The Obama Phenomenon and the 2008 Presidential Campaign

[Primula Baggins]

vison, have you read Wylie's Tomorrow? It's about the consequences of nuclear war in small-town America. Rather quaint, given what we now know about nuclear winter. I found it in Reader's Digest Condensed Book form at my grandma's house as a kid, and chased down a used copy of the complete book some years later.

It's not a bad novel, if a bit grotesque (and seriously dated). But I do not miss that mindset. Not at all.

Faramond, I look forward to reading the article you linked.

Edit: So MS-01 went to the Democrat 54-46. I do think this is significant. The NRCC tried to wrap the Democratic candidate in the Wright scandal using this ad:

http://www.youtube.com/watch?v=zv4qFO2eEJY

And it did not work. This in a district Bush won in 2004 with 63% of the vote. I wonder if Obama is as vulnerable on Wright as people are thinking.

[JewelSong]

Hal I am also interested in seeing your responses to vison's questions and what you would like to see a candidate do about each of those issues.

And I would also like to state that Obama's positions on them are hardly "far left." If anything, they are left-leaning mid-line.

[ToshoftheWuffingas]

Hal we have had a welfare state and universal health care in the UK for 60 years now. Indeed an embryo version of it started 100 years ago. Does that make us 'far left'? What is 'far left' to you? Do you equate it in some way with communism and Stalinism?
I will tell you that not one person here in a thousand would exchange our system for that of the US.

[solicitr]

I will tell you that not one person here in a thousand would exchange our system for that of the US.

And vice versa. Britain's state-run Soviet-style NHS is the worst healthcare system in the developed world, bar none. No thank you! I have unfettered access to the finest doctors and hospitals on earth, care no Briton could dream of (unless they can afford one of the burgeoning private hospitals).

[yovargas]

Hal we have had a welfare state and universal health care in the UK for 60 years now. Indeed an embryo version of it started 100 years ago. Does that make us 'far left'?

Yes.

[Alatar]

I will tell you that not one person here in a thousand would exchange our system for that of the US.

And vice versa. Britain's state-run Soviet-style NHS is the worst healthcare system in the developed world, bar none. No thank you! I have unfettered access to the finest doctors and hospitals on earth, care no Briton could dream of (unless they can afford one of the burgeoning private hospitals).

How bizarre! Which planet are you on Soli?

[ToshoftheWuffingas]

You soli, one well off professional man. Note the key word here 'universal'.

[solicitr]

Cuban healthcare is also 'universal.' I suppose you think that desirable?

I find it bizarre that some think we ought to lower our standard of living to the British level- while 200,000 Britons per year are emigrating to the US, and the figure would be much higher but for American visa restrictions.

I visit Britain frequently, over the course of 30+ years. Every time I go it's rather like visiting an elderly relative in a nursing home: an initial shock at how far the loved one has declined since the last visit.

Alatar: things would look rather different from an Irish perspective, since things there have been up, up, up in recent years and improving your standard of living to British norms is moving in a positive direction. But, for Americans, it would be seriously retrograde.

Our goal should be to universalize healthcare finance without lowering the standard of the care delivered: and I assure you, an NHS approach wherein the government runs the hospitals and employs the doctors is *not* the way to go- unless you have a nostalgic attraction to unscrubbed open wards and staph infections. I think we should look very seriously at the pretty successful German system (which is quasi-private, Miss Prim)- but avoid at all costs turning healthcare delivery over to the people who brought you Amtrak and the public schools.

Of course, doing this without setting up a fiscal implosion will be interesting. Medicare and Social Security already represent forty-two trillion dollars in unfunded obligations.

[ToshoftheWuffingas]

Soviet style! I am amused by your attempts to dredge up Cold War scare tactics.

[solicitr]

Cold war scare tactics my foot. The NHS *is* organized on Soviet principles - try to deny it! - and suffers from the same problems that plague any state-run industry. Questions of Soviet missiles and tank divisions are inapposite- but the complete and utter failure of their economic model is quite on point. I see no problem at all with holding up the USSR as an object-lesson in How Not to Do Things.

[JewelSong]

I am a US citizen and have lived and worked in the UK for the past two years. It is a pleasure and a relief not to have to worry about health care.

In the UK, if you lose your job you don't lose your health care. This was always a fear of mine in the US. When I was between jobs for about 5 months, I had no health care and it was a real worry. Everytime you change jobs, you have to change your healthcare and it is a huge pain in the ass. And many jobs pay only 50% of the costs. Some jobs don't provide health care at all and people have to pay out of pocket or they go without.

Since I have been here in the UK I have had no complaints about the heath care. I have two ongoing medical conditions that have been treated competently, compassionately and with good speed. I have been seen for emergency treatment (a possible broken ankle) and had an x-ray, exam and advice from the doctor with only a relatively short wait (it was in the middle of a busy workday.) I have had all my regular exams with no problem and all of them were carried out efficiently and in a professional manner.

I sincerely wish we in the US could get off our collective butts and implement some kind of universal health care plan.

[Alatar]

Soli it might surprise you to know that I have been in both the US and the UK many times and I can absolutely guarantee you that I would rather be ill in the UK than the US. Sure, if I have some rare complaint and I want to pay big money for a top specialist, I might well take advantage of the ridiculously expensive American consultants and surgeons, but on an average day, with a broken leg or in need of a stitch? Give me the NHS anyday.

Frankly, your condescending attitude to the "lesser" countries is not only ignorant, its insulting. You really have no clue.

[Frelga]

How bizarre! Which planet are you on Soli?

One where not buying a Mercedes every month is a proof of fiscal prudence and an example to those who can't afford weekly groceries.

[Voronwë the Faithful]

But all places where Hillary has won have the "worst demographics for Obama" and those are all the republican states, and swing states...

hal, you really need to get your facts straight before you post. In fact, the whole reason that Obama has essentially won the nomination is that he contested in all 50 states, and won the most of the "Republican states". The vast majority of Clinton's delegates have come from heavily Democratic big states such as California, New York, New Jersey and Massachussetts. As for swing states, states that were within 5% in the 2004 election have been split almost exactly evenly between Clinton and Obama. Moreover, there are a number of traditional "Republican" states that Obama won that he is likely to be competitive in in the general election.

I hesitate to bring it up... but polls and media coverage has been wildly inaccurate in the last two presidential elections... they twist and distort things to an extent that is somewhat surprising.

This, however, I agree with.

[Erunáme]

Another American citizen who is now (only recently) a UK resident.

Ever since I got married to a UK citizen, my outlook on healthcare has changed. I consider the UK system to be superior. I went without healthcare for about a year and a half and then my husband and I both went without for 6 months until he got a job. We had one emergency incident that cost us lots of money. Then when he quit his job in order to move back to the UK we had another 5 months without healthcare and again, I was scared that something would happen.

It's been such a relief to know that the second I landed on UK soil I am entitled to healthcare, job or not. I also know my husband's grandfather who had a serious condition (blocked arteries in his leg) was well taken care of during his surgeries and treatment.

The UK system certainly is not the worst healthcare system in the developed world. It is absolutely absurd to say so and that's coming from an American citizen.

[Teremia]

We've had similar experiences to JewelSong's, but in France (another national health service): concussion and pneumonia both handled competently, no long waits, and low charges.

A few years ago a friend of mine went into (slightly early) labor the day I arrived in London, and so I went into the hospital to help her through labor. It was a very non-interventionist birth, by US standards. Not a lot of personnel around, either (the doctor or midwife was around when the baby was actually appearing). I had to go find diapers in a shop, because the hospital didn't supply them! But everything went well, and honestly, the birth was a low-key delight compared to my own experiences in the US.

[Primula Baggins]

Soli, it's lovely that the system works for you, but not everyone is like you. Consider what it's like for people at the other end of the system who have poor insurance or no insurance, where major illness could cost them everything they own or where the costs have to be borne by the health-care system because the people don't own anything.

Why is this acceptable and waiting a couple of weeks for a non-urgent procedure is not? Is it perhaps because in your position you don't have to wait, so for you it's a step down? Perhaps you don't know anyone who's uninsured or lost their insurance because they got sick, or anyone who's stuck in a dead-end job because a family member has had a dangerous illness and can't get independent insurance, or anyone who works full-time but whose employer does not offer health benefits. The absurdity and waste of our present system has got to be addressed.

It's not even that great of a system any more. The United States has a higher infant mortality rate than Cuba, Ireland, the UK, Canada, New Zealand, Australia, and 40 other countries, most of whom have the "socialized" system you deplore, according to the CIA World Factbook. (Link)

[yovargas]

NOTE: I do not see sol saying the US system is good, merely preferable to the UK one. A lot of strawmen going up in response to him. ( Also note that he recommended the German system, which I know nothing about.)

I have no opinion on the healthcare issue being personally too uninformed to take a meaningful position (except that Clinton's mandate idea boggles my mind) but whenever the "my healthcare system is better than your healthcare system" debates come up (surprisingly often) I notice the same thing: everyone has horror and success anecdotes for each country where the system utterly broke down or worked miracles. From that, I've concluded that which system is better probably depends a whole lot on the particular situation so that neither can be flat-out said to be better or worse. That said, I find sol's assertion that we should look for ways to provide healthcare to more people without lowering the quality at the highest levels noteworthy.

[vison]

A national system like Britain's would be a disaster in the USA and I sincerely hope no one ever tries it. What is needed is a national insurance scheme - but even that has to be carefully structured. Health care money gets sucked up by bureaucracies, and after awhile it seems like there are more pencil pushers than nurses. But the US private insurance companies are worse, the bureaucracies are just as bad and the client is helpless in the face of capricious rules.

It's true that for certain procedures in certain places in Canada there are long waiting lists. My husband's back surgery last April is an example - we gladly paid $5,000 for it. However, if we had gone to Bellingham or Seattle for that surgery, the bill would have been over $50,000 - the difference is that except for the actual surgeon's fee and 24 hours' care in the private clinic, everything else was covered under the BC plan.

We expect a lot more from the "health care system" than we did 50 or even 20 years ago. Treatments and procedures that were not even dreamed of then are common now, and people want them. In BC we have operating rooms and diagnostic equipment standing unused because of a shortage of nurses and technicians. I think this is a scandal, and so is the fact that a few years ago the medical schools in Canada cut back on the number of students they accepted.

Canadian doctors cut up stiff, as the saying goes, when our scheme was brought in. But they got over it. They are not employees of the state, they run their practices as they always did. They, like many American doctors, are educated at largely public expense. They work at hospitals the public builds and staffs. They can choose where to live and work, just as if there was no state-run insurance. The bureaucracy is still heavy on the system, though.

Prim: yes, I read that Wylie book. It was pretty awful, but you know, it was the era. I read them all. I never thought he was a good writer, but he did tackle ideas no one else seemed willing to touch. "When Worlds Collide" was one. It was the first time I ever read about the ecosystem, about things being connected and necessary. Very interesting to a kid.

[Primula Baggins]

The fact is, though, yov, providing the same high-quality health care to everyone in a country is probably impossible. The care here for the well-insured is dynamite, but there isn't enough money in the country to provide it to everyone. And the really cutting-edge treatments are outrageously expensive.

When I had chemo I had a shot the day after each treatment that stimulated my bone marrow so my white-cell count didn't drop. It meant I didn't have to take special steps to avoid exposure to colds and such. I have the bills: each injection cost over $6,000, though my insurance paid only $3,000 or so. The chemo treatments cost only half that, each.

There was no motivation for my doctor not to order those shots; I paid nothing for them. There was no motivation for me to refuse them; they made my bones ache, but in that position you say yes, yes, to everything your doctor suggests. And they might have saved me a case of pneumonia or at least a case or two of the sniffles.

But I didn't need them to save my life; the surgery and chemo did that. So we added to the health-care cost bloat (and drug-company profits) for very little return. That's how the system works.

But there isn't enough money for everyone to get those shots. There has to be some triage, some judgment applied, maybe saving them for people who are weaker than I was or who are around small children at home. But people react with horror to the mere idea of rationing health care. Surely we can find the money somewhere . . . when we can't.