Your entries on health care and the two reader responses you posted got me thinking again (As your site always does).

I see at least two additional reasons why national health care is a good thing.

One - massive epidemiological data sets. If we have access to everyone’s health care record (made anonymous for research purposes) we have a massive data set with which to work for research. Just one practical application of a centralized data set would be the ability to better identify negative drug interactions for multiple medications.

Two – (and this is why I think national health care is coming) US Businesses are disadvantaged against companies that operate in a country with national health care.

I do agree that Americans need to take better care of their selves. But shit does happen. And a review of bankruptcy cases will show that a vast number of them are the result of unexpected medical expenses, often for people who were insured to begin with.

To take the position of Michael S. one or two steps further we could ask "why should we provide fire or police service to people?" If your house burns down, it was probably your fault. If you are in need of police assistance, again, it’s probably your fault for being in the wrong place the wrong time. I think people would be much more vigilant if we just removed these unnecessary government "welfare" programs for the unlucky person who feel entitled to some sort of protection.

But on a more serious note. . . There can and should be a baseline of services for people. All those "exotic" treatments will still exist because there’s a market for them, but we don’t have to pay for them. Truth be told, I don’t want to pay for anyone’s breast implants either, unless it was the result of some massive disease or trauma. A great example of "baseline-plus" government provided service is from my home state Minnesota. Every year, someone is going to go out the ice too early or too late and fall through. Whoever bails your dumbass out (fire dept, police dept, DNR. . .) sends you a bill for services. It makes sense to me. Can’t this be a model for all government services? We provide the basics, but if you are a real screw-up you can help with the costs.

Matt recommended two fascinating links: an essay entitled Beyond Money: Toward an Economy of Well-Being and a book, Small Giants: Companies That Choose to Be Great Instead of Big

Regarding Michael S.' entry:

Individuals would take better care of themselves because they knew they would have to pay for the consequences.

No they wouldn't. People take up smoking when they are teenagers because they think it's cool and then it becomes an addiction. People have injuries from accidents because "accidents happen." People take up dangerous sports because it's thrilling -- even when they know it increases the risk of injuries. People have irresponsible sexual escapades because the sex is pleasurable. People use dangerous street drugs because they are seeking a thrill or they are trying to self-medicate psychological/psychiatric problems.

Pain and illness is already a consequence of unhealthy or dangerous lifestyles. People don't avoid them now even if they have to pay for them and they won't if we make everyone responsible on their own. Social Darwinism is just cruel.

People would scrutinize expenses much more, since they were footing all the bills, which would force much more competition from providers.

They might. But that doesn't mean that the more economically powerful healthcare corporation is going to reduce their bill anymore than they already do. The credit card companies don't reduce your interest rate on your bill just because you ask them to, and people scrutinize their credit card statements at probably the same rate (and just look at what abuses the House and Senate banking committees are uncovering). Michael S. just doesn't understand how the courts work. They typically don't listen to debtors.

People would make valid price/benefit trade-offs choosing plans that may not cover certain kinds of expensive/exotic treatments, but would offer great value on the basics. Women who have breast surgery will do it because they think it will make their husbands/boyfriends love them. Besides, such treatments/surgeries are rarely covered, anyway. Furthermore, this argument would only be effective for medical treatment that is truly elective and only for those who are only marginally able to afford it (think upper middle class). Wealthy people who seek cosmetic surgery or "exotic" treatments are not the kind of exemplary treatments that we need to provide for.

The way the US system is now, people expect EVERYTHING because they don’t have to pay for it (their employer, or government) does. Guess what the second biggest improvement to US healthcare would be? Getting the government out of paying for treatment?

He doesn't seem to understand that medical care has a higher legal protection than other consumer items (outside bankruptcy). The case for national health care is also partially predicated on the fact that the consumer will benefit from the economies of scale. With a single payer, administrative costs will be reduced and hospitals will have to justify their fees in relation to other medical providers in their area (and the fact that a single insurer -- the government -- will know just what everyone is charging and will be able to negotiate the best price for everyone).

The number 1 thing that I believe can be done to improve the US health-care system is to eliminate tax deductions for health care. This would lead to a sea change in the medical system, with employers dumping coverage as a benefit and individuals having to take responsibility themselves. The effects would be profound in so many ways.

Individuals would take better care of themselves because they knew they would have to pay for the consequences.

People would scrutinize expenses much more, since they were footing all the bills, which would force much more competition from providers.

People would make valid price/benefit trade-offs choosing plans that may not cover certain kinds of expensive/exotic treatments, but would offer great value on the basics.

The way the US system is now, people expect EVERYTHING because they don’t have to pay for it (their employer, or government) does. Guess what the second biggest improvement to US healthcare would be? Getting the government out of paying for treatment?

I realize that such a market-based medical system sounds frightening to many people, and we can all imagine horror stories where people would die because they didn’t have enough money to pay for treatment. However, I would argue that as counter-intuitive as it might seem, people would be far more able to pay for treatment in such a free-market medical system, and the treatments themselves would be cheaper and more cost-effective.

What we might very well see is that many of the most exotic treatments (transplants, etc) become far less common, since fewer people could afford them. But would that really be such a terrible thing? If we could all get great (and inexpensive) medical care, maybe it wouldn’t be so terrible that we abandoned the birth-right to extraordinary treatments and expensive cures.

(Written in response to the entry of April 5 Corporate Rot about the poor training and lack of benefits which is hollowing out employment in the U.S.

I think that my proposal to create a national health care and pension system would go a long way toward alleviating the problem. If corporate, capital gains and income taxes (self-employment taxes are nothing more than Social Security and Medicare taxes) were raised to the level needed to provide the same level of coverage that government workers get (and you would get savings from the economies of scale) companies could afford to hire those programmers on a temporary (maybe even a permanent) basis. The workers could move from job to job without fear of losing health care benefits or their pensions.

America has always thrived on economic dynamism and an "interchangeable parts" kind of system (there is a word for it, but I can't remember what it is). What we need is more social stability to make it work.

Furthermore, there are many people who can't "pull themselves up by their bootstraps." They simply don't have those skills and it's not something you can teach. They need someone to look after them. And (this is an important point) there is a criminal element that will take advantage of the situation of lack of government oversight in financial matters.

Think of corporate executives taking money that should have been put into pensions and ramping up pay for themselves and then directing the corporation to file bankruptcy to shed the obligations to the workers. In reality this is a kind of theft. We may define it in our legal system as a breach of contract, but it is taking money that rightfully should have been paid to the worker all along, in that sense, it should be defined as a form of embezzlement. Embezzlement is defined as theft (misappropriation) by someone in whom property, or money, has been entrusted. It is a form of larceny.

We could solve part of the problem by passing a law that says that any company that underfunds a worker's pension plan will have it's corporate veil pierced (making the officers, directors and trustees personally liable for the debts to the workers). That would make corporate execs -- or their masters -- pay closer attention to the financial health of the company and the worker. Imagine what effect that would have if the corporate exec knew he could lose his big house, fancy cars, vacation home, time shares, bank accounts (and any family member's he transferred money to) and have any future earnings garnished to pay back the workers. I think you would see a lot less "underfunding " of worker benefits.

(Written in response to the entry of May 3, 2007 Paradox of Plenty: Consumer Alienation)

Have you read The Long Emergency by James Howard Kunstler? If you have not, you and he certainly think along the same lines. I read Mr. Kunstler's book about a year ago and feel that we, as a nation, are slowing grinding toward what he talks about.

I have some strange measures of the American consumerism patterns. I count self storage buildings in the areas that I travel and also monitor how many bags of trash people take out on trash day. (I have never claimed to be normal) There is some virtue to this kind of study. One has to purchase, and then throw away, a lot of stuff to have 5-6 bags of trash at the curb each week. Our household consists of my wife and myself. We usually have one bag of trash each week. Across the street is a household consisting of a husband and wife and they generally have at least 5 bags of trash. Are they 5 times as happy as Barbara and I?

I call Fred, the neighbor above, the "Tool man". He has every conceivable gadget that the Chinese can make. His yard is a little bigger than ours. I mow with a 20" push mower. Fred had three riders, a push mower, a gas leaf blower, a gas trimmer, a gas sidewalk edger, and a gas snow blower! Jeeeez. Kunstler would just die! I am about to. Our society just can't go on like this. Yet when I try to talk to clients about this kind of stuff, they glaze over or say something like, 'that is depressing, I don't want to talk about it anymore." I think this kind of attitude seals our doom!

There are a lot of Amish that go to the Chelation clinic that I use. They are the exact opposite the typical American consumer. To paraphrase the Bible, The Amish shall inherit the earth....if there is anything left of it when we are finished. By the way, the Amish that I have met and become friends with seem very happy, and have none of the junk that the rest of us own.

Just a quick note in regards to the housing/debt topic you've been covering this week:

A co-worker has been looking for a house in a nice Chicago suburb (a nice, middle-to-upper middle class burb, but not someplace untouchable like Hinsdale or Winnetka). He has a big family and needs a three or four bed. The three beds go for $650,000 and the four beds go for $7-750. These are considered "deal" prices (though I think we'll see even better deals over the next couple of years!). The interesting thing is that a good percentage of the houses they've looked at have been in foreclosure. They were shocked at the amount of people who had gotten in over their heads and lost their homes. This has given them pause, to say the least.

I found your post today to be of particular interest. Most of my friends are in their thirties, with young children. All of them have college degrees and most are employed in "white" collar jobs. None of us live extravagantly. Yet, none of us feel like we have any money at the end of the month to save for retirement, our kids college education, etc. In fact, if something unexpected happens (dental work, school activities) most of us have to use a credit card to cover it. We all have balances, a fact that we do not share with our baby boomer parents, partially because of embarrassment, and partially because they have a hard time understanding that if you want something, it's hard to put 50 dollars a month away for it when you have a $3,000 credit balance hanging over your head and nothing left at the end of the month.

Thank you again for all your hard work. I check your site daily because I find that I always learn something!

You made this point below, and I've seen it stated elsewhere, but I'm wondering if the market is really that easily affected by one or two sales.

Even if 99 of the homes were purchased for $500,000, the value will drop to $400,000 the moment a comparable residence in the area sells for $400,000. As interest rates rise, then the next house might sell for $350,000, the next for $300,000 and thre next for $250,000. It would only take a handful of sales to drop prices 25% - 50%, and in a much shorter period of time than the market thinks possible.

Is there any evidence to back up this theory?

For instance, if someone comes in to the market with lots of cash, eg. a California refuge buying in small town Oregon, and they overpay by $100,000 - does the market value for all comparables now rise accordingly?

Also, if the Fed keeps printing money, it will have to go somewhere, so do house prices really fall, or is it that they stay flat but inflation wipes out their values too?

As a Canadian who visits the US frequently, I'm amazed by the following things:

- general US culture of entitlement (not the Republican slam on welfare) but the expectation of everyone that they can all live on funny money endlessly and everyone can shop at costco and walmart till they have no more room for their stuff

- the complete disconnect between the population and the government fighting a war halfway aound the world - there is zero effect on the population at large (unless you happen to have a family member or friend in the army)

- I had a friend, generally a liberal, who during the disputed year 2000 presidential election, said "just choose one or the other and get on with it" - Have Americans been bought off to that degree that they don't have to care about who leads them any longer?

Is the US the current Rome, too far extended, population too pampered, getting ready to fall?