake of the shareholders") is flat out morally bankrupt.

Ebert: [Zein] writes:

"It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive at first... and if it does sound counter-intuitive, then you suffer from low intelligence and need to get your "duh-face" checked out... assuming you can afford to do so."

I just wanted to be sure nobody missed that.

---I would have, as a large solid block of continuous typing is rather taxing to someone who reads all day for a living. Short paragraphs offer needed mental breathing space.

---I agree with Zein, except for the "duh-face" remark; typically it's youthful zeal to call everybody who don't buhleeve whut you buhleeve stoopid, get a clue, you moron, har har. Totally immacherrr... but Zein is otherwise quite right.

---Case in point: my wife and I split up. We made personal agreements about our son, not court-assigned (that got in the papers). Me, by then a firm believer in the body's capacity to maintain and heal itself, she a professional in institutional psychology and a firm believer in taking a tummy ache to the doctor, if erring on the side of caution.

---When my kid was in 3rd grade he'd missed 30 days of school thanks to her firm belief, tho' he was with me summers and vacation. So I took him for the next 3 years, summers too (he liked me better anyhow).

---I am SO tempted to say, "with a systematic method of judicious slaps, kicks, punches and threats, I straightened the little bastard out." (He'd laugh at that; I never did feel a need to punish him for anything, very good boy). But I didn't have to do much of anything. Mainly he was now living with somebody who didn't believe in all that e-z-2-get-sick stuff; kids simply absorb their parents' beliefs. We'd talk it over now and then.

---Not only did he never have a tummy ache, he never missed a day of school again until he graduated high school (when he'd skip out now and then). Except for getting sicker than a dog from shots administered in the army (everybody did, and the publicity program was an out and out lie), he's been largely that way ever since. He'll be 31 shortly.

---So yeah. You teach kids that doctors are a sina qua non necessity, you're guaranteeing health fiascoes individually and en masse. My son has recently taken his ma to the hospital a couple of times. Her problem? Translated from all the latinate fanciness, "I'm miserable and I've got insurance."

---Wanna know yet somebody else I've met, Rodge? Lived with a few years, so learned in detail? A lady whose grandpa was one of the first proponents of cancer prevention. A prominent doctor from Elmira, New York. In the 30s and 40s He'd wheel around lecturing about the dangers of cancer, at a time when the disease was very rare. He made a name for himself this way, a famous cancer prophet-of-doom. I read some of his lectures. Step one, make sure you wash your hands before operating! You'll cause CANCER. Cancer cancer CANCER.

---By jove, he was a prophet. By the late 1950s, cancer had become medical Big Business. It seemed to be just everywhere. It was certainly in the papers and TV all the time. 30-some years later, talking to my Uncle Bill the pharmacist at my dad's funeral (Dad just plain died, no cancer), Bill told me the rate of people coming in for cancer prescriptions was alarming. Alarming. In all his years he'd never filled so many prescriptions for cancer. Certainly wasn't that way back when he started out. Bill just died a few weeks back, but not of cancer. He was 80-something.

---Smoking, then? The Surgeon General did that statistical report in, what, '64? It said that the highest rates of lung cancer were in total nonsmokers and heavy (4 pack a day) smokers. The lowest rate was found in moderate smokers. So said this fellow interviewed on Tom Snyder's "Tomorrow" show. Don't let that stand in one's way in the War against Evil: AAALL smoking is bad for ya! We've always thought so! Tobacco is the devil's weed! It satisfies no normal need! It stains the hands, it strains the purse, it burns the nose, however that old poem went.

---So the Forces of Goodness made a fortune, as Goodness always deserves. Yet cancer increased and increased. Any day now we'll find the cure! Send more money! One of these Forces of Goodness, Robert Gallo, finding himself out of work, managed to invent a cause for AIDS. My oldest brother worked for the AIDS foundation and died volunteering for the AZT experiments, not from AIDS. But who cares about frigging KILLING people with faulty experiments and subsequent treatments when the Forces of Goodness must move forward.

---I knew somebody else back in '64 too, Rodge. A hillbilly neighbor who was 107 years old. She liked to sing songs to us kids and smoke Pall Malls all day long. "Ah smoked since ah was 7 years old," she once said, "all 'cept fer them 10 years mah husband made me quit. He died, so I started smokin' agin."

---An anomaly? An insignificant exception to the Pure Knowledge of the Forces of Medical Goodness? I dunno, but I too started smoking at age 7. So far, just fine. My ancestors who smoked outlived my ancestors who didn't... except maybe Great Grampaw Steinmetz, who fell asleep under a tree with his pipe still going. That's how my biology teacher died, too. I'll be sure not to do that.

---Deficient in test tubes, spinning and whirling things, microscopes and tweezy instruments and poisonous chemicals as my thinking is, I just can't support a juggernaut medical industry whose pills alone kill 225,000 sick people a year, politicized into more screaming for taxpayer money than ever (never mind the insurance scams in which our beloved Bush family has had a high vested interest for generations).

---Indeed, how do those other countries do it? Even tho' I do keep reading that they're in far deeper trouble than is generally proclaimed. I'm guessing that country by country, the citizens have more homogeneous common roots than we do, and so, find it easier to agree on various things. (Despite the complaints I've heard from Germans about the Turks and from French about the Islamic ghettos.)

---For those of you fiercely proud of "all the advances in medical science," what kind of advancement is it when your correctly prescribed pills kill 125,000 patients a year? The pills, not the ailments. What kind of advancement when another 100,000 are killed by incorrect prescription? Get the details from JAMA, not me. And please tell me what kind of advancement this is.

---I forget the count on other hospital-caused deaths, like septicemia (somebody else I know died of hospital bedsores, aka septicemia, Rodge, in 1984. She went in for arthritis). If we could just send this juggernaut over to Afghanistan, we'd win! Just like the neocons said we would! But I doubt those simple, superstitious country folk could either afford it or fall for it.

---So, finally, I'll offer the question I was hesitant to ask from the start of the threads on this subject: are you people really interested in health, or do you just not believe in your own, and so prefer to bitch about what everybody else should do with their money in the name of somewhat overly convicted notions of what is good and right?

"If we don't get every provision right, we can adjust and improve the program next year or in the years to come. What we can't afford is to wait another generation."

-Ted Kennedy

Suppose that a doctor decides he doesn't want to practice medicine anymore: maybe it's for religious reasons or maybe he just doesn't like blood anymore. Would you compel him to practice medicine in order to fulfill somebody's "right" to healthcare? Suppose everybody stopped going to med school for whatever reasons. Would you compel people to go to med school?

In the movies, it's usually the bad guy who comes into the doctor's office and says "Get this slug out of the boss, sawbones. And no tricks, or I'll plug you."

Ebert: To answer a direct question with a direct answer:

No.

Of all the practical topics I have resigned myself not to discuss, health insurance tops the list for its sheer emotion-to-logic ratio. It is a complex subject clouded by bad terminology, unstated assumptions and social entanglements, invariably discussed in a cloud of bad math, specious logic and painful anectdotes. I have been despised for making statements of unpleasant truth on the subject, or pointing out the flaws in arguments that lead to popular conclusions. Years ago the news channels were full of the story of an 11-year-old boy dying of liver failure whose only hope of survival would cost hundreds of thousands of dollars which his mother didn't have. I made the mistake of asking out loud how many children that money could save if applied to preventative medicine, and got called a monster. If I am going to be called immoral for saying 2+2=4, then I want no part of the discussion. But I make this plea in a forum which has always been distinguished by its generally high level of intelligence and insight: examine the argument you're about to post, and if it contains logical fallacies then don't post it even if you like the conclusion. If it depends on the word "need" short-circuiting all thought, rewrite it. If it talks about "government funding" as if this were an unlimited resource, rewrite it. If you can anticipate an opponent's argument, but can't think of a rebuttal other than ad hominem attack, start over. If you're citing a problem and your solution wouldn't actually solve it (though it might make you feel virtuous) try again.

It's easy to make an argument that you yourself find compelling. Try making one that will convince a cool-headed stranger who doesn't share your personal history. And not that it makes one bit of difference, but yes I've been ill, yes I've been broke, yes at the same time, yes I've lost loved ones, and if there were a new treatment that would cure my brother at the cost of all my property and five years of slavery, I'd carry him to the clinic and be grateful, and if I had to rob my neighbor into the bargain I'd probably do that too but at least I wouldn't be a hypocrite about it.

I speak as someone outside of the debate, I live in New Zealand. I must admit, I was shocked that the issue of trying to introduce a Universal Health Care System would be controversial. Surely, a government trying to improve the health of its citizens, to provide care for the most needy, is a positive thing. I could understand people stressing the importance of efficiency in the allocation of money spent, in the importance of preventative care and education. I just don't understand why people could be angry about a government being concerned about people's well-being and doing something to improve it. I mean, isn't that why we have government, to provide collective goods and services that are not provided by the private sector. Roads, police, education , health, defence, electricity... I knew that President Obama would not always be able to maintain his levels of popularity, but for people to be so angry that he is trying to improve health care? That is the nuttiest thing I have heard of for a long time. Maybe he should just go and spend some money blowing people up, much more useful.
If one lives within society, as most people do, then issues such as health, education, crime, are a societal concern because they affect us all.

As a Canadian I have always found it bizarre that so many people will protest in the street about Universal Health Care. I have never had to worry about the cost of my own health or that of my family. I have been self-employed, a poor student and currently employed by a regular job. No matter what my financial state, I have always been able to see a doctor and get treatment. While my drugs are only covered by my employer, my life has always been taken care of.
Recently my niece needed emergency heart surgery days after she was born. Thanks to the doctors at Sick Kids in Toronto, she is now breathing on her own and has a good prognosis. They did not need to worry about denied coverage or costs. I can’t imagine having to worry about the cost of everything on top of it all.
Besides basic freedoms and education, I think that health care should be a right given to all people. I think it is the duty of members society to ensure that these basic rights are afforded to everyone. I am glad my taxes go to others and their health care. While out system is obviously not perfect, I can sleep knowing that my family will be cared for and never be denied coverage due to some ridiculous clause.
Keep up the fight, Roger. This is one thing batter I would hate to see lost.

First let me write that I am a dual citizen of Canada and the U.S., my mother the American, my father a French Canadian. She never relinquished her citizenship so I am one of the very lucky few who may vote in both countries.

The single most important difference between Canadians and Americans other than gun crimes is on health care. The Canadian system is single-payer one in about 70% of the population, while the rest have private or semi-private coverage.

It irks Canadians to no ends when American politicians, usually conservative, fudge the facts on universal healthcare. They have, and it began with Ronald Reagan, distorted the argument in a way that it has seeped into the American psyche that universal healthcare coverage equals "Socialism" or "Communism".

However, single-payer or universal healthcare does not mean "government-run" healthcare. That is the first mistake conservatives make. Single-payer/Universal healthcare is simply a payment delivery system, not a healthcare delivery system. Healthcare in Canada and in Europe is delivered mainly through private enterprise and private equipment.

Insurance companies in America do indeed have a profit motive. America is a nation that depends on it's citizens to be sick in order to drive up profits. That is why it is cheaper to eat McDonald's than it is to buy the stuffs to make a great big salad. Healthcare insurance companies in America are in reality a useless middle-man. A pimp. They extort the hard-earned money of American citizens and then make it their business to drop as many people from being insured as possible in order to drive up profits. This is un-American to me. And not very Christ-like either. In the last 8 years, healthcare insurance companies have seen their profits go up by something like 400%.

The healthcare bill has not yet passed. It is not too late to make sweeping changes that actually benefit the country at large. But change does not come into being on it's own. It doesn't come into being solely by the act of voting, or by changing the color in the White House. You have to keep at it, keep kicking down doors even after the big election victory.

President Obama is not Superman. Too often, Americans scapegoat everything onto their presidents and their elected representatives when the whole joke of it is that they will only act when the people put pressure on them to act. On that front, the conservatives and their cracked-out followers at those obnoxious town halls have successfully defended the status quo. And they can't even explain their position in a way that makes any sense!

The healthcare bill will ensure that you cannot be denied coverage for having a pre-existing condition. That's all nice and good, but that isn't real change. That's just nibbling. The healthcare insurance companies are the cause of hundreds of billions of dollars of waste that could be used to benefit all Americans. The "public option" is railed against by the very crowd that used to stand for "competition in the market place". Funny then how conservatives are now arguing against their very own philosophy of the last 30 years. If the public option is so bad, than please demand to find out why it is that your elected conservative politicians won't drop their gov't healthcare plan!

I like President Obama. I voted for President Obama. But I'm sorry to say it, he needs to be more like George Bush. Bush didn't have the votes to do anything, and yet dragged the country into two wars, into massive deficit spending, warrantless wiretaps on American citizens, dropping the Geneva convention's rules on torture. Meanwhile, Obama has all the votes he needs to push through real change, and we're watching our chance slip away because the President is too concerned with trying to please everyone, particularly by constantly responding to and trying to massage a segment of the country that doesn't even believe him to be a citizen of the United States!

Progressives in America have exactly one year until the midterm elections in 2010. One year before they lose their cushion in both chambers of gov't. One year to really push through real social change the way Lyndon Johnson or FDR did. It is a time for grand and sweeping gestures, not just more backpeddling and nibbling.

Perhaps the biggest mistake President Obama made was by not going on the offence early on and framing the argument in terms of universal coverage being a prescient "Moral Value". A moral imperative. For whatever reason, progressives in America are too timid to ever use the "Moral Values" card even when their policies reflect such Christ-like ways of being!

One year to pass real change, and then Obama will basically be a lame duck after that. So now is not the time to be a milk-toast. It is time to write letters to your elected reps, to knock on doors, to sign petitions, to have town halls demanding that the public option be in the bill. If you don't like the "public option", than fine, keep whatever option you've got. Funny how hypocritical most American libertarians are: unfettered individual liberty is always good enough for them, just not everyone else. If you really stand for individual liberty, than keep whatever plan you've got, but don't deny me my public option, dammit!

By berford howser: "Health care is not a right. It is an individual responsibility. That is not subject to opinion. It is fact, whether we want to disagree with it or not."

Health care notwithstanding, but your opinion is subject to my opinion and I think your grand pronouncement is just one persons opinion.

I wonder, if Medicare is nothing more than socialized government intrusion that is slowly eroding away the fabric of our society, will you reject it once you are eligible? Do people with these opinions put their money where their mouth is? I could be wrong, but my guess is no.

To all the people posting here about their personal freedoms and rights, you would be wise to remember George Carlin:

http://www.youtube.com/watch?v=hOKC5MhkAp0

As for health-care, when I lived in Canada for three years, I received excellent health-care coverage for roughly $400 a year. That's how much my mother pays a month for her health-care and that's before co-pays($50 per visit, multiple visits a month, plus prescriptions). In order to afford it all, my retired father had to go back to work. They're trying to hold on until my mother is eligible for Medicare. As for me, since I got back to the United States, I have been denied coverage, denied service, denied medication despite being a healthy young man with "excellent" health insurance through my work. Should I get seriously sick here, I would be bankrupt. Maybe I should move back to Canada.

Until there is strict oversight and regulation of all major corporations, there will always be a disparity of wealth and privilege burdening the middle class with huge debts and little upward mobility. We do all the work and reap none of the benefits.
Hmmm, seems like George Carlin was right again:

But all of our history suggests that government-run programs, on the whole, become bureaucratic and inefficient. Too much money gets wasted. Whereas free enterprise (for-profit) programs, unchecked, tend to look to maximize profit above all else. Moral obligations fall by the wayside and people lose out on services because the CEO is worried about the profit margin.

"The upper class keeps all of the money, pays none of the taxes. The middle class pays all of the taxes, does all of the work. The poor are there just to scare the shit out of the middle class. Keep them showing up at those jobs."

Jerome Groopman has an informative essay in the New York Review of Books about doctors and diagnosis and treatment, the limits of medical science and efforts to ameliorate those limits.

One of the most vital and seemingly obvious facts that many conservatives seem to reject is the idea that a system that has characteristics of socialism can (and already does) work within a capitalist, free market system. Clear examples are the police and fire department.

The vast majority of "left-wingers" and, well, Obama voters are wholly in favor of free market capitalism. Maybe I don't need to say this but the responses I often get to my beliefs suggest that many people do think I'm a socialist. But the fact is that we really only disagree on which goods and services should be subject to all of the conditions of the market. Personally, I think it is safe to assume that our wants and needs for the various widgets we go about buying and selling in the market are fundamentally different than our single most vital human need: good health. This is what makes health insurance a different "commodity" than things like beer or computers or, something more easily comparable like car insurance. We don't need to be able to drive if we know we can't afford it and arrange our lives around our access to other means of getting around. Therefore, while it's obvious that having transportation gives people some advantages, I can heartily agree that we don't *need* car insurance to survive and prosper and that is why car insurance in a wholly free market enterprise. But every one of us needs good health. And we need it not just to treat us after catastrophic events, but also to treat us more regularly to prevent such events.

Something like 57% of us (and rising, according to a recent poll) believe we need health reform now, it seems that many of the people who reject the current types of plans being bandied about do still believe that people should not be denied healthcare for pre-existing conditions, they believe that insurance companies are profiting improperly off of people, and many of them believe that access to affordable health care should be a human right, not a privilege (to believe otherwise is not pro-life). So the disagreement we have comes in how to go about accomplishing a system that functionally works to serve these beliefs in what is right. In short, I really don't think we're so different in our beliefs as the contentiousness of these debates often suggests and I really would like to see more concessions made by conservatives who too often seem to be fighting a battle shrouded in selfishness -- even if that's not the case.

Roger,

I work on Capitol Hill for a moderate Democrat, and I'm writing to challenge your optimism for the health care bill (which is why I must remain anonymous). You told Sandra that it "looks like its going to pass," but I'm here to tell you that the bill will pass, yes, but without a public option.

Unfortunately the moderate Democrats -- Landrieu, Lincoln, Baucus, Nelson, Lieberman, Bayh and Wyden -- are not going to vote for a bill with a public option. It's a sad fact that most liberals working on the Hill are slowly starting to admit. And the vote for cloture, which would allow passage by a simple majority, will not be voted for either. It's not that these moderates don't support cloture, but for most of them, they're reelections in 2010 depend on a "Nay" to cloture.

The bill, therefore, will force insurance companies to provide coverage to those with preexisting conditions; but as to the real reform the health care industry so desperately needs -- that Americans so desperately need! -- it seems the Republicans have won again.

After the 4th of November, it seemed the Republican Party was dying, that conservatism had seen its last reign; but with the health care issue, I think the author of "The Death of Conservatism" is going to have a difficult time publishing another book -- other than one titled, "Oops, I was wrong."

To quote the Huffington Post, let's all observe one moment of silence for the public option, and the 44,000 people who die every year without it.

Mr. Ebert,

I agree: it would be great to give the government the free hand to help give people healthcare they need, rather than continue to let the greed and indecency and waste of the private system run unchecked. But I feel compelled to repeat my question from a longer post I made this morning: what about conscience protection? How can we give government so much power to help, and still be assured that some well-meaning zealot with a trendy new bioethical agenda will not be able to use government power to coerce voters and doctors into becoming complicit in practices which they find to be deeply immoral, such as abortion, euthanasia, and cloning? Or do you consider the consciences of millions of Americans to be a small sacrifice to make in order to treat the diseases of millions of other Americans?

- Brother Augustine, Cistercian monk in Texas

Ebert: That zealot would need a great deal of (hardly likely) support from Congress. Your very remote fantasy should not be an issue in the health care debate.

Ebert says: "I've spent a good deal of time in Canada and know many Canadians of political persuasions both left and right quite well. It's my impression that Tommy Douglas, a socialist who passed the national health legislation, is the only prime minister of any party that allof them like."

Very true. In 2004, the CBC held a televised, country-wide contest to identify "the Greatest Canadian of all time." Tommy won the title - beating even our fathers of Confederation. Let that be a testament to how strongly Canadians value their universal health care system - and the memory of the man who made that happen.

But interestingly, Douglas was never Prime Minister. He was the Premier of Saskatchewan, and the first leader of the federal New Democratic Party, but never held the highest office.

PS- As a Canadian, I may as well sound-in: I have never been anything but satisfied with our health care system, and I think it's scandalous the way it has been raked through the muck lately.

Ebert: Wow. The way they talk about him, I just assumed...

Mr. Ebert,

Thanks for the post. As usual, very compelling.

I, too believe that the biggest problem with health insurance is that it is profit-driven (and if there is a more disgraceful way of making a profit than basing your business on the suffering of others, I cannot think of one offhand).

With that in mind, I think I can solve the healthcare problems of the entire nation with a simple, single paragraph law: "All companies, persons, corporations, or other entities are herewith expressly forbidden to offer health insurance, bond, or other payment or compensation to medical provider(s) in return for any compensation whatsoever, unless such company, individual, corporation or other entity operates entirely as a non-profit corporation pursuant to 26 U.S.C. Section 501(c). All such companies, persons, corporations, or other entities providing such medical insurance will submit to strict oversight by the IRS and the Department of Health and Human Services to ensure their non-profit status, and all non-compliant companies, persons, corporations, or other entities shall be immediately disbanded or shall immediately become the property of the United States Government."

Without the motivation of profit, no health insurer would need to exclude existing conditions, deny treatment, or otherwise milk the system. This solution will go a long way toward fixing the broken sysetem, and should please libertarians (the law would not say you cannot run a healthcare insurance business, just that you must do it on a non-profit basis and submit to oversight to prove that non-profit status) and everyone else, too. If this results in insurance companies all giving up and going under, then so be it. We go to single-payer government health care and direct pay by those who can afford it.

P.S. On many fronts, I consider myself a libertarian. I oppose the death penalty because I do not trust the government with making that sort of irreversible decision, I believe abortion should remain legal for the same reason (a decision best left to the individual), I believe people should have the ability to attend private schools, I also believe too much taxation and regulation can stifle business and have an adverse effect on the economy.

I even believe the government should not be making medical decisions ("rationing care"). Problem is, the for-profit companies are ALREADY rationing care. And doing it for the wrong motivations ($!). And the burden on coroporations and individuals to pay the middle-man profits to the healthcare insurers AND the spiralling cost of the care itself is opressive, and threatens the foundation of our entire economy. So, it is time to cut out the insurance middle-men (or at least rein in their cut of the pie), and put our dollars to better use.

Bottom line, even though I consider myself an economic (and social) libertarian, some things are too important to leave to the free market. Healthcare is one. Energy is another. Excessive profit-taking in either can wreck an economy. So, if and when the market cannot adequately control such costs, restrictions must be considered.

Keep up the good work.

Having worked for a government agency for almost 20 years, I don't have much faith in a "public option" for healthcare. Too much wasted money. This doesn't mean that it would be a bad idea to force health coverage through payroll deductions for premiums that get sent straight to the private insurance provider. If we end up paying for the un/underinsured when their care is critical (emergency room visits), we may as well get premium payments to the extent we can.

Roger, thanks for another thoughtful and wonderful post.

Capitalism is simply this:
Sell something for as much as you can.
Make it for as little as you can.

That's it.
The only time corporations are concerned with the public good is if it is more profitable for them to be concerned than to not be.

Roger,
Why not privatize the fire department as well and only people who choose to pay get their services, I bet that will motivate them to improve their services while keeping personal liberty intact!

Many of the libertarians I come across maintain a general opposition to government action, or at least intervention, in their own lives. They maintain that free enterprise and unfettered markets will provide a solution, and not only a solution, but the best possible solution. That the market will achieve equilibrium and provide the most efficient, cost effective solutions to any problem.

Some are so adamant in this they believe that an unfettered market is a good unto itself. When I meet those that maintain this position, I become wary. Is not the goal to create health, strength, happiness, prosperity and security? Aren't means to such ends merely that, and not goals of themselves?

At the heart of the argument for pursuing unfettered markets there seems to be, at least in part, a gamble. The belief that an unfettered market will provide the best solution presupposes that it will succeed. A failure can bring collapse and devastation. And the willingness to allow the market to decide is the willingness to accept the failure. In other words, you must be willing to gamble with everything to get the best outcome.

One of the greatest proponents of the unfettered, unregulated free market in recent history is former chairman of the Federal Reserve Alan Greenspan. Having been in the position during one of the strongest economic expansions in American history, Mr. Greenspan and most of his contemporaries were hardened free market supporters. And not just free markets, but markets as unburdened by regulations as possible. (Mr. Greenspan, for example, was so against regulation that he opposed regulating the derivatives market to the extent that he didn't even believe fraud should be regulated. That is to say, the market would take care of people lying and cheating, and the government should not intervene even in the such cases.)

For much of his time at the Fed, Chairman Greenspan's beliefs seemed to be justified. He was right. A de-regulatory, laissez faire approach had created economic health, strength and domestic stability. It was great.

Right until it wasn't. When Mr. Greenspan testified in front of congress in late 2008, he was a changed man. He testified that his belief that an unregulated market would produce the most efficient, best solution, was, at least in the case of the financial sector, simply, and horribly wrong. Not only was it wrong, he believed there was a flaw in his belief of how the world worked as a whole, that his the core belief system upon which he had based decades of his life and public service, was flawed.

There are many things we do not leave to the free market. There are not competing legal systems that we chose from in case one doesn't deliver justice. There aren't competing militaries we can choose from in case one fails to protect us from being killed, or competing road systems or police forces or fire departments.

Some things, it seems, are too important to gamble with.

The supporters of universal health, I believe, think health care is one of those things. The opponents believe, in effect, that gambling with it is alright because it will produce the best result. I've come to think the former are correct.

Health is not a product that can be discarded if you don't like the results, or shopped around until you find the one you want. I can buy a computer and get rid of it if I don't like it. I can't do that with my health insurance if they fail to keep me healthy. By the time I decide I want something else, I've already paid with something I can't get back. In the end, I think life is too important to gamble with, and that's why I think universal health care is the right thing to do.

The liberal argument always seems to boil down to this: Our health care industry is broken, so we need universal coverage for everyone. But that is a non sequitur. There may be other, better methods of reform than the government taking over the health care system. Consider: insurance costs are so high because people use it to insure against virtually guaranteed costs, like routine doctor visits. That's like getting car insurance for oil changes! If we find a way to reduce medical costs to realistic levels then people won't need insurance for most things, and insurance costs would drop dramatically so people can afford it to cover only emergency situations. The trick is finding a way to reduce those medical costs, but we can't do that if liberals won't acknowledge it as a potential solution.

I also must take issue with your statement that "You and I will end up paying for them, even though they were unwilling to help pay for us." How do you or I pay for anything that "they" don't also pay for? While taxes may be levied unequally, in the private sector costs are absorbed across the board. Everyone will end up paying to their own ability as prices rise to cover sunk costs and other industries are forced to follow suit. Universal health care will not eliminate this problem. All it will do is, again, shift the equal cost distribution to an unequal one through taxation.

You can argue, as you have, that universal health care is "right," but don't say it is necessary or even more fair -- at least, not until you have addressed the alternatives that liberals usually dismiss without thought.

Oh, and your free enterprise argument only works if we have a truly free enterprise system. Since the "free" means free of government interference, ultra-conservatives would strongly disagree that we have a truly "free" enterprise system at work. Perhaps it is the government's fault our current system is broken...because they keep trying to fix and manipulate what might work better if left alone.

I am an American who is now a student in the U.K. I pay National Insurance premiums and obtain health care through the system. Is it perfect? No. Do I worry about going bankrupt if I or my spouse have the misfortune to have a catastrophic illness? No. What I have noticed here is that no one need go without basic health care if they are unemployed or low-income nor for any reason involving ability to pay.

I spent 30 years working in insurance claims in the U.S. primarily in self-insurance non-profit pools. Every year I sat in meetings with actuaries and accountants and saw the rising cost of medical care force us to raise rates, even though the pool was not making a profit and indeed was often in the red.

From my perspective, part of the problem is not so much that the insurers were greedy or heartless but are placed in a position where the consumer ( patient) had no real conception of the cost of health care. It is not like going to the grocery store where you can see the price of steak and the price of chicken. For a very good explanation of how the system works I suggest going to the NPR web site and look at the Planet Money segments on health care issues. "This American Life" also has had very good sessions on health care.

I do agree that Americans, as a social group, are best served by making sure that everyone has access to food, shelter and basic health care. Are we so self-centered that we can only support ideas that only benefit a portion of the whole, even if we are fortunate enough to be one of the few? I am hoping that we will find a way to ensure that no one falls through the cracks and everyone in included in the ability to live a healthy and productive life.

I will believe the idea that government is not profit-driven on the day that our president and our congressmen waive the salaries, pensions, and all other financial perks that come with jobs they would do for free, and probably cut off one or more of their limbs to attain.

One irony of this debate, where so many commenters here and in other online threads are quick to classify all libertarians as "selfish rich people", is that libertarians fight so hard to shape our government into one that doesn't hand out earmarks or grant special benefits to corporations. I wish we could all agree that corporations, government, and our communities are not "evil", and refrain from painting them as the real world equivalent of the all-seeing evil eye atop the mountain in the Lord of the Rings movies. They're groups like any other, made up of good people, bad people, and most of all, people just trying to pay their bills and get through the day without being yelled at by the boss. If we could stop classifying people in terms of the religious terms of "good" and "evil", if we could get beyond prefacing our statements with words like "I can't believe this rich Democrat or Republican could believe this evil, selfish thing..." then maybe we would be forced into holding a clear debate on the issues.

I think the repairs we could make to health care now have been pretty well laid out by commenters here and elsewhere. Health savings accounts; tax benefits for individual buyers, not just businesses; repeal of restrictions on buying insurance out of state; repeal of state-specific requirements for insuring for unnecessary treatments like hair transplants and gastric bypass surgery; opening up new medical schools to train more doctors, nurses, dentists, making the field more competitive; allowing doctors with out-of-state licenses to cross state lines to provide free, voluntary medical services for poor or needy patients; reforming patent law so that the government cannot grant medical patents for procedures already widely in use and then allow the patent owner to charge new fees to use those procedures (a practice I read about years ago that I haven't heard mentioned in this debate).

The changes I've listed above (and many more) can only be made by government. So I ask you -- why aren't they being made? Why aren't these changes even being talked about? Is it simply that neither of our two political parties will admit to being the architects of a system that is causing people so much hardship?

To modify the initial question in your post: What if the day has already passed where people have died because of the government regulations listed above? What about their families? What about their children? Do we not owe it to the people we've lost through the injustices of our health care system to fix the real problems, rather than just throwing our hands up in the air and saying "let government handle it"?

Libertarians are not telling you to "butt out" of health care. We're asking you to dig deeper for the truth.

I appreciate your attempt to address libertarian arguments specifically, but this essay seems to misunderstand libertarianism to some extent. Libertarians and liberals have more common ground than you think. We all want everyone to be fed and healthy, and we only disagree about the most appropriate and most effective means.

Most libertarians with any sophistication don't believe that corporations are "motivated to bring about the public good," or that big business is always in the right. On the contrary, many libertarians dislike big business as much as left-liberals do, but for a different reason: because big business often uses government to obtain privileges for itself.

That's certainly the case with the insurance and pharmaceutical industries. Insurance companies benefit from a tax code that since World War II has pushed people to buy insurance instead of paying for their healthcare directly. As far as I know, no one disputes that this has played a huge role in driving up costs. There's a reason why doctors made $5 housecalls fifty years ago, and don't do so now. It should be no surprise that the insurance companies favor President Obama's proposal to force everyone to buy insurance.

The pharmaceutical companies of course have tremendous sway in Washington as well. They use the FDA and many other means to keep competitors out, drive up the cost of drugs, and cause people to favor drugs over preventative measures and alternative remedies. The pharmaceutical companies like government healthcare, and it's not because they have suddenly abandoned the profit motive.

As for trusting government, one problem with that is that government agencies supposedly intended to protect consumers are often "captured" by the industries they're supposed to regulate. To libertarians, it seems naive to assume this would not happen with government healthcare or any other big-government scheme. Give government more power, and the wealthy and powerful will find a way to use it to their benefit at everyone else's expense. You can say that we need to clean up government to make it less corrupt but, as Illinois residents know well, that is easier said than done. And libertarians believe, based on their study of economics, that government planners could not succeed in centrally planning, even if they have the best of intentions -- their interventions will create more problems than they solve.

Also, it's not really fair to accuse libertarians of "selfishness." I think part of the reason for confusion on this point is Ayn Rand. Most libertarians are not Randians, and do not share her selfish philosophy of life.

Libertarians believe a true free market -- which is not what we have now -- would make everyone better off, including the least advantaged in the economy.

Libertarians have a lot of confidence in private charity because private charity does, in fact, raise lots of money for lots of causes, many of them far more trivial than healthcare. If private charity is not meeting healthcare needs now, this may be in large part because government has crowded it out. It used to be that charity hospitals would, in fact, treat people for free who couldn't pay. Our distorted, insurance-dominated market has eliminated this.

So on the utilitarian level, libertarians believe freedom makes everyone better off. On the moral level, libertarians believe it's inappropriate to use government coercion to make people do things or pay for things -- and all government programs ultimately rest on force to make people participate.

I don't expect any of this to convert you to libertarianism, of course. But I hope it provides a little clarity on what libertarians believe -- and why, even though we have great differences, we're not quite as far apart as you might have thought.

My wife is German. A good friend of mine's wife is English. I, like my friend, am American, living in New York, attempting to work in media.

My German wife and I had a tough road finally getting health care for us, and it was such a huge culture shock to her that it completely shifted my perspective on the matter. All these talks about rationing are ridiculous.

Before we had our health insurance (which, between my employer and I adds to about $800 a month for my wife and I), my wife had a surgical procedure she had to go through and we did the math - it was cheaper for us to pay for a flight for her return to Germany. We made an appointment and paid for the flight. There was no RATIONING to be done. We made an appointment and she flew there. She had to have 3 appointments for the procedure - of which every appointment was made WHILE SHE WAS THERE. She was there for 10 days.

I had waited in line for a procedure far longer under an individual insurance plan from Blue Cross. It took forever to find an appointment with a specialist, AND I needed to, constantly, debate with the billing department to get discounts and payments because, even with the $220 a month insurance, couldn't afford the procedure or medication that was suddenly not covered.

It got so I was afraid to make an appointment for anything. Including what became a chronic back injury with an even more difficult recovery.

Now to my friend's English wife. She happens to be a part of the British aristocracy, one of the more well to do families in the entire country. How much do they pay for private health insurance that competes with a public option - of the kind that only the elite of the country pay for - $300. Oh, I'm sorry, $300 a YEAR.

And recently she was in her home country when an emergency required her to make several appointments, which were made, while she was there.

We are the only country that does not do this. The insurance that my employer and I are paying for now - which I would lose if I lose my job, and given the freelance nature of what I used to do, I'm now tied directly to one place - $800 a month total. I pay 50% because I work for a small businessman. Mildy, it's cheaper than the $220 per person individual plan we used to be on. It's also several times better in coverage. Things that I have always wanted to test and look out for I can now look at for a "mere" $50 co-pay.

IN the three months and $1200 we've had this insurance, the company has spent a grand total of $68.50, which I just got from our handy dandy new on-line account service on their website. Also, according to that, they had denied our in-network insurance company chosen gynecologist payment for my wife's first annual check-up for her pre-existing condition of being a woman. That's right, in these first few months, my wife's gynecologist was denied payment by our new, wonderful, insurance company, why? The incredible level of bureaucracy that the insurer put up in order to accept or deny claims. A phone call confirms that it was because the gynecologist's billing department used the wrong number in a form somewhere. Which we got from their office. Because, like us, they have made several calls to the insurer trying to discover why this is the case.

I would say that the disparity is enough to warrant looking into something else.

If there WAS a good, competing program in the free market, I'd likely take it.

Because it's there, and has been there for awhile.

My other american friend and I? We work middle class jobs in an industry that is not failing. We work hard, harder, in order to not lose these jobs for fear of keeping our families covered. We both just turned 30 and have several gray hairs.

My father, who's close to retirement age, is equally afraid of this. He and my mother attempted a small business, which was extremely successful for 8 out of 10 years. In 2 short years they were ruined and it took nearly two years for both my parents to reenter the job market into their old jobs 10 years too late. With no retirement or nest egg. And now with senior level health care bills.

What kind of system is that?

UPS and FedEx do quite well on their own when there's a post office.
Stanford University does quite alright with UC Berkeley not too far away. Virgin Airlines is developing its own private space program, which would not have happened if Kennedy hadn't spearheaded NASA. Come to think of it, if Kennedy didn't subsidize engineering degrees, we wouldn't have University super-computers, and we wouldn't have Steve Jobs, Bill Gates, and the like. The epitome of the entrepreneureal spirit.

We have the opportunity to do this now.

Just one more snippet:

I have one friend who, at the time, worked for starbuck's. He was spouting a lot of the same stuff you hear in conservative arguments. I asked how much he paid for his health insurance - and he said $50.

I told him how much real individual health insurance costs for a single, healthy 20 year old - $220. I went on about how, at 30, my costs went up and I had to find a way to cover my wife, who was used to a Private/Public system in Germany.

I then asked him if he thought that more people paying into a group plan could possibly account for his low premium rates.

And then, a week later, he lost his job.

There is a specter that seems to haunt getting universal health care--that of the delusion that I, an independent American, am exempt. From age, time, illness, accident, greed, stupidity. I am somehow excused from one of the most fundamental facts of life.

If you exist, you will need help. You will get cancer. Your child will have autism. Your son will cause a car accident. Your daughter will burn the house down. Your wife will develop diabetes. Your husband will develop a brain tumor. Your mother will get Alzheimer's. Your father will incur crippling arthritis. Your stepchild will sink into depression. Your sister will be bipolar. Your brother will be schizophrenic. Something is going to rip the ground right out from under your feet. And if it already has, something else is waiting.

Not because you're evil, stupid, shortsighted, or weak--or not only because of those things, at least. And you will never be good, smart, longviewed, or strong enough to avoid the slings and arrows of our shared outrageous fortune.

We evolved to survive together. It's hard, people are parasitic and lazy and mean, but not everybody, all the time. As Americans we chose and keep chosing the system we have today, and if there's one thing we all can agree on, it infurates us at least fifty percent of the time. But it keeps going, and can be improved, as can we--in spite of ourselves, mostly, but it can be done.

Ebert: This is so very, very clear.

I made it far into middle age with nothing more than a tonsilectomy and appendectomy. Then cancer came along and played a surprise.

A quotation from the villain of Ann Rand's "The Fountainhead" I find illumiates my thinking on the matter of the 'Nanny State'

"The basic trouble with the modern world, is the intellectual fallacy that freedom and compulsion are opposites. To solve the gigantic problems crushing the world today, we must clarify our mental confusion...In essence freedom and compulsion are one... Traffic lights restrain your freedom to cross the street whenever you wish. But this restraint gives you the freedom from being run over by a truck. If you were assigned to a job and prohibited from leaving it, it would restrain the freedom of your career. But it would give you freedom from the fear of unemployment. Whenever a new compulsion is imposed upon us, we automatically gain a new freedom. The two are inseperable. Only by accepting total compulsion can we achieve total freedom."

The Obama admin merely wants us to gain the new freedom of universal medicocre, rationed healthcare by accepting the compulsion of massive new deficits, and ruinous personal taxes.

Below are excerpts from Mario Cuomo's Keynote Address at the 1984 (in that year, Walter Mondale was defeated by Ronald Reagan in the Presidential election) Democratic Convention in San Francisco (I'm confident that people who would criticize the messenger believe they're actually offering an intellectual critique of the speech) - this speech is perhaps the most eloquent defense of the belief that there's more to life than just selfishness (and, that sometimes, working for the common good serves the purpose of selfishness as well):

"Thank you very much.

On behalf of the great Empire State and the whole family of New York, let me thank you for the great privilege of being able to address this convention. Please allow me to skip the stories and the poetry and the temptation to deal in nice but vague rhetoric. Let me instead use this valuable opportunity to deal immediately with the questions that should determine this election and that we all know are vital to the American people.

Ten days ago, President Reagan admitted that although some people in this country seemed to be doing well nowadays, others were unhappy, even worried, about themselves, their families, and their futures. The President said that he didn't understand that fear. He said, "Why, this country is a shining city on a hill." And the President is right. In many ways we are a shining city on a hill.

But the hard truth is that not everyone is sharing in this city's splendor and glory. A shining city is perhaps all the President sees from the portico of the White House and the veranda of his ranch, where everyone seems to be doing well. But there's another city; there's another part to the shining the city; the part where some people can't pay their mortgages, and most young people can't afford one; where students can't afford the education they need, and middle-class parents watch the dreams they hold for their children evaporate.

In this part of the city there are more poor than ever, more families in trouble, more and more people who need help but can't find it. Even worse: There are elderly people who tremble in the basements of the houses there. And there are people who sleep in the city streets, in the gutter, where the glitter doesn't show. There are ghettos where thousands of young people, without a job or an education, give their lives away to drug dealers every day. There is despair, Mr. President, in the faces that you don't see, in the places that you don't visit in your shining city.

In fact, Mr. President, this is a nation -- Mr. President you ought to know that this nation is more a "Tale of Two Cities" than it is just a "Shining City on a Hill."

Maybe, maybe, Mr. President, if you visited some more places; maybe if you went to Appalachia where some people still live in sheds; maybe if you went to Lackawanna where thousands of unemployed steel workers wonder why we subsidized foreign steel. Maybe -- Maybe, Mr. President, if you stopped in at a shelter in Chicago and spoke to the homeless there; maybe, Mr. President, if you asked a woman who had been denied the help she needed to feed her children because you said you needed the money for a tax break for a millionaire or for a missile we couldn't afford to use.

Maybe -- Maybe, Mr. President. But I'm afraid not. Because the truth is, ladies and gentlemen, that this is how we were warned it would be. President Reagan told us from the very beginning that he believed in a kind of social Darwinism. Survival of the fittest. "Government can't do everything," we were told, so it should settle for taking care of the strong and hope that economic ambition and charity will do the rest. Make the rich richer, and what falls from the table will be enough for the middle class and those who are trying desperately to work their way into the middle class.

You know, the Republicans called it "trickle-down" when Hoover tried it. Now they call it "supply side." But it's the same shining city for those relative few who are lucky enough to live in its good neighborhoods. But for the people who are excluded, for the people who are locked out, all they can do is stare from a distance at that city's glimmering towers.

It's an old story. It's as old as our history. The difference between Democrats and Republicans has always been measured in courage and confidence. The Republicans -- The Republicans believe that the wagon train will not make it to the frontier unless some of the old, some of the young, some of the weak are left behind by the side of the trail. "The strong" -- "The strong," they tell us, "will inherit the land."

We Democrats believe in something else. We Democrats believe that we can make it all the way with the whole family intact, and we have more than once. Ever since Franklin Roosevelt lifted himself from his wheelchair to lift this nation from its knees -- wagon train after wagon train -- to new frontiers of education, housing, peace; the whole family aboard, constantly reaching out to extend and enlarge that family; lifting them up into the wagon on the way; blacks and Hispanics, and people of every ethnic group, and native Americans -- all those struggling to build their families and claim some small share of America. For nearly 50 years we carried them all to new levels of comfort, and security, and dignity, even affluence. And remember this, some of us in this room today are here only because this nation had that kind of confidence. And it would be wrong to forget that.

So, here we are at this convention to remind ourselves where we come from and to claim the future for ourselves and for our children. Today our great Democratic Party, which has saved this nation from depression, from fascism, from racism, from corruption, is called upon to do it again -- this time to save the nation from confusion and division, from the threat of eventual fiscal disaster, and most of all from the fear of a nuclear holocaust.

That's not going to be easy.... And in order to succeed, we must answer our opponent's polished and appealing rhetoric with a more telling reasonableness and rationality.

We must win this case on the merits. We must get the American public to look past the glitter, beyond the showmanship to the reality, the hard substance of things. And we'll do it not so much with speeches that sound good as with speeches that are good and sound; not so much with speeches that will bring people to their feet as with speeches that will bring people to their senses. We must make -- We must make the American people hear our "Tale of Two Cities." We must convince them that we don't have to settle for two cities, that we can have one city, indivisible, shining for all of its people.

Now, we will have no chance to do that if what comes out of this convention is a babel of arguing voices. If that's what's heard throughout the campaign, dissident sounds from all sides, we will have no chance to tell our message. To succeed we will have to surrender some small parts of our individual interests, to build a platform that we can all stand on, at once, and comfortably -- proudly singing out. We need -- We need a platform we can all agree to so that we can sing out the truth for the nation to hear, in chorus, its logic so clear and commanding that no slick Madison Avenue commercial, no amount of geniality, no martial music will be able to muffle the sound of the truth.

And we Democrats must unite. We Democrats must unite so that the entire nation can unite, because surely the Republicans won't bring this country together. Their policies divide the nation into the lucky and the le