Well, when we did it, it was 1946. We were (economically as well as literally) rebuilding the entire country from the ground up at that point anyway, having expended not just the entire country's, but the entire Empire's wealth and resources on fighting the war. So there was essentially no entrenched rich lobbyist class to protest against the welfare state; Labour, promising to implement the Beveridge Report's recommendations on setting up a welfare state, had been swept in with a huge majority (ousting Churchill from Number 10!), and the Health Minister most associated with setting up the NHS was one of 10 children and left school at 13 to work in a colliery. The medical profession fought him every step of the way; he claimed (says Wikipedia) to have eventually won them over when he "stuffed their mouths with gold". This presumably works less well on mouths already stuffed with gold.

How you arrange for similar circumstances in the US I don't know. The Great Depression might have been a good opportunity, but this current depression, painful as it is among everyone up to and including the merely comfortably-off, is unlikely to wipe the slate of the very rich clean like World War 2 did here. And in the US, with a few Old East Coast exceptions such as the Kennedys, political power has always inhered in wealth rather than in birth as in the UK.

One other thing that did occur to me: you (that's "you" the US in general) have voted Democrat majorities into the House and the Senate, Democrats most or all of whom presumably stood on a platform of health-care reform. You then voted a Democrat president into the White House, who very definitely stood on a platform of health-care reform. Yet despite a clear majority of you voting for it twice, meaningful health-care reform is still not looking likely. Something is not working properly in your democracy.

Peter

Ah, but the Kennedys were fabulously wealthy. Their father, Joe, amassed a huge fortune, mostly through real estate (though seeded with some, uh, seedy ventures in the '10s and '20s). And, unlike that of many of the prominent philanthropic businessmen of the 19th and early 20th centuries, most of that money was passed on to his children, rather than going towards charity. Then again, being devout Irish Catholics, Joe grandfathered 30 children, so that money got spread out pretty quickly.

In addition, Joe was somewhat obsessed with getting into politics. His own aspirations to high office were torn asunder when he sprouted a defeatist attitude early in World War II, when he was ambassador to Britain. He then started grooming his eldest son Joe, Jr., who was killed in (odd) action late in WWII. Then he started grooming his next oldest, John. I imagine that obsession got passed to the other two sons, too. However, only a few of the grandchildren are politicians, and currently only one. Might have something to do with those few being the few that knew their fathers past age 10.

Many of the Kennedys are activists, some political, some social, but I doubt we'll see many more Kennedy politicians.


That would be an incorrect presumption. Many of the Democrats elected into Congressional office in 2006, when they regained majorities, have serious problems with the idea, and they are a big part of what is holding it back. The Democratic party of the last thirty years has been one of the most disjoint parties ever to be in existence. It's nearly the equal of a European-style coalition party. If we were to go by pure party numbers, Democrats could pass anything they wanted to right now. (Or could, before Ted Kennedy passed away.) But it's just not that unified here.


Yep. The same thing that fails to work right in every large collection of people: the squeaky wheel gets the grease.


There's no way you could know this, but, FYI, the accepted adjective is "Democratic". (In reality, the name of the party is the "Democratic Party", and "Democrat" as a noun is a backformation already, albeit an accepted one.) In recent years, Republicans have started using the word "Democrat" as a diminutive adjective — kind of a pseudo-subtle epithet.

Ah, so there's no equivalent of the whip system? or it doesn't work in the same way? Over here defying the party whip is reasonably rare; it's (in US terms) as if the DNC (or RNC) could say to members of Congress, "vote yes on HR676 or we'll suspend or eject you from the party". Not having that form of party discipline, as it's called, seems... better, actually. More democratic. Though it will tend to lead to logjams such as the current one.

I actually wrote "Democratic" first, but then changed it to make it clearer (especially in the phrase "Democrat{,ic} majority") that I meant the party, not the abstract idea. I suppose the capital "D" flags that difference too; we don't really have that problem over here, as Labour aren't very conservative, and the Conservatives aren't that interested in labour, whereas in fact both US parties are democratic and (in the British/Australian sense) republican. (Though, of course, in Northern Ireland, "Republican" means something else again.)

Peter

There is, but it's not as strong as it is in the UK.

My understanding of the UK election system is that while you're technically voting for an individual, you're really voting for the party. Whereas in the US, you're definitely voting for the individual, and their party affiliation is almost more of a shorthand for the things they're likely to support rather than an ironclad rule.

Virtually no one votes with their party 100% of the time. Statistics on the current session of Congress show that party loyalty ranges from 98% to 58%, with a median of about 92%, for the Senate (the upper house) and 99% to 64% with a median of about 95% for the House of Representatives (the lower house).

No one is kicked out of a party in the US. Compliance is enforced through reelection support, committee assignment, and general assignation of relevance. There are, however, caucuses in Congress that are unofficial groups of congressmen that often function as a bloc and can help defend their more junior members.

It's an uneasy mixture of both, really, but skewed towards the party thing, especially as the prime minister is (essentially) voted in by Parliament rather than from a separate popular vote. So even if your favoured party's local candidate is a bit of a doofus, you pretty much have to vote for him or her if you want your party to form the government. (And because there's no such thing as primaries in the UK -- only paid-up party members get to participate in selecting candidates -- it's not your own fault if your local candidate is a doofus.)

Just for completeness I should add that not quite all votes in Parliament are the subject of a whip. Ones that aren't are called "free votes", and the convention is that Parliament is given a free vote on "issues of conscience", or in other words moral or ethical issues that don't necessarily divide on party lines: abortion, the death penalty, that sort of thing.

Peter

That's because our government isn't a democracy. It's a republic, thank goodness. Add to that the fact that we are quite restricted in our choices, either Democrat or Republican. While we do have other parties, our system is really set up for only two. As such, one has to pick the person that they most agree with. It does NOT mean that they agree with everything that party stands for, just that they tend to agree with them more on the issues that matter most. It is certainly possible to be pro-choice AND anti nationalized health care, but there is no way to express this belief at the voting booth.

While I'm currently registered as a republican, I really lean more toward libertarian. I typically vote republican, but I am never 100% on board with their platform. They're just a lot closer to my views than the democratic party and the libertarian candidate never has a snowball's chance in hell of actually winning.

No, it's both. In their desire to point out the differences between the American system of government and the ancient Greek form, our civics classes have done us a disservice in incorrectly defining "republic". A republic is merely a form of non-monarchical government where at least some of the people have at least some influence on government affairs.

The most precise term for the American system of government is a "constitutional republic", which is a form of "representative democracy".

And it's full of lawyers who obfuscate things behind three or four layers of related crap until the original concept is no longer obvious to most observers.

Exactly. A true democracy would be a very scary thing indeed.

I was just being preemptively apologetic! It can suck when a worthy thread gets buried by tangents and I am very interested in your original subject.


I think I am, too. In terms of Obama popularity/mandate, we have all of this other huge stuff going on like bailout bonanza and Afghanistan and Iraq, but the teabaggers didn't seem to have *that* much traction until their outrage over socialist health care demons took over the news cycle.


Insurance companies *definitely* make money by insuring people!!! That isn't the same as getting care to people. And the insurance companies have done great by cherry picking populations, denying claims for preexisting conditions, et cetera.


I haven't kept up in many years, but I think that there are tons of studies in this area and many at least show that the uninsured delay seeking care for longer periods, are sicker when they show up (in the ER) and cost more to fix. And sure there are plenty of healthy people both insured and uninsured, but the insured ones aren't maybe averse to seeking care and aren't so much at risk of getting a $16.000 bill liek a relative of mine.


OK, you can blow off cost if you want. But you can't. Cost is key. All health care systems ration in some way to restrain costs. The question is how you do that and where does that limited pot of money go. People in the U.S. *with* insurance have come to believe that the pot is infinite.


I'd rather have something good that gets passed. But I think too much has already been given away for that to happen.

I knew some of this, but thanks for the exposition!

As this decent article notes, FDR did have a go, but it was dropped from Social Security. Defeated by the AMA and the even-bigger-then spectre of commies. And I think several other factors figured: medical technologies were less developed, overall costs relative to GDP were lower, and patient bonds with family and community physicians were stronger. Like in the movies

Thirty-plus years later, LBJ managed Medicare, but we somehow can't interpret what it provides as a Good Thing unless it is for old folks. So socialism is OK unless it is for young people


I always enjoy calm understatement.

Special interest money, special interest money, special interest money.

People want to try to make the case about how the Democrats really differ from the Republicans. Maybe the occasional Kucinich differs, but just look at where they all get their campaign contributions. Not very different.*



(*once again I plug Kevin Phillips' _Wealth and Democracy_)

You're moving the goal post. (What are you, a Republican?) The point is not to get insurance that's better than what we have now; it's to get some level of coverage to people who have none.

Insurance companies definitely go out of their way to avoid paying for expensive things. We all have that specter hanging over our heads of getting cancer and our insurance getting cancelled because we didn't report that ingrown toenail we had twenty years ago.

However, until that happens, I'm still able to pay $30 for a month's medication instead of $500 or more. I'm still able to make an appointment to see a doctor for $10. And that's far better care than the uninsured are getting now, because they're getting none.


While that's a perfectly reasonable way to interpret what I said, that's not what I meant.

What I meant is that the whole population of people who are currently uninsured shouldn't cost the insurance companies (significantly) more per capita than the set of people who are. Yes, the sick uninsured are likely to be more expensive than the sick insured due to their conditions festering, but the ratio of the sick uninsured to the healthy uninsured is likely to be about the same as the ratio of the sick insured to the healthy insured.


Yes, including the one those of us with insurance currently have, and which is self-sustaining. I fail to see why adding a new group of people to it is wildly expensive. Yes, there will need to be subsidies from the government for the poor, but we're subsidizing them now when they go to the emergency room.

Yeah, you can tell they're exactly the same based on the way no Republican has expressed support for any health care reform bill, there are nine sponsors of HR3200, the private market plan bill that most everyone is talking about, all Democrats, and eighty-seven Democratic sponsors for HR676, the single-payer bill.

For anyone who wants to know the current state of play on the healthcare debate, this interview with Sen. Jay Rockefeller (D-WV) is pretty informative. He lays out where things are now, what's gone wrong with the negotiations so far, and what he sees as high priorities from his perspective as the only quasi-progressive voice of any stature on the Senate Finance Committee.

I have to say that I'm impressed with Rockefeller so far, and very surprised given his history of caving to Republicans on important issues like FISA. The fact that someone is in there threatening to vote no on the bill if it doesn't get better is a small glimmer of hope in an otherwise dark and depressing scene on Capitol Hill. I hope he sticks to his words, and I hope he gets some support from the rest of his party, including the President.

OK, out of frustration I have slandered the Democrats. Yesterday morn I awoke and heard BBC talk about the demise of the Poland/Czech missile shield plan. If we had Bush #3 that would still be on and also programs like the F-22 Raptor might yet be unrestrained.

And yes, the Republicans are worse, though I have this feeling that if the Dems suddenly decided that health care reform was a terrible idea, the Republicans would be required to take it up as a new cause celebre. Lockstep, awful opposition. They should be ashamed.


So, Kucinich, my rep (McDermott) and 85 more. OK, some Democrats *are* different. One third of the Democratic reps are willing to openly avow their support for this radical concept being promoted by subversive foreigners (Canadians!) to undermine our way of life.

Now the other two-thirds of the Democrats support health care reform, too. It just so happens that alot of them support the plans that don't upset well-funded special interests. In the end, I think you'll see health insurance companies running Norman Rockwell-type television ads talking about how great health care reform is and what a pleasure it was to take part in the reform process -- once it is very clear that their 31 percent is not threatened.

Are the Democrats different? Not different enough. Not just health care but things like campaign finance reform, My old rep, Barney Frank. Gad, we though he was a liberal model in the day, and I certainly think he is still smart as a whip, but did he help save us or help rip us off? I still can't decide.

With the position the Democrats enjoy right now, you'd think we could hope for more, but they are even losing their optimistic, *slightly* liberal middle (supporters). I listened this AM on the radio to a number of those folks who are just holding out hope for even the the "public option", never mind single-payer, and feel like the notion of their "Hope" president is slipping away. And for folks further to the left, there just isn't enough in play for them to get excited about. Go march to demand health care reform? No way, not *this* sorry-ass excuse for health care reform.

So, writ large, I still don't feel like the Democrats are that different. Timid, no compelling, unified vision for good programs or government, and awash in unacknowledged special interest money. I invite those 85 reps to jump ship and join the Progressive Reform Party.

(Not sure any party by that name exists yet).

Our two-party system has been broken before and it sure is now.

Apologies for the fractured, time-delay nature of my response. I sometimes just don't have the BTUs to plough through everything....


OK, let me try to paste here what I was responding to:


I said: "you aren't going to get more care for the same money without driving cost out somewhere."

You responded: "This is based on the fallacious argument that insurance companies cannot make money by insuring people. This is clearly an insane argument, as insurance companies are currently making money doing just that. I think that's one of the complaints."


I hope that if you look at it again you'll see that I wasn't trying to move the goal posts, just trying to say that I wasn't making an "insane argument". I guess my issue isn't that certain segments of the health care economy make money (I mean the companies that refill oxygen tanks have to make *something*, right?) but that the deliberate administrative costs related to our insurance-based system don't refill anybody's oxygen tank. It just pushes money around and adds to practitioner frustration. 31 percent.


You are making part of my point for me.


Yo-Leven! I am still employed (sans preexisting conditions) and am still covered, too. And you are right that the uninsured are getting squat, relatively.



I am kinda running out of BTUs here, but I would just chime in with:

- Our costs are already considered to be way too high.
- Our outcomes relative to cost suck when compared to our 1st world peers; screw the fixation on waiting lists. Who lives longer and enjoys better quality of life?
- We still have some national discussions to have with respect to these bogus "death panel" scare stories. They are bogus, they really suck, but they reflect an underlying conversation that isn't happening on an adult level. What percent of health care costs are expended in care for folks in different age brackets during the last year of life? the last month? the last week? This is part of the "rationing", "will this expense make any difference?" discussion.
- Insurance-driven care is essentially that. How do we get to a system of care that is comprehensive and where we can trust the motives of the system and providers within it?

"Wildly expensive" to add a new group? It is a pretty damn big group and it is pretty much a given that costs are already too high. You make the case that converting people from uninsured to insured is almost cost neutral. I don't think that is so but I am not motivated to back it up with retro-research. A lot of this category of care has been born by institutions as uncompensated care that they factor in, so maybe you are right, but you also have to factor in folks who just flat out are not getting certain care because they just can't come up with the scratch or who are just getting retirement-busting surprise $16K cardiologist bills in their mail box.

More later!

Slightly closer, to something.

http://news.bbc.co.uk/2/hi/americas/8304375.stm

Pretty sad that it has taken 97 years to get this far. (RE, a universal healthcare plan first put forth by Theodore Roosevelt when running for president in 1912 as part of the progressive party)