No, the problem is that healthcare services are too EXPENSIVE because people don't have to pay directly. Third party payer means that people who clip coupons and shop for a month to buy a TV don't even know how much an MRI costs, and are gladly willing to pay for the most expensive one out there because they are spending other people's money.

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102211467.h...

Edit: That's from 1991 today I think it's closer to 50 - 100$.

You ever HAD an HMO? The M is for "Managed" and trust me, they manage it. When I had to see an orthopedist because I sprained both my ankles, I not only had to wait 1.5 weeks, but I had to drive to some random office park 45 minutes away to get the subsequent CT scan he prescribed me afterwards, because that was the option my insurance co. gave me.

Health services are not - NOT! - too expensive because people don't have to pay directly. That is not the problem in the US.

As I described in the above posts, I have paid out of pocket for several healthcare things in Austria -- before I had the social insurance -- and it cost less than the equivalent in the US, with the exchange rate.

The extremely high cost of education, the overhead of insurance company management (it takes time and money to deny all those claims), handling insurance claims (a huge % of administrative work for doctors' offices), the usurious cost of malpractice insurance, and of course, the profit motive in creation of medicine (which naturally raises the cost of the FDA's resources), etc., etc. all conspire to create the expense.

These costs can be drastically reduced in a single-payer system, or one close to it, especially one with free higher education.

(Austria is not quite single-payer, although every single citizen is insured by the govt. There are, I think, 3 types of social insurance, and some people have additional "hospital memberships" (~US$700/yr) or additional private insurance.)

Not to mention that taking away the costs of preventative care, tests, and early intervention can, over a lifetime, reduce the total cost of a person's required healthcare.

Why on earth do you want to blame the people who need the MRI, whether they choose the Budget Rent-a-Wreck or the Premium version? (How ridiculous!)

For fixing America's medical and insurance - in lieu of of free higher education, it'd be simple to drastically reduce requirements to practice medicine. To practice medicine in the United States, doctors have to go through crazy rites of passage, including years of their lives and hundreds of thousands of dollars. Groups like the American Medical Association have intentionally tried to keep the requirements very high, as that keeps doctors' fees and wages up by restricting supply.

Undergraduate + medical school + residency is way more than necessary to become a competent doctor. Could anyone really claim with a straight face that 4 years of intense study, plus 2-4 years of hands-on apprenticeship wouldn't far more than enough to practice a specific kind of medicine? People pick up many skillsets as difficult as medicine to a competent degree in a lot less than 10 years and hundreds of thousands of dollars of costs.

As for Austria, it's an interesting case, huh? Austria has one of the longest traditions of social services in Europe - Otto von Bismarck, Prussian Chancellor, was huge on it. Austria has lots of practice and does a pretty good job of offering a number of services.

There's a few downsides, though. Of course, most people have probably heard the argument about how it slows growth and innovation, and there's some truth in that. Typically people counterargue, "Yes, but it's a worthy tradeoff to improve quality of life in the present." And there's merit in that too.

But using Austria as a specific example - one of the real dangers of socialization of important elements of an economy is that it makes it much easier for the government to go totalitarian, as was seen under the Nationalsozialistische Deutsche Arbeiterpartei, the National Socialist German Workers' Party.

Limited socialism can work with a very strong constitution to limit governmental powers. But without that, politicians become in control of the courts, military, and economy. That's a very dangerous combination.

One of the tricky parts about socialism is that it can't adjust fast enough to fill diverse wants and needs. Governments are rock-and-hard-placed: A fast moving, fast changing government makes lots of mistakes. A slow moving, slow changing government doesn't adapt very fast.

But one thing socialism is really, really, realy good at is making what Clauswitz (another Austrian-Prussian, genius military scholar) called "total war". That's where your entire economy, culture, and civilization is focused on conquering or destroying another civilization.

Every major combatant during World War II went to a more socialized economy, including the United States and England. Government assumed control of much of the production and media. The Allies needed to, because the Germans and Japanese were that focused. One of the reasons that France fell is because it was severely overwhelmed in terms of technology: Less aircraft, less artilery, less mechanized infantry. The American and English governments saw this, and took greater control over their economies.

But could any of this have happened without government control of economies in the first place? A charismatic, psychopathic Austrian-Prussian Lance Corporal took over leadership of the National Socialist Worker's Party (Nationalsozialistische, shorthand "Nazi"), and they already had large control over the nation's factories, food, banking, education, medicine, media, and so on. The "trusting the government" culture lets the inevitable bad government run by a psychopath run amok.

You could take North Korea as another example - they have the fourth largest army in the world (fourth! despite being #47 in total population!). All they produce effectively is military, but they do a pretty good job of it.

So a bit of a tangent there - I'm with your analysis completely about why the costs are high in the United States. I just also point out the very real dangers of state control of the economy. More government power leads to an easier path to totalitarianism and aggressive war. That's one of the reasons Bismarck, a real expansionary conquerer type himself, introduced the culture of social services to Prussian Austria. It builds national loyalty, especially with government-run education. It endears the people to the government and makes them reliant on it. And it lets them flip into "war mode" easily when the political leadership wants to.

There can be some advantages, but there's quite real dangers. I share the take as a casually interested historian, and would be very happy to hear some other people's replies and analysis.

It's one of the most entertaining books I've ever read.

What is interesting to me, though, is how Great Britain was an amazingly capitalist power. I never really realized the extent to which the entire empire -- which never really made that much money for the government -- was just a thin candy shell around British commerce, which made England the wealthiest nation in the history of the world. It's staggering to see, during the Naval Arms Race, how tiny england, with half the population of massively industrialized Germany, dedicated itself to laying 2 keels to every 1 that Germany laid down.

I agree with your sentiment that the socialist countries forced a degree of socialism on the more independent, capitalist nations. Look at Great Britain! It causes physical pain to look back and see what the taxation picture was before the world wars.

But.

There are other emergences of socialism that are called for and accepted because they're the best workable way of providing something that's necessary, either for business reasons or the demands of human liberty.

Sure, maybe someone can figure out a way to have all private toll roads, and make that work without ridiculous regulation and abuse ... in the meantime, we have to move goods. We're going to socialize that, fully realizing how hard de-socializing is, because we have crap to get done.

On the other end of the spectrum, child labor laws. I'm of one accord with the thrust of an observation made by Paul Graham -- 'maybe child labor laws are saving kids from something they don't need saving from; maybe 17-year-olds could do something.' Bravo! Until we can figure out a way of carefully instilling a culture of real productivity into youth, however, we had an existing problem of four-year-olds working with machinery that sometimes ate their fingers.

At the moment, health in the States is a joke compared to the rest of the first world.

Currently, the system of incentives we have pressures people to sacrifice their precious health for a few extra short-term dollars. Because of the economic circumstances of their parents, children will die in this country that would have grown to adulthood in the rest of the first world. The incentives are set up to encourage reckless behavior that will eventually result in a crushing burden of debt, so people will be trapped in poverty who could have escaped in other countries.

These are massive, existing problems in the US. Now, you can't blame a country for doing what the rest of the first world has done, which is to say: let's fix the problem.

It seems unreasonable to expect any other behavior.

Saying socialism leads to Totalitarian fascism is a gigantic line to cross. I'd say that maybe the #1 reason of totalitarianism is introducing democracy to a country that hasn't learned to question its leaders. Hitler and the Nazi's came to power legally through the introduction of several bills, but no one opposed them. The German constitution at that time was riddled with holes because it was a franken-constitution from the US UK and Switzerland. Checks and balances were already weak, and separation of powers was weak, but people didn't press them which was mot of the problem. Much of the Nazi's rise to power has nothing to do with socialism but much more to do with corporatist control via the marriage of industry and government. As well as the failure of the people to uphold their own democracy.

Remember that fascism is the antithesis of democracy because it puts people in groups and manages them. This marries corporatism in a way that it allows certain groups to affect the economy more. While in some sectors there was much top down corporatism, in Nazi Germany especially supplies for war. In others there was bottom up where companies would request things of the government to do.

Not only that you seem to be confusing Germany and Austria. Austria was conquered by propaganda, some democratic means, but mostly a marching of troops into it.

Your argument falls flat because in any democratic system where people don't take it upon themselves to uphold the checks and balances of government will decline as government gains more power. Just look at Putin's Russia, or the "Democratic" PRC.

I think that most people (including me!) would argue that just because somebody (or some government body) calls itself socialist, doesn't make it so. Everything I know about the Nazi government points to that -- they called themselves socialist, but they weren't, not really. Very similar to their line on religion, too. With one hand they claimed to be Christian, but on the other hand, Hitler and his govt implemented policies that were meant to greatly reduce the popularity of religion (e.g. church taxes -- still in existence today!).

Socialism doesn't necessarily mean a centrally controlled or planned economy, or govt owning businesses, or govt employing everyone and the division of resources. That, to me, sounds more like communism. Socialism the way it's practiced in most of the EU today involves a type of capitalism, with an underpinning of higher tax rate, worker/consumer protection laws, and social services.

So those things don't necessarily go hand-in-hand.

Austria really is a perfect test case, because the emperors had a rather populist bent compared to other emperors/empires. You nailed that for sure.

But... its military is absolutely pathetic. They have no budget, no war machinery, no devotion, and no popular support. All this despite, or perhaps because of, youth conscription. (Every male has to do 9 - 12 mos I think, in military or social services. Which pretty much means guarding the border and helping out in avalanches.)

I don't know where you're from, if you're aware of the perception of the military/govt in Austria. If you are, forgive me if I am repeating things you already know :)

But, for example, the Austrian military recently purchased a small batch (I think 6?) of old fighter jets. Not all, apparently, in working order (and it's questionable if they even have sufficiently trained people to make use of them). They will never get used. And this has become a quintessential national joke -- about how they bought a bunch of broken planes, how they think they're relevant but they're not, etc. Not just on the street, but in the newspapers.

The cities are surprisingly rich with anti-nationalists, people who think nationalism is a disease, who hold protests and summits against government, capitalism, racism, the EU, socialism (quite a lot of communists here) and so on.

The economy isn't centrally controlled; it's not as easy to start a business as in the US, but it's still very easy; it is, in my mind, a great mix of socialized services and free market. There are consumer and worker protection laws, but the tax rate is not nearly as high as, say, Denmark.

You can even get unemployment benefits if you quit your job (or are self-employed), to encourage worker mobility (which puts pressure on employers to shape up) -- and yet the unemployment rate is extremely low.

But despite all these goodies, Austria is hardly a country where government is Mother and Father, and the people are ready to fall in line and fight for her.

Compared to the US, Austria is as unpatriotic as they come. Nobody sings songs about Austria. Nobody talks about how they are so grateful to be "free" (or the Austrian equivalent). Nobody goes around saying "Well, sure there are problems, but our x system is the best in the world!" There is simply not the same kind of beloved national mythos we have in the US (although people do seem quite fond of the last real emperor and empress).

Nobody even displays the flag.

In fact, I'd go so far as to say that Austrians are a spoiled lot, because they have no idea how good they have it. :)

As for innovation - one of the things that has helped me the most have been "alternative therapies," including an immune system booster medication called Bronchovaxom.

Turns out it costs nothing, because it's a bunch of dead bacteria, works extremely well... and isn't available in the US. Guess it doesn't make enough of a profit to make the FDA approval process worth the money?

Profit motive is only a motive for certain kinds of innovations. Many of the biggest life-saving inventions in healthcare came from love of humanity or curiosity, not profit motive (think antibiotics and vaccinations).

EDIT: As an aside, regarding people being willing to fight for the country... every European I've told about the Pledge of Allegience has been absolutely gobsmacked. They don't believe that in the land of the free, every day, millions of schoolchildren are forced on pain of punishment to kiss up to the government. Now that's kinda brainwashy, if you think about it.

This is simply unproven. There is a study by Elizabeth Warren who often makes this claim in the media, but her study does not prove it.

Her criteria for "medical bankruptcy" include, for example, a person who spends $50,000 on hookers/gambling/coke, and $1001 on syphilis treatment. She also has no control group.

Their new results, however, apply a stricter standard, upping the bottom line number to $5,000 or 10% of household income, and they report a change of less than 1% if they eliminate the hard $5,000 and just go with 10% of income.

You seem to be claiming that people who are going to go bankrupt even if you remove their medical expenses are somehow meaningless data points for the question being asked by the study. That makes no sense, though. The cases that make it into the study are 'Medical debt below threshold, bankrupt anyways', 'Medical debt above threshold, bankrupt regardless', 'Medical debt above threshold, bankrupt as a result'. You're saying that we shouldn't care that the first category is proportionately shrinking, because it may be the case that the second category is accounting for all of that shrinkage. Even if that were true, that's still a reliable indicator that medical costs are growing.

Your "no control group" criticism makes absolutely no sense here. What are they controlling for? They aren't running an experiment, they're reporting on the proportion of bankruptcies that meet a particular definition, and how that proportion has changed over time.

I'm not disputing this claim: "80% of US bankruptcies meet Elizabeth Warren's Criteria #1."

Her criteria is simply an arbitrary cutoff, and does not prove causality. If a person spent 10% of income on medicine, but 30% on gambling or taxes, it is unfair to attribute the bankruptcy to medical spending.

The control group would be needed to measure whether medical costs are correlated with increased bankruptcy.

Incidentally, total bankruptcies went down (in absolute number). Medical bankruptcies (by her definition) roughly stayed the same in absolute number. This is most of the explanation for the increased proportion of medical bankruptcies.

Actually, the claim (by proponents) is a bit over 60% and even that is fishy.

http://meganmcardle.theatlantic.com/archives/2009/06/why_war...