Mosh Pit - 92nd Comment
My name is ...

Here there be political commentary.  Skip on by, if that ain't cher thang :- )

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Dr. Grumpy, who runs a medical center, sez,

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People ask me all the time why EU countries appear to do better on some particular measure of medical performance. Or why they can afford to insure more of their population etc. I point out that the EU style medical systems simply could not exist in their current forms without the US. EU governments are able to spend so much on social programs because:

1. As Matt point out, the US taxpayer heavily subsidizes the security of the EU, something I think the EU has long taken for granted until recently when "stuff got real" with the Ukrainian crisis. The US tax payer essentially foots the bill for world stability, and the EU countries have been happy to allow us to do so (I don't blame them, they are only acting rationally). Sure, the US benefits from world stability also, but we pay for it.

The US nuclear umbrella and NATO (and our willingness to risk our home cities in a nuclear conflict) render it unnecessary for EU member countries to run their own nuclear programs. This reduces the risk of another nuclear arms race.  This is especially true of Turkey, Japan, and South Korea.  

The US keeps open the sea lanes of communication, to the advantage of EU economies which are heavily dependent on imports and exports. The US could use its dominance to direct strategically and economically important resources like oil to US advantage but instead uses its dominance of the seas to ensure a free market in energy (oil). This makes it less necessary for China to build a blue water navy, for example (taking huge pressure off of Japan, S. Korea, and Australia to do so as well).  The EU has about 2-3 functioning aircraft carriers, and the only member able to project force beyond its borders is Great Britain, and even there only to a very modest extent.

Our very expensive efforts in preventing nuclear proliferation also benefit the entire world.  Imagine how the world would look with a nuclear arms race between Japan, China, North Korea and South Korea?  Or between Saudi Arabia, Egypt, Syria, Israel, Turkey, Iraq, and Iran?  Remember, the US-USSR Cold War was stabilized by Mutual Assured Destruction. With distances of thousands of miles there was always time to evaluate and launch a counterstrike.  But distances in the middle east and over the Yellow Sea/Sea of Japan are so small that it makes it possible to get in a preemptive first strike without a guaranteed counterstrike.  This factor would be immensely destabilizing.  We've already seen India and Pakistan come to the brink of a nuclear exchange several times, and only the heavy involvement of the US provides any stability there.

2. The US also directly injects billions of dollars a year into EU economies by basing troops there.

3. The US acts as a near limitless dumping ground for all of the high margin luxury goods that these other countries' own markets can not absorb. Sure, trade goes both ways. But can you imagine a world without the markets that the US provides to the EU, China, Japan, Korea, and the developing world?

4. The US pays both the development costs and the entrapreneurial costs for most medical advances, and these advances go on to benefit the rest of the world.  EU and other government run healthcare systems use their monopsony purchasing power to negotiate prices for new drugs and devices at ~ cost or just a little more. The US market is the only market that pays full price (or maybe even above full price since so many other economies are paying so little).  Most new drugs and medical devices are developed with the US market in mind.  In this way, the US market is the main driver for innovation in the field of medicine and for new surgical products.  We pay full price, which covers the direct costs of development, as well as the costs of taking the risk to develop new advances (entrapreneurial costs).  Particularly with new medical/surgical devices, we also then figure out which new technologies are actually worthwhile once they are on the market.   The EU is plenty wealthy enough to pay its fair share of these costs, but they refuse to do so (again, they are just acting rationally).  Of course, once developed, new drugs and devices are then available to the rest of the world.

- See more at: http://seattlesportsinsider.com/article/more-science-set-free?page=1#sth...

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Dr. D sez, 

In the abstract, Christianity is steeped in the idea of "he who gathered much had none left over; he who gathered little had no lack."  That's a metaphor from the days of Moses and manna from heaven.  We'd all love to see nobody in want.   The first Christian church, in Jerusalem, they all VOLUNTARILY sold their goods and disbursed from a common treasury.

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In practical terms, Capitalism is cast as "greedy" and Socialism cast as "jealous."  I think that the average Capitalist in the street is not greedy.  It has been my experience that the average Socialist in the street is jealous.

If G-Money wants to work very hard, and write some cool novels, and eventually be prospered, I don't call that greed.  Greed means having excessive wants and desires, especially those not earned. 

If Dr. Grumpy wants to go through 12 years of school and residency, and then put up with all the insane headaches of running a medical center, and then make his $180,000 a year for it, I don't call that greed.  Marshawn Lynch, now there is a greedy man.

The U.S. never set up a Department of Equality.  It set up a nation in which everybody had the chance to work hard and get ahead.

If you can't see that the American entrepeneurial spirit has led to --- > a staggering array of bounty, benefits, tech, and medicine, I'd say you don't have much wisdom.

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Every. Single. Time. I have debated a college prof on socialism, I've shown him the receipts for the money I send overseas to starving people.  I ask him what he does along those lines.  The answer has always been nothing.  He doesn't give any of his state-stipulated $80,000 per year to junkies on the street.  He wants me to do that.

To the extent that a Socialist is simply a Kindergartener saying, "Hey, if I only have a box of 16 crayons, I don't want Sally to have a box of 32," I have nothing but sadness for him.  To the extent that he is working like Mother Theresa to ease the suffering of the poor -- as Cindy and I try to do -- I support him.

It doesn't seem to me that the world's most eminent Socialists - Lenin, Stalin, Zedong, Guevara, Castro, etc - had particularly altruistic motivations.  :- /

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Dr. Grumpy's specific comments on EU socialism are provocative.  I don't want to besmudge them by even commenting.

Cheers,

Jeff

 

 

 

Comments

1

Good on Doc for moving this post to front page.  It was way too good to be buried as comment 8000.  What bothers me about socialism in the United States, is that there isn't government oppression of slackers to go with it.
If the government is going to pay for health care, then citizens should be punished for morbid alcoholism, eating too much sugar, not exercising, contracting STD's, missing doctor's appointments, and the like.  
Giving a child FASD, the most common cause of retardation, should be a serious crime.
If the government is going to pay for food or housing, then a citizen should be accountable to the government for achieving a certain level of productivity.  
There should be a national conscription or civil service requirement for young people, as they do in Israel and Switzerland.  Young people should not be allowed to spend their twenties playing Call of Duty in their parent's basement.  
As it is, a large segment of the country pays no real taxes, except the paltry 3 percent Medicaid + Social Security, and get free entitlements, but has no real constraints placed on its liberty.  I think that there would be a strong disincentive to abuse U.S. socialism if social responsibilities were worked into it.  
Maybe these ideas are extreme, as they only seem to be adopted in places like Venezuela and Cuba, but social justice should work both ways.  Just noodlin'.  
 

2
misterjonez's picture

I've spent plenty of money on direct charity, including paying for medical procedures my employees could never hope to experience, and many of them have been emergent, life-saving procedures which were not inexpensive (at least, not inexpensive by *my* lowly standards). Never once have I begrudged those expenditures, just like I don't begrudge the competitive enterprise which brought the money to me in the first place.
My sister has several political viewpoints which are opposite my own, and her position invariably boils down to, 'You (me, misterjonez) are the problem with the world. You need to change in order for things to get better.' To which I reply, 'The way we change the world is through our deeds, not our words -- unless you're a writer of some kind, of course. And if writing is the course you've chosen then I will gladly help you present your thoughts to the world in that way (context: I've served as an editor for about a dozen of my brother's books, as well as my own handful of novels).' There is a genuine disconnect between us when the conversation gets there, and I'm still trying to figure out how to re-solder the thing :-)
But I do think that there is a large segment of the population that does, indeed, simply want to tell the rest of us how to live rather than leading by example.

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In the Exodus scenario with manna, people went out and did their own "cotton-pickin' " hunting and gathering.  :- )  In Acts 2, the social underclass was very responsible in its role.
But nowadays, the PC line sounds to me like "Cough up the money and don't bring anything up about connecting it to work."  Yet when I personally take a "jobless person" shopping, they grab all of the ridiculous stuff, as opposed to a sack of potatoes, a couple of loaves of inexpensive bread, some baloney, liver, etc.  The reality is, in America the average poor person is a very irresponsible person.  Take groceries to their house, as we've done many times, and the smell of MJ is a foregone conclusion.
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I just saw a thread on Field Gulls the other day in which people cast a 100-post debate in terms of *starving people to death.*  Literally.  As if unaware of the dozens/hundreds of food banks, the food stamp system, the homeless shelters, all of the "safety net" provisions that society generously provides.
My 78-year-old mom, with cancer, got food stamps, rent-controlled housing, Medicare, Medicaid, umpteen other things and even if not for her family, she'd have had all the free medical care, food, and clothing she needed - chemotherapy, surgery, prescriptions, absolutely everything her doctor signed off on (which was anything she asked for).  Without working.  In 3rd world countries, the situation is a little different - 
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If it were the case that an able-bodied American man could not get 1,500 calories despite his best efforts, that would be one conversation.  But that ain't where we are, not from my experience.  Take me to a guy who wants a hand UP, instead of a hand OUT, and I can't wait to meet him.  
Don't mean to sound harsh :- ) but I've spent a whale of a lot of time with folks who need money.  (And there's a 'halfway house' next door to the church where I work.)  Maybe 1% or 2% have had any real interest in building a responsible life.  Your mileage may vary.
Viktor Belenko, who defected to the West in a MiG-23, looked around America and marvelled, "You mean everybody has a car and a house and even if you don't want to work, they give you food?!  They've done it!  They've built the state Stalin promised!"  :- )

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Now in the US, not only is the debate deeply skewed by a lack of perspective...it's deeply skewed by incredibly foolish notions like the canard that it's not enough to give people in need the material things they need to survive...the bare essentials...we have to HAND them DIGNITY. In Michigan, the GOP controlled state legislature tried to pass a law requiring that people using their EBT money to buy clothing had to only do so at second hand and discount shops like Salvation Army and Goodwill. The progressive answer...from everywhere in the country and in the most literati of publications was, "That's undignified...making people spending public money buy old clothing! Don't the poor deserve the occasional name brand, new clothing item?" I can't even begin to explain just how morally bankrupt that position is.
And we don't just give them the things they have to have to survive...we give them smartphones and phone cards so they can play Angry Birds and chat with friends (ostensibly so they have a phone number to use to apply for jobs...but do we need to give them smart phones for that? Would not a rotary hard-wired telephone suffice??)
You all may be aware that I went through 18 months of personal torment because I couldn't get a well-enough paying job to support myself and had to ask my parents to keep me afloat while I was making 11 dollars an hour in NYC (I wouldn't have taken the Yankee internship if I had any career prospects coming out of grad school). I lived comfortably enough, but I didn't buy extra stuff and I felt absolutely MOR-TI-FIED that I hade to keep asking for money at my age. I refused to get an EBT card (I qualified for one), and called home a few times ready to quit my job and move home/work in fast food or something to save money while I kept applying for meteorology jobs, but my parents refused to let me do that. It is beyond offensive to me when someone tells me the well-off in this country OWE IT to the poor to not only make sure they don't starve or go homeless, but make sure they are handed their dignity. You can't get dignity in Macy's and you can't collect it at the SSA office, and for anyone to ask me to or anyone else to hand them dignity is an affront to everything in which I believe and the way I've tried (and often failed) to live my life.
Another little anecdote for you, on the question of whether capitalists are, in general, greedy. I just had my company's annual "advance" in which we discuss the progress of the company and the CEO and top level project managers share their hopes for the next year and the basic strategy for how to get there. Do you know what the first 20 minutes of that advance was dedicated to, apart from people desperately grabbing for the coffee and donuts? The CEO got up and spoke about how immensely proud he was that he had built something that did well enough that 93 good people could have a job and benefits and a common purpose. THAT is capitalism. People don't just try to make money so they can buy four homes and two luxury yachts...the people who want four homes and two luxury yachts are usually not the ones doing the active capitalism...they're usually "old money" who inherited an empire. Capitalism...the engine that makes this society great...it's guys like my company's CEO who had a dream to build something that would enrich himself AND a swarm of other scientists and and salespeople and engineers...that would be an institution in its town...that would make people safer by the products it offered. Weather Decision Technologies started with three guys and some computer code that made a useful app to view radar data. It now is worth like 13.5 million in revenue per year, employs 93 people, and makes some of the best products in the weather data and forecast services industry. Creating real wealth out of *NOTHING*...making the world better by offering information businesses and event planners and such need to keep people safe...AND making life better for 93 of us with the necessary skills. That's not greed...that's greatness.

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Line up an open job for any taker, and offer to bring your sister around as you drive up to people with "ANYTHING HELPS" signs and offer to take them to a job interview :- )
The reply:  "I'm disabled."
For putting fliers into envelopes?  How did you buy that Big Gulp sitting over there?
"I have PTSD and can't stay inside long."
And so on...   most readers will be fascinated to know:  at the halfway house next door, each denizen has a tailored "script" they use to bum money (their phrase).  When an individual goes far enough downhill (is too wasted by substances), "their game ain't workin' for 'em any more," they'll tell you.
It is my heartfelt, loving philosophy that we do these people a disservice by hand-patting them.  That is also the philosophy of any social worker who has been around them long.
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There are some people out there truly in need, widows, orphans, etc.  Let's all of us, democrat, republican, whatever, go find them and help them.

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misterjonez's picture

I remember chuckling when an article pointed out how John Rockefeller probably saved more whales' lives by revolutionizing the kerosine industry than every pro-whales activist in human history combined. When Kerosine's price plummeted to around 10% the price of whale oil-based lamp fuel, due solely to Rockefeller's ingenuity and 'greed,' there was simply no further need to hunt whales as extensively as we had done. Talk about one man's supposedly megalomaniacal obsession with money resulting in a good deed...and, oh yeah, he dropped lamp oil prices by 80-90%, making it possible for even the poor to light their homes after dark. I don't think I need to speak to this particular crowd about the value of education, which requires among other things the ability to read, which requires light, which isn't freely available after, well, you know...dark ;) The reason Rockefeller became so wealthy is because he provided a service which the entire world desperately sought, and human access to education flourished while the hunting of whales for lamp oil plummeted.
Greed gets a bad rap. The impetus for people like your CEO, or any other corporate giant, to get up and assume risks that most of us would faint at being subjected to, is that they will be rewarded for doing so. But no company survives, let alone thrives, by serving only the owner's agenda.
Zig Ziglar had a line which, paraphrased, went, "In order for you to get what you want, you need to help as many other people get what they want as possible." That, ladies and gentlemen, is capitalism at its core. Enlightened self-interest is another term I've heard used to describe it, and there has yet to be a better system invented, let alone applied, by humanity.

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Chicago Mariner's picture

As a German born medical software entrepreneur living in the US, spending lots of time in the Philippines and married to a doctor, I think you make number of valid points. I'd much rather be an entrepreneur here than in either Germany or the Philippines, for different reasons. Market forces are incredibly powerful at shaping behavior and finding equilibrium within the limits proscribed by society. There are inefficiencies around common goods and long term benefits, for which legal, policy and regulatory levers are imperfect solutions. Society changes those limits over time (see tobacco, marijuana, glass-steagal, etc.). In the case of the healthcare system, the incentives are horribly skewed towards pay for procedure rather than paying for improved population health. The people may have good individual intentions, but the system responds to those perverse incentives. Add to that all the incentives for opaque pricing and cockamamie ideas like "employer aubsidized" health insurance, and it's no wonder that we spend nearly twice as much on healthcare than any other developed country with less than middling results in overall population health measures.

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IcebreakerX's picture

I think that, though there's a lot of people freeloading, there's also a severely understated reverse issue which is an overemphasis on giving as a moral norm.
Working in education, there's a HUGE emphasis on 'service learning', 'volunteering' and all that fancy niceties. That's all great when your parents can buy you a Maserati and all the Starbucks you want, but when you're stuck doing jobs when you should be studying or otherwise AND you're asked to community service shenanigans, all to get into university, I think that's a bit much.
I personally don't believe in giving away any sort of labor or time without a cash (or other) return. I mean, I'll do work if I feel there is a sufficient return that's not cash, but I don't believe in unpaid internships or particularly value volunteer work as being magically more valuable than a kid who's socially & academically well seasoned.

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this post and thread of comments makes me very, very sad.
There is no use for me to try to respond point-by-point. So let me just pose a question: rereading what's been said here, do you feel it's possible that it is drowning in a deluge of stereotypes and straw men?
Not trying to be deliberately provocative. Just stating my opinion (hopefully respectfully...)

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It just always bugs me the way people frequently claim that socialist policies work in certain countries without the understanding of how much that workability depends on heavy subsidies from outside. The EU democracies really enjoy an artificially favorable situation unique in world history. Under even these circumstances, they struggle to make these policies work, and in fact have actively worked recently to make their economies (especially in Sweden) *more* like the US economy, not less.

11

...After the 1970 census, the Swedish economy was 11th in the world. They were humming along alright. Then they went socialist and their economy dropped gradually from 11th to 42nd i the world. Not horrible in the grand scheme of things, but a big drop. One swedish economist put it thusly:
"Enacting top down socialism is a little like peeing in your pants. It might be warm and nice at first, but it leaves an awful mess and you'll be cold and miserable before long."
That'll do for me as well..LOL
Note, Sweden has move to the right and seen its economy rebound into the mid-teens in global rank. FWIW.

12

No problem Diderot.  Here's the thing.  I didn't come by my opinions about poverty from hearing about stereotypes from Rush Limbaugh.  I actually had a liberal bent for a while.  Then, when I was 25, I got a law license, and a job as a public defender.  At my PD firm, I was the felony domestic violence defender.  I've defended all manner of violent crimes including one where a parent murdered his toddler because the kid was bothering him during a video game session.  Then I went into private practice.  Now, I'm almost 33 years old, and I do mostly criminal law, especially drug trafficking defense, child custody, adoption and personal injury.  The point is, poor people and I have more than a casual acquaintance.  Most people who have their stuff together don't go see a lawyer more than once in their lifetime.  I've worked closely with thousands of people from the underclass of society who have ongoing legal problems that would make you want to curl up in the fetal position under your desk.  My own counsel will I keep as to what stereotypes are improper.  :)
Doc and Grumpy are presumably much older men who also work in demanding service industries.
Poverty problems are often generational and usually include a few of the following:
Bad parenting
Bad nutrition
Bad education
Lack of ambition
Mental Illness
Drugs
Lack of exercise
Alcoholism
FASD
I don't hate the underclass, but I think we are doing a great disservice to the poor by giving entitlements without matching responsibilities.  For example, There has been many instances where horrible parents fight tooth and nail for custody of their children because custody meant better welfare benefits including subsidized housing and WIC.  This is wrong, and happens quite often.  If there were mandatory classes and drug testing as a precondition for federal subsidized housing, then bad parents would be less inclined to keep their kids and would give them up for adoption or give custody to other people who cared.
I don't mean to turn another young person into a cynic, It only took me about three years, but I'm interested to hear your opinions on poverty and how you came about them. I'm  willing to respectfully debate the issue.
 

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Diderot, when I went to the UW I was -100 on a -100 to 100 liberal/conservative scale.  I was pro-gay marriage, anti-gun ownership, anti-death penalty, pro-abortion, in favor of a 90% upper tax rate, literally argued that parents who paddle their kids should go to jail, etc etc etc.  When Ronald Reagan beat Jimmy Carter I literally went on a physical rampage destroying stuff.
Over the course of the next 10 years it was working in the trenches, not straw men, that caused me to re-think these issues one by one.  And as Mojician says, it's hardly my mission to disillusion a young person who is optimistic about working with the disadvantaged.  I think you SHOULD work with the disadvantaged, as Cindy and I and Mojo continue to do.
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The middle ground is, we both care about the poor.  You still hear my anti-intellectual tone in my writing, correct?  That's because I authentically can't stand to hear somebody, doing well in life, scoffing at those with less education or money.
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Anybody here who wants to send $10 or $20 per month to a 3rd world country, it will allow a family of eight to eat Grade B rice instead of Grade C rice, for a month.  Sometimes they break down and cry when my friend takes them over to the Grade B barrel.  
No phony commercials where the money goes for everything BUT food and medicine.  We'll get your cash straight to starving people.  email me and we'll get you set up.
Warmly,
Jeff

14

First of all, I would like to thank those who are attempting to prevent me from losing the idealism of youth. I think my grandchildren would find this funny. For me, the youth ship has sailed. (At least being old means having had the chance to see Mantle, Mays, Williams and Koufax play in person.)
There are three basic themes which seem to be in play here: Capitalism vs. Socialism; Treatment of the Poor; and the U.S. Health Care System. (Off the top, I claim no inside knowledge of the last one). So for the time being, let me just address the first one.
Straw Man: Socialism is the alternative to Capitalism. No, it isn't. It may be the perceived opposite, but it's not close to the proper discussion (in my mind). The much better topic is a better version of capitalism than what we've now got. I think you'd find few people who would rally against the concept of the entrepreneur. And I, too, say hooray to the guy who puts 93 people to work doing good for them--and society.
But let's get real; once he gets good enough to employ 930 people, or so, he's going to probably take the buyout offer from a much bigger capitalist. Big fish eat little fish; it's the way of the world.
But the big fish play by different rules--ones they generally can't change, because they're primarily publicly traded.
Let me assert this. If you run a business, your first requirement is to make enough revenue to cover your costs. If you don't, you're not a business for long.
If there is money left over above cost, you have three basic ways to use it: 1) you can reward your shareholders; 2) you can reward your employees; 3) you can reward yourself.
What do you do? Well, if you're at all interested in #3, you know your bread is buttered by catering to #1. Employees don't vote to keep you in power, boards of directors (presumably representing shareholders) do. So every quarter you write your own report card in the form of a financial statement, and wait for the judgment of the market. This may be capitalism in the purest sense of the word...but it's toxic for society--and ultimately even for your own business.
The reason is that America's economic engine, for over a century, has been the middle class. And in a country where 70% of the economy derives from consumer spending, you are burying your head in the sand if you focus only on the short term goal of extracting wages, benefits, discretionary spending and discretionary time from that working middle class. You are committing slow motion suicide. Someone here quoted the advice that you get what you want by helping others get what they want. Is our current system doing that for the middle class?
OK, one more note on this. If socialism is the enemy...why do our corporations get so much of it? Why are laws written that allow them to avoid paying their fair share of taxes in their country of origin? why are oil companies still getting direct subsidies from the government? Why do the good people of Washington State drop payloads of tax dollars onto the corporate headquarters of Boeing...only to have them laugh...kick the ribs of their line workers...and fly out of town on private jets they didn't even build?
Today is election day. I voted. But I know the results won't matter. Democrat or Republican, the people who write our laws will still be bought by corporations.
Is that enough youthful idealism for you? :

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Chicago Mariner's picture

One of my favorite not-for-profits is a group called kickstart (http://www.kickstart.org) that designs products and the business models to support them that help poor people make money. Example - the MoneyMaker Max treadle irrigation pump. They sell it through local distributors and retailers in Africa for $150, and the average farmer recoups their investment in less than three months. Everyone in the supply chain makes money, and they plow money back in to development of new products, education, etc. customer acquisition costs are still high (lots of on farm and in store demos are necessary to convince someone living on the edge to do something different) but those costs are rapidly decreasing as more people are lifted out of poverty. So far so good: As of September 2014, 140,000 jobs created and 820,000 people lifted out of poverty. Capitalism at work baby.

16

On the toddler and the video game.  :- (
Then you go on to say you've got problems that would make us assume the fetal position under the desk ... :- O
Inspiring, the fact that you've been able to maintain your ease and good cheer, while burying yourself in that stuff, up to the elbows with both hands in the air.  Somebody's got to do it.  Maybe some day we can hit an M's game amigo.

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My apologies for the assumptions about your youth.  That's funny, though, man :- )
My original reference to Capitalism / Socialism was an offhanded one.  Of course I agree that our economic system is much more nuanced than that.  The U.S. system has always had strong "socialistic" checks and balances inherent.  Antitrust is a check and balance.  Military employment of civilians is a type of socialism.
Something like 47% of Americans pay no federal income tax, and most Americans (including me) are very glad that our system is able to support that.  :- )  Most well-to-do people are delighted to share of their excess, in principle.
Lot of middle ground here.  If we want to start exploring that issue it's great by me.  My reaction goes to the left-wing idea of resenting success, and punishing it out of jealousy, but that isn't where you're coming from at all.
Best,
Jeff

19

My post is not meant to suggest that socialism is necessarily evil or whatever, as its proponents are often driven by good intentions.
My post is merely to point out that extreme socialism doesn't (and can't) really work very well, without certain very favorable circumstances (eg the US picking up the tab for world stability, providing huge markets for other countries' exports, and picking up the tab for the development of medical advances). Even with those circumstances in place, the EU struggles to meet its obligations. This problem will only get worse as the EU population ages.
The US pays more per person for healthcare for several reasons. Personnel in the US are very expensive compared to the rest of the world. Not just doctors... all providers. Nurses are very, very expensive here compared to the ROW. Part of that is the education requirements we place on nurses which are exorbitant and in turn expensive. Building healthcare facilities are very expensive in the US, compared to the ROW, for may reasons. Part of this is related to the strength of the US... even unskilled/mid level skilled employees can demand high wages here. Part of it is related to unionization. SEIU is very powerful.
As I noted above, we (the US market and taxpayer) also pay the development costs for new medications, devices, and other advancements that the ROW gets to enjoy (as cost). The EU and Canada are a rich block of countries. They could pay their fair share of these development costs (instead of using their monopsony purchasing power to negotiate minimal prices). If they did, then comparing the costs per person spent on healthcare between the US and the ROW would look less lopsided.
Also we tend to spend a *lot* more money on saving preterm kids (that would be considered nonviable or "stillborn" in other countries) and also especially at the end of life. These are both cultural differences that can not be addressed by healthcare "reform".
My point in all of this is that the US system is unique in that its markets provide much of the impetus for innovation in the healthcare field, and the entire world benefits from this. Therefore, we should be very careful when proposing reforms, so that this unique character is not destroyed.

20

The dad was a juvenile so he got 25 years on account of his immaturity. Sorry about that. No more Debbie Downer posts. We need to come up with more cheerful political discussions. Marijuana just passed in Alaska last night. Do y'all want to talk about that.

I'd love to catch an Ms game some time. I only see a game every few years though.

21

Grumpy, I respect and admire your knowledge in this area. So, two sincere questions:
1) The numbers I recite here are from memory so probably not perfectly accurate, but I remember reading (maybe a decade ago?) that of the 23 top medical advances created in America over the previous couple decades, 16 were the product not of the 'market', but of government funded entities (e.g., CDC) or government funded research projects at universities. Maybe this is entirely wrong. But assuming it's right, that means most of the time it's our tax dollars which are creating our health care improvements (simplistic conclusion for the sake of argument). And if that's true, does this not constitute socialism in some form? Are not the collective resources of the country underwriting a collective benefit for all citizens? (BTW, this is NOT a defense of socialism--just an inquiry on what Jeff refers to properly as the 'nuances' of our economy and health care system).
2) The idea of monopsony purchasing power has been raised a couple times. In simpler terms, I'm assuming this plays into patients in America having to pay the proverbial $12 for an aspirin when they're in the hospital. Of course, this is infuriating to people (including me). So my question is why the U.S. does not exert similar pressure on the purchase of that aspirin. If we 'invented' the advance, why must we wind up paying more for it? (I realize much of the answer is included in your post above). But if we adopted a single-payer system, as have many European countries, could/would we exert that same pressure? Or would that necessarily, in your mind, make the entire global health care network recede/collapse?
thanks.

22

I guess we all see the world through the prism of our own experience.
Although, as a reporter, I covered criminal courts for a while as a young man, I certainly don't have the degree of insight that you do concerning the justice system...and the people it deals with. So no argument with your viewpoint.
However, I did serve for many years on the board of directors for an independent school that dealt with homeless kids...at the time when the local school district refused to admit them because of the lack of a permanent address. The parental population ranged from single mom's fleeing domestic violence to people actually working for a living who could not afford security deposit and first month's rent--anywhere. They lived hand to mouth, and day to day in motels. Some even in tents. The school academically was led by a couple of leading national authorities in educating homeless kids, and the facility included two hot meals a day for the students...and an ample clothing exchange.
So my point is just to say that, from my personal experience, there are MANY poor people who are not living on the dole. They are working--sometimes both parents--and they are still inarguably poor.
I understand the people winding up in the criminal justice system. I understand the stereotypical 'homeless' guys who wind up next door to Jeff. But I reflexively have to react to the labeling of the 'poor' as somehow uniformly incorporating the negative traits of indolence, substance abuse, mental illness and at least minimal criminality.
I think that does the 'poor' a disservice...and it does US a disservice.

23

The problem I have with coporate taxes is that corporations operate at a disadvantage.  If you go out and work and produce income, then you pay your taxes and that is the end of it.  If you make less than $50,000 and you have dependents, chances are, you don't pay any taxes at all.  If a corporation goes and works, then it is taxed up to 35 percent of its profits if it makes more than $18 million.  Then, when it distributes dividends to its shareholders, they pay an additional 15 percent in taxes.  So, every big corporation pays a full 50 percent of taxes on all of its profits.  This is the highest corporate tax rate in the first world.  This is all federal, and when you are talking about tax breaks for local big business, you are talking about the state and local sales tax, income tax, property tax, business property tax and the like that is added on to the fifty percent corporate tax.  
Now, consider that corporations are necessary to make things that are too grand for a single person to build.  An engineer can make his own DIY ultra light air plane.  He can't make a jumbo jet.  An artist can draw a cartoon strip.  He can't make a Pixar movie.  Noah built an Ark by himself, but it took him 200 years.  All other grand construction projects in human history have been a collaborative effort.  I think that a modern boat yard and lumber mill could churn out an ark in 18 months if they could procure an adequate supply of gopher wood and it didn't need to be laminated.
Also, corporations do not have any safety net.  If people don't like Windows 8, there are layoffs for everyone at Microsoft (18,000 and counting).  If shareholders are tired of Amazon not turning a profit, heads  will start to roll.  If Boeing doesn't churn out the jet that the world wants, its time to go shopping with Airbus or Embraer or whoever.  
Contrast this with the social safety net we've constructed for the ultra poor where a poor person can do almost anything he wants and still obtain benefits.  My concern with the poor person obtaining benefits is not that I begrudge him his survival, but that the system is rigged for him to want to fail.  Its a cold hard world of responsibility and strings attached if you are on the path to self sufficiency or surplus efficiency.  If I want $10,000 from a bank, my promissory note and security agreement will be 37 pages long, and I will be accountable to the last penny.  If a poor person wants subsidized housing, its all free.
A couple of more points about capitalism, 1. It doesn't squelch art.  People still find a way to do what they enjoy, such as blog at SSI, even if they have a job.  2. As stated above, profits are tied to serving important human needs.  2. It corrects inefficiency more quickly than government. 3. You are right in stating that it isn't a dispute of capitalism vs. socialism.  In America, we have a lot of both, and it is important to find the right balance.  
Just noodlin.
 

24
BShaw's picture

Out of law school I was a public defender, and also represented indigent clients trying to keep their children after CPS intervention. I have never done anything where the need was so great, and my inability to help (being limited by government approved tools and counselors, and people's refusal to help themselves,etc) were so far apart. It is a sisyphean task. I recognize many of the issues mojician listed above, and agree with them.
I would also add that strict capitalism, untempered with compassion (in my case, Christian compassion), is as untenable as any other economic philosophy. I respect my friends (and many commenters here) who tend toward what I would consider socialist principals out of desire to help the poor. I simply think they are using a flawed method to try and effect a noble end. Where they (and anyone) run into trouble is jumping to conclusions about motives.
Put it this way - I'll hold off calling you a Stalinite if you refrain from telling me that my insistence on individual responsibility and hard work is cold-hearted greed. :) 
Just my thoughts.
 

25

And global capitalism has lifted over 1 billion people out of poverty in the last 30 years or so (mostly in China, India, and Africa).

26

My experience is mostly only with poor criminal types.  There are many poor people who need help and aren't abusing anything.
Thanks for the reminder.
 

27

Awesome!  There should be a secret public defender handshake or something because its definitely an exerience.  CPS cases are world class nasty.  Hope you stick around and post more often.

28

Having just returned from a biobanking conference in Europe, I was quite surprised to hear how many European nations force patients to bear the brunt of the cost to bank their samples. I just assumed the government assumed the cost. I think we make assumptions based on journalism that isn't completely accurate. And it isn't cheap.
A couple of years ago, I took a boat ride in Sweden. I was shocked at the incredible number of rich, luxurious homes that dotted the shoreline. Where did all these wealthy folks come from? I then spoke to a lawyer giving me a ride to Stockholm. He began to politely lecture me on the generous social policies of their nation. I asked if the trade off of high taxation was worth it. He replied calmly, at first, that, yes, taxes were high. And the more he elaborated, the more agitated he got. Before long, I thought he was ready to start the Swedish Tea Party, he was getting so angry about it. This is an experience I get quite often: a calm explanation that begins to rise into annoyance and eventually anger.
One more thing I have experienced, that is off topic, but I want to share it, because it's just so darn cute. When people in Europe ask me where I'm from, I tell them Seattle, and then add the home of the Sonics. Almost without fail, they perk up about the Sonics, and they begin to tell me "Yes! The Sonics! Shawn Kemp, Gareee Pay-Ton, Detlef Schremp!" They make an immediate connection to the Sonics. And often, they are surprised to hear the Sonics are no longer around. It rarely fails. That Sonic team made a huge impression on Europe, and it happens regardless of the country: France, Spain, Italy, Germany. They really were a world class team and acquired fans all over the globe. And nobody knows who the Oklahoma City Thunder are. It's just the darnedest thing. Stupid Howard Schultz.

29

The internet was a government research project. Velcro, cryogenics, advanced aviation, GPS, the web browser, computers...lots of great things happen when the government funds research. Research...GOOD. :) The problem is when government then funds a COMPANY for product development and protects that company from market forces.

30

...Weather Decision Technologies began with software based on research funded by the government. :)
I doubt WDT would be doing as well as it is now if it hadn't split off and become independent and privately held, freeing it to pursue its own course.

31

You can lose your Starbucks, and bring back The Sonics, and the Europeans would probably consider that a great trade. Did I tell you already that Howard Schultz is an idiot. Oh yeah, I did.

32
misterjonez's picture

of why an aspirin costs so much in the hospital: the paperwork. Even using a centralized storage system like a Pyxis, it is literally illegal for a nurse to administer a medication without going through three sets of five checks (at least, that's how it was when last I worked ~6 years ago) to verify a patient's identity, and that the drug is correct, as is the dosage, the time, etc.. To actually do this properly takes between 3-10 minutes per 'round' of medication, depending on how many pills we're talking about. Naturally many nurses, being human, eschew one or two of these check sets, but to administer medication 'by the book' takes quite a bit of time.
And, as we all know by now, nurses don't come cheap. Even working a rural hospital on the lowest teir unit, I made between $26-30/hour base pay and that went double(!) for overtime. So if it takes a nurse ten minutes to give a pill 'properly,' meaning by checking doctor's orders, patient identification, proper medication, dose, lack of allergies, etc, then that's between $4-10 just for the nurse's labor. To go 'by the book,' anyway. Add on top of that the Pyxis costs, the stocking process, etc.. and I was absolutely dumbfounded when it looked, to me as a nurse (and I constantly railed against inefficiencies in every healthcare setting I ever worked...I even managed to spearhead some minor departmental reforms, now that I think about it) it actually looked like those costs could very well be justified. Which was sickening to me.
Please don't mistake me for justifying, ideologically or morally, the fact that aspirin costs $12 in the hospital. I'm just saying that I, like pretty much everyone else, am appalled at that particular reality and dove into the matter hoping to find some great injustice. The truth is that nurses are paid too much to be giving out aspirin, but the way the system is in the USA, they're the lowest 'ranked' medical professional that is allowed to do so in most hospitals.

33

You are leaving out the most interesting part Rick. What is a biobank? Is that where Ted Williams is stored or is it more like a cryo-ark? Are they growing livers? That sounds awesome.

34

Blood, DNA, RNA, and tissues, tumors, stem cells, etc. are cryogenically stored for research mostly, but more and more for personalized medicine, to help match patients with cancer and other diseases to promising clinical trials. That Ted Williams thing - that was crazy stuff.

36

That's completely awesome Rick.  So when is your company going to clone the wooly mammoth?
If you can cryo-preserve an embroyo for indefinite time, why can't you do that with an adult?
How does a cryo preserved embroyo or sperm come back to life?  What kick starts it?
The plans for a cancer tumor library sound very interesting.  Are all doctors going to get to use that, or is it just going to be for that particular hospital?

37

Finished the Ben Bradlee biography on Ted Williams last month.
Best cryogenics/baseball book ever!
(Seriously, it's fascinating).

38

in 1, 2 and 3 for what I know, Mojician. Actually, I'm more involved in the data management of these biobanks (www.freezerworks.com). It's a company my wife and I and another partner started back in the 80's (I do the marketing these days). We did virology data management for HIV research and the clinical trials. If you saw the Dallas Buyers Club with Matthew McConnaughey, yeah, we were doing work behind the scenes in those days. One of our major clients is the American Museum of Natural History, which serves as a genetic frozen Noah's ark, not unlike that picture from Jurassic park (I assume) you have above. Seed banks are a vital area of cryogenic banking as well (we recently ran a cool feature on one in Australia).
The plans for the tumor center is to link up with other centers, so that researchers and healthcare givers can be match patients with the best therapies and clinical trials available. the editing I do is my volunteering bit for the ISBER society.
Thanks for asking Mojician.

39

My mind goes immediately to Futurama and then, usually, to President Nixon. Would enjoy a review, Diderot. In fact, if you do, I might want to run it in our Newsletter! We do book reviews.

41

It's these little side conversations that make this site so darn interesting. Very interesting and diverse community, here.

43

Been tied up.
 
1) The numbers I recite here are from memory so probably not perfectly accurate, but I remember reading (maybe a decade ago?) that of the 23 top medical advances created in America over the previous couple decades, 16 were the product not of the 'market', but of government funded entities (e.g., CDC) or government funded research projects at universities.
 
It seems like you might want me to argue against government funding or sponsorship of any form.  Just to be clear, my point is that extreme/EU style socialism doesn't (and can't) really work very well, without certain very favorable circumstances (eg the US picking up the tab for world stability, providing huge markets for other countries' exports, and picking up the tab for the development of medical advances).
 
I don't know the exact numbers, but certainly some (many?) advances *begin* at universities or the NIH as government funded projects.  Or at least the ideas/early development.  Of course, that doesn't mean that this research wouldn't get done otherwise.  However, the expensive, risky, and arduous part of bringing things to market happen after the basic research.  Many compounds have to be evaluated and weeded out prior to starting animal trials, then more are weeded out prior to human trials (which necessarily are long, expensive, and paperwork and personnell intensive, and highly regulated.  This is also true of new medical/surgical devices and imaging technology.  This can take decades, even for technologies that have already been proven in other areas.*
 
So, yeah, I have nothing against that sort of funding (though if not done by the government, private money would fund it... think Bell Labs). 
 
It is however, yet another direct example of how the US taxpayer is subsidizing scientific and medical advances which go on to benefit the rest of the world.  This just reinforces my point that these social democracies could not exit in their current forms w/o the direct and indirect subsidies provided by the USA.
 
 
 
 2) The idea of monopsony purchasing power has been raised a couple times. In simpler terms, I'm assuming this plays into patients in America having to pay the proverbial $12 for an aspirin when they're in the hospital.
 
 
It is partially that we're talking about different things here.  $12 aspirins are partly a product of cost shifting, where hospitals charge higher rates to people with money (or ones that have insurance) to cover the costs of providing care to those that don't have insurance.  Also, as others have pointed out, everything medical is expensive, whether it is equipmwnt, physical plant construction, personell, etc.
 
If we 'invented' the advance, why must we wind up paying more for it? (I realize much of the answer is included in your post above). But if we adopted a single-payer system, as have many European countries, could/would we exert that same pressure? Or would that necessarily, in your mind, make the entire global health care network recede/collapse?
 
I do think think that if the US adopts a single payer system across the board, it would seriously retard medical innovation, innovation that benefits the entire world.
 
It is important to realize that ~50% of the US healthcare market is already basically "single payer":  eg Medicare, Medicaid, or VA (that's pre ACA).  Already, Medicare pays for hospital procedures in block payments (DRG reimbursement)... that is, they pay the same amount for a hospitalization whether you use the latest technology or ancient technology.  And they pay the same whether the pt stays in house 2 days or 10 days for a given DRG (Diagnosis Related Group).  
 
Sure, the US could go to an EU system and dictate terms to the drug companies and deny new device etc.  This would save money on expenditures, but this strategy is not magic... there would be real repercussions.  But where would the market for new innovation come from then?  What would drive people to come up with new advances, pay the development costs, and take the risks involved with production?
 
Say the government just took over the legal industry, and decided to pay 50% less for all services than had been customary previously.  Or the IT industry.  It would certainly "save money", but I suspect it might warp those markets severely.
 
The answer, IMO, is not to cripple what makes the US system such a unique driver of innovation.  The answer would be to get the other rich nations like Canada, Japan, and the EU to start paying their fair share of the costs of development.  Unfortunately, this is unlikely to happen.
 
Just remember that comparing the US system and EU style systems with a mind to efficency or bang for the buck that you are comparing apples to oranges... there's no way the EU systems could perfoem the same way without the US.

44

...not that this applies to every progressive, but I find the latest example of progressive thinking in action that's been in the news in the last few days a beautiful illustration of exactly the sort of "dismiss them because of who they are" and "do what you think shold be done with or without their support for their own good" mentality:
Jon Gruber.
Google the name if you're not paying attention. Hint: he's one of the leading architects of the Affordable Care Act. And his attitude is exactly what conservative scholars have been warning about for decades regarding the progressive left.

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