Kindly Excuss Me Folks: US Politics Question

R

ruben

Guest
Some month ago, an Israeli woman living in the USA was back here in Israel for a vacation and I took the opportunity to ask a lot of questions about what is going on at the USA. She lives in New Jersay.

The most amusing issue for me was the issue of the public health insurance or no insurance that Obama is promoting and Mrs Hillary Rodham tried her own when her husband was President. And this is the issue I would like to ask your opinions about in this post, as well as the info - the very info which seems to be highly controversial.

According to this woman, if you are a chronic unemployed, or a homeless, or whatever nearby on these fields, you still will get free governmental paid medical treatment. but not at every hospital. Is this accurate ? And what about continuous medical treatment, or vigilance ?

Then I launched the most logical question about what then Obama wants when he waves the banner of equality and she answered that what Obama wants is to widen the available medical services, so that much of what is sold, or got, now only by prived money will also be put on the service of those 28 million uninsured Americans.
Would anyone at RFF like to make the facts more accurate?

The third thing that I have not clear relates to the Democratic Party itself, and not what that woman told me. According to what I hear on the radio here, potentially the new laws Obama would like to pass Congress, the Democrats have by far since the elections a large majority. However there are enough Democratic folks in the lower House to put in doubt that majority and those folks have already obliged Obama to compromise in what he origianally wanted (which I would thank anyone to explain it).

Here it becomes either absurd or comic. If indeed there are any egalitarian advances Obama has been proposing and he is being sabotaged by part of his own party representatives - then these folks should be exemplary punished and put to public shame at the environments they were elected.

But if they are not, (and it seems to me they are not) and Obama is going to the vote without being strongly supported by the absolute majority of his own party representatives at the low House - so this is strange and requires some explanation.

It would be of interest to you, perhaps, that the Israeli authorities are looking very close to how much powerfull Obama is inside the US, and for the same reasons I am. Untill a week ago he was portrayed here as an astronaut in world politics, failing everywhere, that still needs to learn that man is bad since birth. And of course the most strong proof has been till now that Health Insurance he has not passed at the Congress.

Cheers,
Ruben
 
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Two observations: don't trust people who live in New Jersey. Um, ah, wait... let's amend that one; I live in New Jersey.

No, but seriously, this is the politics what is achievable rather than the politics of what's good or what's right. Combine that with weak will and what you get are lame compromises.

As an Obama supporter, I will register my disappointment at the administration and the Democratically-controlled Congress for not being better able to execute the will of the people represented by our election results of a year ago. I am a long-ago high school classmate of the president's Chief of Staff, Rahm Emmanuel, who is known as quite a bulldog when it comes to enforcing his will or that of his boss. I had hoped he and the rest of the president's men & women would have been able to craft and drive a better bill through a solidly democratic Congress. Obviously, my optimism and idealism overrode my own native cynism. Seems in retrospect that I overestimated all the players here. We needed Obama and his people to do something like Lyndon Johnson did with such US landmark legislative milestones as the Voting Rights Act, the Civil Rights Act and the creation of Medicare. Apparently, Mr. Obama's fine ideals and soaring rhetoric notwithstanding, these are not the times for men like Lydon Johnson to enact daring initiatives. Much to the great loss of those of us in the USA. I guess a lousy, heavily watered-down healthcare reform bill is better than none, but not by much in my estimation. Apparently, the view from the White House is different than from where I sit.

Ruben, as someone living in challenging times in Israel, you, too, must have some sense of the vast gulf between what would be the right thing for your government to do and what is actually doable. Looking at all of the developed world and comparing it to the US, it is self-evident to me why people outside the US are baffled at our stunning inability to catch up to everyone else at providing our population with good universal healthcare. To those of us here, it's simply the crummy descent of our politics into petty ideological bickering with little benefit or results for the voters. Just more of the same. Very disappointing to me. BTW, about 70+% of Americans seem to favor a robust public option, if not a European-style single payer system. Here, rather opting to support the will of the majority, our elected official often prefer to pander to their politic base (read: to the extreme wings of both parties). So, we get the richest country on earth with 46 million uninsured. Go figure.
 
Many Americans hate to discuss either politics or religion, usually because they are not capable of discussing either without falling into absolutism and the worst kind of party politics. This is not my observation, but my wife's, who spent the first 18 years of her life in New York State and 20 years subsequently in California (five of them with me). Do not expect all replies to be as balanced and rational (even if slightly partisan) as Rob's.

Cheers,

R.
 
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Roger, me a partisan? Heaven forbid. No, actually, let's be honest, I am a partisan. But, I not an ideologue. For all the money our government collects in taxes every year, we ought to be able to assure that all citizens always have access to adequate healthcare. Anything less is an embarrassment. Nothing in doing this runs in anyway counter to all the ideological stuff (free enterprise, etc.) that we usually bicker about.

You are right though. Ruben is far more likely to hear heated ranting and raving quite different from my own tone.

I love my country, but we are doing the wrong thing here.
 
Roger, one of the great challenges of being an American is dealing with the fact that not only are we wrong as often as people many other places on the globe, but we are damned self-righteous about it, too. All that Manifest Destiny, exceptionalism nonsense. Of course, to my fellow countrymen who are convinced that we are never wrong, all what I just said is a load of steaming horse crap. To each his own. One good thing here is that we can generally argue stuff like this without being carted off to jail somewhere (occasionally, we fail to stay true to that very fundamental ideal).

BTW, totally off topic, how is Frances doing? I lost track of the thread on her health.
 
ruben said:
According to this woman, if you are a chronic unemployed, or a homeless, or whatever nearby on these fields, you still will get free governmental paid medical treatment. but not at every hospital. Is this accurate ? And what about continuous medical treatment, or vigilance ?
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Currently in the US, if a person is unemployed and NOT eligible for public health benefits such as Medicaid or Medicare, they can be treated at the emergency room of the local hospital for life-threatening situations only. This means that illegal aliens, people who are unemployed and do not have health insurance, etc, do not get coverage, and will not be treated unless their malady is life-threatening.

Then I launched the most logical question about what then Obama wants when he waves the banner of equality and she answered that what Obama wants is to widen the available medical services, so that much of what is sold, or got, now only by prived money will also be put on the service of those 28 million uninsured Americans.
Would anyone at RFF like to make the facts more accurate?
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There is currently a gap between those who receive health care as a form of public assistance (Medicaid) and those who have their own insurance or can pay for their own medical treatment themselves. These are the chronically uninsured. Estimates vary on how many of them there are, but the stated goal is to close that gap so that everyone legally in the US has some form of health insurance coverage.

http://en.wikipedia.org/wiki/Medicaid

The third thing that I have not clear relates to the Democratic Party itself, and not what that woman told me. According to what I hear on the radio here, potentially the new laws Obama would like to pass Congress, the Democrats have by far since the elections a large majority. However there are enough Democratic folks in the lower House to put in doubt that majority and those folks have already obliged Obama to compromise in what he origianally wanted (which I would thank anyone to explain it).
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In order for the House to pass a bill, they need only a simple majority. However, in the US, politicians are not required to vote with their party, and many do not, depending upon the issue. In the Senate, a simple majority is also required, but without a super-majority, a bill can be effectively stalled through a process known as 'filibustering'.

http://en.wikipedia.org/wiki/Filibuster

Here it becomes either absurd or comic. If indeed there are any egalitarian advances Obama has been proposing and he is being sabotaged by part of his own party representatives - then these folks should be exemplary punished and put to public shame at the environments they were elected.
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Elected officials of whatever party have to concern themselves with the desires of the party, but also with the desires of their constituents who voted for them. If they do not make their own voters happy enough, they'll be voted out of office. If they do not make their party happy enough, they will not receive party support at re-election time. They have to walk a tightrope between the two. They also get pulled in various directions by big campaign donors and special interest groups that spend a lot of money to get what they want. So just because the party wants something, it may not be the case that the party member will vote for it. In fact, in the US, it is seldom that everyone votes on party lines on every issue.

The house and senate 'whip' of both parties are the people designated to keep party members in line, but it doesn't always work.

But if they are not, (and it seems to me they are not) and Obama is going to the vote without being strongly supported by the absolute majority of his own party representatives at the low House - so this is strange and requires some explanation.
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It really isn't that unusual here.

It would be of interest to you, perhaps, that the Israeli authorities are looking very close to how much powerfull Obama is inside the US, and for the same reasons I am. Untill a week ago he was portrayed here as an astronaut in world politics, failing everywhere, that still needs to learn that man is bad since birth. And of course the most strong proof has been till now that Health Insurance he has not passed at the Congress.

Cheers,
Ruben
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This will be a centerpiece of his first term in office, and may help dictate whether or not he gets a second term. My prediction is that he will get a bill passed into law, and it will serve well enough for him to hang his hat on and claim it as a victory. However, I sincerely doubt it will actually do much of anything, as it is likely to be very watered-down by the time it makes it to his desk. It will make no one happy, but it will fulfill the terms of his campaign promise. Just my 2 cents.
 
bmattock, nicely explained and succinctly, too.

here's the rub: because voter turnout in the US is typically low, especially in non-presidential, so-called off-year elections, the voter base to whom members of the house and senate are directing their politicking, rarely reflects that broad spectrum of people in this country. with turnout in most house senate races in non-presidential election years hovering at around 50% of eligible voters, most congressional incumbents know they needed please everyone, only their most energized constituents. of course, as a nation, we only have ourselves to blame for the results of our own lazy apathy. while american's are known for cherishing our freedom, we rarely accept the responsibilities of it, especially in the realm of simple civics exercises such as being well-informed and voting when we have the chance.

another issue here is that because of the non-proportional representation of our senate, with two senators from every state regardless of its size, we are frequently left with senators from states from minuscule populations gumming up the works because of the power of our fillibuster provisions (any single senator can more or less hold up the entire body on bit of legislation simply by monopolizing the floor indefinitely. it takes a 60-vote (out of 100) super majority to get such a senator to yield up the floor and allow a measure to come to a vote. to prove that I'm less partisan than I might seem, let's agree that both parties have seriously abused the power of the fillibuster. of course, the most famous fillibuster in history is probably fictional: Jimmy Stewart's days-long speech in the Frank Capra film MR, SMITH GOES TO WASHINGTON. Unfortunately, few real senators in either party these days (or even then, probably) are quite so high-minded as was Stewart's accidental senator Smith. mostly, their highest aspiration is to get elected and keep their seats indefinitely.
 
I want to explain how health care works here in Norway - and many other European countries that have similar system.

We have a public health care system. All the doctors an nurses are employed by the Norwegian State. - There are also expensive private clinics too, but they play no major role in health care as such, but are more in the business of enlarging boobs and lips etc.

We pay our total health care bill through taxes. Out of 4,7 million inhabitants the work force/tax payers are not larger than 2,8 million people. Health care cost is enormous. It is covered, more or less, by our hefty 20% sales tax which is the main reason that American tourists find Norway 'expensive'. In relative terms, even though a Norwegian tax payer pay between 30 and 45% income tax, he/she still pay less taxes than Americans. This because the Norwegian State don't have a hefty debt that must be served with a interest payment each year that must be covered over the tax bill. The Norwegian State has a large fortune, or pension fund, which owns close to 1% of all shares on the world's stock exchanges.

The government just decided that all - 4,7 million, Norwegians shall have a swine flu vaccine, an expensive and major undertaking. Right now, about 1,1 million Norwegians are already vaccined. Just the vaccines costs close to a billion NOK. But the value of our pension fund's investment in Glaxo, Smith & Klein has increased with more than a billion NOK...

Is Norwegian health care available for all?

Absolutely all!

Is it available for illegal immigrants?

Officially, No. But they get treatment even though. This because we Norwegians are decent people. That said: Illegal immigration isn't that much of a problem here, but it is increasing. But also: An American mountain climber, with no right to Norwegian health care, and without an insurance, that had an accident was rescued by the Norwegian Rescue Service (Air Force) and treated for weeks at a Norwegian hospital without ever being presented a bill. The tabloid press often blows up cases like this to tell us why our total heath care bill increases so fast. But the truth is that the Norwegian population is growing older (demographics) and that 'never has so many been treated for so much'.

And quality..?

Generally good. The health crew is highly competent and working closely in cooperation with research facilities at our universities. But facilities can be run down and old. You can not expect to have a room for yourself. While medical equipment is very good and plenty. The government is right in the middle of a hospital up grade program, though. Here in Oslo we several very good hospitals with excellent 'hotel standard'. Quality is often a regional issue.

Efficiency..?

This is a serious issue. Our heath car cost is increasing drastically and more than the 'expected volume output'. After many years with increased efficiency - through the 90', efficiency is now falling. This is a major task for our politicians and health care administrators to find a solution to. Health care efficiency is a complex field that involves budgets of both local and 'federal' government, since care for old people is a local government responsibility and hospitals are covered by the federal government. And so on.

We are not there yet, but one day our general 'health care for all' just might be limited to 'general' health care. With, say, football players and risk sport performers excluded. - Or new and unproven cancer treatments.

'Privatisation' is another miracle cure for efficiency that is presented by the right wing politicians. But most Norwegians trust their public health care system. Any major privatisation is not in the cards.
 
One thing the EU needs to catch up on is the E111/EHIC. This is a form that allows reciprocal treatment in other EU states (and some non-EU as well). But why should one need it? Surely a passport or other proof of EU citizenship should suffice, as indeed it does in quite a few EU countries.

But I also have medical insurance built into my travel insurance. It's £155 (a bit over $200, or about 175€) for annual multi-trip insurance, up to 45 days per trip, for Frances and me -- and we can travel separately. I can recommend it (I use Worldwide).

Cheers,

R.
 
robklurfield said:
Olsen, I'm jealous and wish the US could find the intelligence and willpower to insure the health of all of our citizens.
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It is not the mandate of our government to provide health care. It's not a matter of intelligence or willpower, our nation was simply not designed to operate in that way.
 
bmattock said:
It is not the mandate of our government to provide health care. It's not a matter of intelligence or willpower, our nation was simply not designed to operate in that way.
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Dear Bill,

Or as one European journalist wrote (I paraphrase from memory), "To a European, 'Keep the Government out of Health Care' reads as oddly as 'Keep the Government out of National Defence' or 'Keep the Government out of Road Building'."

Nations aren't designed. They adapt and change. Britain wan't 'designed' for a national health care system until the mid-to-late 1940s. I would consider it an insult to the USA to suggest that your country is incapable of providing a national health care system, so it is merely a question of will. If enough people want to change the mandate -- as is repeatedly suggested by surveys, as well as by the election of Obama -- then it is their mandate. What else can a mandate be, at least as far as a government is concerned?

Cheers,

R.
 
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Bill, with all due respect, while you may be right if your fundamental philosophical assumption is originalism, the reality is that a nation is not a static entity that gets etched in stone immutably. If this were the case, slavery would still be legal here and gladly it is not.

When the framers drafted the Constitution, health care still consisted of leaches and cupping. We've moved well past that. I don't believe many people went bankrupt in 18th century America over health care costs. They got sick and usually died if it was anything serious. We also had debtors prisions, women couldn't vote, non-landholders couldn't vote, etc., etc. Don't we also stand for progress, change and a society that is always evolving to be "a more perfect union?"

We spend $1,000,000 per year for each soldier we send to Iraq or Afganistan. I'd like to see some of those hardworking and heroic men and women come home soon and see a large portion of that money go to sending them to college, to job training and to other places that will make us a better nation. We spend more money to send those folks overseas to get shot at and blown up than we spend on them when they come home injured and in need of care. We owe it to all our citizens to do better. For 1% of what we spend to have one soldier in Iraq for one year, we could provide health insurance for one family here, perhaps a family near and dear to one of those brave soldiers. 1%!

bmattock said:
It is not the mandate of our government to provide health care. It's not a matter of intelligence or willpower, our nation was simply not designed to operate in that way.
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Roger Hicks said:
Nations aren't designed. They adapt and change. Britain wan't 'designed' for a national health care until the mid-to-late 1940s. I would consider it an insult to the USA to suggest that your country is incapable of providing a national health care system, so it is merely a question of will. If enough people want to change the mandate -- as is repeatedly suggested by surveys, as well as by the election of Obama -- then it is their mandate. What else can a mandate be, at least as far as a government is concerned?
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With respect, I disagree. We are neither the UK nor the EU. Our Constitution defines a narrow role for the federal government, reserving the majority of actual power to the states. I fully realize that the Hamiltonian viewpoint of a stronger federal government and weaker states has come to represent a common ideal, but the Jeffersonian viewpoint is what was actually embodied in our Constitution.

To that extent, if there is indeed a mandate (we could argue about that, but I accept that many want national health care), there is a method by which the mandate and purpose of the US federal government can be changed; this is by amendment. It is very difficult to get an amendment passed, but it can be done. This would change our basic role of government, and if it can be done, then good on it. That might be the 'will' of which you speak.

I would also add that the current proposed solutions are nothing like a single-payer or nationalized health care system, but simply a patch upon an existing system which doesn't work all that well to begin with. That something needs to change I do not dispute, but I disagree with those who say 'we must do something', for the simple reason that trying random things is not likely to bring about positive results.

To the surprise of my conservative friends, I have said that if we Americans decide to change the role of government and to make health care a basic tenet or civil liberty if you will, then let's completely gut our current system and go with a 100% nationalized one. Tax everyone, provide health care for everyone, all health care professionals and systems are owned by or employed by the government, no more health insurance companies period. I do not think patches at this point are of any particular use, and cost me money for nothing of value in return (to me). I would have no problem with such a system.

I will add the caveat that when 'the people' are paying for the health care of others on a non-voluntary basis (ie, through mandatory taxes or fees and not by voluntary private insurance), then the people have a right to have a say in how that money is spent. Therefore, smokers do not get health care for lung cancer, fat-asses don't get treatment for heart conditions, etc. You will be mandated to take care of yourself or you will not get treatment. It's the only fair thing to do for the many who do take care of themselves.
 
Bill, one more minor quibble on the topic of mandates. Our Constitution by virtue of defining that Congress shall make laws and have the power of the purse, gives Congress a mandate to pass laws that reflect the will of the people. It seems to me that the last election did something we haven't seen in many years... giving the Democrats a majority in both houses and the White House. The voters spoke. The President ran on plank of providing healthcare for all. Many of the Democratic majority in the House and the Senate also ran on such a stance. That's what a mandate is. The framers where very smart men (notice, there were no women there; today there would be); the accounted for the fact that the nation and its people would change and evolve. They provided a durable and flexible framework within which we the citizenry can manage change through our elected government. If the electorate wants some form of universal health care, then we should have it. The last election was the populace speaking and giving its mandate. That's democracy in action. Our legislative bodies are behaving lately as if this weren't so, by arguing over issues that the noisy members of their political base are in a twitter about. The bulk of the US populace supports healthcare reform. There is the mandate.
bmattock said:
It is not the mandate of our government to provide health care. It's not a matter of intelligence or willpower, our nation was simply not designed to operate in that way.
Click to expand...
 
robklurfield said:
Bill, with all due respect, while you may be right if your fundamental philosophical assumption is originalism, the reality is that a nation is not a static entity that gets etched in stone immutably. If this were the case, slavery would still be legal here and gladly it is not.
Click to expand...

A constitutional amendment is the appropriate way to change the basic role of federal government in the US. Nothing short of that is appropriate when redefining basic rights.

We spend $1,000,000 per year for each soldier we send to Iraq or Afganistan. I'd like to see some of those hardworking and heroic men and women come home soon and see a large portion of that money go to sending them to college, to job training and to other places that will make us a better nation. We spend more money to send those folks overseas to get shot at and blown up than we spend on them when they come home injured and in need of care. We owe it to all our citizens to do better. For 1% of what we spend to have one soldier in Iraq for one year, we could provide health insurance for one family here, perhaps a family near and dear to one of those brave soldiers. 1%!
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With respect, I spent last Saturday at a Veterans Day parade, trying my hardest to encourage others to attend. We had over 1700 marchers, and about 200 watching the parade. In Detroit; where well over a quarter of a million will show up on Thanksgiving on the same street in the same city for a turkey day parade.

I'm a veteran. I know how much my fellow citizens care for us. I saw all 200 of them at the parade Saturday. I have a right, if anyone does, to wave the bloody shirt about what veterans deserve. Please leave veterans out of the discussion unless you are one yourself. It pains me to see people who do not otherwise give a rat's ass about us attempt to speak in defense of us.

Sorry, bit of a raw nerve for me. Everyone loves veterans long time these days, lest they be hammered for being anti-American like the anti-war people on the 1970's who made their disdain clear were. But it's just words. "I Support The Troops" on bumper stickers doesn't mean jack to us unless those words are backed up. I saw about 200 people who actually supported the troops last Saturday, in a city of about 900,000. When people get to talking about what the dear, dear, troopies deserve, my hackles rise. Nothing personal, please, just understand that in my opinion, people only throw the word 'veterans' around when they wish to make a point, and that point isn't about veterans, it's about what they personally want.
 
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