8 Comments

1. Stevo  •  Jul 2, 2009 @2:24 am

   Switz: interesting commentary on your Canadian trip. I thought I would chime in on a few of your themes.

   On #1 (hybrid cars): I think the US is the only country in the world with so many large cars and trucks for our fat and indulgent selves, not to mention the typical American male has a lot of testosterone and needs to prove it with the big truck. Oh yeah, Americans aren’t very into the environment thing, or saving money on smaller, more fuel efficient cars. If you’ve ever been to Europe, you’ll see an amazing display of mostly small cars — night and day vs USA.

   On #2 (obesity): well-said on your part. Unfortunately, the obesity epidemic is a sad representation of what’s wrong in America. We’re brainwashed to watch TV, go to movies, shop, work long hours and drive our big cars to work, and eat out and get more “value” for the dollar when we eat. Many of our communities are not designed for walking and exercise, but more for driving and shopping. If you exercise and don’t eat much, and don’t go to the mall with your credit cards, you might not be consuming. And if we’re not consuming in this country, we’re not being patriotic.

   On #3 (Canadian indifference to America): why should they care about us when we don’t really care about them? It is very rare that I hear comedians here talk about Canada (ok, occasionally happens but not often)? I think us Americans think we are the center of the universe, and if other countries don’t worship us, something is wrong. I know you said you like this (that they had indifference to us), but the fact that you “noticed” this shows bias that you assumed they would be otherwise.

   (skipping #4) On #5 (lack of American stores): I go back to #3 –> how many Canadian stores do you shop at here at home? I can’t think of one, unless I am unaware of it. Why do they have to have American stores? They are their own country and people! Again, I am fascinated by the assumption that they would be focused on America in their daily lives, in their comedy, etc., and that they would have a significant number of American stores. We have American stores here, they have Canadian stores there. Simple as that. They are their own people and don’t need us for everything, right? Do we assume that they are just another state of the USA?

   What I really want to know is, did you see the gloom or anger on their faces because they are stuck with universal health care? Did they wear t-shirts that say, “screw our nanny state”? Were people dying over there in the streets because the wait to see a doctor was too long? Did they complain about their lack of freedom because of ‘big government’? I know I am being dramatic but I’ll be willing to bet that most Canadians are on the whole content with their system, not that it’s perfect, and I bet most Canadians feel they would rather have healthcare for all than what we have. And if universal healthcare is such a bad idea, why do the industrialized countries in the world all have it (besides us)? Aren’t these countries democracies? If they voted for it, are they all nuts? I guess we are the only sane country in the world (not to mention we are also the center of the world), right?

   Sorry if this is long or in any way perceived as too negative, but I feel that as an American who has visited a few other countries in the world, that we have a lot to learn about ourselves by going outside once in a while. If nothing else, we need to learn that we are not the center of the universe, and that some crazy ’socialist’ countries (what we consider socialist) are probably healthier than we are, and probably also happier (there are studies that ‘measure’ happiness and we are not the winner, by far!) And, no, I am not a socialist, but I do feel that our great country has room for improvement. I think it’s crazy that our people are by law supposed to have car insurance but not health insurance! We care more about our own cars than human life! That’s sick! Just my 2 cents.

2. ProfSwitzer  •  Jul 2, 2009 @8:36 am

   Thanks for the input, Stevo. In regards to 3 and 5, let me clarify. I thought there would be more negativity towards Americans, and instead I was met with apparently indifference, so that was a good thing. I was surprised by my reaction to it mainly because I didn’t realize that was how I thought until I took this trip. If you had asked me before the comedy club if I thought they would joke about Americans, I would have thought they definitely would. But I didn’t really think about it at the time, and only realized after the fact that, geez, they didn’t say a word about us. That was a good thing. With #5, we’re the largest economy in the world and we hear about how we have global companies, so I figured that being right next door to them and speaking the same language, we’d have a larger presence there than we do. I had never heard of Tim Horton’s until I went there, and the franchise is huge. Yeah, I live in my own isolated little American world — I guess I just never realized how much before now, and I woke up to that realization a bit, and am better for it.

   No, I didn’t see any protests about universal health care or socialization. You say that you bet most Canadians would rather have what they have than what we have, yet over 80% of Americans say they’re happy with their health care too. If your standard is “are they happy with what they have?” then there’s no reason to change our system either…

   Having said that, I think we actually agree on quite a bit on health insurance and health care — and yes, I think we could change our system to cover more people and maybe even cut costs. On the record, here’s what I would propose. Remove the tax break for firms providing health care, which a) puts the self-employed at a severe disadvantage, b) removes your concern over medical care prices because your firm is paying much of the premium, and c) ties your health care to your job. If you want to compare health insurance to car insurance, then we have to treat them the same, and right now we don’t at all. If we break the link between your health insurance and your job, then people will be more concerned about costs and will be smarter about their health care. I think a requirement that people have health insurance as well as regulations preventing health insurance companies from not covering people because of pre-existing conditions is a good first step, as long as you also remove the tax-deductibility of health insurance benefits. If you’re not going to remove the tax break, then make HSAs a federal tax thing (instead of an employer option). I put a decent amount of money in mine every year for expected expenses on dental, vision, etc. And I watch every dollar I spend on those areas because it’s my money, not my health insurance company’s.

3. Jack and Annie  •  Jul 2, 2009 @5:20 pm

   “As it turns out, I’m happiest just being at home with the best four-legged friend a guy could ask for, a wonderful woman who loves me despite the fact I can’t ever seem to just relax, and a job doing what I love most with fun colleagues that make me feel lucky to show up to work every day.”
   Hummm… sounds like youre only missing children in your life! Sorry, I couldnt resist! lol

4. Stevo  •  Jul 3, 2009 @2:28 am

   Switz: excuse me if I am making you nauseated by continuing this dialogue, but I have some follow-up comments to your reply, regarding healthcare (surprise). First, when you quote that “over 80% of Americans say they’re happy with their health care”, I looked up that poll, and found that there is a lot of spin in that statement. First of all, the statement you made had to do with a question about satisfaction of CARE, not cost. So if they like their doctor but can’t afford their coverage or care, they might say they are satisfied with their care but not their cost. Yes, they also asked about cost, separately, and you didn’t mention that part. I will get to those results in a moment. But first, and perhaps even more important, is that the poll separated “very” satisfied from “somewhat” satisfied. Big difference, if you ask me, between very satisfied and somewhat satisfied. It’s very easy to get someone to say they are somewhat satisfied with something, not so easy to get someone to say very satisfied. Where I work, patients survey our doctors and this is very important to our organization. To put it bluntly, somewhat satisfied is not good enough in medicine, at least where I work! That being said, only 49% of Americans surveyed are very satisfied with the quality of their care. Even worse, only 23% are very satisfied with the COST of their healthcare. And this is the same poll you are referring to. Furthermore, 85% are concerned about their future health care costs for their family (59% very concerned). Finally, and most worrisome in my opinion, is that when asked about satisfaction with “the overall health care system in this country”, only 10% were very satisfied. Only 10%!!! This was an “overall” question, pertaining to the whole system, so I think this is more powerful than asking about the quality of their care (= doctor). No one really ever questions whether we have good doctors or not in this country. I think if anything, you can read this poll and come up with a conclusion that Americans like American doctors, but Americans are NOT satisfied the system of health care in this country. This is a far different conclusion than the one you propose.

   And, last but not least, yes, this poll asked about the “public option” plan that Obama is proposing that would compete with private plans. The question was, “Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?” 62% supported it. So, to recap, only 10% of Americans were very satisfied with the overall health care system in this country, and the majority (62%) propose a government-sponsored public option to compete with private plans. Again, quite a different conclusion than yours! While we’re at it, there was another study (http://www.cnn.com/2009/HEALTH/03/04/uninsured.epidemic.obama/) that showed that 1/3 Americans were without insurance at one point or another in the last two years, and that 4/5 uninsured were in working families (dispels the myth that these are lazy, undeserving mooches).

   So when you refer to this poll (about satisfaction with care), take a closer look at it (http://www.washingtonpost.com/wp-srv/politics/polls/postpoll_062209.html?sid=ST2009062304056) and I think you’ll see there’s a lot more to it than the simple “Fox spin” (“fair and balanced” Fox did spin this poll, but what else is new). I watch and read Fox, despite what you might assume from my commentary thus far, but I also watch and read other networks and sometimes I go beyond the spin to find the real truth, as in this case. Yes, I even watch the O’Reilly “no spin zone”, but there is no such thing as the “no spin zone” — even the “Factor” has its share of spin despite its claim to the contrary. By the way, speaking of spin, if you haven’t seen it, I highly recommend “Sicko” (movie by Michael Moore). Yes, it has its share of spin too (this is a given), and you have to read through it, but deep down, there’s a very humane, moral aspect to health care and universal coverage that is brought to light in this film and that of which is often ignored in purely market and politics-based talk. You can’t really spin the humane aspect of health care and universal coverage, so at least for that, it’s definitely worth a look. By the way, if we can’t occasionally consider what is the humane, or moral thing to do, once in a while, just at least consider it, than our society is in deep trouble. Yes, I think universal healthcare is the humane thing to do. And eventually it will save us all money down the road if it is done right. Preventive care, electronic medical records, effective and coordinated management of patients with chronic conditions, and cutting out waste and inefficiency in care, etc. — I agree with Obama that these are all key to a successful future for healthcare, whether it is universal or not. And yes, of course, I know that if we do someday adopt universal healthcare, that the devil will be in the details. Not all universal healthcare in the world is the same, and just having it doesn’t guarantee it will be good. And how to pay for it and run it is an entirely different discussion, extremely important in its own right, but I am far too exhausted just from writing this to even think about discussing these details. Although even just having that discussion in the first place is progress as I see it.

   By the way, last thoughts for now — your ideas, especially the one about HSAs, are mostly good ones in my opinion, and I am “somewhat satisfied” with your ideas, but they are not big enough in my opinion to make a significant dent in the grand scheme of the problem as I see it. This is fun, by the way, and I am glad you are doing this and making for an interesting dialogue / discussion. -Stevo

5. ProfSwitzer  •  Jul 3, 2009 @9:20 am

   Since we’re talking polls and omission, when they ask if you think that we change the health care system, will the quality of your care get better, worse or the same, only 16% think it will get better.

   I think what you have is a big problem of people wanting quality care but also wanting it to be cheap, and those are very much at odds.

   And if you’re only “somewhat satisfied” with my ideas, that’s not good enough, right? Only 36% of Americans are very satisfied with Obama, according to that poll, by the way…

   Stevo — I think you’re making too much over my citation of that poll. People are concerned about the costs but most of them like the quality of the care that they get — and those same people who are very concerned about their costs rising in the future also think that if the government gets involved, it might decrease the quality of their care.

   I take your point about being humane to heart. I think the problem I have is that right now, 45 million Americans have no health insurance. About half of those could be on another plan but just aren’t because they haven’t signed up for it. So we’ve got a situation where about 9% of the population really can’t afford it or get it. Why overhaul the entire system for 9% of the population? Why not just do something about them?

   Costs are rising and there are things we can do, yes. I have no confidence whatsoever that a universal health care system won’t result in higher costs and lower quality. Pretty much everything the government has done until now has resulted that way, yet this area, 1/7 of our economy, is going to be different? Pardon my skepticism, but I think Washington has earned it.

6. Stevo  •  Jul 3, 2009 @3:26 pm

   Switz – I absolutely agree with you that most people want high quality and low cost, and therein lies the rub! And I want to clarify that I am not suggesting that the whole system change. I think having a public option is very reasonable, to compete with private plans, which is what Obama is proposing. By the way, I don’t think because something is ‘government-run’ that it inherently is bad. I don’t see protests in our country go get rid of public schools, but I do see parents choosing private schools when they aren’t satisfied with public. I also don’t see protests to get rid of the postal service, fire department, police department, the library system, etc., all ‘government-run’ programs. And I don’t see our military vets vacating the VA healthcare system, which by the way, has recently received a great deal of acclaim for its high quality after going through reforms over the last decade. For that matter, the military itself is ‘government-run’, and I don’t see protests that private industry should protect us instead.

   That all being said, I think “9%” (uninsured percent) is an underestimate of the ‘problem’ if you consider that 1/3 were without insurance over the last two years at one time or another — when people change or lose their job, they are likely to lose their coverage, etc. If you lose your job and your insurance, then get a major illness, you are in big trouble (being without insurance), and you might not ever be able to get insured again, now that you have a pre-existing condition. I don’t think that is ‘healthy’. Plus, there is a group of what we call “underinsured” — many people simply can’t afford their medical bills despite their insurance and so they don’t take all of their prescribed medication because they just can’t afford it. They might not get recommended tests either because of co-pays that they can’t afford, as well. I see this all the time, and these people are insured! Along these lines, I am sure that you have also heard that medical bills are a top cause of personal bankruptcy in this country (very recent Harvard study confirmed this). It seems like our priorities in this country are a little backwards, in this regard. It seems to me that people should go bankrupt when they make dumb decisions, spend more than they have, or maybe when they lose their job and can’t get work, not when they get sick. The fact that medical bills cause so much bankruptcy says more about our society and our healthcare “system” than it does about the individuals affected.

   So, in summary, I am not saying that the whole country needs to go to a government plan, but there really needs to be something not only for the uninsured but there needs to be major reform for people who do have insurance. Maybe I am biased because I am in healthcare myself, but I do agree that healthcare is a major problem that is probably only going to get worse if nothing is done.

   If nothing else, Switz — think of this for a moment. You’re an educator. Any young person can get a public education in this country, study hard, and get into college if they have good grades. If the student can’t afford college, financial aid is there (often from the government), so in this country, in theory every hard-working student should have a shot at a college education. Yet the same is not really true for healthcare. If you are a hard-working person, yet your employer doesn’t offer health insurance, and you can’t afford it, you are out of luck. Most uninsured are working people! Don’t get sick! There are data that report 18,000 die every year in this country simply because they don’t have insurance. This is more than six times the death toll of 9/11! Every year! It’s more than four times the total US death toll in Iraq since the war began! But somehow it’s not that important. I really think our priorities are a little, you know, back *sswards.

   Disclaimer: yes, I am passionate about this stuff. Perhaps you can say a little too passionate, but I am in the field of healthcare and I do see people lose their money or their lives because of our ’system’. So I don’t feel that I am crazy for wanting something better for our country and its people. Granted, yes, the devil is always in the details, but I don’t think healthcare was ever ‘invented’ to be a business or industry, it was created to serve people, regardless of ability to pay or regardless of employment, pre-exisiting conditions, etc. How we got here is a little insane, but we need to get healthcare back to its roots a little!

7. Benjamin Seghers  •  Jul 3, 2009 @4:28 pm

   I agree with you, Stevo; The numbers Dr. Switzer pointed out didn’t seem to jive too well with the numbers I was familiar with. So I wasn’t at all surprised when you pointed out only 10% of people in the country are very satisfied with the health care system overall.

   For decades now, the health care system has been a top domestic issue for Americans. This shouldn’t be surprising to anyone. It’s a catastrophe. Costs, in particular, are a big issue as you point out. Naturally, the issue of health care is not an abstract one. It has many real implications that do in fact hurt people in tangible ways. So, again, it shouldn’t be surprising people care about this issue and that they have strong and consistent beliefs regarding it.

   What most people are in favor of is a national health care system. Most often, Americans try to compare this with the Canadian system. But that’s only because it’s near by. Australia, for example, has a much better system (i.e. “Medicare”). And it’s only been very recently that this has reached the political agenda in a meaningful way (namely because America is not a participatory democracy). In fact, it’s only been this campaign that the issue has really become important within the political discourse. Before that, there was little political support (as opposed to popular support) for it.

   What’s changed between then and now that has allowed politicians like Edwards, Clinton, or Obama to discuss the issue? The difference is that manufacturing (e.g. GM–now bankrupt) has come out in favor of it because they cannot cope with the high prices of health care any longer. So it has been industry, not public opinion or will, that has brought the issue to the forefront. What was before “politically impossible” is now a top issue for politicians because it’s become a problem for a major sector of American capital and corporate interests. I think that’s probably the worst part about it.

8. ProfSwitzer  •  Jul 3, 2009 @6:05 pm

   Benjamin — although I think it’s a bit of hyperbole to describe our health care system as a “catastrophe,” your point about industry is spot-on. That’s one of the reasons I’m not completely against a single-payer system, if executed properly. Other governments pay for their workers’ health care, but our firms have to pay for ours, and that puts our firms at a distinct competitive disadvantage.

   My skepticism comes in the “properly executed” part. What we’re seeing today with Congress passing mammoth bills with sweeping reforms, but that nobody in Congress actually reads before voting on, billions in pork and kickbacks to cronies and special interests, leads me to believe that anything that comes out is going to be what’s in the best interest of politicians and a small set of other people — not what’s in the best interest of the American people as a whole.

   One more thing: the statistic I cited was supposed to be the percentage of people who said they were happy with the quality of their health care. I didn’t phrase it correctly and that’s my fault.

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