Why Health Care Reform Is So Difficult in the United States

Humphrey_Taylor_HIWhy is it so hard to change the American health care system? And so much easier to change other countries’ systems?

I pondered this question recently while attending the Commonwealth Fund’s International Symposium on Health in Washington where our latest survey comparing primary care in eleven countries was discussed. I heard presentations describing changes that have been, or are being, implemented in England, France, Germany, Norway, Sweden, Switzerland, the Netherlands, Canada, Australia and New Zealand. In some cases, these are fundamental reforms in how medical care is delivered and how providers are reimbursed. Many of these countries can demonstrate real improvements in the quality of care and efficiency in their systems.

Evidence of how much more difficult it to improve this country’s system is provided by the OECD data from nineteen countries on the number of “deaths amenable to medical care,” that is deaths that could have been prevented by appropriate medical care. It is bad enough that the United States has dropped to last place – with the highest proportion of preventable deaths – of all nineteen countries measured. The data also show that all the other eighteen countries had lowered the number of preventable deaths over five years by much more than this country’s modest 4% improvement.

I would suggest that all of the following are reasons why it is easier, in some countries much easier, to reform their systems than it is to change ours:

  1. Their systems are so much simpler. Ours is much more complicated with our “thousand points of payment,” Medicare, Medicaid, Kaiser, the VA, the Mayo Clinic, HMOs, PPOs, and millions of employers and their different health plans.
  2. They already have universal coverage, so they can focus on improving quality, efficiency and cost containment without a huge ideological debate about the roles of government and the private sector.
  3. They have parliamentary systems, where their governments can usually win the votes of a majority of legislators and only a simple majority is needed. It is much, much harder for an American president to win enough votes in both houses of Congress, including a filibuster-proof sixty votes in the Senate, for controversial new legislation.
  4. Lobbies, representing special interests, are much more influential in this county.
  5. The power of money; elected officials in most other countries do not have to raise larger sums of money for their campaigns, and are therefore much less beholden to industries or professional groups.
  6. They only need a bare majority of votes in their legislatures. None of them have anything like the US Senate’s ability to filibuster.

Another factor that may also make a different is the influence of partisan news networks, especially Fox News, and of talk radio, that spread emotional and often misleading arguments, fuel populist feelings and dumb down the debate.

I should note here that the ease with which parliamentary systems can enact major reforms is not always a good thing. After World War II, Britain’s Labour government nationalized its substantial steel industry. It was then privatized (i.e. denationalized) by the next Conservative government, nationalized again in the 1960s and then denationalized in the 1970s – by which time it had been almost wiped out.

However, when we look at the difficulties our presidents since Theodore Roosevelt have had when trying to pass major health care reforms, one wonders if the uniquely American barriers to change and reform are really desirable.

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37 replies »

  1. 401 k
    The workers have the freedom to decide how much moolah will be deducted from their checks and deposited into price savings account.

  2. I totally agree that our system is exteremly complex. We have a lot of middle-mens to increase overhead, who suck up individual’s money and then lobby, using that money, against rightful decisions like health care reform. The $$ spend on trying to prevent healthcare reform could have helped millions of needy people. We are so bogged down by legislation that we do not even think of cost or quality of care. It is almost time to pass health care reform..something will be better than nothing.

  3. all ethical decision making is structured around values. In order for universal health care to be embraced by all citizens in the United States, they will first have to agree to the collective value of equity and fairness and embrace the goal of meeting their collective responsibility to each other while maintaining individual rights and freedoms. That may prove to be the most difficult obstacle of all.

  4. Oh, No special treament for the Rush Linbaugh who has put a Free advertising plug in for the Industry. Tort Reform is not the issue as only 1 to 5 %percent of lawsuites proceed with any rewards. These are the most serious Cases of Medical Error that end in a lifetime of infirmity, Disability and Death. Tort Cases are the ONLY means of accountability! Otherwise, the patient would bare the insurmountable costs of Medical Error.
    The problem is,neither the doctors or the institutions want to be Held accountable for anything that may happens. If it be Medical Error or Hospital Acquired Staph Infections. They Contend that the patient is privledged for the knowledge and skill of the Doctor and the technology of the institution. If the results end to be; the amputation of all limbs from Preventable Staph Infections or simply operating on the wrong body part. No one is accountable . You should just be happy that you are alive and have not severed a critical organ. So what, if you cannot walk ,work ,or feed and cloth yourself! Doctors and Institutions do not accept any responsibility.
    Tort reform is not the answer. Accountability and responsibility for errors would lend toward fewer extremes and legal actions. Consumers are left out of the debate simply because the contracts are between Insurance and the Provider.

  5. Often we forget the little guy, the SMB, in our discussions of the comings and goings of the Internet marketing industry. Sure there are times like this when a report surfaces talking about their issues and concerns but, for the most part, we like to talk about big brands and how they do the Internet marketing thing well or not so well.

  6. Sure, those reasons contribute to the difficulty of passing healthcare reform in America. Let me add to that list, getting a bit more broad:
    1) Health benefits are paid with pre-tax dollars.
    This disrupts the labor markets and puts certain groups at a disadvantage. It also encourages Cadillac plans. Regardless of what people say, fact is that Cadillac plans encourage excessive health demand and consumption that do not contribute at all to health outcomes. I can go on and on regarding this topic, but details are beyond the scope of my argument in this particular instance.
    2) Roughly two-third of adults in America are overweight and about half of all the deaths in the United States are either from cancer or heart disease.
    No wonder we spend so much money on healthcare — we are sick as hell. Ban trans fat, raise taxes on smoking to discourage youth from picking up the bad habit, and introduce healthier foods in schools. When it comes to Medicare and Medicaid, I have no problem as a young American helping out the elderly and needy, but I would rather not pay for their healthcare bills if they are a regular at McDonald’s and do not remember what a fruit or vegetable looks like. If they do not care about taking care of their health, I am not happy about footing their health bill.

  7. Hello
    This is a good post and I came to know so many new things about American health care system.You have given good reasons about it and I think every one would agree with it.Thank you very much for such informative post.

  8. There are those who have argued, with erudition, that pervasive dislike of African Americans by Caucasians is a powerful impediment to health care reform in this country.

  9. MD as HELL,
    I do agree with you that legislative measures that force people to purchase a particular product from a private entity is most likely unconstitutional and I sincerely hope that somebody brings this to the Supreme Court.
    BTW, this is not the first mandated government interaction by virtue of birth and citizenship, the draft is, but there are no constitutional issues there.
    The obvious solution, if we indeed want to provide universal care, is some form of taxation and I know we are in disagreement whether we should do that or not.
    Yes, the founders had a vision of minimal government, but they also had a vision of a “virtuous people”. I would submit that one cannot exist without the other.

  10. I read this piece and a good portion of the comments, and can only offer this, as a psychiatrist who has been thoroughly wiped out by all the intrusions into my specific specialty these past 15 years: when you triangulate a 2 person relationship, ie doctor-patient, by third parties like insurers and other administrative organizations, the relationship is doomed. I once wrote a letter to the editor of my local newspaper back in 1996 after a story about the behaviors of managed care and noted in it: “take the F-O-R out of profit in health care and better care might be restored.” Also, where the hell was Congress when it became obvious the shield that ERISA created for managed care prevented responsible litigation against these organizations when they began to seriously disrupt care decisions?
    The status quo of the pending legislative efforts by this Congress is not the answer. Health care is not a right, it is not something we as physicians have to provide and risk being impovershed to practice. One of my mentors in medical school was right, now almost 25 years later: “everyone thinks they can be doctors and dictate care decisions, but when the going gets tough, these charlatans are the first for the door.” In my psychiatry residency, it was echoed a bit differently: Everyone is a psychiatrist until they screw things up, and then they duck to leave you and the patient to deal with the feces hitting the fan (little change with words to be printed, you get the idea)”.
    Again, take the profit margins out of the equation, and watch those who have no interest in care leave. Not easy to implement, but, it’s a start. Just try doing that with politicians! Over 40% of them are millionaires? When at best 1-2% of the total US population is? Maybe end being a politician as a career choice!
    One last comment that will outrage but is truth, to me at least: we as a species were not meant to live in the numbers that health care now allows past the age of 70 years old. People don’t want to hear this, but, how many billions can the planet hold? And watch how boomers will rage that they should live longer than anyone before, or even after them for that matter. Well, if this legislation becomes reality, this generation group will find out what it is like to see their generation have a shorter life span than their parents. And how many of the members of Congress are in this age group!
    It is a shame evolution hasn’t found a way to select out narcissism a bit more efficiently of late.

  11. “They already have universal coverage”.
    -What do you do when life gives you lemons?
    “Another factor that may also make a different is the influence of partisan news networks, especially Fox News, and of talk radio, that spread emotional and often misleading arguments, fuel populist feelings and dumb down the debate”.
    – I knew it! There is no freedom of speech in said countries. So sad. Apparently there is only what the government wants you to believe. What about the oh soo [NON]partisan? “news” networks like MSNBC,NYT,CNN et al? Just because they hold liberal views doesn’t inherently make them innocent from propagating their ideology through lies and/or rhetoric drenched in pathos.If we all had one set ideology it would say so much about the power of the media (govt run media) over it’s citizens. God Bless America.

  12. LsnNLrn, great point, the federal government already took over all student loans, is it that hard to imagine they only provide loans if you study a field they approve? Maybe they start rationing degrees and only allow so many of each? Sorry we don’t have any loans left for history why don’t you try medicine instead.
    They also have taken over the small business buisness loan market, if you dare try to open or run a business sans the education they think you should have they will just prevent you from borrowing money.
    This is what happens when you trust the government to provide that which you should provide or procure for yourself. It was only a couple hundred years ago our ancestors living in colonies and villages starved to death waiting for rations from the king, more recent in third world countries.
    wow DeborahB you must be living the lilly white dream life. For millions of Americans there is no assurance the police will come if your assulted and for many millions more the fire department is your friends and neighbors that volunteer. Are you that ignorant of America living your big city liberal life?
    What you lack in education you make up for in spades in neavitity. “I am probably uninsurable due to pre-existing conditions.”
    What you mean is you can’t buy insurance at a price you want to pay which in no ways means you are uninsurable. You can’t even use the basic terms properly. Under HIPAA you are guaranteed the ability to buy an insurance policy, your just unhappy that someone else isn’t paying for you to retire at 62. A far as I am concerned get off your lasy ass and get a job and pay for your own benefits. Try some night classes while your at it.
    poor Deborah has a stressful job so she wants to quit working and have the rest of us pay her bills so she isn’t so stressed. That sums up the entire problem right there.AMerica has way to many Deborahs these days.
    “For the writer who suggested we implement Medicare for all – I say, bravo, and agree totally.”
    Of course she agrees she doesn’t have to pay for it. Screw everyone under 50 as long as Deborah can selfishly eliminate the stress in her life the rest of us can go to hell. You want stress Deborah try figuring out how to pay the 100 trillion dollar tab for your greed.

  13. Nice try folks. There is but one reason: a corrupt congress, owned lock stock and barrel by the insurance industry. But worse, by other industries as well. Only public funding of campaigns will return congress to the people, and for $5 per taxpayer per year it’d be one terrific bargain.

  14. I hope that none of the writers who are so sure that we don’t need healthcare reform ever get sick, or old – and uninsurable. Not all of us can get insurance from employers and not all of us are well enough to work. And for those of us in those categories, private insurance is often unaffordable even if available.
    Our healthcare system is an embarrassment. And it is a right. I equate it to knowing the police will come if you are assaulted, or that the fire department will come if your house is on fire. You should be able to get health care when you need it.
    I am hoping to retire (soon) at 62 to avoid major health problems down the road. I am probably uninsurable due to pre-existing conditions. After COBRA runs out, under the current system, I will have an 18-month gap when I will buy some sort of coverage. The high-risk pool in my state is at least $800 a month but will keep me from bankruptcy if I become seriously ill during that time… until I can go on Medicare at 65.
    What a crazy system… and I am fortunate to be able, painfully, to afford the premiums of the high-risk pool. Most are not so lucky. It will certainly have a negative impact on my financial situation, but not as much so as the impact of continuing to work in a very stressful job will have on my health.
    Good luck to all of you who don’t think we need reform. The current bills are terribly flawed and probably won’t help my situation since they won’t go into effect quickly enough. But it’s a start.
    For the writer who suggested we implement Medicare for all – I say, bravo, and agree totally. Most of our excessive costs have to do with the many provider systems we have in place.

  15. Healthcare is not a right, it is a service. By nature, our healthcare is dependent upon someone else to render the service of their expertise. Healthcare as a “right” to all citizens would suggest that there is, and always will be, healthcare personnel to provide us our “right” to care. An absence of healthcare professionals would mean that our “right” to healthcare would be restricted. Is the next legislative bill going to force citizens to start a career in a health related field so that we can have our “right” to healthcare? Something cannot be a right if it is dependent on individuals to provide us that “right”. This is something the framers must have understood and is why the only “rights” we have are to life, liberty, and the pursuit of happiness. All of which are not dependent on someone else, but on ourselves.

  16. to MD as Hell
    Equating is the wrong word.
    I am not equating health with health care. but perhpas you weren’t paying close enough attention to Mr. Taylor. United States is last in “deaths that could have been prevented by appropriate medical care.”
    I doubt you would argue that physicians in this country are that much worse than physicians elsewhere, so the only other conclusion is that people do not have access to care. I think you might agree that if they did have access to care it would likely be appropriate.
    Underpinning his point is that health care may not be sufficient for health and may not even be necessary for health, unless of course you get sick or injured. In which case, health care is necessary, but again not sufficient.
    Consequently improving access to care is a necessary step, perhaps not the only necessary step, and perhaps not a sufficient step, but still a necessary step to improving American health.
    I comment to you the book “Measure of America” for some interesting statistics.

  17. When the left and right start attacking each other, or when Democrats and Republicans do, we don’t solve problems, we create them. This bill will likely create more problems then it solves, like many of the bills that come out of Congress.
    Nations cannot be civil and moral. In order to meet one persons concept of what is “civil and moral”, they would have to force others to meet their view, which is not civil and moral in itself.
    If either left or right, Democrat or Republican, believe a problem is serious enough that it needs a law to enforce it, then do not attack the other side, do not start the conversation with insurance bad, opposition bad, instead respect everyone that has a part in the conversation.
    Oh, and if you want people do trust the government, don’t diss the opposition when they have control. Respect them. Because to most of the people you are all the government, so when you put down the other side, it reflects on the government overall.

  18. Margalit,
    This legislation is the first time a person must interact with the government to remain legal. Prior to this one did not have to interact with the government. If you have no income you do not have to file a tax return to remain legal. You are not required to vote. No one need ever here of you. Your birth is recorded in the state of your birth; there is no fee for that record entry. Your death will be recorded; there is no fee for that.
    With healthcare you will be interacting with the governemtn just to exist legally. I have a problem with that.
    Inchoate but earnest,
    Thanks for the Christmas wish. Santa might be able to bestow sanity, but healthcare can never make the insane sane unless it controls them (the insane) on a daily basis so as to avoid noncompliance. If that does not work they can just change the definition of sanity to fit their model, like climate change.
    You are equating “health” with “healthcare”. Even worse, you are confusing coverage for actual care. You also are confusing “stupid” with “uneducated”. Please don’t.
    It will come as no surprise to any of you that I have sent all four of my children to private school, pre-K thru 12th grade.
    Not all illnesses are contageous, but the herd mentality and fear mongering can stampede all sorts of unhealthy things towards passage into law.
    A smart sick person can partidipate in his or her own care with greater understanding and appreciation of the choices than can either the uneducated or stupid (or both).
    Merry Christmas everyone! May God’s perfect peace touch all of your lives.

  19. Chamby you obviously have never owned a business and get your news from uninformed lefty sources. America is not at a disadvantage becuase of our health insurance. This is ignornace and propoganda. FIrst off half of small businesses don’t offer it, that would mean they have an advantage over foreign competition.
    Next you fall in the common lefty mind trap of thinking if the government pays for healthcare it is free. Where do you think the taxes come from to pay if the Gov takes over???? Business. If a business owner had the choice in paying $1 to deliver healthcare himself or paying $1.20 to have the government do it how does logic dictate he is disadvantaged?
    Next you assume every dollar saved in healthcare cost goes back to the owners bottom line, benefits are in leui of pay, eliminate benefits workers will want higher pay, what has the owner saved?
    Finally is control, when the economy tanked businesses reduced their benefit plans to save money, you don’t have the option to cut your tax liaiblity.
    Speaking of shallow lets add your knowledge of foreign medical insurance, just google it and see all of the carriers that provide insurance for american employer’s oversea employees. It is far from uniquelly American, there are benefit expenses in every country.
    “Second, we need to eliminate the ability for companies to discriminate based on pre-existing conditions.”
    If you can take the time to write this crap why can’t you take 5 more minutes and learn what your actually talking about. Look up the word HIPAA, peopel moving from job to job and have worry about pre-existing? The only people that have pre-ex are those that don’t buy insurance until they are sick and need it. When you get the facts strait it sure changes the problem doesn’t it?

  20. I would like to suggest an additional reason. And please accept it as a suggestion, which I hope you, Mr. Taylor, can ascertain.
    In this country, because of the ability of individual legislators to block legislation, any final product is a consensus product that is a sum of deals made. Consequently broad reform is nearly impossible. What you get is aa bunch of micro-reforms that total to a macro mess. Witness Michelle’s law, Womens’ Health and Cancer Rights Act, HIPAA, Mental Health Parity (twice).
    Other countries may be better able or more willing to create a legislative framework and leave the details to the experts.
    P.S. As a retort to MD as Hell – I heard someone making the argument that health is a public good just as education is a public good, “And frankly I would rather sit next to someone healthy and stupid, than next to someone smart and sick.”

  21. Dear Santa,
    Please bring Mr. Nate & Mr. Tim sanity this Christmas. They seem like nice people but they are really, really confused.
    PS: please bring a double helping for Dr. Hell.
    PSS: Your cookies & milk will be in their usual place.

  22. When individual rights are the goal of government, the majority can be a tyranny, just like an aristocracy or a king. The founders knew this, debated the solution, and intentionally created a system where it is difficult for even a majority to pass laws. IT WAS BUILT THIS WAY ON PURPOSE. (Does anyone even read the Federalist papers any more?)
    For its purpose, it works very well.
    But, the left changed the purpose of government, from a limited apparatus to accomplish a few things, to that of an apparatus to engineer and manage the entire economy. Well, of course, for that goal it does not work well. It was explicitly built not to do that.
    The truth is that the left is trying to do something with our government it was never intended to do, and are like children, throwing a tantrum when they can’t drive the car.

  23. As always, Humphrey provides clear insight into a complex issue. The one item I take issue with, however, is his focus on the US’ status with respect to avoidable death. While no one, of any political stripe, should be satisfiede with the US’ standing in this ranking, the more critical issue for both the short- and long-term viability of our health “system” is our abysmal ranking with respect to avoidable illness. If we don’t get quickly get on the path to solving that probelm, all the rest of our efforts, no matter how morally sound, will be phyrric.

  24. One thing I find interesting to hear from the generally pro-business Right is how they ignore the fact that American business is at a competitive disadvantage in the global economy with the burden of health insurance as provided through the employer. How one can be adamantly supportive of a better business environment without realizing that eliminating the employer-based system would free business from a uniquely American business cost shows how shallow the arguments from the talking heads really is.
    That may sound bleeding heart liberal of me, but I’m sure the following will make me sound downright conservative, too.
    I believe strongly that we do not need government-based insurance, rather that we need a few key measures implemented to change the system we have. First, the insurers need to be competing for the business of the actual insured, rather than trying to sign up employers to grow their insured base. The ultimate consumer of their product is NOT the employer they are trying to snag, but the mass of employees. This means that insurance companies would be trying to solicit from the pool of 300M US citizens, rather than focusing on signing up as another provider to a large company.
    Second, we need to eliminate the ability for companies to discriminate based on pre-existing conditions. If you look at the issue, as an individual moves from employer to employer, as long as they have been continuously covered, any pre-existing condition is generally ignored, and coverage remains as you change from insurer to insurer. Since the insurance companies already accept pre-existing conditions under this model, any change to policies not based on employment would truly not be relevant to their business model and risk.
    For the above to be available to anyone, you need to make insurance portable and available to any and all. If you remove the size of the employer as a condition for the cost of insurance, and force insurers to compete for the pool of the entire US population, self-employed or unemployed would now be no different than one employed by a Fortune 500 company. Price discrimination based on type of employment must be eliminated.
    Notice that if the model changes from employer-based to individual-based, where the size of the insured group is now the whole of the US citizenry, insurers are now free to grow their insured population to the point where it will mimic the entire country. In theory, no pool of insured would be significantly different than another, and therefore, you would see some notion of price parity since the risk to the insurer pool would be identical to any other.
    Competition then becomes based on service to the insured, which would fuel innovation in health care and health services. It becomes in the interest of the insurance company to move the level of health of the entire pool of insured to be healthier to minimize cost and maximize profit. It would make preventative measures more cost effective and beneficial. If one insurer were able to better manage individual health than another, more people would have an incentive to leave their “less healthy” provider and join the pool of the “better” insurer.
    Note that none of the above suggestions require a significant government investment. You would want to improve the oversight to ensure insurers are playing by the new rules, but it would not require as large a public investment as the current plans in our bodies of Congress.
    I have no doubt that we will never fix the problem, because of the problems outlined (and others), but at least I can say I have contributed to the thought process … although I’m sure none of our esteemed decision makers in DC will ever read this.

  25. In your partisan blathering hump you ignored the largest reason our system is so hard to reform…
    …it has never been about reform. The goal of liberals has always been about controling the money not improving the care. That is why Medicare cuts off after 60 days, that is why Medicare reform cuts reimbursements instead of fraud, and why COBRA and HIPAA did more to make attorneys rich then improve quality and access.
    Never once have Democrats attempted to improve care just increase power, you can throw Teddy and his HMOs in there as well. Maybe if you watched a little more Fox news you wouldn’t be so clueless.

  26. MD as Hell- You raised a very interesting point. When we calculate the benefit of healthcare reform it is seen in light of avoiding doctor/hospital visits.
    No economic value is assigned to better health of an individual. It’s almost as if healthcare cost are sunk costs.
    Somehow I cannot get to accept that theory. Our last economic boom cycle was based internet driven productivity.
    I would like to hear a theory, whereby sickness had no impact on productivity. How about define your productivity. How many patients did you see on the day you were down with fever? Do you think that had any impact on national economy, however trivial?
    We are truly lacking a national study on lost hours due to sickness. If we could, then I am pretty it will do a lot to strengthen argument for investing in health.
    After if silly things as improperly designed business offices that cause workplace injuries can cause damages worth billions, why couldn’t 3 million hospitalizations in a year cost nothing more than 1 trillion of hospital charges?
    Isn’t there a sort of weird connection that Japanese, who are the healthiest, are also among the most productive in the world?

  27. Here are some additional reason why I think healthcare reform has been so difficult.
    1. Most people are happy with employer provided healthcare insurance.
    2. Those at losing end are not politically organized. The gainers are politically organized for sure.
    3. The cup of sorrow is not overfilled yet.
    4. We still have uninsured market to tap in.
    5. Republicans drained so much money on wars and tax break for rich that nothing is left to fund healthcare reform or any other noble intiative.
    When we would have all employer healthplans with $10K deductibles and when everyone is insured there would be no stopping to healthcare reform. Unfortunately, Social security crisis could hit us before all favorable conditions are created for more comprehensive healthcare reform.

  28. Working in the healthcare industry I always find it amusing looking at how our current system is compared to that of other nations and how easy it is for them to make changes. The original question “Why is healthcare reform so difficult in the United States?” comes down to numbers. You list ten countries above that have made real improvements in quality of care. Looking at 2008/2009 numbers, the population of all ten of those countries (290 million combined) is less than that of the United States (over 305 million). That is only looking at our census, as anyone who has been to a hospital in Texas or California recently will tell you there are a lot of illegal immigrants also being seen that don’t fall into those numbers. You simply cannot look at what a nation like Germany or France have done with their healthcare systems and try to extrapolate it to what we are dealing with here. I don’t ever hear that we should look at Indonesia, Brazil, or Pakistan (the countries closest to our own in terms of total population) and try to incorportate their systems into ours.

  29. Mr Taylor-
    I believe it is so difficult because we are a very young nation obsessed with high technology and the value of innovation in the free market. In this regard we need a strong dose of humiilty.
    Also we are very late in coming to the reality that any nation that professes to be civil and moral needs to provide at least BASIC health care to all of its citizens. Here we need a strong dose of morality.
    Dr. Rick Lippin

  30. “…..since it was created to protect the individual from a clueless majority.”
    MD as HELL: Absolutely not! Our government was created to give a voice, the ultimate voice, to the majority of the people and protect them from the tyranny of hereditary aristocracy and monarchy/dictatorship.
    Individual rights were acknowledged and protected to prevent majorities from persecuting individuals. However, decisions that do not infringe on these individual rights are left to the majority.
    I don’t see how health care reform (the original proposal) infringes on any inalienable individual rights.
    As to health care’s value to the nation, if we follow your argument to its obvious conclusion, medicine is completely unnecessary to the nation, and a Darwinian approach would serve the nation better.
    Here I am wondering what is meant by “nation”. Is it the fascist definition? Or is it just a collection of individuals, in which case it would be difficult to satisfy the best interest of the nation without satisfying the best interest of a majority of its individuals.
    (I really think that you are contradicting yourself a bit when you state that government was created to protect the individual, but at the same time it must ignore the individual in order to benefit the nation.)

  31. Hub,
    You have equated “health” with “healthcare”. They are not the same. In fact, healthcare does not contribute to the overall health of the nation. It keeps less healthy people viable and makes the country less healthy overall.

  32. In my opinion our legislative system is just fine. It should indeed be damn hard to pass controversial new legislation in the absence of overwhelming agreement.
    As to the partisan inflammatory media, I would climb barricades to ensure that Fox News has the right to air their misleading and sometimes plain stupid and erroneous arguments.
    There has been no administration in this country that was not “victimized” by the opposition sponsored press, starting with George Washington, and with the exception of one misstep, freedom of the press took precedence over the current agenda and even the Presidential persona. And so it must remain.
    I do agree with the remainder of the arguments, and even if there is nothing novel about moneyed interests corrupting the legislators, it seems that in our times it has achieved new heights.
    The obvious solution of campaign financing reform may not be enough. I believe that we need to amend the constitution to limit legislative terms in office. Unfortunately, I am not optimistic about the ability (or inclination) of the current hoard of career politicians to sever the limb on which they are very comfortably seated.

  33. “Healthcare is not valuable to the nation…It is sometimes valuable to an individual” ???
    That reminds me of parents who used to ask me “when was the hospital going to circumcise their newborn boy?” I would usually respond that the hospital does not do anything, a doctor has to do it. The nation is much weaker when many of the individuals who make it up are unhealthy.

  34. Mr. Taylor,
    You falsely assume that healthcare has value and we should allow our government to enslave us to prop up the altar of healthcare.
    Healthcare is not valuable to the nation as a whole. It is sometimes valuable to an individual. The individual is the protected entity under our present form of Constitutional government. It stands to reason our political system should have difficulty running over the individual, since it was created to protect the individual from a clueless majority.
    It’s a beautiful thing.