American Views Abroad

Thursday, June 18, 2009
One of the most realistic comments on rationing health care appeared in today's IHT. New York Times business columnist David Leonhardt takes on the R word:

'Today, I want to try to explain why the case against rationing is not really a substantive argument. It is a clever set of buzzwords that tries to hide the fact that societies must make choices. In truth, rationing is an inescapable part of economic life. It is a process of allocating scarce resources. Even the United States, the richest society in human history, is constantly rationing. It rations spots in good public schools. It rations lakefront homes. It rations the best cuts of steaks and wild-caught salmon. .....Milton Friedman's beloved line is a good way to frame the issue: there is no such thing as a free lunch. The choice is not between rationing and not rationing. It is between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries and gets worse results by many measures, it is hard to argue that is is now rationing very rationally.'

This struck a cord this morning because in yesterday's LA Times there were a series of articles on how health insurers refuse to limit rescission of coverage. Rescission, of course, is a nasty move to drop customers and cancel medical coverage for some sick policy holders even though they have been paying into their policies for years:

'It also found that policy holders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.',0,5870586.story

Is it any wonder that whenever anyone asks if a return to the home country is planned now that the time has come to consider selling our home, the only honest answer is no because of lack of good quality health insurance? With all the illnesses the two of us have been up against these last few years (Parkinson, strokes, heart attack, a major OP correcting a scoliosis, a new hip), one thing we do not have to worry about is paying medical bills, getting good quality care, not having to worry about being thrown to the wolves financially because of medical expenses for care or medicine.

There has been a lot of discussion in Germany about how quality and care for non-private patients has fallen a notch or two recently. Yet this has not been our experience. Whether as a private patient in the hospital (where an extra insurance pays the difference) or as a non-private patient outside, the quality has been excellent, the wait for appointments rather short, all tests have been done that were needed. Of course, it does depend on whether one has a serious illness or is just trying to calm one's nerves if something might be wrong. There have been attempts to put off CAT scans for weeks, but a simple explanation of what's behind it all has always led to an immediate appointment.

Society has to make choices. One extremely important one is to see that every citizen and resident has health insurance, in particular for serious illnesses. It is hard enough dealing with a range of health problems, but having to be brought to financial ruin because of medical expenses seems uncivilized. Nor is there anything wrong with allowing the government to provide a health insurance plan along side of private ones. The main thing is a peace of mind knowing that coverage is there and it works when everything else in life seems to be falling apart.

Friday, June 05, 2009
The word of the day is stereotype. President Obama: I consider it part of my responsibility as president of the United States to fight against negative stereotypes of Islam wherever they appear. But that same principle must apply to Muslim perceptions of Americans. Just as Muslims do not fit a crude stereotype, America is not the crude stereotype of a self-interested empire.

Der Spiegel is doing a three part essay on Trans-Atlantic Comparisons: Sophisticated Europeans, Obese Americans? at,1518,628381,00.html. Interesting to look at its photos and charts comparing poverty and wealth between the US and various western European countries. It leaves little place for normal stereotype thoughts.

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