… wait until it’s more expensive! [laugh track]
This is hilarious. Here’s a video of Mitt campaigning in New Hampshire on health care: equating “HillaryCare” with single-payer (it sure as hell wasn’t); and trotting out this old conservative saw:
I have a little joke that I steal from P.J. O’Rourke, the comedian who said, “If you think health care is expensive now, just wait until it’s free.”
Ho ho ho, that PJ’s such a card!
That’s total health expenditures per capita, 2003. We have free-market health care, and we spend way, way, more than bad old government health care.
We need someone to get in Mitt’s face in NH on this. Anyone going up there?
Please share widely!
That bar graph turned into a double-tier bar graphs that shows the amount the individual also pays for taxes (of course adjusted to the estimated amount of our taxes that goes to healthcare).
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Til you do that, this graph is only half the story.
So it includes taxpayer-paid care and private.
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You bet, places with more signficant government health care (whether true single-payer or no) pay higher taxes. But they don’t pay health insurance premiums (or not as much, depending on the system).
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So you shouldn’t pretend that health care money not going to the government in the US is necessarily going into your pocket — in fact, even more of it is going out the door to the “medical-industrial complex”, as Jon Kingsdale puts it.
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A breakdown would be useful, sure. But this is the whole story.
Nothing newer than 4 years old? Charley, this feels like a snapshot to make a point…
… by all means show me the numbers. I’d love to see the good news.
Payments to private companies good
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Payments to government doubleplus ungood
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It’s not about economic efficiency, it’s about ideology.
Perhaps countries with single-payer health care pay more taxes to support the system, but I think that it is important to note that we already DO pay a fairly significant amount to support Medicare and Medicaid, which are certainly two of the larger social-spending expenditures, not to mention other health programs that are funded by taxes (like those funded by cigarette taxes, or uncompensated care assessments on hospitals, etc.).
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I might be coming from a somewhat different angle on health care, because I support a single-payer health care NOT because the US is a “free-market system”, which is most decidedly is not, but because the unique system of health care delivery we have in the US is so incredibly inefficent and expensive.
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In any case, whenever somebody brings up the “socialized medicine” canard, one can just remind them that in fact: 1) we do have “socialized” medicine already, which is 2) supported heavily by tax dollars and also 3) just so happens to be the most inefficient form of health care on the planet.
Globe Op-Ed over the weekend:
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We don’t currently have a free-market system, we have a bastardized system of markets and regulation. Just like the Big Dig was a bastardized private/public enterprise.
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A public system could work just fine, as could a differently-regulated private system (I like markets just fine, but I also learned about external costs and market failure in week 2 of microeconomics, so yes, I see a need for ways to correct those).
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But to design and implement such a system we need to get the bastards marginalized. And by bastards I refer to those anonymous ‘special interests’ who craft legislation that perverts the public good (see, for example, the recent handiwork of the voting machine vendors viz a viz election reform).
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And frankly, I don’t know how to do this, given the realities of the American political system. Spending money = free speech here, and while I don’t entirely reject the logic of the SCOTUS decisions on the topic, it’s surely a problem in practice.
If we’re paying money toward the government for health care, or to Blue Cross Blue Shield, so long as people are getting the best care available at the most reasonable rate? What Charley’s graph has done – and what we’ve consistently seen at least since the 2000s – is show that all of these social medical systems not only treat everyone with top-notch care, but also do so at a rate their nations can better afford. In America, we pay more and get less – 44 million or so get nothing, except death, suffering and bankrupcty.
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What I don’t get is so many Republicans (if not the Republican party, the Republican base) are wholly concerned with protecting the troops – we can’t defund them, no matter what the scenario. They need our support, even if its billions for better armor and equipment. I’m totally 100% in favor of those policies of better armor, equipment, etc., but why don’t the very same people feel the same way about health care? No one can prevent getting cancer, it just sneaks up on you. Why should anyone be damned because they can’t afford the premiums? It should be a moral issue, just as it is to protect our troops when we send them to war, to give every American a generous minimum of coverage, no matter what they can or cannot afford. It’s just a basic principal that anyone should understand who’s ever lost someone they loved.
Why is everyone so sure that paying through the government will ensure “best available care at the most reasonable rates”?
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When has government ever exhibited the ability to procure the best available anything at anything remotely resembling a reasonable rate? The only thing I can think of is the Lousiana Purchase. Instead, government is likely to deliver something akin to public education: some service that is excellent in spots, manifestly awful in others, middling in most places, and all at astronomical cost.
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It seems to me that everyone’s main gripe is that even though the individual is the consumer of healh services, it is the employer that procures insurance. So the guy who hates Cigna is stuck with Cigna, because his HR Dept likes Cigna. Maybe it would be better to simply unlink employment and health insurance, and let everyone buy what they want.
If you’re going to include the LA purchase, you’ve got to include the acquisition of AK too! Loads of black gold.
First – even if you’re right and the US Government could never deliver competency in health care – could it be anything worse than what we have now? Your charge is that the health care system would be spotty at best. Well, it already is spotty. Furthermore, the system wouldn’t fundamentally change the way care is given – just on how it’s funded, who has coverage and what kind of coverage people have.
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No one I know is arguing to nationalize hospitals.
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Now, I’d say it will the overall quality of care would improve and be less hit-or-miss. It will never be perfect, but certainly the government can make a huge impact. Why? If the Government is finding some hospitals aren’t up to snuff, it has a very large ability – especially if we’re the one’s holding the purse strings – to make it get up to par. We can create stricter regulations of care as well as offer incentives to hospitals that have better rates of saving lives, etc.
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Secondly, we’ve already proven we can create a decent health care system that is more efficient than the private sector. It’s called medicare.
Here’s the real reason the medical per capita is high: US has more TVs per capita than most of the world’s nations; drinks more sodas and has more McDonalds restaurants per capita.
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Nothing says triple bypass louder than a supersized value meal.
that more dietary awareness and more leisure time for exercise, et al would be good things. I don’t think that lifestyle accounts for all the difference, but surely it’s part of it.
…extended end-of-life care. The two of those combined don’t account for all the difference, but I think they’re a large, large chunk.
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On the other hand, World Health Organization stats (PDF) show smokers making up 24% of the US population, as compared to 35% in France and Germany, 27% in the UK, and 33% in Japan. So we probably save on some expenditures there.
…like replacing Marshmallow Fluff in school lunches, requiring more truth in advertising from chains like McDonalds, taking soda machines out of high schools, eliminating less healthy cooking fats from restaurants, cand urbing smoking in bars and restaurants, they’re decried as “moon bats” and are told they are over stepping free markets and personal freedoms, and cries of “aren’t there more important things to worry about?” ring through the commonwealth and nation.
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Is not an ounce of prevention is worth a pound of cure? I’d much rather pay for a decent school luch for a kid and diet & nutrition education in school than his angyoplasty and hospice stay 50 years down the road.
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Not to mention, the McDonalds argument doesn’t take into account people with insurance suffering from undiagnosed brain tumors and people who saw off their fingers and still pay thousands of dollars in detucibles and co-pays.
military veterans (12 years service) in America. I was denied the medical benefits promised to me by the government as I was $1k over the “means test” figure and was catagorized as a “low priority veteran”….and therefore ineligible for medical care ….can you imagine?
So the question is..if the government can’t provide health care for mere 24M vets which is less than 10% of the US population, how in hell are they going to provide health care for 300M+ US citizens? My friends who do have VA benefits tell me that the wait to see a doctor ( non emergency) is 8 to 12 weeks. How long would the wait be with 10 times the number of people in the program?
Meanwhile, the politicians have made sure that they have medical benefits beyond belief. It would be great to see a”low priority politician”
I think that’s not an uncommon wait time for non-emergency visits in the private sector, depending on the practice, area, etc.
Does that chart take into account the money not spent on patients who die waiting for care in some of those countries?
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How about the money they spend when they come to the states to get care?
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Does it reflect rationing of care because of limited revenues in some countries?
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A chart of numbers taken out of context doesn’t mean a lot.
But in Mass the first step was to require college students to have health insurance, then later the entire population.
The internet reports of 3000% markups for common prescription drugs, most perhaps made overseas kind of bothers me as does my dentist telling me most vaccines are also made overseas. People without health care can simply not support the industry.
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Couple that with big pharma telling us routinely to ask our doctors about medications X,Y and Z.
Remember, even your dog food might be contaminated so whatever politician of any party says about improving health care I can safely consider it merely the babblings of the village idiot.
Does this chart take into account the oppressive amount of malpractice insurance that doctors have to carry in the US?
Re JoeTS @ Mon Aug 13, 2007 at 13:43:53 PM EDT, the response by Charley is on the mark, but I’ll also add a few things. Although Charley’s graph was of %GDP, the graph would not be much different if it were per capita. I’ve seen it put both ways, and they are virtually identical.
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Regarding JoeTS’s comment about taxes, the problem that conservatives have on this issue is that they ignore amounts paid in health insurance premiums. Amounts paid in taxes in, for example France and Germany, for health care would likely mean that amounts paid for health insurance premiums would not be as high as in the US.
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Re Hoyapaul @ Mon Aug 13, 2007 at 15:30:01 PM EDT exactly correct. The USofA has a bastardized health care delivery and financing system that, I believe has been intentionally designed to maximize cost in both. And the politicians are reaping the benefits.
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Re CentralMassDad @ Mon Aug 13, 2007 at 17:12:23 PM EDT
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Why is everyone so sure that paying through the government will ensure “best available care at the most reasonable rates”?
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Experience.
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We have no experience with the French system (we do have friends who have had experience, and they were begeistert), but we do with the German one. After my spouse had been diagnosed (by our home physician) with a DVT (deep vein thrombosis) he was instantly whisked away to the local hospital (Muenchen-Pasing), where he resided for a week. Many tests were done to try to figure out why the DVT. After he was released, we paid the bill (US$5K) and our American insurer reimbursed us for every penny. Fast forward a few years. I had been posting on a generally conservative web site in the US. One of the posters suffered a DVT. The hospital gave him a few injectors of Heparin (what they prescribe before Warfarin), told him to inject them himself on a daily basis, ran no tests, and told him to go home. So ist “Healthcare” in den USofA.
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Re Charley on the MTA @ Mon Aug 13, 2007 at 20:11:45 PM EDT
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8-12 weeks…I think that’s not an uncommon wait time for non-emergency visits in the private sector, depending on the practice, area, etc.
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That’s for damn sure. We have been customers of Lahey Cinic for decades and the wait for a specialist now is on the order of 8-12 weeks. It’s a Wahnsinn–an idiocy–unless you get in touch with their “patient advocates” (another layer of burocracy) who might be able to fit you in to some overworked person’s schedule.
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Re Shawn A @ Mon Aug 13, 2007 at 22:30:16 PM EDT
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No, the numbers of non-American people who come to the USofA for health care is in the noise (in other words, too small to be worthy of measurement).
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Does it reflect rationing of care because of limited revenues in some countries?
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Actually, you raise here an interesting question. I don’t have the URL for it here, but about a year ago, I read a report from the OECD about waiting times for elective surgery. The reason that I read the report was that some fellow objected to a Canadian-style plan for the US because he didn’t want to have to wait for a couple of months to get scheduled for elective surgery (although, as mentioned above, he might have to wait months to see a specialist in the USofA). The problem that he had with his argument was that the waiting times for elective surgery in the USofA were no different than the waiting times in France and Germany, according to the very OECD report that he had cited.
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What was the clinical outcome in both cases?
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I am all for replacing insurance premiums with income tax, IF the result is at least the same service for no greater cost.
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That is a big “if” though. It sure seems to me that the result is as likely to be paying a lot more for less service. I simply do not have much confidence that the government can improve upon the efficiency even of a manifestly inefficient system. It seems more likely that we would wind up with a system controlled by a new, powerful public-sector union, subject to the same impulse for perpetual fiddling, like the tax code, for pleasing interest groups. It will wind up covering accupuncture, homeopathy, chiropracty, and aromatherapy, if those groups have sufficient lobbying efforts.
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I appreciate the European comparisons. In a perfect world, I don’t think that I would object much to the French system. I question the extent to which these various plans–wonderful as they may be– can be effectively transplanted to the USA. It may be like planting a plam tree in Massachusetts.
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For one, Europeans are far, far more comfortable with large and intrusive government. Heck, even as we speak, they are slowly building a brand new government that regulates things so trivial as how much ale must be in a single serving in a pub. That degree of comfort with government is utterly alien to America, for a variety of reasons. Indeed, in no small measure, hostility to government is our raison d’etre.
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Second, each of the wonderful European plans were implemented during a period of such extreme distress that government had to control literally everything in order to ensure continued national existence.
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I remain skeptical. I would like to see more small-scale experimentation at the state level before embarking upon hyper-ambititious nationalized programs.
…although I hasten to point out that health “insurance” is an inefficiency all by itself; and that the public sector unions are the least of your worries — it’s the private sector lobbyists. (Medicare Part D says a $900 billion “hi”. Medicare Advantage, too.)
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That being said, the point is that there is precedent for more efficient and better health care with much more of a government role.
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And there’s plenty of reason to think that state-level experimentation id doomed to fail, b/c you’re not dealing with a closed system.
We’re tops in per capita spending on education and libraries, too! Sound the alarms!!!
Diane, do you think it’s OK that we spend ~50% more than any other country, but we get roughly the same results — or worse? Is that just fine by you?
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If not, I don’t ever want to hear from you about wasted tax $$ again, for anything.
No, Charley. Spending 50% more than any other country for roughly the same results is nothing to be proud of. But, I do question your jump in logic to “bad old government health care” as the way to go.
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My analogy illustrates the following:
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– In the U.S., spending more — especially, if it is on something with either a powerful lobby or public support — is accepted if the money is going to a “good cause”.
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– In the U.S., we can have a government system that spends more per capita than other countries and still not outperform other countries.
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I think the per capita spending metric is simplistic and is certainly not a basis on which to declare the system needs a complete overhaul. From an OECD report:
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Differences in health spending across countries may reflect differences in price, volume and quality of medical goods and services consumed.
Are we spending more because X costs more or because we’re buying more X? How much of what we spend is “fluff”, voluntary expenses, that do nothing to improve our health but are available because we are a wealthy country?
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Between 2000 and 2005, health spending per capita in the United States increased, in real terms, by 4.4% per year on average, a growth rate slightly higher than the OECD average of 4.3%.
The growth rate is the same. Is this significant?
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Over the past decade, the share of health expenditure spent on pharmaceuticals in the United States increased from 8.9% of total health spending in 1995 to 12.4% in 2005. This remained below the OECD average of 17.2%.
While we spend more than other countries on pharma, it’s percentage is lower. Does this have any impact on the quality outcomes?
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As for the quality metrics that follow in the report, how will change the health insurance system improve staffing ratios? How will it improve obesity or infant mortality rates? How will it improve the number of hospital beds?
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Jumping on the universal health insurance and anti-pharma bandwagons is tempting. But, they don’t address these questions. This report from Finland brings up some interesting questions, such as what is the impact of medical training and decentralization? And none of the plans I have seen even address the costs.
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Charley, I would love to see improvements — who wouldn’t? But, I am very concerned about the current steamroller. Imagine you got everything you envisioned from your government health care system, except the results. What if all the changes are made, and costs don’t come down, quality and access aren’t improved. Then what?
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I think it’s easier to push for market-based changes than government ones. Maybe all we really need is to repeal the HMO Act of 1973.
Re: Mr Weebles @ Tue Aug 14, 2007 at 08:48:27 AM EDT
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What was the clinical outcome in both cases?
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I know the clinical outcome in my spouse’s case: he’s still alive. But Heparin is a powerful anti-coagulant and should be monitored closely. The hospital did in my spouse’s case. It strains credulity to believe that it could be satisfactorily monitored on an outpatient basis.
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Moreover, what the hospital was expecting the patient to do was to inject himself with the drug. The injections are to go into the lower abdomen. And without any training as to how to stick the needle in. An aside: when I was a teenager in the 1960s, my father gave my mother injections to desensitize her for her hay fever. He (an engineer) had to practice for weeks with an orange just to understand how to do the procedure correctly.
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Now, fast forward. Give someone a bunch of syringes, without any training, and expect them to apply them properly. To themselves. And not monitor the results of application of a highly potent poison.
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Re CentralMassDad @ Tue Aug 14, 2007 at 15:04:54 PM EDT
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Second, each of the wonderful European plans were implemented during a period of such extreme distress that government had to control literally everything in order to ensure continued national existence.
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No. At least in Germany, government organization of the health care system (it is not a single payer system, but close) was instituted in the 1880s by Bismarck in an attempt to forestall the advances of the Social Democrats against the monarchy. And, that was before the Preussen up north induced the southern German countries (Baden-Wurtemburg and Bavaria) to join the German state.
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Continuing with CMD
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I am all for replacing insurance premiums with income tax, IF the result is at least the same service for no greater cost…That is a big “if” though. It sure seems to me that the result is as likely to be paying a lot more for less service. I simply do not have much confidence that the government can improve upon the efficiency…
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The problem is, that you in the USofA have a problem. You in the USofA have a problem that the combination of the exorbitant health care costs, the ridiculous expenditures on the military/industrial/congressional complex, and the prison/industrial/legislature complex are going to bankrupt you. We saw vestiges of that last Friday, when the Fed injected hundreds of billions of dollar bills into the financial system to forestall a financial panic because of “sub-prime” (read “high risk”) mortgage lending. Inflation is waiting.
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On the topic of this point, I will merely point out that insurance companies are paid to arrange for payments, which are then paid for by the underlying companies. There is no insurance–there is no spreading of the risk. The so-called “insurance companies” are nothing more than claims processors.
Your posts on Germany are always interesting. I always thought that the German system, like the rest of Europe, was a result of the nationalization of everything during and in the wake of the war. Thanks for the correction.
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As for the problem afficting the US economy: yes, indeed. Though, once the cost of the endless war in Iraq is stopped, I think we are in a better position than much of Europe, due to their far greater difficulties with an aging population, and a more expansive welfare state. In any event, inflation is indeed lurking for all. I am surprised that it has not bit harder already as a result of the spike in fuel costs, never mind the fluctuation in the currency markets.
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Your posts on Germany are always interesting.
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…lest anyone wonder, I do not tout Germany as the fount of all wisdom. I cite it here as a counter-example to the US experience that I know best.
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Getting down to brass tacks.
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Though, once the cost of the endless war in Iraq is stopped, I think we are in a better position than much of Europe, due to their far greater difficulties with an aging population, and a more expansive welfare state.
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Um, maybe. But that ignores the fact that the US’s military/industrial/congressional complex will likely keep throwing money into that complex. Watch Robert Grunwald’s documentary, The Selling of Iraq and pay particular attention to the eyes of the people who make the armaments. The eyes are the mirror of the soul. I’m sorry to bring up a religious thing, but it’s true: the eyes tell you what the people believe. And, it was obvious that they didn’t care that their work would lead to the unnecessary deaths of other people, as long as they got their paychecks.
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And further pay attention to the US companies that pay the mercenaries.
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I think we are in a better position than much of Europe, due to their far greater difficulties with an aging population, and a more expansive welfare state.
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Don’t bet on it. France and Germany (and Italy, by the way) are doing very nicely. After Daimler sheds itself of Chrysler (that merger was stupid from the get-go, and I could go further) they will probably do quite well.
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A couple of other points. One, if the US is not having a difficulty with an aging population, it is probably because of (!) illegal immigration. Deal with it. Two, the “more expansive welfare state” is dealt with in the US via other means. I mean emergency rooms for medical care by self-described indigents. I sincerely don’t understand that some people here cannot understand it. My contracts prof (1971-72) told us again and again, you can’t get blood out of a turnip.