Health care lies that trap us all in an inferior system of medical care

I recently saw a post on Quora that encapsulated nearly all of the myths, lies, and misconceptions that surround the US medical care system. The Affordable Care Act may put an end to this nonsense. We shall see.

I have analyzed these myths below. In each case my answer follows a brief summary of the original point.

1. Multiculturalism: No one else is close in the ethnic variability of the US. It affects our decisions to work together in ways not even fathomable elsewhere. 

I live in a neighborhood where practically everyone is an immigrant. They're all different ethnicities, from all over the world, but they have one thing in common: They're all poor. So you're saying that our country is great because people come here from all over the world to clean hotel rooms and serve hamburgers.

2. Social mobility: you still can go from outhouse to penthouse. 

The US does not offer its people the best chance of becoming well-off. Many other countries give their poor people a better chance to get rich. ln the US, only 6% of people born into the lowest economic group (bottom one fifth) make it into the top economic group (top one fifth).  see Economic Mobility of Families Across Generations for details. Countries with a better chance for improving your status are Denmark, Norway, Finland, Canada. see Page on brookings.edu for details.

I love the part where you say that immigrants take advantage of educational and entrepreneurial opportunities. The educational system is rigged so that very few people get elite educations, and most of those come from privileged families. The cost of a higher education has become so high that many poor families can only afford to send one child to college. 

The US has some laws that favor entrepreneurs but many others that do the exact opposite. For example, becoming a doctor is a way to get rich, but states control the number of students who enter medical school and the number of doctors who can practice medicine. They have strict laws forbidding non-doctors from practicing medicine. Once again, these laws harm the very poor, who cannot afford a real doctor and instead use faith healers and patent medicines.

Every entrepreneur knows that what you earn depends on how much you have to invest, and poor folk got nada.

3. No cost lawsuits: Other countries haver loser pays for court costs.

It used to be easier to sue a doctor in the United States, but Health Insurance companies and vulnerable corporations--like those that sell tobacco and asbestos--have made it much more difficult to sue anyone. An individual rarely can afford to do so. Many states have passed "tort reform" laws that limit the amount you can receive and also prevent class action suits from being filed. A recent $5 billion class action judgment against big tobacco companies was rejected by an appeals court that said class actions can't be joined by people in other states. So every person injured by tobacco-related diseases must join in a lawsuit with others from their own state. Since these cases last for years, it may not be possible for people in small states to recover their losses at all. 

Tobacco companies and Asbestos companies have learned how to game the system so they pay only pennies on the dollar for actual costs of deaths due to their life-threatening products. Asbestos companies did this by declaring bankruptcy, then allotting a small amount for future damage claims. Afterwards, they can start up business again without worrying about the consequences of their former actions. That outcome results from the lenient bankruptcy laws of the US.

Besides, if everyone has health insurance, the costs of health care are much lower and there is no necessity to sue. The US has the highest health care costs in the world but its high costs do not make their people healthier. 

4. Americans view of the value of life: We put those over 70 on dialysis, ventilators and other extraordinary measures.

The belief that Americans place a higher value on life than elsewhere is a myth. Americans have an average life expectancy of 79.8, while Sweden, Iceland, Norway, Finland, and Italy all have higher life expectancies. These are all socialist countries that have national health systems. If they placed a lower value on life, they would let their people die. But they keep them alive longer than the US does.

5. A fundamental difference in how we are constructed: It is ACCESS TO not the NATURE OF our health care system that drops the US in all the rankings.

I don't understand how you can separate the nature of the health care system from how many people it refuses to care for. You're saying that our health care statistics are worse because we don't provide health care to the poor. You just complained because other countries ration health care by age (which isn't true), but you're saying the US system only looks bad because it rations health care by wealth.

Yes, the US looks bad because poor people can't afford necessary health care. Many lose their lives needlessly because of this system of rationing. This results in a health care that looks bad and is bad, unless you judge a health care system by the way it treats the rich. If those statistics where the US looks bad only considered the health of the rich, the health system would look better. But then you couldn't compare it to the other countries of the world, which do provide health care to the poor.

I suppose you're actually claiming that the US can't afford to give health care to the poor because there are so many poor people here. But the median income in the US is among the highest in the world. See Household income for details. So what you're saying just isn't true. The median family in the US has more money to spend on health care than nearly every other country in the world. The reason we don't provide health care to our citizens isn't because we can't afford it. It's because people like you believe that it is acceptable morally or philosophically to deny health care to people "from the third world country" inside the US.

6. Paying for everyone else's research: Our drugs are DRAMATICALLY more expensive. 

Public Citizen has published an extensive report on the claim that drug companies need higher prices to conduct essential research. The report concludes, "But this R&D scare card is built on myths, falsehoods and misunderstandings, all of which are made possible by the drug industry’s staunch refusal to open its R&D records to congressional investigators or other independent auditors."

Every other country in the world pays less for the same drugs than the US, despite the fact that publicly funded scientists provide much of the research for these drugs. The drug companies have managed to convince our Congress that every other country in the world is wrong to pay less for drugs. They have done this by spending large sums of money on lobbying and public relations. The US is the only country in the world that falls for this stuff. I guess that is a form of "American exceptionalism", but I think it is something we would all be better off without.

Our Decrepit Constitution: 2. The Framework

Americans credit the men who wrote the Constitution—the framers--with great wisdom and foresight. Supreme Court Justices have started a cult that worships the Constitution as a perfect document. They pore over its text and the opinions of its creators as though they were religious texts and revelations of the true word. Some also claim that the framers were inspired by God, usually by a Christian fundamentalist God.

None of these beliefs is true. The framers were neither godlike nor exceptionally wise. The document is not based on religious ideas. The Constitution is deeply flawed and becomes more so with each passing year. The framers made it hard to change. Amendments require passage by both houses of congress with a two thirds majority, then ratification by three fourths of the state legislatures. Most amendments also specify that they must be ratified within seven years.

The framers have recently been considered by some the infallible source for American law. This assumption implies that they were always right, at least about law and government. This assumption was very far from the truth.

The framers invented the electoral college, ostensibly to prevent the voters from making a mistake when electing a president. Instead, it was the electoral college that made the mistake, in 1800, when it gave the same number of electoral votes to both Thomas Jefferson and Aaron Burr. The House of Representatives elected the president that year. The Constitution created a crisis where none existed.

The framers decided that each state should have only two senators. This compromise gave more power to the less populous states at the expense of the states with larger populations. In 1787 the most populous state, Virginia, had 20 times the population of the smallest, Delaware. In 2010, the most populous state, California, had 65 times the population of the smallest, Wyoming.

History tells us that states vote in regional blocs, with relative size having little to do with their decisions. Neighboring states New York (a large state) and Rhode Island (a small state), for example, voted for the same presidential candidate in the last seven elections. Neighboring states Louisiana(small) and Texas(large) voted for the same presidential candidate in the last seven elections as well. Louisiana and Rhode Island, both small states, voted for different candidates in all seven elections.

Since small states no longer vote in a bloc--if they ever did--the election of two senators from each state, regardless of population, does not serve the purpose intended by the framers. Instead of balancing the interests of different sized states, California's two senators represent a disenfranchisement of 36 million voters in relationship with Wyoming. The framers may have been right in 1787, but their judgment on this matter, at least reflected by presidential choices, is wrong today.

The framers made no provision for political parties in their Constitution. This oversight has become a serious problem in recent years. The British Parliamentary System recognizes that there will always be more than one party. The leader of the majorityThis arrangement gives the leader of parliament, the prime minister, the ability to govern if he can unite his own party behind his platform, a relatively easy proposition, given that all members of his party stood for election on the same platform.

The American system divides government between political parties. This division makes legislation more difficult to pass and slows down the process of government. James Madison argued that representative democracy rather than direct democracy because he claimed that direct democracy gave rise to factions. Madison defined a faction as a group of citizens united in some passion or common interest against the interest of others. He singled out the factions that arise from inequality of wealth and argued that a representative democracy would protect the minority from the majority.

Madison believed the best way to guard against factions was to create a representative democracy. Direct democracies, he claimed, always failed within a short time. The difficulty that arises here, which is a major difficulty with all opinions expressed by the framers, is that these conclusions are drawn on examples with almost no data. The number of direct democracies documented by history in Madison's day was precisely one, the direct democracy of Athens during the fifth century BCE. Any argument based on such limited data must be questioned.

Why Bill Gates Laughs at the IRS

The tax situation today resembles that in France before the French revolution. Commoners had little enough to call their own, but what little they had was taken in taxes. The nobility had nearly all the wealth but were exempt from taxes. So today, the top 20% who own 80% of the wealth in this country pay almost no taxes on it. They pay income taxes, but this only exposes their income, not the wealth itself.

Take a single example. Warren Buffet is worth about $58 billion, yet his salary is only $100,000 per year. The federal income tax on his salary is about $38,000. In 1956, Buffett was worth less than $1 million. So his average increase in wealth over his lifetime has been $58 billion divided by 52 (2008 - 1956), or approximately $1 billion per year. If the increase of wealth were counted as income, his income tax rate is $38,000 divided by $ 1 billion, or about .0001%. Why should a man of great wealth, like Mr. Buffett be paying only .0001% of his annual increase in wealth when the average person in the lowest quintile, the poorest 20% of the population, pays 11% of income in taxes (state, local, sales, property, etc.)?

It is fun to fantasize about the wealth these people possess, but why should they pay no taxes at all when the rest of us pay so much? The reason is that the wealthy are able to control both tax policy and public opinion much more effectively than the French nobility of the ancien regime. The idea of taxing wealth itself is seldom heard in the public forum. People are convinced, not only that capitalism is a great good, but that concentration of capital in a few hands is also beneficial. The two ideas are not inseparable.

Conservatives protest that they shouldn't have to give up what they have attained and have it given to someone else. This is the basis of all taxation, so the argument could also be used to abolish all taxes. But modern states have become larger for a reason. They are like fish swimming in a tank with other fish. Bigger fish thrive. Smaller fish get eaten. So the government supported by taxes provides protection to the wealthy, by monetary policy, military defense, treaties on trade, the list goes on and on. In fact, the wealthy receive services from the government in proportion to the size of their fortunes. The more they have, the more they have to lose. They should be taxed accordingly.