A quick rant

The following was an email. Background: a non-political list was becoming politicized with neo-con and libertarian trash talk. One member tried to engage me off-list to continue the argument (that we have the best health care system available). This was my (long) off the cuff response. I thought it merited sharing - but you can judge for yourself. To begin with, the individual claimed that I favored socialized medicine....hmmm. His other key argument seemed to be that government is corrupt, so should be allowed to do as little as possible.

Dear Xxxxxx,

Fair enough. I am in favor of socialized medicine - not the least afraid to say it or use that term.

Our society and government has become bigger and more complex than the founding fathers ever considered (at least from what I've read). Making any system (medical or otherwise) difficult.

To suggest that all government is corrupt is a bit broad from my perspective - and makes it hard to identify and correct the problems. I think the corruption in government varies, and that corruption is at least as controllable as the problems with our current system of medicine.

As background: I'm not an expert, but I try to keep up with the news, outside reading, and refer back to my studies (BA Political Philosophy, MBA Finance/Marketing).

I think our federal government has become significantly more corrupt since the republicans started to take over Washington. Boy, talk about running away from your beliefs, eh? BTW, either you get that statement or you don't. I no longer try to convert die-hard republicans.

Either one believes in the basic social compact theory of government or one doesn't. In the latter case, one can try to achieve a dictatorship or the like that drives ones own interests, or one needs to turn to anarchy (which I consider to be the libertarian model without cheating). Anarchy sometimes works - in small groups where resources are not in short supply. I think that it has yet to succeed in any sort of large group much less a nation. I don't believe in dictatorship - although some of the right wing-nuts seem to. Often in the guise of a Christian government. So, yes, I believe in the social compact theory of government.

That inherently supposes socialism. That is, the social compact requires us to consider the needs and interests of those around us. We have to balance our needs and wants against those of our peers, friends, colleagues, leaders, followers, enemies, and assorted low-lifes. BTW - what's so bad about that?

Fundamental to a social compact is a sense of justice. You know, things like where the constitution guarantees equal treatment under the law. One aspect of justice is to recognize that no system of distributing wealth is perfect. That some people fall through the cracks, and usually it is through no fault of their own. Hence, we have a need to provide some baseline quality of life for these individuals.

Now some people (like the dittoheads) would say I'm soft on lazy folks who want to live off of my work. Well, that's an interesting concept. I venture to say, none of those people have ever spent time living the life of these so-called welfare-cheats. If they did, I think they'd see that the lifestyle provides plenty of incentives for change, but few avenues. I do think that its possible to get trapped mentally as much as socially into poverty - and that it is largely the responsibility of the individual to fight the mental trap. But, these folks aren't generally in the position to fight the social traps - and if we don't take care of that, and their basic quality of life - then these individuals have no benefit from the social contract. Just as companies and rich people fight contracts which they decide are not in their best interests, those individuals left out by society have found ways to fight back over the eons.

It is irrational to think that this sort of unhealthy conflict will change unless these individuals are co-opted into the system - that is brought into the benefits of the social contract. Many people prefer to hate, disdain, whatever these individuals. It doesn't solve the problem - but seems to make these individuals feel better about themselves. Oh well...it's hard to fix shallow minds.

The constitution, the declaration of independence, the federalist papers, etc. don't talk about capitalism or free markets. Funny that so many people today (often influenced by the neo-cons [which is short for Neanderthal con-artists]) seem to think that democracy, capitalism and free markets are inherently related. They're not, ever hear of the term: Social Democrat?

Very few people can speak with any accuracy about what a free-market is, either in a classical sense or as the term has come to be defined by economists. Too bad, 'cuz that means that they just don't know what they're talking about. Thinkabaudit. Free markets sound like a good idea. Air travel isn't a free market, but is one of the closer examples currently at hand. Guess what, airlines can't make money in anything like a free-market. Nor can anyone else. It is only by undermining a free-market that business succeeds.

I keep meaning to look up a piece by one of the marketing guru's (not Drucker, but I can't think of who right now - a sign of old age). Anyhow, it defines what marketing (and therefore fundamentally the strategy) of companies should be. Funny thing, its almost a point by point description of all that is considered predatory or unfair trade and/or monopoly behavior. In other words, the marketing gurus fundamentally teach that business should actively undermine free markets. So, it should be no surprise that its hard to find any free markets.

In a related item, economists have concluded that in a fair stock market, no one can beat the system (that is average over-all returns) over time. Any short term wins are random chance. We know that some people are able to regularly beat the system - although most of us can't. Yea for free markets!

Capitalism. Hmmm, what can we say. Largely defined by the Marxists (no i'm not one of them - they're crazy). Understood correctly, I think a capitalist is someone who succeeds in undermining free markets in order to accumulate more wealth/material/capital/power for themselves than their contribution to society might otherwise earn. Is that what we're all about? Not me or most people I know. Capitalism is not the same thing as commerce or commercialism. Both are driven by greed (which is fairly instinctual), but the capitalists get ahead by cheating the social compact and fair play.

Unfortunately, many in this country don’t understand that distinction and fall for simplistic arguments - that convince them to support capitalism. The business leaders of this country drive this thinking, even though they intend for capitalism to be just as defined by the Marxists. Hmmm.... almost enough to make me want literacy standards for voters.

Going back to the freedoms thing... What rights to do we have? The constitution doesn't protect our right to be tax free. Being tax free isn't necessarily a good thing. It is arguable that as a nation we would be stronger and our economy would be stronger if business wasn't taxed on income (maybe not for real estate either), and that the general public picked up the difference. Now, that won't happen because there are too many people making too much money off of the current tax system. And, they're in a position to protect their interests in the social compact. Eh?

We also aren't free to opt-out of social welfare programs such as: 1) police and fire protection; 2) protection by armed forces; 3) national forests; 4) other national resources like the capital; 5) EPA standards (although shrub has made these largely go away); 6) FDA standards (shrub's tried to prune these); 7) public roads, airports, sea ports, etc. Why is health care such a hot button? We don't see most people getting upset about this other SOCIALIST solutions.

Healthcare is funny. Its often one of the most emotional purchases we make, and often with little time for research and comparison shopping. As such, we are particularly vulnerable the anti-free market forces. I hear folks say that they know someone from Canada and that person says Canadians come here for medical care all the time. Can we parse this a little?

First, only wealthy Canadians could possibly afford to come here for health care - we're too expensive and they aren't on our insurance plans - so ya gotta be rich. By the way, if you've spent much time with the rich - most of them need (that's need not want - just ask them) more of everything.

Second, I live in Illinois. Many people from Illinois go to Minnesota (Mayo Clinic) or Ohio (Cleveland Clinic) or other places out of state for medical care. Does that mean our medical system in Illinois is deficient? NO!!!!

Most of the people who go out of state are in a position to pay for their own health care comfortably, and have good health insurance. They fall into two categories: 1) hypochondriacs, who just aren't ever satisfied with a diagnosis. They travel from famous clinic/doctor to famous clinic/doctor seeking someone who will invest in their hypochondria. 2) legitimately seriously ill people who either are looking for THE sub-specialty expert to ensure that they get the best possible care - or looking for an astute second opinion. These folks can afford the best, have a serious condition, and know how to get business taken care of. Bully for them. But, the bottom line is that the available healthcare facilities in Illinois are extremely good across the board. Thankfully, because most of us don't have the option to seek out out-of-state health care.

I married into a medical family (funny thing to do. i named our dog doc. guess what happens on at a familhy gathering when I say "here doc!"). My wife is a clinical psychologist. Her brother is an orthopedic surgeon. Her mother was a GP. Her father was pioneer in emergency room medicine. Both her Grandfathers were surgeons. Her cousin is a rheumatologist in Canada. Her Aunt just retired as a GP in Canada. Now these are all people serious about taking care of patients. Guess what, they all think the Canadian system is much superior to ours. Cheaper, more streamlined, and more willing to let the Doctor make the decisions as to what is the proper course of treatment. Think about that last idea - it's not one the "anti-socialists" want you to think about. When insurance pays for your medical care, you get a form of socialized medicine where greed is the driver of all decisions related to the quality of your care. Makes me shiver.

People want to blame Americans' eating and exercise habits for all the shortcomings of our healthcare system. Well, both are factors in our overall well being. But, Canadians (and arguably Australians) are much like us and report better health statistics for a lower cost. So.... the argument doesn't pass the smell test.

I have a friend, an investment banker, who is convinced that our health care system is the envy of the world. But, he doesn't get that opinion from foreigners. He points out that in England, the national health trust wouldn't give his wife the care she gets here for her MS. Its true. On the other hand, she gets her treatment from a doctor who works outside of conventional protocols. And, my friend has the position and insurance policy to make this work. Most Americans with health insurance couldn't get this protocol. Those without a policy can't get any protocol. I think the English system is more effective and more equitable - even if nimrods don't have the opportunity to opt out. Meanwhile, people in my friend's position are able to get supplementary healthcare both in and out of country. So - the rich don't get shafted - they just get to uphold the social compact with the rest of us. Now, call it socialized, call it bongo medicine, call it anything - but it sounds like an idea that merits serious consideration by every American.

Then there's the subject of intellectual property rights. That's a biggie, which I can't do justice to right here. 1) How much intellectual property, owned by the drug and related companies, was created by themselves with their own funding vs. how much comes directly from government research or their own research funded by the government? Check it out, you might be surprised at the answers. 2) If you think of an idea before I do, what about that sequence is other than luck? And, if its only luck, why should you get exclusive rights to the idea? 3) What particular societal benefit accrues to having a corporation have IP rights? And, how do IP rights actually play out in business (if you check you'll probably find it serves only to exclude new/small players - big players trade rights back and forth all the time - IMHO all of IP law [globally] needs to be seriously revisited starting with questions like: what do we want to accomplish?). Have you ever discussed with anyone knowledgeable how effectively rights are protected in the courts [even for big business]? I think you'd find that even for simpler technologies, it’s a total crapshoot. Things that don't deserve protection get it, and things that do deserve don't. I remember a business law professor talking about a patent having to do with a paper mill. A roller had a groove and was described as such in the patent. The competition simply claimed that they didn't use a groove, they used a slot (which had the same shape, location, dimensions) and they won. ERGH!!!

There is no system that can ensure that citizens get what they deserve, and deserve what they get. At least no one has come up with one yet. This probably is related to Arrow's Theorem (which I think is now proved so no longer a theorem). Basically it states that given three or more alternatives to rank, and three or more voters, no voting system can be devised that ensures that the collective preferred option is selected. If you've never heard of this before, stop and take a second to think about it - the idea should blow your mind. Start with the fact that there are generally a lot more than three issues in voters minds when they go to a poll - hence no voting system is guaranteed to reflect the collective voters wishes. Then, consider that we "vote with our $" every day, and again each decision involves more than three factors (like, which color do I like, which will get me in the least trouble with my wife, and what can I afford). As a society, we may be buying something other than what we want. The good thing is that most voting systems work most of the time. But, not always - and this is before we get to issues like: lying politicians, brain-dead or brain-washed voters, limited and skewed information in the marketplace of ideas.

Back to IP. Historically, there seems to be a big disconnect between those who innovate and those who profit from innovation. Now, there are all sorts of silly arguments that its not really innovation but risk taking that drives profits. And, that the innovator doesn’t encounter risk, but that the firm that owns the IP does. BS! Firms don't engage in risky behavior. Why? Cuz managers don't engage in risky behavior - it puts their bonus at risk.

In a slightly different vein: an attorney I know specializes in class-action lawsuits. This might upset me, but it does seem to be the only mechanism to get businesses to change shoddy behavior. Anyhow, he was explaining to me one time how this works. First, they look for a case where there's already been a criminal conviction. A criminal conviction has a much higher standard of evidence, and therefore all but assures them that they will prevail in the civil litigation. At the end of trial, there is a form of fact finding to determine how hard the case was to win. You see, they get paid contingently. So, if they only win half their cases, they only get paid half the time. The system is set up to apply a multiplier to their hourly fee (which is very similar to that of the corporate atty's on the other side of the aisle), based on the difficulty of winning the case, to ensure that at the end of the year they get paid as if they won all of their cases (in other words they didn't suffer from contingent pay). As I said at the beginning, these guys (with some notable exceptions) generally only take shoe-in cases. Yet, they often argue successfully to receive up to treble their hourly rate. No wonder legal fees take such a big dent out of settlements. What's this all about? Everyone tries to beat the system by getting paid for risk that doesn't exist.

OK, now some game theory. Why the social compact? Cuz we're all better off working together rather than each on his/her own. Individual homo sapiens aren't very successful in nature. However, we are all better off (at least to the degree that we're motivated by greed) if everyone else has to follow the rules of society - but we don't. Whether this means coming to a full stop at an intersection, or engaging in business by the rules, there is this fundamental conflict. We need everyone else to obey and believe that we obey, but we want to cheat. Guess who succeeds best at this play? How about the people with the top 1% of personal income? But, of course, they claim that capitalism or some magic hand ensures that they only got what they deserved for their contribution. In fact, they'll all argue that that they've been shafted.

Well, I got a right fine rant going here. :)

Xxxx, your points seem to be: 1) you don't trust government and that nothing can be done to improve it; 2) you don't like socialism (it's not clear why, or in what context [ie should we get rid of the army too?]; 3) You're in favor of intellectual property rights; 4) Innovations are a function of profits which are based on IP.

If you believe 1, then don't vote - it won't help.

You probably have a narrow definition of socialism [and capitalism] that warrants some more thought - especially in light of the relationship between democracy and the social compact.

3 apparently is based on 4, but doesn't demonstrate analysis of the truth value of 4. I would suggest that most innovation occurs because some people are naturally innovators - not because of greed or profits. If so, then the social value of IP rights sinks quickly.

I welcome challenges to the above. But, I just can't let you get away with suggesting that we have something good going on here with our health care delivery program.