Monday, September 07, 2009

parochial americans

most the americans I know are cool

but from time to time, i come across the most contrary people,
not that there aren't such people in other parts of the world, but
it's just more fun to rant about the richest country in the world (and shouldn't they know better after throwing their weight around the planet for the last 50 years and not even winning a single war in that time (think: korea, vietnam, chile, somalia, afghanistan, iraq, etc etc)

anyhow, what occasions this annoyance? you guessed it: healthcare

I have the temerity to get involved in what I think is an open debate (its online and not in a private mail list) on this, so I inject some comments
1. data from US medical pub
2. comment that there are many models for funding national provisioning of healthcare

Note: I did not venture an opinion, except to say that I accept that the UK NHS Is
a) not an exemplary model to follow (actually it isn't bad, but see next):
b) the conditions for setting up a system whereby the state employs all medical staff in a country are almost certain never to arise anywhere or anytime again other than in post war england which had some very odd pre-conditions and some timely money (thanks to Keynes) from the USA.

anyhow so I sugges that one might look at some of the other systems in the world that do better (or cheaper, or both) and take components of them for a revised US system - note that (as in the UK) this does not preclude people using private insurance based healthcare, just provides for a scaleable, cost effective, and lawyer/insurance company free syse that sets a better operating point for the majority (and therefore average) person - actually, evidence shows its better for rich people too whether they opt in or go private, but that seems to be too political for some people )though why evidence based medicine is political is a mystery to me - perhaps people prefer their pinions to be based in mythology and rumour rather than fact).

I drew an analogy with music where record companies often recently have their heads in the sand ignoring both old (e.g. live music, like the grateful dead used to perform or the rolling stones still do) and new (e.g. subscription, pay per item, or paid through adveritsing, as in lastfm, itunes and spotify models) - this was purely to point out that often there are many workable models and some beliefs that the incumbent model is best and futureproof may be weak under even the mildest scrutiny.

ANyhw, no sooner do i say this than I get accused of all sorts of things. I dunno, I gave up being involved in the "discussion" - but it depressed me that
the debate had sunk so low and that people that lived in such a great country could have their views distorted by the massive vested interests wheeled out and repeatedly given preferential coverage in the media - the majority voted for Obama, but the healthcare mafia are sure fighting to beat him down - the massive failure for constitutional democracy that this will represent is as bad as many things Bush did with virtually no mandate.

Some of the discussion bordered on the surreal type of conversation one used to have with white racist south africans during Apartheid, 10% reasonable on any topic under the sun except one.

I talked to a friend from microsoft who'd had a similar experience on a different topic (guns) when on a long visit to the US - note neither of us actually expressed a particular opinion as to one "side" or another, just put in some comments and datapoints....what is annoying about this is that there are lots of discussions on the healthcare model in the UK (and elsewhere) due to ageing population, recession, advances in pharma etc, and so an informed discussion is of global interest/relevance. Of course, I undersrtand that some americans have a distaste (hatred?) of "big government" and that this colours their views of anything a government might do - biut it is monomaniacal to reduce every debate to this (at the least, an hypothetical "good" government might do somethign better - indeed, as exemplified in germany, france, scandinavia, greece, ireland, and quite a few other places, they do. for much less money. allowing for differences in how data is counted (e.g. infant mortality etc) - do you think WHO and health practioners are morons and don't know how to do statistics? certainly the majority of widely circulated US press coverage doesn't present data - indeed, laughable errors "Stephen Hawking would have died if he depended on the NHS) are propagated daily.). Articles are written by people who havnt practiced for 30 years or are not actually on the medical front line, or have zero knowledge of economics.

I used to admire the US education system in its ability to instil a sense of open discussion from high- school on - perhaps many people still acquire this, but the rapid domination of any discussion by a small number of hyper-aggressive, sociopathic, parochial few makes engagement in any important topic completely pointless.

so there.

p.s. on a minor note, I got "told off" for suggesting that the US government had supported the IRA. well, from JFK until Reagan, successive US presidents courted Irish-American votes (much as they courted, or at least didn't offend Cuban-American voters) and went to so far as to claim their "oirish" ancestry - during this time, you could go into a bar in Boston or NY and see collections being made openly for the IRA, a proscribed organisation in the UK at the time (and the UK was allegedly supposed to be an Ally of the US). If that isn't government support, it is as close as needs be - certainly it wasn't until Senator George Mitchell's fantastic missions to NI to help the peace process that anything actually constructive towards solving the situation was attempted. One hopes his contributions in the middle east have even 5% of the impact. one wonders how the US would have felt in 10/11 if someone had gone round arab restaurants in the Edgware Road part of london collecting for al qaeda.

1 comment:

Inspector Clouseau said...

Although both sides / factions in this debate (about what went wrong with the US education system) are entitled to their positions, I seriously doubt that any one side is fully or primarily responsible for what is occurring here in our society at this point. It's probably 50/50 or 51/49 at worst. However, I am reasonably sure that continuing to argue and fight about it, without actually addressing the underlying root problems, will not advance anyone's interests. We should all Try Harder.