Elephant to Clarke and Platt
Hm. Bit more preaching I'm afraid. Preaching is a terrible thing.
PLATT'S EXEGESIS OF RMP:
> "What's so vague about the New York stock exchanges? Aren't values
> what they're dealing with?."
>
> Here we see Pirsig equating values (quality, morality) with the
> quintessence of capitalism, the stock market.
Er, no, Platt, we don't. We see Pirsig understanding the stockmarket as the
pursuit of dynamic quality. Understanding something in terms of something
else is *not* 'equating' the one with the other, unless you have recently
changed the meaning of 'equate' as part of your dictionaries project. If
RMP was *equating* the two here he would be saying that we jump off hot
stoves because that suits the NYSE. He isn't saying that, I hope, because
that would be silly.
And Yes Platt, since you ask, there is plenty of evidence that the US
healthcare system, while substantially more expensive per-capita than the
NHS, is also significantly worse. Worse morally, worse clinically. I think
we can start with the fact that so many millions of Americans aren't covered
by the system at all, which is bad enough. One might also mention the fact
that in the US the payment incentives for Doctors are similar to the
incentives for Lawyers, ie they are paid by the disease, not by the cure.
And then we can add up the number of life saving proceedures that were
invented in the NHS as against those that the states have pioneered, the
incentives towards US medical researches concentrating on relatively
insignificant health-problems that are cheifly suffered by the rich as
against bread-and butter health care (e.g. the disasterous slow-down in the
antibiotics race) etc etc. All these facts have been gone through by
radicals in the UK conservative party. They were at one time very anxious
to prove their assumption, shared by yourself, that a private system would
be higher quality and cheaper than a 'socialist' arrangement, and naturally
they turned to the US for statistics to back them up.... where to their
disappointment they discovered the exact reverse. As a result plans for
health-privatisation were quietly dropped, never to be heard of again.
CLARKE WROTE:
> I guess my point is that my cultural bias forces me to
> think in terms of Socialism=Welfare=Disaster.
If you really *are* forced to think what you do because of your Kultur, you
might as well not bother. Think that is.
But if you do think about it, perhaps you will note that 'cultural bias' is
just your way of forclosing difficult thinking by filing all the relevant
evidence in the bin.
Speaking of evidence filed in the bin:
CLARKE WROTE:
> Regarding the US system of health care - the rise
> in health costs in this nation is in direct, empirically-verifiable,
> relationship with one thing: the increase in "social health" programs such as
> Medicare and Medicaid. While I'm not disputing the need to address the
> health concerns of the poor, it still forces my "cultural filter" to think
> National Health=Exorbitant Costs=Disaster. The social pathologies of this
> nation are simply different from those of Europe, in that what works well in
> one nation may not necessarily work well in another,IMO.
Fascinating speculation. How To Identify And Compare Social Pathologies In
One Easy Stage.
But of course you *haven't* tried what works well in 21st Cent. Europe. You
have tried what worked exceedingly badly in 19th Cent. Europe, with roughly
the same results.
Any system which included the US private sector heath-insurance system would
be hugely expensive. Why do you think they got Clinton's health programme
stopped - paid for all those campaign adds when it was going through
congress? - it would have lost insurers a hellava lot of money. You are
callculating the cost of 'welfare' health-care on the assumption that it
will remain *additional* to private provision. But the whole meaning of
*socialism* in this context would be that the state system is good enough to
be *instead of* private provison, not *additional* to it. *That* is what
makes the NHS so cheap and effecient compared to your system. When NHS
spending is maintained and looks secure (i.e. when margaret thatcher isn't
in power) there is no real motivation for taking out private health
insurance - if you have any kind of illness or statistical tendency to it
you won't get cover anyway, and the cover note you get has 'will refer you
to the state system if anything is seriously wrong with you' marked accross
the bottom in tiny print in anycase (i.e. the exact opposite of the US).
'Why pay for non-comprehensive private insurance when you have already got
comprehensive state insurance?' - this is what UK citezens ask themselves
(Again, the exact opposite of the US position, where most of the electorate
(I won't say 'population') have comprehensive private insurance and are
understandably reluctant to fork out for non-comprehensive state insurance
on top). For state provision to work efficiently in Dollars and votes it
has to be instead of, not as well as, a mass private insurance system.
This is the difference between the system that existed in the UK before the
National Health and the system which existed after: before you either paid
up, or you depended on charity, or you died, or you lived with ill-health.
That seems to me to be a fair discription of the US situation at present,
with the twist that the state is one of the charities (charity is what
'welfare' really amounts to, unlike the NHS). Well, I can tell you the
historical four-point 'social pathology' of that pay-or-die system in the
UK, and you can tell me whether that describes the US:
1. The Doctors made a lot of money and kicked up a fuss whenever the
government tried to interfere.
2. The poor suffered disproportionately bad health and substantially higher
mortality (ave. life expectancy varing by as much as 20 years by economic
class).
3. The rich suffered indirectly by dying of diseases like TB that were
cultivated amougst those without access to proper heathcare (or indeed
housing).
4. Rich and poor alike paid the economic price attached to death and
ilnness on an unnecessarilly large scale . Any situation in which potential
workers die or lose efficiency or take time off or leave the labour market
due to illness puts the real cost of labour up, wastes investment in
training and education, and can lead to localised economic deserts where no
form of honest economic activity is possible.
Does this describe Africa? Or New York?
Let's be practical about this.
You want the rich to stay rich, and the health to stay healthy? Well there
are two ways of acheiving this. Strange thought this, you could treat a
poor man's healthcare as every bit as important as a rich man's - treat the
disease, not the credit card. Or, more feasibly, you could set up
disciplined squads of public spirited state officials so that poor unhealthy
people can be exterminated, thus preserving public health.
That might create a labour-shortage, and then again maybe not. So many
begrudging ineffective partial charity hand-outs are just prolonging the
agony, aren't they? Hell, we're just keeping them more or less alive so
that they can continue to be ill and out of work. What's the point in that?
Better just get shot of the lot of them. Cheaper in the long run, the short
run, every way you look at it in fact, and better for public health too. We
can do a simple test - anyone with fewer than $20,000 dollars on the stock
exchange can be sent to Madagascar and nuked.
But then again, a modest propsal this, perhaps that nuking would represent a
terrible waste of all the nutrious post-date fast food they've been
charitably fed on till their timely demise. Surely the thing to do would be
to arrange for them to be composted right here in the US of A and spread in
a fine humus dust over the cotton fields. If this was done at just the
right time of year a bumper crop could be guaranteed - because we don't need
them alive and healthy to bring the cotton in no more - we have machines
for that.
I commend my proposal to the Nation.
Yours trully
Jonathan Swift
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