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Merciless

This blog is not only my personal soapbox, it's my public face. Folks who read what I post here may or may not thereafter buy my books. Consequently, these days I try to avoid writing about stuff that is likely to be controversial. Call it the chilling effect of capitalism; I can say what I want if and only if I'm willing to do without that portion of my book royalties that comes from the folks I piss off.

There are some folks I can do without, mind you. (If you're a BNP member or voter you can fuck off right now. I don't care if you don't buy my books; I don't want your bloody money.)

However, this comes at a cost. I don't like biting my tongue continuously. I have strong opinions on a number of subjects — including politics — and what use is a soapbox if I can't use it from time to time?

(Click the link below to continue reading if and only if you don't mind me expressing strong views that may be contrary to your own.)

This brings me to my topic of the day: mercy, and the lack of it.

I've been suppressing the urge to explode angrily ever since Thursday, when Abdelbaset Al Megrahi was officially released from prison and flown home to Libya. His release — on compassionate grounds, as he is suffering from terminal cancer and has weeks to live. Mr Al Megrahi was serving a life sentence, handed down by a rather oddly constituted Scottish court for his part in the bombing of Pan Am Flight 103 over Lockerbie in 1988 — the biggest aviation disaster ever in British airspace, and one of the biggest acts of terrorism of that decade.

What am I angry about?

Let's leave aside the fact that many people (including the UN observer at the trial) consider Al Megrahi's conviction to be a serious miscarriage of justice. (The allegations of fabricated evidence should to be taken seriously; the Flight 103 investigation took place in the middle of a very chilly period in US/Libyan relations, and we have seen since then that the CIA is a pliant tool in the hands of those who want to fabricate evidence justifying action against uncooperative Middle Eastern nations. The CIA is an intelligence and covert operations agency under political direction, not an independent investigatory/detective bureau; its emissions should be considered with the utmost skepticism.)

What makes me angry ... Well, to start with it's worth noting that the loudest denunciations came from the White House — an entity with no legal standing whatsoever in the Scottish judicial system. But we expect external interference from the White House: it's what the Imperial Presidency is there for.

What bugs me is the complete lack of comprehension of the quality of mercy that seems to have crept over the US political class this century.

Even if Al Megrahi is a mass-murderer, the fact remains that he is dying. It is long-standing policy in Scotland to exercise the prerogative of mercy when possible; in general, if an imprisoned criminal is terminally ill, a request for release (for hospice care, basically) is usually granted unless they are believed to be a danger to the public.

That's because the justice system isn't solely about punishment. It's about respect for the greater good of society, which is better served by rehabilitation and reconcilliation than by revenge. We do not make ourselves better people by exercising a gruesome revenge on the bodies of our vanquished foes. Kenny MacAskill, the Justice Minister, did exactly the right thing in sending Al Megrahi home to die.

Meanwhile, the angry spectators who're throwing scat come from a country where prison rape is endemic and tolerated to the point where it's a subject for cheap jokes.

American attitudes to crime and punishment are unspeakable; disturbing, mediaeval, and barbaric are some of the adjectives that spring to mind. But above all, the word that most thoroughly applies is merciless. The commission of a crime is taken as an excuse to unleash the demons of the subconscious, however dark, however disproportionate, upon the perpetrator. Once labeled a criminal, an individual's right to fair treatment is utterly expunged, and any violation or degradation, however grotesque, is seen as something that they brought on themselves.

Why?

Well, let's pan across the political landscape and look at another current cause celebre that provides a window into the darker corners of the American psyche; the issue of healthcare reform.

I've been watching the war of words with increasing disbelief for the past month, trying to get my head around the reason why so many loud, vocal citizens seem to be so adamantly opposed to something that's in their own best interests — the US healthcare system is utterly dysfunctional, even for those with health insurance costs are spiraling out of control, and the current system is becoming a major drag on economic productivity — many business start-ups abort because the founders can't obtain healthcare, many novelists of my acquaintance are in serious financial trouble or are terrified of giving up the day job (that comes with insurance), and so on. The current mess is responsible for 22,000 avoidable deaths per year — a 9/11 scale catastrophe every six weeks.

And yet we hear rhetoric about death panels, idiotic allegations that Stephen Hawking would be dead if he lived in the UK and was dependent on the NHS (this just in: Stephen Hawking is British and, er, alive because of the NHS), and so on. What's going on?

What's noticable is that the "debate" isn't about the need for healthcare, or about actual medical issues. It's about ideology, and outlook ...

Near as I can work it out from over here (caveat: I've spent somewhere between four and eight months of my life in the USA — this doesn't make me an expert) there is a small but significant proportion of the US population who hate the poor and want them to die. (Or at least to go somewhere where they're invisible and can't act as a perpetual reminder to the haters that their own security is at best tenuous.) I'm not sure why there's this hatred — my personal feeling is that it springs from numerous sources: from prosperity theology (if you're poor it's because you're ungodly and deserve to suffer), insecurity, lack of empathy, or a combination of these factors in different people. Other observers have different theories: M'Learned Friend opines that it's because the American conservative movement rejects Rawls's preconditions for justice. (That doesn't go far enough for my taste; they also seem to want to reject the entire concept of the Social Contract.) And then there's the growing tendency towards eliminationist rhetoric against socially sanctioned out-groups. (Arguably the endorsement of maltreatment of convicts is an emergent part of this trend, feeding into and normalising it.) .

The subjects vary — crime and penal policy, healthcare, don't get me started on foreign policy — but there is an ideological approach in America that is distinguished by one common characteristic: words and deeds utterly lacking in the quality of mercy.

There is a cancer in the collective American soul — a mercy deficit that has in recent years grown as alarmingly as the budget deficit. Nor is it as simple as a left/right thing: no political party has a monopoly on merciless behaviour. Rather, a creeping draconian absolutism has cast its penumbra across the entire arena of public discourse, tainting every debate, poisoning and hardening attitudes across the board.

Calls for revenge on a sick and dying man are part and parcel of the pathology, as are shrieks of outrage against the mere idea of subsidizing healthcare for the indigent or unlucky, or rough talk about "every now and again ... pick[ing] up a crappy little country and throwing it against the wall just to prove we are serious".

Mercy, it would seem, is a scarce commodity in the Empire.

Are you ashamed yet? If not, you're part of the problem.

(And by the way, I don't want your money.)

452 Comments

1:

Interesting. I've been trying for years to figure out what it is about American public discourse that was off-kilter, but I couldn't quite put my finger on what it was. You've summed it up nicely.

Thank you, Mr. Stross.

2:

+1 Charlie

To add to your blood pressure, witness this town hall Q&A run by Barney Frank where a questioner called proposed healthcare reforms "Nazi policies."

http://www.youtube.com/watch?v=nYlZiWK2Iy8

3:

American politics care nothing for human values, as the politicians have only one actual job: to get elected, and then reelected. They will and do say anything to achieve that goal. Our political representatives whom we elect, don't really represent us, but the people who fund them towards election. Which is not individuals, it's companies and organizations, who represent far more wealth in a contained package than any individual can. And what company cares about mercy?

4:

One comment - the generation of politicians current in power or running the parties is one that has been extremist since their student radical or radically anti-radical days. They began with inflammatory rhetoric such as "Up against the wall, M-Fer" and "Burn, baby, burn." And both sides have the moral passion of a fanatic. While they aged into the usual adult life of jobs and children, I think this mindset still informs their political opinions.

They are also the most polarized generation in American history since the one that came to power in 1860, and you know what happened then.

Says I who am a few years younger than they are and have watched them for decades. I originally cheered as they - some of them - crusaded - for what I thought was right, and then backed out is bewildered disgust as they got violent or started talking about a totally undefined Revolution which seemed to amount to tearing everything everything their forebears had built. And in that atmosphere the extremes took over and the moderates retreated as I did. They'd rather be right than functional.

I hate to be a Boomer-basher, but that's my $0.02

Pat from the States.

5:

P.S. Yeats apparently lived through such a period himself.
Consider the line:
"The best lack all conviction, while the worst
Are full of passionate intensity."

and see if you recognize anything on today's political scene.

6:

I think "rejecting the social contract" is precisely the right frame for understanding the American right (and even the middle, at times). You might even shorten it to "rejecting the social" - while Britain may have backed off from Thatcher's claim that "There is no such thing as society", many in the US have not. We still believe that unconditional personal freedom is possible and that interdependence is a problem to be overcome rather than a fact to be recognized and embraced. We believe these things in spite of overwhelming evidence that has accumulated for decades if not centuries (even in 1776, Adam Smith recognized the tremendous interdependence that makes modern systems of trade worthwhile).

A similar argument is made in much greater detail by Margaret Somers, a sociologist at Michigan. In her recent book, Genealogies of Citizenship, she draws on the example of Katrina (among others) to try to figure out what the hell went wrong in the US and why we seem to have rejected the social, and citizenship more broadly. She argues that problem isn't rejecting the social contract though, but rather that we've taken the social contract to be more contractual than we used to - we pay the government for services, and if you can't pay up, what value are you? Etc. So, more emphasis on the contract, and less on the social.

And yeah, shame and embarrassment are accurate descriptions of my feelings on the topic.

7:

Um, wow, Mr Stross. I went into this post expecting something measured and serious, and I got that... but with added body blows, unpulled punches, and serious panache. I don't think I can thank you enough for summarising some of the problems I see with American political rhetoric (observing from the relative safety of across the Pond and also from the heart of the beast) in such a wonderfully stylish way.

8:

If I might make one clarifying point:

My invocation of Rawls, cited by Our Gracious Host, was as to the healthcare debate as it has been stated in public; I was trying to diagnose the illness from a particular set of symptoms. I would go even farther than does Our Gracious Host here for the more general problem with American political discourse:

Neofeodality without noblesse oblige.

That is, my invocation of Rawls does have an underlying assumption that may not be valid at all for a substantial part of the American body politic: That "justice" — whatever it may be — is the primary and proper objective of any system of governance (whether we're talking traditional notions of "governance" or more abstract ones, or even more particular ones). However, when considering the accumulation of power without regard to its use; and the passing of that power without regard to damned near anything other than primogeniture, particularly suitability to possess or exercise that power (as understated/implied in the first episode of Blackadder III); etc.; my views become perhaps even more radical than those of Our Gracious Host. Which may seem particularly odd for a career military officer who firmly believes in the ideals stated (however haltingly, and however inconsistently — "three-fifths of all other persons") in the most radical political document of the Eighteenth Century (the US Constitution), but there it is.

9:

Why should I feel ashamed? I skipped the "turn on, tune in" and went straight to the "drop out". I'm a happy parasite on American society, taking whatever benefits I can get while I wait for the inevitable collapse, or my death, whichever comes first. I have nothing to be ashamed of.

//You'll still get my money, whether you like it or not

10:

Although there're many factors that contribute to the absence of empathy from the US psyche, one of the ones that isn't mentioned enough is suburbanization.

The US middle class - never mind the aristocracy - reside in neighbourhoods that are rich, white and McMansion'd as far as the eye can see. They never interact with anyone that isn't in their demographic, they never have to empathise because they hardly ever deal with anyone that's living a different life to their own.

They have no concept of what suffering is.

Combined with the national obsession with bootstraps and it's hardly suprising that the country's predisposition is to savage anyone and everyone weaker than themselves.

11:

This is something I've noticed before. I think it goes even further, though. I'd summarise it like this:

There is a significant number of people (particularly in the US, but there's some here too) who would rather smash things than improve them.

In the case of the justice system, they seek revenge rather than correction. In foreign policy, they would rather invade than address the causes of the issues between nations. In healthcare, they'd rather shut down a flawed NHS than improve it. This pattern repeats everywhere. As far as I can tell (and my understanding of people is admittedly very poor), they are motivated by hatred rather than hope - not any specific prejudice, but when presented with any situation, they look for something to hate and base their thinking on that.

I find these people greatly disturbing and do not know how to deal with them.

12:

(educated American viewpoints below, doesn't add much to the debate, except yes, some of us are exasperated too)

Regarding Al Megrahi, I have no problem with compassionate release... but greeting him as a returning hero in Libya was tasteless. Perhaps I'm seeing it filtered through US news reporting, but it turned an "OK, I feel for him," into "Oh. Why'd we let him go?"

On health care in the US: almost everyone agrees it's broken, we spend too much, administration and insurance company profits eat too much of the dollars, but fixing that is complicated. I fear we'll end up with a compromise that satisfies neither Democans or Republicrats, and definitely doesn't provide benefits to enough of the uninsured.

The phrase that keeps coming to mind on the US health care system is the old Camel cigarettes ad: "Are you spending (smoking) more, but enjoying it less?"

13:

When I heard that someone carried a sign saying "Keep the Government's hands off my Medicare" I knew this was a completely fucked-up discussion. Your point about the lack of mercy in the American political system is quite interesting.

14:

Your points about the lack of mercy in the US penal system are well-placed. However, I think it is a big mistake to attempt to connect a lack of sympathy for convicted criminals with the present health care debate. For example, in today's New York Times, there is a story about the massive abuse of the Medicaid system which has become a "$44.5 billion target for the unscrupulous and the opportunistic" and spends more than the far more populous California system.

There is no doubt that there is tremendous room for improvement in the US healthcare system. The problem at the moment is that very few people on the Right or on the Left trust the people who recently spent TRILLIONS bailing out the Wall Street banks to do anything even halfway reasonable about it. The fact that the Obama administration has now been shown to be cutting the very backroom deals with the AMA, AARP, and the drug companies that it recently denied only confirms the American public's opinion that there is something rotten going on... again.

The attempt to push health care reform through isn't taking place in a vaccuum. Less than one year ago, Americans witnessed a massive theft performed for the benefit of Citi, Goldman Sachs and a few giant zombie banks in the name of saving the American consumer despite the fact that most Americans opposed it. So, it seems strange that they should be castigated for failing to go along with the same political players when they are told of an even bigger crisis that must be immediately solved by the federal government for the benefit of the uninsured.

Basically, a great many Americans of both major parties strongly suspect that the reform will amount to something that screws over the currently insured, doesn't help the uninsured, and will hand massive amounts of their money to a few groups of favored insiders. And they're probably right.

15:

Another part of this is that in the US, "justice" has become a synonym for "punishment." Every time the criminal-in-chief said "bring X to justice," it was clear that he meant "string them up." (These are the same religious nuts who pretend to be Christians and think that Leviticus is the whole of the Bible. Everyone but them is an abomination unto the Lord--and they're not sure about each other)

16:

As an American, retired military type, who does buy your books and will continue to do so (my god, if I had to agree with the politics of everyone I enjoyed performing for my pleasure, I would miss out on a lot of good stuff!), I am sad to say I have to agree.

I have had people tell me that they didn't want any of their money going to help anyone else. No compassion, no mercy.

You sum it up best with the line: "a perpetual reminder to the haters that their own security is at best tenuous." This is, as my wife says, the reason why women will attach blame to a rape or domestic abuse victim, because if the victim wasn't responsible in some way, if they hadn't done something to provoke the crime, then anyone is vulnerable.

17:

What do you expect from a country which still has capital punishment? America is hopeless.

18:

My fellow Americans are almost _totally_ unable to grasp the concept of social class. There is "the poor" and "everyone else," and most people who are poor consider themselves middle class. (See "Working Class Hero" And you think you're so clever and classless and free,
But you're still fucking peasents as far as I can see
.)

This is an arranged state of affairs, brought on by 90 years of anti-red activities by Ye Olde State. Back in the day, Debs (a Socialist) could get 6% of the vote from prison. Then, there were the Red Scares, the House Committee on Unamerican Activities and related domestic propaganda, the introduction of mental hygene films promoting an atomized consumer society, COINTELPRO, Reagan/Bush/Clinton/Bush/Obama's Neoliberal policies...

Long story short, as soon as this Engineering PhD can find work elsewhere, he is gone.

19:

I've lived in the US for near 40 years (born in the UK) and, outside richard hofstadter, I have rarely seen the cultural landscape described so well in such a short space.
Not only will I continue to buy your books, I would like to see some fiction with a theme developed from this rant.

20:

Charlie: I think you're right; you've found a common thread: the notion that all people are precious no-longer seems to be popular.

I've likewise been cheering the decision to release of Abdelbaset Al Megrahi, and have been dismayed by the complaints from the White House, the Scottish parliament, and elsewhere.

I've been hoping that Obama will have a "Let Bartlet be Bartlet" moment and begin work to implement a social safety net worthy of the name.

Just implementing public healthcare would have enormously positive effects: there'd be real preventative care; the costs for everyone would drop substantially; the enormous incentive for the sick and injured to sue the people 'responsible' for their condition will disappear, as they no-longer have to recoup the crippling costs of their healthcare from each other.

Perhaps what the US needs is their own version of Tony Benn.

21:

@19: Peter V: I fear that a story on this subject might be enormously depressing, unless it was one about a group of characters fighting to fix it.

(I am reminded of Cory Doctorow's "Little Brother".)

22:

Comedian Patton Oswalt has a bit about America being a "retarted trust-fund kid with nuclear weapons" which goes (in part):

America: THIS PLACE IS PRETTY! WHAT'S IT CALLED?

Respondent: It's called 'Paris'

America: IS THERE A DISNEYWORLD?!?!?!?!

Respondent: No, we don't have that ...

America: DISNEYWORLD!!!!!!!!

Respondent: Okay okay. Just don't blow us up!

I'm sure you'll not get many arguments that our Yanqui sensibilities have been on a steady decline (if not in complete free fall). When this started to happen is open for speculation, though I personally feel it started with the empowerment of the Christian Right, and their seeming belief that Jesus was an American and that Armageddon is something we should be rooting for to happen.

But it seems that the health care debate only goes to underscore a large portion of our population's willingness (almost a seeming desire) to live in fear.

Some daffy bint from Alaska says that death panels are right around the corner, and people simply refuse to believe otherwise. Even when you read them the actual legislation verbatim. Anyone who watched Jon Stewart's interview with Betsy McCaughy can witness blinkered, philistine pig-ignorance in action (apologies to John Cleese for that line, but it fits dammit).

So now the discussion is no longer about the merits of universal health care. It's become an angry mob screaming about Socialism, Nazi-like plans, gun rights, big brother, etc. And all because someone told these people that they should be afraid.

And what's really been sad about this has been the seeming willingness of Obama and the Democrats to let it happen. They let the opposition frame the argument. You'd think they'd learn, after all these years. But I suppose old habits die hard.

I am a bit torn about Al Megrahi, I must confess. I do support the death penalty in cases of murder. If you see fit to take a life outside of self-defense, I think you forfeit all claim on your being. But it hardly matters for two specific reasons.

Firstly, he was in a Scottish jail and, therefore, subject to Scottish law. All of our protestations make us sound like ... well ... see the "retarted trust fund kid" bit above.

Secondly, the man is dying. Shouldn't see 2010 by all accounts. So what does it matter where the painful death actually occurs? Relatives of the victims probably feel different (hell, at the very least they have that right). But in a few months, this will all be a moot discussion.

Hopefully I don't have to return my copy of Wireless when it finally arrives ;)

23:

Hmm, playing with the graphs at Gapminder World[1], it seems that on a global scale, the US health system is not particularly bad — it's trailing the leaders, but it's still with them.

The crazy thing is that it's spending about twice as much as most other countries to achieve this.

The UK spends US$3064 per person or 8.2% of the GDP on health; the US spends $6657 or 16% of the GPD (2005 Gapminder figures). On the outcomes, the UK is slightly in front (slightly higher life expectancy, lower infant mortality).

That's 16%, or almost a sixth of the GDP!

[1] http://graphs.gapminder.org/world/

24:

WRT David @ 20:

Well, we don't (technically) have a peerage from which for him to step down from, but VT Senator Bernie Sanders is a Democratic Socialist. (Sanitized to "Independent" or "Democrat" in the press.) Tony Benn, for all his fine merits, doesn't seem to be restraining New Labor much. Sanders is about as effective.

We're going down like the Roman Republic after which our government was modeled.

25:

Yeah, not too fond of the political tone here myself; haven't been since, oh, Nixon maybe. Getting worse, Reagan started the really bad slide.

I don't know why it's so important, but it looks to me like the issue to far too many people is that somebody might, ever, for even a moment, get away with something; for you to obtain a benefit paid for by me that you don't deserve is somehow the worst possible thing. This is the core of the attack on the safety net programs, for example -- some people obtain services from them that they don't really deserve. Most people would say, of course they want to help the truly needy, they just aren't willing to be taken advantage of. Or maybe this is the rationalization and they really DON'T want to help the deserving, but know better than to admit it.

26:

My personal opinion, as an American who has lived both outside of America and in the heart of small-town conservative USA, is that a good part of the American cultural identity is wrapped up in the concept of self-determinism. We reject pretty heavily that anyone is owed anything—you have to work for your food, pay for your medicine, and not get caught for your crimes. The flip side to this is that if you have a wacky, risky, potentially stupid idea, you're welcome to try it. You're welcome to assume as much risk as you'd like.

Now, obviously this is not 100% pure, but the underlying beliefs run through much of American culture. We don't like people who break laws, 'cause they're gaming the system, and if they get caught, then they've taken on too much risk and they deserve what they get.

There are obvious problems with this system, and the health care debate is a good example of a place where people are unwilling to give up their potential to make bad decisions, even though it's in the best interest of society to have them do so. I wonder, though, if there's any way to keep the 'land of opportunity' mindset and still preserve social contracts, or if they're two sides of the same coin.

27:

Very well put, Charlie. The only thing I'd correct (and, BTW, I'm American) is that you forgot to mention race. American politics is... I'm not going to say all about race, but much more about race than even most (white) Americans realize.

I am convinced that the major reason we don't have a decent health care system yet is race. You can motivate a substantial fraction of Americans--especially in the southern states--to vote against their own self interest by suggesting that it might lead to "the undeserving" (for which, read "the brown") getting goodies too. Combine that constituency with the money power of insurance companies and, at least until recently, you had a sufficient coalition to kill health care reform. We'll see whether it's still big enough now (I'm cautiously optimistic).

28:

I once heard it said that, outside of the USSR, America was the most regimented society on the face of the planet. Well, consider that regulated, production-line (non-religious) mind control began with Edward Bernays and the not-so-high-minded Wilson administration back in 1916, and boy, hasn't it been a long, weird advertising barndance since?

As for Megrahi and Lockerbie, I strongly urge everyone reading this to google 'Flight From Justice pdf' - that was the investigative article by Paul Foot, published by Private Eye several years ago. It has ALL the gen, up till that point anway, and leaves no doubt whatsoever that Megrahi was fitted up. The perpetrators of Pan Am 103 are still walking around, free as can be, and our government, the US government, and Gaddafi, all know it.

29:

Are you ashamed yet? If not, you're part of the problem.

No, Charles, I'm not ashamed; I'm angry - furious that the few with the loudest voices and deepest pockets can make the rest of the world think the whole barrel is rotten.
I really and truly believe that the biggest problem in America today is apathy followed closely by a deep-seated sense of entitlement. Everyone has Rights, but few are willing to accept the Responsibilities that are part and parcel of having and maintaining them.
My one vote doesn't count for much in the grand scheme of things, but if I didn't vote, it wouldn't count at all.

30:

Bravo! More money to you from sane people!

31:

I don't really understand it, but the American public is like a blank slate waiting for some idiot asshole with an agenda to tell them what they think. There are television commercials and powerful groups behind this anti-healthcare thing. Probably the insurance companies are a large part of it. The right powerful parties can tell the citizens any damn thing and they'll not only believe it, but will fight for it! Even if it's bad for them personally, and/or bad for the public as a whole. They can't explain their position, so they get hostile instead. They can't explain it because they don't understand it, they are just doing what somebody they follow told them to do. If they'd take a moment to THINK, chances are they'd figure out what idiots they're being, but the powerful parties warn them against thinking or listening to reason - so they don't! That's the part that bothers me the most. That many people don't even understand why they are taking the position they're taking, and that they refuse to even THINK about what they're doing. It's just about getting an emotional response from the masses, they'll follow the leader to their demise and scratch your eyes out if you try to warn them too aggressively. It's a constant source of wonder and frustration for me.

32:

Apropos Mike Cobley's comment, Paul Foot summarizes his investigation here:

"There is, in my opinion... an explanation for all this ... It is that the Lockerbie bombing was carried out not by Libyans at all but by terrorists based in Syria and hired by Iran to avenge the shooting down in the summer of 1988 of an Iranian civil airliner by a US warship. This was the line followed by both British and US police and intelligence investigators after Lockerbie. Through favoured newspapers like the Sunday Times, the investigators named the suspects - some of whom had been found with home-made bombs similar to the one used at Lockerbie.

"This line of inquiry persisted until April 1989, when a phone call from President Bush senior to Prime Minister Margaret Thatcher warned her not to proceed with it. A year later, British and US armed forces prepared for an attack on Saddam Hussein's occupying forces in Kuwait. Their coalition desperately needed troops from an Arab country. These were supplied by Syria, which promptly dropped out of the frame of Lockerbie suspects."

If you want to read the full report, Private Eye will sell it to you for a fiver.

33:

I think it's worse than just a lack of mercy,; there's an easy extrapolation to a lack of empathy in general, and that then heads to a root cause — an selfishness ingrained in the communal psyche of the middle class. They only deserve the best, and no-one else matters.

The same selfishness was on show on when the tax plan was going through Congress — even though the vast majority of people actually got a tax break, they complained because they believe that one day soon they'll be in the bracket of those whose taxes were increased.

34:

@26:

The land of opportunity thing is a bit of a myth, too. It may have had currency in the past, but today it's been shown that social mobility in the US is lower than in European social democracies. In fact, this shouldn't seem so terribly counterintuitive: if you don't have any sort of social support to fall back on, you're going to have to take a very different attitude towards risk. When risk means living badly from a low state subsidy for a while until you can bounce, you can get a lot more daring than when it means losing everything: home, social respectability, medical care...

However I think this lack of mercy is not a uniquely US phenomenon. Here in Europe we have our own issues in this regard. It's just that, perhaps, the process is not as far advance. But more punitive laws, and demonisation of outcasts (illegal immigrants, in the UK asylum seekers, "benefit leeches", etc) are not unknown in this old continent.

35:

Mercy is a complex thing in geopolitics, easy to take an action that looks merciful but increases the chances of another airliner getting bombed.

Geopolitically, I don't see the value in giving him a get of jail free card if he is sick. Nor do I see a lot of harm in it

As far as America's take on healthcare goes, it's basically a bastardization of tough love.

And "this century"? You got to be kidding me. We've gotten quite soft compared to the last two centuries (-:

Fundamentally it comes down to what you think the purpose of society is? How to balance incentives that maximize the rate of societal advancement and production of extraordinary people versus maximizing immediate health and welfare of the masses?

Would it be merciful to put into a place a system that increased healthcare for the lower and middle classes if the price was a 5% reduction in medical R&D and technical advance?

Tough question.

I think the underlying philosophy behind a lot of this thinking is that too much social safety net will prevent society from achieving maximum potential by killing off societal drivers for self reliance and self determinism.

That is something that there is reason to believe has happened in Europe.

Also the fear that if we destroy the profit margin in healthcare we kill innovation.

It's actually quite a thorny problem. However a lot of the assholes making the arguments both ways are trying to ignore the thorns

I am personally for the some variation on the Obama plan

36:

I've been pointing out to anyone who complains about Al Megrahi's "hero's welcome", just how often in the UK "we" (in as much as a few hundred people at an airport can represent an entire country...) have given plenty of similar welcomes to Britons convicted in another country on their return to ours, where we have believed them to be unfairly convicted, yet the country returning them has not dropped the conviction.

As for Americans objecting to heroes welcomes for terrorists, two words: Gerry Adams.

It's a particularly relevent example in fact, because it also illustrates that sometimes the best solution to stopping the terrorism is to let people out and engage in a way that doesn't involve bombs: do we want more Pam-am's, or should we just accept that the past can't be changed and get on with the fact that talking to Libya seems to resulting in less deaths now and in the future, just as it has in Ireland?

37:

Like Kerry, I'm not ashamed, but to say that I'm angry -- well, there are no words for how I feel. Just thinking about the subject of health care makes my heart race and my blood pressure rise. I'm seeing a repeat of Clinton's mistake in slightly different words. Hell, the very first damned thing Obama did was to take single-payer off the table. The very first thing he did was to cave in to the Right before even starting to fight. I had faint hope for Obama, to say that he's better than Bush is to damn him with faint praise.

To those wondering how this all started, it was there from the beginning. The Puritan ideas took root early and have prospered. I regularly find myself in arguments with fools who think that they are utterly independent, who "pay their own way" in every way and who claim that everyone should do this, all the while utterly blind to the benefits they reap from the society of which they are a part. They condemn anyone that doesn't believe as they do, live as they do, look like they do, act like they do. Worst of all, they condemn anyone who would live on "government handouts" while at the same time depending on their monthly Social Security checks to keep them in groceries and electricity.

And yes, you are exactly right but if anything you understate. The proportion of people who hate the poor and want them to die is larger than you would believe. Of course, they won't express it like that, but that's what it amounts to. The worst part is that many of these people (using the term loosely) who loathe and abhor those less fortunate than them are themselves loathed and abhorred by those who have more wealth than they. They consider themselves part of the "elite," all unknowing that the truly wealthy would cheerfully and without a second thought consign them, too, to death by starvation, disease or neglect.

Those fucking bastards are the _enemy_ and deserve to be fought tooth and nail until they or we are utterly defeated. Instead, those who should be fighting them are _appeasing_ them, are seeking their _approval_. Meanwhile more people are starving, more people are dying of easily-preventable conditions and conditions in many parts of the South and Appalachia have reverted once again to that of the Third World (ref http://online.wsj.com/article/SB125090339313750961.html).

What's the solution? I haven't the first fucking clue. I hope it doesn't involve violence but I'm afraid it might.

And my blood pressure is up again. Time for some deep breathing.

38:

It's about race. Any social welfare system in America disproportionately transfers from whites to blacks and hispanics. Whites are mostly not eager to do that, or, more generally, people aren't interested in supporting those they perceive as outsiders. American opposition to social welfare programs springs from this. Who do you think Reagan was talking about when he campaigned successfully against welfare queens in Cadillacs?

Besides that, it has been shown that diversity is correlated with declining civic engagement: http://www.boston.com/news/globe/ideas/articles/2007/08/05/the_downside_of_diversity/

"Harvard political scientist Robert Putnam -- famous for "Bowling Alone," his 2000 book on declining civic engagement -- has found that the greater the diversity in a community, the fewer people vote and the less they volunteer, the less they give to charity and work on community projects. In the most diverse communities, neighbors trust one another about half as much as they do in the most homogenous settings. The study, the largest ever on civic engagement in America, found that virtually all measures of civic health are lower in more diverse settings."

Do you think people who are not engaged, and don't do things like vote or volunteer, give a crap about some stranger's lack of health insurance?

39:

I was born in Alaska. Mark Russel said,"A republican in Alaska is a True Republican-even if they're a Democrat!" But during the Reagan Error I became disenchanted with the growing mean-spiritedness of the GOP. The joke is they stay awake at night afraid some poor shmuck might get a cheese sandwich he doesn't deserve.
The arguments against Heath Care go to simple & emotional phrases like "Death Panels". Legislation,of course has to be long, precise and becomes such a mish-mash...There are also people who wouldn't go along with a BLACK President (I live by some of them) no matter what!
I almost think the Dems delayed the vote on purpose. I mean to young people the GOP must seem like a bunch of crabby old farts! Screaming "Socalism" how mid 20th century! Especially when most of our stuff is being made in China.

40:

It's bread and circuses here, just without the bread.

I've lived here all my life, and completely don't understand it. And yes, I'm ashamed on behalf of my country, and angry, and frustrated. And I wish the vocal lackwits didn't represent us to the rest of the world.

This was crucial to the founders of the US:

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

but we as a country seem to have forgotten everything after "defence".

41:

As an Englishman in New York (8yrs, now) I get to see a lot of this. Last week, walking to work, I saw a few NY newspaper headlines screaming about the release, and tried to work out just what they were getting frenzied about; internal debates on why we imprison people and so on.

In the end I came up with one word: REVENGE.

The American "justice" system isn't about rehabilitation, about protecting society, about deterring crime... no, it's about revenge; an eye for an eye. Of course mercy doesn't come into it!

42:

Delightful to have my own gut-feeling expressed so cogently. It reminded me of this news story that I read when I was visiting Pittsburgh on an internship from the UK. I was struck at the time by how the facts - a struggling 13 year-old who sounds, frankly, depressed, who is taken into care as a punishment for missing school - were presented just as facts, with no sense that there might be any alternative approach.

The problem is that too few truants are sent to court.
Problem, indeed.
43:

I have to say that I think you have the wrong analysis. As a Brit who's lived in the US for over 20 years, my perspective on the US is somewhat different.

Your theme is the 'lack of mercy' and one theory you posit is that there is a hatred of the poor. Apart from my observations that this is not true, if it were so, then one would have to explain why charitable giving is so very much greater in the US than elsewhere. On it's face, this seems to be a counter-factual to your thesis.

The health care issue is far more about the ideology of government involvement that anything else. The US is set up to limit government involvement and the Reaganite ideology that "the government is the problem" which has been stoked by the right wing for 30 years is what is at the heart of this debate (and the cynical use to which it is put by the vested interests). Talk with many Americans and read the poll questions about health care and you can see clearly that the issue is about who runs the system, not about the desired outcome. Certainly there is a group of people who think that health care is the same as any other good or service and should be paid for individually, but these people are easily identified by their opposition to public schools and social security too.

The rhetorical device of attaching to all Americans a common label is wrong. The US is a very diverse set of cultures. Individuals here, as they do, as in the UK, exhibit a wide range of ideas and beliefs. At the very least, one should be able to discriminate between the public postures of politicians and the real beliefs of the citizenry. Did anyone ever believe Margaret Thatcher's views reflected that of the UK as a whole?

Finally, I am not one to allow political views of a creator to determine my reading. You have excoriated Orson Scott Card's views on same sex marriage in another thread, and while I have not read anything of his for a long while, should he produce something that I would like to read, his antithetical views on the marriage issue would not influence my decision to buy it.
It only becomes an issue for me if the created work becomes a soapbox for the author's views.

44:

Charlie...yes, I am an American, who has voted for the Republicans and Democrate equal numbers of times...but...BRAVO!

I agree with what you said wholeheartedly, and you changed my mind about the release. After reading your post...I have come to agree that you are right about letting him go home to die.

So let me, an American, vent a little bit about what has become of my country of late.

The political system in the US is melting down, and the US calls itself a "Christian" country (at least the Conservatives call it that). But America's attitudes towards compassion and the poor and the sick are truly anti-Christian. In face, truly Satanic. Truly evil. No compassion, and no desire for anyone to give up even a dime to help those less fortunate than themselves.

Our drug laws, for example -- unjust and ineffective (and I have no love for recreational drugs, and I wish they could be expunged from the world, but this is impossible). Legalizing them would do far less harm than the current drug laws, and not increase drug addiction one whit.

Our healthcare system, which has totally failed to control costs or promote quality, or even allow choice for many (most) people. The utter, cynical, self-serving hypocrisy of the so-called "Conservative Republicans" (and I used to be kind of a Conservative Republican, too, back in the 80's) of today.

America seems to have a malignant streak that crept into its character in recent years. It is a cancer on our nation. If this cancer is not cured, I shudder to think of what will become of this country.

Ed

45:

Poor post Charlie. Not that I disagree with some of the points, but it s a jumbled mess if unrelated things.

Al Megrahi - stipulate, for a moment, that he's guilty. 270 people were blown into small chunks of flesh. Why should we have mercy on the person who did that? Yes, he's dying... but why shouldn't he die in prison if he is guilty? AS to the White House commenting... 180 of those 270 people were US citizens. I think that entitles us to comment. If the reverse were true and someone who'd been convicted of murdering 180 UK subjects were being released like this, am I to believe the British government wouldn't have an opinion? Please...

As to his guilt, well, if your justice system convicted an innocent man, I'd say that's YOUR fuckup. Oh yes, I know, the all powerful CIA. Again... please. If Al Megrahi is innocent or there are powerful reasons to believe the trial as tainted by bad evidence he should have been retried *whether or not he was ill*. His illness and his conviction aren't related unless you'd like to argue that it's fine to jail an innocent man if he's not dying or that you should release a man guilty of 270 murders because he his. We disagree on that latter... and on the former.

46:

unholyguy: Would it be merciful to put into a place a system that increased healthcare for the lower and middle classes if the price was a 5% reduction in medical R&D and technical advance?

Tough question.

Not tough at all: it's a straw man argument, and the correct answer is you do it.

Hint: medical R&D and technical advance (a) benefits the rich disproportionately (consider the crappy state of R&D funding for diseases of poverty, for example) and (b) is a tiny chunk of the medical budget -- indeed, the pharmaceutical industry spends a whole lot more on advertising than it does on research. Most actual useful research comes from government funded institutions such as the NIH, academic institutions, and/or charities such as the Welcome Foundation.

(Oh, and (c) a 5% reduction in R&D progress means at most a one-year-in-twenty decrease in incremental improvements. Insignificant, unless summed over a period of multiple centuries.)

In contrast, improving healthcare for the poor is merciful, period. Remember: 22,000 avoidable deaths per year due to a broken healthcare system! Your government spends US $100Bn a year on the TSA to avert another 9/11 -- what should it be spending to mitigate ten actually-occuring 9/11's-worth of deaths every year?

It seems to me that you've been drinking the wrong kool-aid.

47:

I would agree that a lack of mercy helps stoke the resistance to health-care reform (or more properly, health-insurance reform), but I don't think that's what animates it. There are two things really driving it:
1. Entrenched interests that don't want the reform (I heard that the US insurance industry is spending $6 million/day on anti-healthcare lobbying right now).
2. Nutty right-wingers (but I repeat myself) who are violently opposed to any policy advocated by Obama. Obama could propose a resolution stating "pie is good" and they'd be holding anti-pie rallies.

It just so happens that the entrenched interests are good at whipping up the hysteria of the nutty right, as we've seen with Betty McCaughey's death panels and Dick Armey's step-by-step instructions for disrupting meetings with legislators.

48:

You pusillanimous pussy. Mercy is for the weak and slow of mind.

49:

Rick @43: so, to paraphrase, you consider revenge to be good?

Your second point: on a smaller scale the British government has a tendency to wash its hands of stuff outside its borders. And to cave, flatulently. I for one find the Scottish government's willingness to stand up to bullying somewhat more encouraging than Westminster's supine posture over, for example, the Gary McKinnon case.

Furthermore: Al Megrahi had an appeal in process, winding through the Scottish legal system. He abandoned it last week because it would have blocked the application for release on compassionate grounds and was unlikely to come to trial before he died of cancer. Yes, this highlights a problem with the Scottish legal system (lack of urgency in processing appeals).

Finally: there is an old principle of justice that it is better that ten guilty men go free than one innocent man lose his liberty. If this sticks in your throat, just consider the possibility that it could be you.

50:

Ken MacAskill spent 25 minutes justifying the decision. He made a long and eloquent case for mercy. However, if it had been me I would not have released Megrahi until he was unable to walk unaided - then there would have been fewer triumphalist scenes in Libya. Also, I noted Gaddafi's quite restrained speech, different in tone from what came after.

51:

Ming: how good is your health insurance?

(Friendly tip ... this blog has a moderation policy. Read it before you post again.)

52:

Thanks, Charlie. You've nailed it.

53:

Only a snub European could turn such a serious slap in the face of justice into a childish anti-American tirade.

If you truly think that a person who murdered 270 people can even be rehabilitated, then you have other issues. Never mind the fact that he served 11 days for each person murdered (I'm sure that gave him a lot of time to contemplate the gravity of his actions... yeah). I guess you prefer the UK sentencing system, where rapists and murderers are released in 3-5 years? In my opinion, crimes do exist where capital punishment is warranted. Murdering hundreds of people would be a good example.

Oh, but of course, he was innocent, right? Well why not give him a new trial? It's not the fault of the USA that Scotland can't properly run a justice system.

More sickening than any of that is how you spend the second half of your article running us down, in a way almost justifying the murder of my fellow citizens because they were members of the Big Bad Empire. Sickeningly, you're just reflecting the same vibe that I get from reading the reader comments on many UK online papers. I think that if we had another 9/11 the UK would be in the same position that the stone age Arabs were in the first time around - laughing and dancing in the streets.

If anyone is lacking empathy, I think it is you, Mr. Smug European

54:

Ironic Cross First Class to 'Son of Steven Seagal'! (What's next -- "John Wayne's Right Nut"?)

Step out from behind the Anonymous Coward alias and I might take you a little more seriously.

Meanwhile -- until you give me half a clue that there's something more to you -- I'm just going to picture you as an overweight Mall Ninja type, wanking over his knife collection in the privacy of his parents' basement. OK?

(PS: I see a sudden influx of trolls starting after 6:45pm, or around 1:45pm EST. Has this post been picked up anywhere 'interesting'?)

55:

As someone who was not born in the States but came to it later in life, I have the (perhaps dubious) privilege of being able of now being INSIDE a system which I am able to parse from an outside perspective. And what you say, Charlie, is very much what I am parsing the system as. Right down to the "crappy little country" comment. I was born on one of the "crappy little countries" that the United States destroyed in order to use its rubble to shore up its footing in the world. What mercy...?

56:

Charlie the leaders of our country are bad, stupid in groups and generally corrupt, why should we have even a modicum of mercy for them? Your moderation is fine, I figured you would see the joke, but the issue is real. I have been on the wrong end of law and I have a contempt for this system that won't end. Mercy is in the eyes of the beholder and I've none to spare for the f'ed system that frankly is holding me back. You know what it's like to start over, again and again. The best thing is that it is all falling apart and for the first time in years I feel we can get ahead again. However mercy is a thing enjoyed by victors and my side has not won yet. Your mileage may vary.

57:

Ming: Sorry, irony doesn't work well in pure textual media.

58:

There are two subjects here, and although I agree they are linked by something in the American psyche, I'm not sure how close the link is.
The Al Megrahi case is straight-forward, and its coverage in the UK news media has been utterly shameful throughout. Everyone and his dog has been interviewed, and mostly they have voiced their basest instincts for revenge. Where have the moral leaders, the philosophers, the ethicists been, to explain the meaning of compassion? As a society we used to hold compassion as a virtue. Now we see it as a weakness.

"He never showed any compassion". So what? What the heck has that got to do with anything? Are we supposed to model our society's morality on that of its enemies? This is exactly the same nonsense which we have heard about torture, about Guantanamo, and about the whole GWoT. And it's a sign that the terrorists have won. They dictate the agenda, and those who share their shallow revenge-fantasy worldviews are in charge.

As for the US health-care debate, that is being driven entirely by the richest segment of society. Politicians who are bought and paid-for by the insurance industry, talking to TV pundits who can't afford to show us the poor. Kudos to the few among this elite (such as Jon Stewart) who are willing to stand up and say (paraphrase) "everyone needs health-care, and I am prepared to help pay for it."

The average American, despite all the propaganda, is very much in favour of a single-payer health-care system. Congresscritters who pass a universal health-care law, and the president who signs it, are guaranteed re-election and a place in history alongside FDR. Anyone who opposes it will never be heard from again. All the arguments you now hear against it were used against Medicare, against Social Security, against Medicaid. Try scrapping any of those systems now and you'd see a revolution.

The US could have a health system as good as the UK's, paid for entirely out of government money, without spending another cent. The per-capita cost of government health-care (Medicare, Medicaid, VA) in the US is more than the per-capita cost of the NHS. This is the right thing for the US government to do: hugely enlarge the VA and extend its benefits to all, free of charge, paid for by merging in Medicare and Medicaid. Anyone who wants to carry on buying health insurance is of course free to do so (just as they are in the UK). This will destroy the insurance companies. Fuck 'em. They exist to suck money out of the healthy and to deny care to the sick. They are scum and are lucky to stay out of jail.

59:

Peace is War continued without overt violence, people still die horridly over ideas in conflict. Ming knows this well.

60:

Print this post up as a book, I'll give you my money for it. Send a bunch of copies to Congress while I'm at it.

61:

Thanks for this, Charlie. Necessary and important. And I am greatly amused by the less-than-cogent criticism.

(BTW, I *did* Twitter about this a little while ago, but it was after the 1845hrs point you mentioned... but my apologies if I drew some flies.)

62:

Many thanks for noticing the lack of compassion in the US healthcare debate. I certainly don't think "hate the poor and want them to die" is an overstatement; if anything, it understates the level of indecency thrown at the less fortunate by the extreme right wing. Unfortunately, they have their own news network, so they never need to stick their heads outside their own echo chamber....

By the way, I, for one, tend to buy books *more* often from those authors courageous enough to take a stand on issues of substance. Please don't fear the soapbox; in the US at least, I can assure you that Republicans don't understand your brand of humor (it requires an education, and they *hate* the education system) anyway, and so are far from your most loyal buyers.

63:
(PS: I see a sudden influx of trolls starting after 6:45pm, or around 1:45pm EST. Has this post been picked up anywhere 'interesting'?)

Erm, whoops? Sorry. I thought it was too good an article to not be read.

(BTW, thanks for Wireless)

64:

I am a Yanqui and don't disagree in the main with any of these assessments. But I think it's important to keep in mind the historical context of the United States in these dynamics: basically, none of this is particularly new. The U.S. was until the 20th C. a shockingly lawless place, much more violent than Europe even then. This ebbed through the 20th C. just as the full force of the state's monopoly on violence was used to repress (often by means of terrorist violence) a large segment of the population; murder and other violent crime went back up when this was no longer a tenable strategy, and in response state violence was increasingly used to respond.

There was never any golden age of civic righteousness, democratic equality, peace or an undisturbed social contract. To the extent it might appear so in retrospect, those previous arrangements were always based on systematic exclusion of women and minorities from the deal. The great egalitarian measures of the New Deal, home loans for returning GIs, etc., were only possible through the explicit white supremacy of their distribution. Mercy and equality, in short, have always been highly contingent in the US: it's not "getting worse," it is and has been.

The last generation of economic deregulation has exacerbated the badness of outcomes for the poor (see Barbara Ehrenreich's recent excellent column for more on this) and of course the market has no mercy. But to the extent that the general populace is lacking in mercy it's a mercy that has been historically absent, except in those circumstances where majority groups could be assured their mercy would only be bestowed on those like themselves.

As several commentors have mentioned, this really is about race. It's all about race, always, in America. It was our original sin and we've not gotten past it yet, and it leads to all sorts of variously awful societal dysfunctions like Charlie mentions. My only small consolation is that the powerful have always been interested in limiting the rights and justice of as much of the rest of the populace as they can, and they are broadly less successful now than they have been in the past. Always more work to do, but this is not something that can be viewed in isolation: it's part of a constellation of dysfunction that only through sustained demands for justice and equality (always and ever put forward by a relatively tiny part of the populace) can we make progress.

65:

Mark: Nothing to apologize for -- I was just curious as to where the noisemakers were coming from. (I try to keep a reasonably civil level of discourse going here, so folks like "Son of Steven Seagal" are a bit anomalous -- symptomatic of another slashdotting or similar.)

66:

the flow proceeds by transcendence of polarities

67:

Its been said before but we have to say it again because no-one was listening -

MEGRAHI DIDN'T DO IT.

Read the Private Eye/Paul Foot report, and look up the additional article he wrote for the Guardian in 1995. And consider cases like the Birmingham Six - why are people who clearly know next to nothing about the Lockerbie case so grievously positive that Megrahi is guilty? For further info, go take a look at innocent.org.uk

68:

Pat Matthews, #5, no, he was predicting our period. And, as the title of the poem implies, he was also predicting the arrival of a new avatar and wondering if this is something to hope for or dread.

Charlie, this wasn't always so: it seems to have re-emerged as a backlash to the period of liberation of the 1960s and early 1970s. Nor is it universal in US culture. In fact, it may be a minority characteristic. Unfortunately, it's the minority that's in charge. We've had a generation-long campaign to establish a class system in the USA. It has succeeded to the the extent that sober IMF economist Simon Johnson can write about "The Two-Track Economy". Like all class systems, the resurgent US class system is based, ultimately, on contempt by each class for the class below. And, like all class systems, it needs enemies to validate it. For decades we had the USSR. With the USSR gone, there was a search for new enemies, and in Arabs and "terrorists" US "conservatives" found them. The "every man for himself" (it is sexist) ideology of naïve libertarianism plays into this, and of course the whole country is very unhappy because of the recession.

69:

@Charlie 46 it's hypothetical agreed, but not straw man

But still, let's rephrase and spell out the assumptions

Let's assume for a second that government sponsored medical R&D efforts are less effective then private sector. I agree that is a supposition and not proven.

Inherent in this line of argument is a supposition, that private sector is for various reasons faster and more efficient in some things (like innovation) then public. I agree without that axiom the line of reasoning falls apart.

Something like 7 million people die of cancer each year

Let's say a cure is 20 years out

Let's say a socialized medical program in the US makes it 21 years out.

That is 7 million dead people yes?

Now you can argue rollout times and whether such a cure would fully penetrate but regardless that extra year buys you a significant number of live people versus dead people.

This type of benefit from acceleration is repeated throughout the industry.

Also are you really saying that medical research only benefits the rich? Why would you think that? The advances may start out expensive but they do not necessarily remain so.

I'm not arguing against reforming the current state of medical affairs in the US, mind you, but what I am saying is that things are not as clear cut as all that.

Having worked for many years in silicon valley I do very much believe that private sector innovation is not something easily duplicated via government.

70:

I thought "Ming's" irony was pretty evident. I mean, "Ming" in a column titled "Merciless?"

71:

Reply to 11. Many people don't believe that rehabilitation is possible. Others don't believe that we know how to do it. (I fall into that group, although the evidence at hand shows that the current US techniques tend to make matters worse. My general preference is for drastically shorter sentences, but TRUE isolation. Including both guards & other prisoners. [Pre-existing medical conditions would limit the feasibility of this, but such should be rare, and thus not worth bothering about.])

To my mind the first step is to disrupt the prison gangs. One achieves this by true isolation. But people don't like to be isolated, so that, in an of itself, acts as a punishment. The shorter sentences are thus no problem, and may aid things. They give the imprisoned time to contemplate his life, and make new decisions, without stealing so much that there's no life left to return to. I think that something like 3 + the square root of the current sentence measured in days might be appropriate.

N.B.: I've got an idea of what should be tried, but when I started writing it up it quickly got too long. But the purpose is to initiate an inward journey, and to minimize non-self-generated stimuli. So the tools of a writer, a musician, a programmer, a choreographer, a painter, etc. are appropriate, but the cost needs to be limited to something reasonable. So does the size, so don't ask for a grand piano, even if you're willing to supply the grand piano.

72:

I agree with Alex @43. The US is a big country and not so easily characterized by the simple minded generalizations found in this post.

Yes, US health care reform is sorely needed. Polling has shown that a majority of US citizens understand this. The difficulties in passing legislation implies that our political system is also in need of reform. Also, I believe the issue has been sidetracked recently by the attention the media has given to a loud, deranged, and paranoid minority.

I have no problem with the Al Megrahi release (though I wonder why he couldn't have received hospice care in the UK). I do, however, have a problem with the welcome he received back in Libya.

(btw, I recently enjoyed Iron Sunrise)

73:

@67,

Pick another argument. A social healthcare system would not impact R&D. R&D is done by private healthcare companies investing money from current profits to create potential future profits.

All social healthcare would do is move the entity paying current bills and buying current medicines from private companies aiming to make profits to a social entity trying to provide healthcare to more people.

74:

Bravo. As another Brit transplanted to the US I echo the sentiments and the statements.

75:

Charlie - have you gone weak in the head? The opposite of mercy isn't necessarily revenge, but it can be justice. If you simply want to demonize any point of view that disagrees with you, just say that and I'll leave you all to wnk in private. If not well... stipulete, for the moment that he's guilty of killing 270 people. Why isn't the right thing to do to provide him good care in prison? Revenge would be to let him die uncared for at all which isn't what I'm saying. The intersection of justice for a mass murder and mercy for a human being would have been to treat his cancer in prison. Perhaps even allow and enable visits from his loved ones so that they can say goodbye.

AS to his guilt... i'm not about to take the time to read the report metioned above, but let's flip our stipulation and assume he's innocent and was railroaded. Then shouldn't you have released him regardless of his health? Or is your vaunted conscience only pricked when you can feel good that you let a dying man out and you can congratulate yourselves on how superior you are and you'd be content to have let him languish in prison if not for the cancer?

76:

@71 it depends a lot on whether the social medical system is set up i suppose. I believe that we can have the best of both worlds, however I think wrecking the current medical R&D powerhouse of the world is a risk

According to wikipedia Tthe US currently accounts for three quarters of the world R&D in biotechnology and three times as much per capita as Europe.

Why is that exactly?

77:

@69: "My general preference is for drastically shorter sentences, but TRUE isolation. Including both guards & other prisoners."

There was some research on that a while back. Apparently true solitary confinement does very, very bad things to people. Like, torture-bad. Of course, since the actual extent of the damage isn't that widely known, it's not even a good deterrent.

78:

unholyguy: I hear your argument and dismiss it out of hand because, frankly, if I choose my own axioms as carefully as you do I can prove that ZOMG!!! leaving healthcare in the hands of the for-profit system COSTS MILLIONS OF LIVES!!!

Srsly. Get real, m'kay?

(Let me unpack the flaws in your argument.

1. "Cancer" is not a disease, it's a collection of different pathologies that we're just now beginning to understand at a genetic level.

2. You don't "cure" cancer, you simply shove it into remission. Different techniques work on different strains. Different techniques have different side-effects. Some types are near-as-dammit curable today; others, not so much. The number we can put into indefinite remission is, however, climbing steadily over time (rather than being a binary function of some breakthrough: no cure exists, then: cure.)

3. You are postulating a causal link between "socialized medicine" and "delays to basic research". This is bogus; believe it or not, the UK -- with about the most socialist medical system around -- hosts a thriving pharmaceutical R&D industry and punches well above its weight in medical research.

4. You're misrepresenting me (uncharitably: lying about my position): I said that commercial medical research benefits the rich disproportionately, not that it "only benefits the rich". Reason: in a commercial healthcare environment, the research is driven by the existence of a consumer market, i.e. people with the ability to pay. The poor don't have money: ergo they aren't a market.

5: Your sacred Silicon Valley cash cow is massively (indirectly) funded by the government. If you don't believe this, go look up who Fairchild Semi and Intel's first major customers were. (Hint: most of their products ended up working for the USAF in things like the Minuteman guidance computer.) In much the same way: most basic medical research is carried out by teaching hospitals and university departments studying various fields; this is both basic research (without which Big Pharma wouldn't be able to figure out possible strategies for pharmaceutical treatment other than by fumbling in the dark, as they mostly did prior to the 1990s) and applied medical research (organ transplants, face grafts, that sort of thing).

NB: I used to have to deal with drug company reps back when I was a clinical pharmacist. The picture was a lot uglier than you seem to realize, and that was twenty years ago -- it's a lot worse these days.

79:

@unholyguy - could you cite the Wikipedia link you used so we can look at your numbers and work out the correct conclusions. I've seen a lot of disinformation this week based on a completely incorrect reading of a CDC study on US infant mortality.

@rick - Your later example is a strawman, if he was innocent and railroaded the political realities are release wouldn't happen outside of a formal appeal, which takes time, and, as has been noted, didn't take place because he'd have lost the chance for the compassionate release. The real issue is that, as Charlie notes, this is a FEATURE of the Scottish legal system, not a bug.

80:

Ed @44 But America's attitudes towards compassion and the poor and the sick are truly anti-Christian.

I think I have to disagree. The right-wing evangelical sort may claim to be compassionate, but their words and actions show otherwise. A few years ago our local paper printed a letter from a local evangelical minister (I think one from Focus on Family, but don't hold me to that) who stated that Tolerance was not part of his religion. The right-wing Jebus is the one who, supposedly, said "Bring the unbeliever before me and slay them." and "Think not that I bring peace, I bring the sword."

Apologies; quoting 'scripture' isn't my usual thing.
---
As for Obama's statement, I can't help thinking that he had to make it for political reasons. His opponents would surely jump on any other statement, or lack of one, and use it against him -probably invoking his middle name. Not that that's an excuse, but he has enough tsuris as it is. We'll probably never know what his actual thoughts are.

Other than that quibble, Bravo to you, Charlie.

81:

I normally make a habit of not commenting on political blog posts, even those that, like this one, I by and large agree with. However, I deeply dig and respect your work, and so I thought I'd chime in here.

In my own defense as an American: we are not nearly as unified in opinion and belief as we often seem to be. Even amongst American conservatives, there is a fairly wide spectrum of views on health care, the prison system, etc.

America is a massive nation made up of a lot of smaller states. We're a nation that's easily as diverse politically, economically and culturally as the European Union, maybe more so. Consequently, saying that "Americans believe X" is like saying "All Europeans believe Y", with no consideration of the differences between, say, the beliefs of the average Dane and the beliefs of the average Italian.

For example, I am a Texan living in Las Vegas who works in the medical industry as a programmer, and I am utterly in favor of a totally socialized health care system. Nor am I particularly unusual. Almost every single person I know or talk to thinks universal health care is an excellent idea. I can't think of a single person I've encountered who doesn't believe that.

And yet all you hear about on that side of the pond are these right-wing lunatics who seem to think that Obama is behaving like Hitler by wanting to give them free medical care. These people are universally ridiculed here; they are fringe players at best.

Our media is an extremely warped lens at the best of times, and these are not the best of times. I'm not saying that the collective American psyche isn't deeply fucked up in a lot of ways...just that we might not be as united as you might think.

82:

Charles @69: the first step to fixing the US judicial system is to get the mentally ill out of the punitive system and back into a controlled medical environment for treatment.

That'll reduce your prison population by 50-70% in a single step, break the link between mental illness and crime, and let you focus the judicial process on actual criminals and medical treatment on the homeless schizophrenics who can benefit from it.

(See also: why "care in the community" was a crock all along.)

Disrupting prison gangs: good. Isolation: bad. Again, some readings around the outcomes of the Victorian (English) prison system would be appropriate -- they were big on isolation then. (It didn't work.)

Rick @73: we do not serve justice by basing our own moral standards on a false equivalence with criminals -- lowering ourselves to their level. (For the record: I also think the evidence that Al Megrahi was framed is substantial and very worrying, and I would be a lot happier if he hadn't been convicted in the first place -- or if his appeal had been expedited.)

unholyguy @74: this is not clear. All these figures prove is that the USA spends more on research -- not that the research is more productive. If, for example, it's precisely as efficient as the rest of your healthcare system, then the EU's spend is worth twice as many dollars as the figures suggest. (Snide? Sure. But an unbelievable amount of commercial research in the USA goes into developing patentable "me-too" drugs rather than basic research on, like, developing fundamentally new treatments. Because a "me-too" drug can grab a chunk of an existing market, so it's easier to justify to the bean counters. See also Sarbanes-Oxley.)

83:

It's sad, pathetic, but not the least bit surprising that people would conflate the justified outrage over a mass murderer's release with the health debate. It's made all the more pathetic given that the release was a clear attempt to curry favour with Libya's regime, and had little to do with the twisted sense of "compassion" that was trotted out by Scottish leaders. That Europe's Left takes it as a chance to indulge in a smug and hilariously inaccurate sense of itself is made all the more rich.

84:

Zach: new around here, aren't you?

Hint: I'm the "people" you're talking about. Have the decency to address me directly, okay?

Meanwhile, I suggest that in future you read the moderation policy and then all the comments on any given post before you take a shit in the drinking fountain.

85:

Yes I am postulating a casual link between socialized medicine and "delays to basic research. I base this primarily on the reported spending discrepancies and some other research I've seen about medical R&D output.

This may not be true, this is just what I have read.

I disagree with your statement "commercial medical research benefits the rich disproportionately" I think it entirely depends on where you set your time horizon.

Yes I agree that govermnet has a huge role in funding innovation, that it is not private sector only thing.

However, I also believe with the correct level of private sector involvement, government programs disappear into a vast sea of bureaucracy and mediocrity. I have seen that happen first hand. Governments have problems incenting.

I'm not sure where you are going with the "cancer is not a disease" line?

86:

As you can see from the Americans commenting here, Charlie, health care reform is a very complex issue.

The problem with what passes for discourse in America now is that it's all shouting. The divers, educated majority in the middle is vocal, but can't be heard for the rhetoric and shouting on both ends of the spectrum. How do you engage in discourse with someone who responds with, "your (sic) an idiot."

Health care is so screwed up here that it's a joke in the rest of the world. People making $10 an hour can't afford insurance. Not when it's $12,000 a year or more. They could get catastrophic insurance, but that doesn't help with the $50-100 office visit plus meds if they're ill. And God help them if they have a chronic disease.

Insurers won't cover many pre-existing conditions. Childhood diabetes or asthma? Good luck. Cancer that was cured a decade ago? Wait for the insurance rep to stop laughing hysterically before turning you down.

And all those people end up in the emergency rooms, costing us far more than it would if they could get the care they needed in the first place.

87:

As jkd @64 notes (sorry, comment was hung up pending moderation due to the spam filter):

As several commentors have mentioned, this really is about race. It's all about race, always, in America. It was our original sin and we've not gotten past it yet, and it leads to all sorts of variously awful societal dysfunctions like Charlie mentions.

Yes, this is so.

Race is something I've been thinking about posting an essay about for a while now. Only I have blood pressure issues, and I'd have to stop every five words to look at pictures of kittens or something.

88:

I actually wasn't referring to you at all, but great effort at attempting to deflect.

89:

unholyguy: cancer isn't a disease ... it's about five major different underlying types of disease condition, each of which has somewhere north of a hundred different subtypes. See for example the Sanger Institute's cancer gene census project. And what fixes one error may do nothing to (or may exacerbate) another.

And you need to be very careful about what you read on the subject of medical research. See, for example, this report in Nature about pharmaceutical corporations hiring ghostwriters to astroturf peer-reviewed journals with papers about their meds (to assist marketing them at doctors).

There are professional liars at work in the healthcare debate.

90:

Charlie,

As a native born American, I have to agree with your view of the utterly merciless treatment of the poor.

You talk about people acting against their own self interest. I strongly recommend that you pick up Thomas Frank's "What's the Matter with Kansas". He discusses this issue in serious depth. Only here do large numbers of voters vote against their on self interest. How else do you explain how a huge majority of working people, many of them union members, could vote for Ronald Reagan? After the biggest strike breaking in U.S. history.

Essentially, the right wing nuts in this country have somehow perverted Christian morals (pace atheists) to the point where they can persuade a significant segment of the population that mercy is not a Christian value.

It's not a far step from there to believing that poor people want to be poor and, screw 'em.

Overcrowded prisons, lack of health care for both prisoners and the poor is perfectly fine. Don't you understand? They deserve it!

I have had the honor of sitting on a couple of community panels dealing with prisons and government. Nothing I learned alleviated my despair.

91:

Ooops, typo: s/mediaeval/medieval/

Unless that's a canary trap..

92:

Charlie is doesn't really matter if it is one disease, five or actually a field of petunias.

What matters is solving it. The rate of change of advancement is hugely important in this field, that is all I am trying to say. Slowing that rate of change directly correlates to people dying, speeding it up directly saves lives.

What that implies is that whatever system we come up with needs to be sensitive not only to the treatment of the downtrodden but also to the effect it has on medical innovation. This is problematic because it is very hard to measure and quantify, much more so then treatment penetration.

I agree with you about information, there is tons of disinformation out there. However, nowhere do I find anyone claiming western Europe has done a BETTER job of fostering medical innovation then the US, they mostly just argue about how much of a worse job it does.

Perhaps this is not true. There is not much evidence I have encountered to suggest that however.

This means to me we need to take a close look at systems like single payer and ask hard questions about how they provide incentives or disincentives around technical advancement.

93:

David McBride: thank you no, that's British spelling. This is a British blog. Ergo, I'm right and you're wrong :)

94:

i was looking at this link

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

If it is wrong, it should be corrected for sure

95:

unholyguy: it may surprise you to learn this, but while Craig Venter of Celera Genomics kicked off the Human Genome Project, it was the (British, charitable) Welcome Trust's funding that bankrolled the thoroughly international academic non-profit open research project that beat Celera Genomics' private sector program to the goal.

Hint: academics and charities and international cooperation, versus a corporation that wanted to patent the antisense DNA sequence to the whole bloody genome. Luckily for us, the right guys won -- otherwise basic research on human genetics would be virtually impossible without paying Venter royalties.

The UK has about the most extreme single payer system you can find; we have no problem funding both pharmaceutical R&D and general research ... on half the budget the US system consumes.

Read my lips: you're basing your argument on lies put out by corporate shills whose employers stand to lose money if healthcare reform goes through.

By the way, that wikipedia page you linked to is absolutely damning, if you bother to read it all. Have a look at the heading "Overall system effectiveness": ranked first in the world for cost ... and 37th for performance and 72nd for overall level of health! Ghastly.

The 75% of pharmaceutical R&D spending figure? It comes from a 2008 public report put out by ... the Pharmaceutical Research and Manufacturers of America. A little digging around their website delivers the following gem:

"PhRMA is dedicated to achieving in Washington, D.C., the states and the world: 1. Broad patient access to safe and effective medicines through a free market, without price controls; 2. Strong intellectual property incentives, and; 3. Transparent, efficient regulation and a free flow of information to patients."

Translation: it's a lobbying group promoting (2) an intellectual property regime that lets them make more money, (1) access to lots of patients they can sell drugs to ("through a free market" -- standard US capitalist buzz-phrase meaning "we get to set our own prices"), and (3) minimal regulation and free advertising to customers patients.

Would you believe a press release from the Tobacco Industry's tame lobbying organization about how they're being socially responsible and promoting cardiovascular exercise? No? This astroturf is on the same level. Disgusting.

96:

here is the actual quote, mostly european sources

The United States is a leader in medical innovation. In 2004, the health care industry spent three times as much as Europe per capita on biomedical research.[10] Companies provide medical products such as pharmaceuticals and medical devices. In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology. [7][9]. The amount of financing by private industry has increased 102% from 1994 to 2003.[20] Most medical research is privately funded. As of 2003, the NIH was responsible for 28%—about $28 billion—of the total biomedical research funding spent annually in the U.S., with most of the rest coming from industry.[20] The National Institutes of Health play a larger role in funding basic research.[citation needed]

The top five U.S. hospitals carry out more clinical trials than all the hospitals in any other country. Between 1975 and 2008, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In 29 of the 34 years between 1975 and 2008, a scientist living in the U.S. either won or shared in the prize.[21]

97:

@#96 - hmm, that IS one heck of a lot of R&D spend, private industry financing, and an impressive level of clnical trials. Shame it seems to have no effect on the ills suffered by the poorest Americans, or indeed the desperate ills of the world's starving. In short, it sounds toadly marvellous...but what's it for?

98:

@93: Charlie: And I am a British person! I should have known better; I hang my head in shame.

(In my defence, I did spend three -- apparently influential -- years of schooling in the US, which does tend to cause me confusion over this sort of thing...)

99:

Mike: As noted in an edit I made to an earlier comment of mine, I don't trust the figures in that wikipedia article -- sources cited include industry lobbying organizations rather than peer-reviewed or auditable entities.

It's possible to conduct clinical trials until you're blue in the face without actually accomplishing anything useful other than to fill out the paperwork requirements for an FDA product license for Yet Another Antacid. Much of this research is basically junk, servicing the realities of a very distorted market.

100:

@97 yes, bingo. We seem to have missed the point a tad haven't we? However we also do not want to throw baby out with bathwater.

101:

Bed-time.

Actually, it's not my bed-time; it's only 9pm here.

However, I Have A Life, and much as I'd like to stay engaged with you guys, I need 12-16 hours away from the keyboard.

Play nice while I'm gone, or I will ride through the comments wielding fire, the sword, and the delete key of doom.

102:

Ming enjoys this topic. Mercy is an exercise of power, because if the powerful do not have the power to destroy, bend, fold or otherwise mulilate the weaker, they are not powerful and can not exercise mercy. In fact life imprisonment is merciful to the condemned regardless of the validity of the conviction or even if the condemned committed no crime at all.
Mercy can only be seen as the forbearance of compulsion by the use of force for the purpose of convincing your allies and foes that there is a future for them should they capitulate to you. That's it in the proverbial nut-shell. Ming enjoys the wonderful double think here. It is good that Ming lets the Earthlings live and work in his slave factories. They LIVE thanks to the MERCY of Ming.
Mercy expands the self-worth of the powerful at the expense of the dignity and freedom of us proles. Perhaps mercy does not mean what you think it means. Imagine a stupendous thumb in the sky that comes down and squishes people right there in front of you. It promises not to squish you if you don't violate the rules. Squashable offenses subject to change without notice as the law must adjust to conditions. Sign me up for that!! oh wait...
The thumb in the sky keeps on ruling as long as we let it. Mercy, mercy for everyone, mercy for the losers.

Ming the Merciful has quite the ring does it not.

103:

thinking the noble prize winning is probably a solid piece of supporting evidence for the thesis that the US plays some kind of unusual role...

Charlie, it would help me out a lot if you came to the table with references? I agree the information is very very corrupted.

I think it all boils down to there is a certain kind of brilliant person that needs to be incented with money. I think that is why you need the private/public mix to get the most world changing results...

104:

Charlie, you NAILED it. There is a huge, terrifying lack of empathy in the states. I think my father put it best when he said "In this country, we don't give a shit about each other, and healthcare is the way we prove it."

I could go on forever and take up alot of your webspace, but I'll just say I think it stems from the American people believing that it's the same or worse in the rest of the world. I'd bet good money that nearly all of the people screaming down senators in town halls have never set foot outside of this country, and probably most of them outside of their home state. There are a lot of fools over here who think the rest of the globe is more or less indistinguishable from a middle eastern refugee camp.

105:

It's perhaps also worth observing that the governing body that's doing the most to muck up US healthcare is the US Senate, which as far as I can tell was designed to be corrupt and reactionary, and has been so from the very beginning.

Croak!

106:

"Nor is it as simple as a left/right thing"

There is no left in the USA. The entirety of acceptable political discourse in America ranges from centrist (some Democrats) to moderate conservative (some Democrats, a few Republicans) to frothing loons and the cynics who manipulate them (Republicans), with the loons and cynics branding the centrists and moderate conservatives as socialists and traitors.

Conservative propagandists like Limbaugh and Coulter have helped create a situation in which a sizeable minority of Americans will not accept any Democratic administration (or its policies) as legitimate. Race adds a little extra fuel for the flames.

107:

Charlie,

Sorry, I posted a link to your words here because the summed up more eloquently than I could manage what I felt was the common thread between healthcare and compassion in the Al Megrahi case.

Sorry a little **** like Zach followed back down that link.

108:

Whoa, that certainly was and full an honest statement of political opinion. There also seems to be a lot of comments on US health care issues and not many on Magrahi's release. Perhaps nobody is questioning that. I think it was to the Scottish Government's credit that he was released becasue he was dying, but what you must consider is that the Scottish Prison Service do not have the facilities or staff to care for end stage cancer patients (or anything other than primary care), he would not have died in prison but in hospital, if he had not been released on compassionate grounds. The other part of US (and others) outrage is the scenes at Tripoli airport when he landed. Making sure that did not happen was clearly the remit of the US and Westminster government's foreign offices and they failed miserably in preventing it.

As to US health care reform, those who oppose it are mislead as well as totally bonkers.

109:

Residency in the US at the time of the award is no guide to where the original prize-winning research was carried out. Nobel-level research tends to go with the sort of publication record that gets head-hunters very interested indeed....

110:

I'm an American, but I have a problem with this. I think that government's job is to keep you from screwing other people, and other people from screwing you. It's not the government's job to keep you from screwing yourself.

I also flat out don't trust the government to run a program this important. The American government's track record on this sort of thing is abysmal. Medicare is headed towards bankruptcy in a decade or so. They so royally screwed up the CARS rebate program that they have to pull people from the FAA, which is hardly overstaffed to begin with.

I don't have a problem with healthcare reform, but the problem is nobody has any clue what it is that's changing. It changes from week to week. The whole bill needs to be split up into a couple of dozen different bills so we can see what we're getting. They need to be debated one at a time.

I would also like to point out that many if not most of the "Obama is Hitler" protesters are not Republicans or even on the Right. There's a guy called La Rouche who's as far left as you can be without being crazy. Like Ron Paul is as far right as you can be without being crazy.

@90: When is the last time you were in a normal American Church? The only people who think that mercy is not a Christian value are _some_ of the televangelists and megachurches, a smattering of smaller churches, and the few virulent anti-religionists. This is not a significant percentage. Well, I shouldn't say "only". I'm sure there are some other people. The problem is, those are the type of people that get attention.

111:
Charlie is doesn't really matter if it is one disease, five or actually a field of petunias. What matters is solving it.

You do realise that understanding the nature of a problem is rather critical to any effort to solve it, don't you?

112:

Where to begin?

First unless the author in question is advocating something truly evil, like genocide, I generally don't allow his personal or political views to influence my opinion of his work. I judge the work, not the man creating it.

Second, it is none of my country's (yes I'm an American) business how another country runs their penal system, and we should keep our noses out of it. Unfortunately our elected officials can't seem to keep out of other country's business. It's vexing to say the least.

That said, your screed on the health care debate going on in my country, (a wholly internal matter just as your penal services are) was that a case of tit for tat, or were you simply blind to the massive hypocrisy involved in voicing the two together?

As to your sum up of the health care situation; all I have to say is, you're wrong, dead wrong. Note: I'm not trying to debate the issue with you. Nor do I have any interest in such a debate. Anyone who claims that those who oppose the health care reform "hate the poor and want them to die" is rather obviously incapable of reasoned debate on the subject.

All I will say is that I've never had a problem getting medical care, even though I have never been in a position to be able to pay for it straight out, or had health insurance for more than a few months. (And of course when I had health insurance I had no health problems, they always waited until after the insurance was gone. Timing is everything.)

113:

picking up a crappy little country

This is from Meet the Press this morning, said by Adm. Mullen (Chairman of the Joint Chiefs of Staff) about Afghanistan:

I am very mindful and concerned about the threat that's there. The strategy really focuses on defeating al-Qaeda and their extremist allies. That's where the original 911 attacks came from, that region. They've now moved to Pakistan. Afghanistan is very vulnerable in terms of Taliban and extremists taking over again, and I don't think that threat's going to go away. They still plot against us, see us as somebody they want to, to, to kill in terms of as many American lives as possible. And in that regard, we're very focused on executing that mission.

114:

@110 : In what way are people who are broke and out of a job and do not have health insurance "screwing themselves"? In what way are we ALL not being screwed by insurance companies who overcharge us for insurance so their executives can make millions of dollars?

I would like to be protected BY the government, not FROM the government, thanks anyway.

115:

Charlie, a couple of "yes, and" points.

#1. It's not so much that part of the American governing class hates the poor and wants them to die. It's that they hate and fear pretty much everyone put themselves and want them to suffer, because suffering makes submission tangible. They're firmly convinced that everyone but themselves is so wicked that they'll do the right thing - that is, submit to their betters - only when the threat of punishment is constantly present. John Holbo's 2003 dissection of a David Frum book remains relevant; Frum's attitude is very common in some strata of my country's society.

#2. A lot of Americans don't actually suck. Right now large majorities would like us out of Iraq, want war crimes investigated and perpetrators punished, like the sound of single-payer health care, and so on. But we've got one of the most hermetically sealed governing classes this side of Japan thanks to Republican ownership and/or domination of the major media corporations and the Democratic leadership. I honestly don't know what can be done at this point to change it short of a general strike.

Rigel Kent: The sf/f/h writing community includes, among many many others, George Alec Effinger, Thomas Disch, and John Ostrander. We're talking here about people folks like Charlie and I have worked with, or socialized with, or simply admired greatly as assets to the community, and their suffering is damnably real.

116:

@114 by "Large majorities"?, you almost certainly mean "large minorities", there.

How long until the US military and nazi-waving republicans (which I see have just starting whining directly about the release starts making a fuss about all that great healthcare being squandered on people in UK prisons.

B>

117:

Charlie, Charlie, surely you must know that we of the industrialist brotherhood worry about this, dare I say, altruistic endeavor to speak your mind regardless of how it will reduce your financial success! Hurr hurr hurr *smokes cigar*.

Now, be that as it may, we trust you to be a fine and upstanding fellow, so we must believe that this hilarious moocher screed is simply a humorous attempt to bring the looters out of the woodwork! Hurr hurr hurr good show!

Now, as you well know, we've built the finest medical system in the world with our own hands, and it's stupendous! Why, when I stubbed my toe last week, my driver took me to Dr. Hendricks' practice and I received some fine opiates to dull the pain in no time at all. I shudder to think how terrible it would have been in some looter paradise such as the United Kingdom, where I would have had to sit in a waiting room with the moochers for hours!

And furthermore, surely you must think it a genius stroke that we can simultaneously maintain fine care for ourselves while keeping the moochers in line! Why, just last week I heard some weak-minded secretary complaining that she couldn't quit because she can't afford to take her bawling malformed brat to the hospital without mooching off my profits! Serves her right, if she had an ounce of personal responsibility she'd buck up and take the brat to a proper surgeon on her own dime. I think I shall have her attend my toilet duties next week, as punishment for her foolishness.

Hurr hurr, it is pure genius, isn't it, that this way the weak minded moochers must accept low pay and the harsh blessings of my rehabilitative employment, while the decent folk in our land can reap the rewards of their success! And not only that, but the government rewards the greatness of this system through lower taxes! Ahh, the joy. Excuse me while I have one of the girls give me another hot bath.

... ah yes, excellent. Anyway, buck up, don't let the moochers in your native land get you down! I'm sure once we've beaten down the current looter sensibilities, we'll be able to spare a few people with a nice objective mindset to help you clean things up over the puddle.

Regards,
Roger J. America, Industrialist

118:

Please continue expressing your personal opinions. Everyone has them: it is impossible that everyone agrees on anything. Hearing a differing opinion, I find it provokes thought about my own biases and conclusions - I'm not afraid to admit that I'm not always right.

As to your expressed thoughts - I'd try to avoid placing too much weight on the side-effects. Due to the creative nature of your work, many of your biases and thoughts end up being transmitted to the reader through your novels - and people will tend to seek out those who reflect similar thought patterns to their own.

Basically, I think you're 'preaching to the converted' - since I read above and pretty much agree with your conclusions.

Renoir

119:

Bruce Murphy: In 2007, 58% of us wanted us out of Iraq by 2008; 55% now realize we should never have gotten involved at all. Two-third of us want investigations of reports of war crimes and abuse of powers, and already 40% are good with the idea of criminal prosecutions. 65% support Medicare for all, which would of course be the US flavor of single-payer. And on and on like that. The American people have some big problems, including the quarter of us completely detached from reason and fact and being goaded on by the conservative machine, but taken overall we are significantly more moral and more interested in competence and truth than our governing class.

120:

I like PIE.


I really, really, want this to be the next big issue to face the American public.

121:

Regarding Megrahi, the whole point of Justice is that it is blind. Any number of prisoners with cancer have been released on compassionate grounds, and since Good Friday Agreement there have been any number of terrorists released for a variety of reasons. The welcome, well, Libya plays politics like the rest of us.

As for healthcare, there's a really complicated economic discussion to be had based on an anecdote:

A friend of mine is a student, plays bass, works in a (secondhand) record shop, has toured the Balkans gigging at festivals. They and their girlfriend were crossing the street. They were hit by a car, thrown ten, twenty feet in the air. The vehicle, they think, was stolen, nobody was caught.

They've now got limited mobility in one arm, due to the destruction of the shoulder. It works, but not brilliantly, and there's a consistent pain issue. Consider the costs though -

Here, treatment was free. Under the uninsured drivers' scheme (which I as an insured driver contribute a small amount) compensation has been awarded, albeit slowly. Those monies will help meet various opportunity costs. The employers (a well known organisation) are really reasonable about injury and sick time. So too the University.

In the US? Well, for a start, there's nobody immediately obvious to sue...

Then there's how much of the cost of the car (before it was stolen) went on healthcare. Of course here, it's pensions, but, you know.

The point of this, though, is that it's a complex nest of things. What is pretty clear, despite all that, is that for the most part in the UK what we bear for this kind of accident is opportunity cost. My friend's life is not going to be the same as a result of the accident, but they are not going to have to bear a crushing mountain of debt that would have been acquired without their consent.

122:

Alan @33, not just lost mercy & empathy, but a lot of Americans have gained fear -- fear that they will become the sick, the poor, the discriminated against.

mike cobley @67, not the same quantity, but here in Virginia, our governor just gave partial pardons for rape and murder to three sailors who clearly didn't do it. It was so obvious from the beginning that they didn't that they immediately got the name "The Norfolk Four" (one was out of jail when Kaine gave the the pardons). Now they'll be on probation for 20 years and have to register as sexual offenders the rest of their lives, when they were not guilty, even though 26 former FBI agents sent a letter calling the convictions a "tragic mistake."

Charlie @78: 4. ... I said that commercial medical research benefits the rich disproportionately, not that it "only benefits the rich". Reason: in a commercial healthcare environment, the research is driven by the existence of a consumer market, i.e. people with the ability to pay. The poor don't have money: ergo they aren't a market.

My eyes have gotten so dry that the only thing that truly helps them in the winter is , which, as a brand name while I'm in the "donut hole" for Medicare meds, is $200/month for me. Rich people can pay that; I can't.

unholyguy @85, is that "casual" or "causal"? Difference in interpretation.

ibid, @92, heart disease kills more Americans than cancer does.

(boy is this going to take forever to get out of moderation)

123:

@118 But isn't it amazing how numbers leaning quite the other way come up a lot simply depending on the whim of the polling organisation in the language they use? Medicare for all? yes. Government taking over healthcare? no.

Let's look at the 65% for medicare result. I particularly like that the poll sampled 943 democrats and 740 republicans. Balanced, neh? Hardly seems to inspire the confidence in your countryfolk that you're very optimistically showing.

I was recently in the US and had the opportunity to speak to a couple of dozen left-leaning well-off educated Californians about universal healthcare. The near-universal response was along the lines of 'why should I pay for them, my health care is fine', which would be completely standard and expected from someone in the developing world, but was a little startling for what wikipedia lists as a first-world nation.

B>

124:

As an American, if I'm ashamed, may I still give you my money?

@122: the poll sampling more Democrats than Republicans seems fair to me: there are fewer Republicans than Democrats, so an equal sampling would skew the results towards the right.

125:

270 people were blown into small chunks of flesh. Why should we have mercy on the person who did that? Yes, he's dying... but why shouldn't he die in prison if he is guilty?

Because mercy is good stuff. Among other things, it is good for you - it involves restraining the instincts that work against civilisation, which is always worth exercising. Being a liberal is self discipline, as I think Iain Banks said. All that pomposity and delight in others' suffering and vengeance and selfrighteousness. Feel the weight - then push back against it.

Donna@113: I would like to be protected BY the government, not FROM the government, thanks anyway.

Yes. I should like to be protected by the government from things like cholera, the business cycle, and the Russian Strategic Rocket Forces, and I'm quite happy to see to protection FROM the government myself.

This is another point about Social Democracy 101; these two aren't in opposition. Social security exists to protect you against capitalism, judicial review, parliamentarianism, etc exist to protect you against tyranny. It's yet another check-and-balance; even Marx would have happily admitted that Marxism is built on classical liberalism.

126:

Bruce Murphy: If you think I'm getting it broadly wrong, you're welcome to go do some searching of your own. There's a lot of polling data out there. I think it supports my judgment - even if there were only pluralities for the decent and law-abiding thing in a lot of cases, it would still put the public way ahead of our rulers.

127:

@124 So you believe Democrats vastly outnumber Republicans but your elections are still remarkably close. Interesting idea. Perhaps you should try to fix that.

@126 See any fox news poll for numbers going entirely the other way. See the problem?

128:

@122
Given that at least two-thirds of the US population have view more like the Democrats than the Republicans, and in some states (such as California) more than two-thirds of the voters are Democrats, I's say that that poll was biased - toward Republicans.

----
I'm glad the system did the right thing and let Megrahi out, even if it's only because he's dying. I've pointed this out several places where people were having hissy-fits at the idea that someone convicted of terrorism should be released.

(To get an idea of where Americans are coming from socially and politically, I recommend David Hackett Fischer's Albion's Seed.)

129:

'Stephen Hawking is British'

Yeah? Then what's with the American accent? Eh? Eh?

130:

Steve@129: 'Stephen Hawking is British'

Yeah? Then what's with the American accent? Eh? Eh?

That's because he couldn't afford the Kenneth Kendall speech synth for his BBC Micro and got stuck with a Speak&Spell.

131:

Think you just hit the nail on the head there.

132:

Talking about prisons here, leaving healthcare aside.

We can't rehabilitate criminals if 1) prison society rewards and teaches criminality 2) released criminals return to sub-cultures that may have fostered criminality in the first place. They can't "go straight" if they can't get jobs and don't have straight friends.

Rumer Godden's novel _Five for Sorrow, Ten for Joy_ is a novelistic treatment of a Roman Catholic order (Dominican Sisters of Bethany) that worked/works in prisons and welcomes freed prisoners into the order. It offers prisoners support in prison and a new community outside. (Waffling on tense is because the order is hanging by a thread, like so many RC religious orders.)

You can loathe and despise religion and the RCs in particular, but I think that there's something to be said for the method: rehabilitate by inclusion in a larger group that makes it normal to go straight.

Of course, it all depends on the kind of group that's reaching out. Muslims are reaching out to prisoners, but I have the impression that the reachers tend to be angry, hard-line Salafis and jihadis, not goofy Sufis.

Still, if more groups did this sort of thing, there might not be as much recidivism.

133:

Coming in late, so I'm skipping the latter half of comments in order have time to say something; I'm going to be agreeing with a lot of the first half anyway.

Thanks for the impassioned opinion, Charlie, I think in many ways you're spot on about the lack of mercy and compassion in my native land. I can't say I'm ashamed, though I'm angry and disgusted, because I've spent most of my life, since the 1950s anyway, talking about this and trying to educate my friends and colleagues about it, and working against it in the political arena. In many ways the attitudes are worse now, but the seeds of these uncaring attitudes have been around since the beginning of the US.

As other commenters have said, it's about race. It's also about class. When the country was first constituted, only propertied white men had the vote and it was common to hear that "the mob would only vote themselves more bread and circuses". The mob being workers, indentured servants, and so on. And it's about gender; women were third class citizens until fairly recently.

Here in the US we've been raised with the idea that living is a zero-sum game; that the size of the pie is constant, and that whatever you get is stolen from me. This despite the fact that the 19th and 20th centuries saw the greatest increase in overall societal wealth in human history, and much of it was in the US. So the reaction of most of us to others, especially those in other classes or racial and ethnic groups is a fear that they will be able to take away what we need to live. Likewise, anyone who breaks the rules was trying to take away our livelihood; we hate them for that, and want to punish them. Compassion and mercy, we're told, are luxuries that must be sacrificed for survival (consider the behavior of the US government and a large number of US citizens towards any "foreigner" who might be suspected of wishing harm to them).

That started to change early in the 20th century, when socialism and progressive liberalism took root for awhile. But the monied powers who stood to lose their ownership of the majority of the US economy and political system started fighting back, and they and their ideological shills have been pushing the class war, the race war, the gender war, and any other divisive ideology they could think of ever since. This campaign against compassion and the idea of society as a collective rather than a bunch of competing loners really took off under Reagan, and has been a major propaganda industry to this day.

Some specific comments:

Pat Matthews @ 4:
In the US there has always been a majority of any age cohort that accepted the ideology of selfishness and a majority that disagreed and fought against it. I'm a Boomer myself, and grew up believing that I lived in a merciless and compassionless society. There were many of my cohort who didn't agree with me; somehow they co-opted the words of those who fought, and started the big lie that all of our generation were revolutionaries. Not true. The selfishness of the decades after wasn't the result of the aging of the revolutionaries, it was the result of the public display of the fakes and wannabes.

Charlie Stross @ 82:

Charles @69: the first step to fixing the US judicial system is to get the mentally ill out of the punitive system and back into a controlled medical environment for treatment.
Resounding applause, loud cheering, and stomping of feet. I"m not sure that this will affect as many inmates as you think; the figure I've heard is 20%. But it will get the mentally ill where they can get treatment rather than punishment for being ill (though first we have to rebuild all the hospitals and treatment centers we ripped down in the Reagan and Bush I years), and will remove a terrible strain on prison resources, allowing them to be put towards rehabilitating those who can be helped, and preventing those who can't from hurting the others.

134:

@"Rigel Kent" - you may have been sick but do you have a persistent condition? Many of us do, and if you reach your 40s in this day and age without something genetic sneaking up to bite you in the arse you're doing well for yourself.

I have hypertension (like both my parents, my maternal and paternal grand-fathers, my aunts etc...) currently the treatment is simple and it's under control, but it renders me effectively un-insurable. My wife has a couple of non-life threatening conditions which are chronic, i.e. they're with her for the rest of her life and which will never get better, she can live without medication, but it won't be pleasant and, in total, the monthly cost would run to a few hundred. Again, no sane "insurance" would insure something that's already happened/happening.

Insurance is a plain dumb way to think about standard healthcare. At best it's wide risk pooling. For every person like my wife who'll cost a few thousands a year for life, there's me who's cost practically nothing in the last 20 years, and even now is a few hundred a year at the most...

But that's a minor point. While there are stats to show that ER treatment is more "cost effective" than preventative care. The issue remains that it's far too late to do something about High Blood Pressure or Diabetes when physical symptoms start to manifest and you have somebody who either is going to die or be a chronically ill person for life when a few hundred dollars spent a few years before would have solved it.

135:

Charlie@95

ranked first in the world for cost ... and 37th for performance and 72nd for overall level of health!

Anecdotal evidence. A few years ago, I was in California with someone from France, who had been working for some years at Sun Microsystems there. His wife was pregnant at the time, and they were busy making plans...

... for the baby to be born back in France. "I'm not going to let my child born in a 3rd world country" (snide jab at his experiences with the local health system).

When Michael Moore made his video pamphlet (I'd hesitate to call them documentaries) on healthcare, I wasn't surprised.

136:

Great editorial Charlie. Are you going to be ashamed of all the reportedly right-thinking Yanks are sending you money, or are you going to let us have your books for free?

Anyway, I'm not ashamed, nor particularly angry, not any more. Thing is, I just checked my blood pressure, and despite the fact that I allegedly have health insurance, I don't think that carrying that kind of boiling indignation around will do anything but hurt me.

Instead, I'm patient. If the system won't take care of me, I'm working on taking care of myself and those I care about. Whether I'm active in politics beyond this is none of your business, for fairly obvious reasons.

For example, this weekend, I made a deal with my girlfriend (who likes to be frugal) to buy organic food as much as possible this fall, as an experiment to see if it helps us lose weight and see how much more it costs.

Yeah, there are some disgusting things about America right now, and I'd recommend reading Trevor Paglen's "Blank Spots on the Map" if you really want to get your blood boiling.

Anyway, I blame England and Europe, myself. If you guys hadn't sent over all your religious refugees for a couple of centuries, we wouldn't have such a large breeding population of brainless fanatics right now.

Anyway, they're here, and we get to deal with them. Sort of the moral equivalent of radioactive waste, but we have to deal with them. Beginning to realize why I don't like nukes?

Another person I'm thinking about rereading is H.L. Mencken. He was publishing the last time America went through this kind of idiocy, and it's worth seeing both what he wrote about, and noting the fact that, somehow, it passed for a few decades.

137:

Speaking of early release, I see that this last weekend, Lt. Calley apologized. The press reports make it sound like this is the first time he has done so.

For those of us who were not around when Lt. Calley was first in the news (which I gather is now most of us): Calley was in charge of a battle-scarred platoon of American soldiers in Vietnam in March 1968. Believing (it says here) he was under orders to do so, Calley ordered his men to fire on unarmed villagers, killing up to 500 men, women and children. A number were abused and raped as well. He personally killed some 80 or so.

Calley was eventually charged, tried and sentenced to life imprisonment for premeditated murder in 1970. Two days later, President Nixon ordered him released. He eventually spent a few months behind bars. (No other soldiers were convicted.)

Now, apparently, he is truly sorry, which is good.

The US Government can release a murderer after a few days, but does not consider it reasonable for the Scottish government to release a dying man with a similar record to his family.

138:

I correspond with a lot of left-wing English, and they spend a surprising amount of time gloating over and celebrating Margaret Thatcher's current mental state. Based on this, should I assume that all British are vicious bastards who enjoy the suffering of harmless old women? Based on the news, should I assume all Scots are knife-wielding sociopaths who gut each other for fun?

You're looking at the loud, angry minority and assuming that they are representative of the broad swath of Americans. The majority of Americans simply do not care about al-Megrahi. The majority of Americans want health care reform. The majority of Americans want prison reform. And they will get these reforms, after going through their political process and dismantling the ratchets that have caused the current mess. Along the way to those reforms the scared, the angry, the mean-spirited, and the just plain crazy will make a lot of noise. But these people are not the whole of the nation.

139:

Rick Perlstein's recent article In America, Crazy Is a Preexisting Condition is a good read for non-Americans looking in. (The link worked for me - search on the article title if it doesn't. The article doesn't address American attitudes towards crime and punishment and rehabilitation.)


140:

I'd also add something from the field of science fiction and fantasy writing.

It's interesting how popular gothic vampire and werewolf fiction is right now. There's something about bloodthirsty southerners that deeply resonates with Americans right now. Especially if they're drop-dead, stylish and powerful, and medieval in their values.

Hmmm. Looks like it's even infected the BBC: Being Human, anyone?

So, Charlie, let's turn the tables on you:

If you're for civil rights and democracy, how many books have you written where the heroes work within the limits of the law, for democracy and civil rights, and win? Is there something innately undramatic about this? Unsellable? You've got a well-earned reputation as an innovative writer. Why not write about the world you'd actually like to see?

141:

After reading this, I'm not going to purchase any more of your books -- the currrently-available ones that is -- but only because I simply don't have space for additional copies.

I don't find your rant (in the modern sense of "any impassioned presentation") especially engaging because -- even though I'm an American (lower-middle-class, I'd say, which might be much like "working class" in the U.K.), with quasi-intellectual and lower-case liberal inclinations -- I'm unable to find anything in this essay with which I could possibly disagree.

142:

One word: tribalism.

Human beings and human societies all over the world differ in where they draw the boundaries between 'me', 'my family', 'my extended family', 'my acquaintances', 'my people' and 'those others'.

An interesting aspect that is often overlooked is that the 'how should people of one of those classes be treated' metric is also different per society and person.

A complete sociopath will not care for anyone outside 'me'. Similarly, while European civilizations value fair and supportive treatment of *any* of the groups mentioned (and Asian societies prototypically are indifferent as to the fate of anyone outside of 'my family'), American values have the notable distinction of looking like European values from the outside (even though there's a lot of lip service creating a semblance that values are allocated otherwise), but being more exclusive in practice.

Anyone outside of 'my family' is of no concern, and there's quite a bit of 'I like to see "the other people" suffer' going around.

143:

One of the things which amazed me when I moved to the US was the amount of lip service paid to ideas when the actual reality was quite difference.

The number of times in the course of a normal day I am asked to present ID for relatively mundane things is amazing. Buying a drink, using a credit card etc... Presenting my social security number at other times... even having a social security number I need to memorize!

Trying to get any variation on the rules out of a US public body or private company just doesn't happen. It's all very contradictory.

144:

An interesting look at America's current healthcare spending (here) tries to propose a social healthcare system that is palatable to both liberals and conservatives. The author argues that America is already paying for world class social healthcare (22% of worldwide healthcare expenditure), while not receiving value for money with
the current system. That said, given the current workings of the political system, any changes are simply going to shovel more cash at the healthcare industry, while doing little to actually solve the problem.

The media debate about the proposed reform is simply idiotic. The alleged "death panels" already exist, although they're currently operated by the insurance companies themselves, instead of the government. Profit usually trumps compassion and the insured find their coverage removed when they are no longer profitable.

Another surprisingly stupid element of the public debates are the "grass-roots" protests against socialised healthcare. The protesters are in favour of a system which is clearly against their best interests, yet in line with their ideological beliefs. It's shocking that they're completely oblivious to this fact.

145:

I don't think the mentality is "I want to see the other people suffer". I've never met anyone, Republican or Democrat, who thinks like that—I'm sure there are people who do, but I would not think that they're the norm.

I think the mentality is "I don't want to see other people cheat". People who have spent their entire life working rural jobs for next-to-no money, scraping by at the poverty line, and who are justifiably proud of what they've accomplished are understandably bitter of people who seem to be using government money to leapfrog ahead of them.

And they don't want more government money—that's not what they see as a solution. They're proud people who just want a fair chance to make ends meet, and are upset when the government "rewards" other people who aren't working the same 70 hours a week that they're working by taking money out of their paycheck and giving it away to people who won't get a job. That, to my neighbors, is other people cheating.

146:

Charlie, you've spoken on a subject close to my heart. I've lived in Los Angeles for 25 years now, and ever since I arrived I've wondered why when problems came up they didn't take the logical solution to them. (Healthcare is a good example. It was obviously broken 25 years ago and is now collapsing completely. )
Over the years I have puzzled over this phenomenon and I've come to the following conclusions:
First, when thinking in social/political terms, you need to stop thinking of the US as a weird European country, but instead think of it as a weird South American country. Both the US and South America were founded on the violent usurpation of resources and the easy and bountiful profit from them. This leads to a belief in the efficacy and rightness of violence, and the expectation of easy wealth. Compare this to say the historic German attitude of the way to wealth was through collective hard work. You are right in that there is not much strength in the social contract.
The big different between the US and South America is that the South Americans have the Catholic belief in human fallibility whereas in the US the attitude is one of puritanical righteousness. (This difference can be seen in the approach to crime. South Americans put up with it, fencing themselves off from the worst of it. Americans try to suppress it through draconian incarceration policies. Neither wants to address the root cause of the problem.)
The America we saw in the 60's is a historical aberration. To survive the depression and WWII the country became more collective. This social contract was maintained after WWII by the threat of the Communist menace. However, once that threat disappeared, the sense of national purpose also evaporated. Many of the powerful in America now operate on the assumption they are fully entitled to operate in their own interest without regard to the wider society as if the stability and prosperity of the place is somehow an infinite resource that could be mined without limit for their personal enrichment. (They sustain themselves in this illusion with free market justifications.)
The second big contributor to American's direction is its framework of thinking. Americans generally take a religio-moral-legal approach to things, very Aristotelian in that they think they can determine the truth (and presumably reality) through argument. This is why, solutions to any problem, quickly spin away from the simple and pragmatic and get hung up on legal arguments and technicalities. (Infringement on one's liberties often gets quickly dragged into any argument, but if you look carefully, Americans have a very high tolerance for infringement on their liberties. They happily support a draconian legal system that railroads most of the accused through with plea bargains backed up with the threat of even worse punishment if they don't cooperate. This is also the country where the last president suspended habeas corpus with barely a peep from the bulk of the population, and it's a country with an air travel security system that makes the treatment of travelers into Berlin by the East German border guards look like a model of professionalism and courtesy. Note: I have been subjected to both.)
What rights most Americans value boils down to is one, the right to keep as much of their money as possible, and two, the right to threaten people with firearms (see first conclusion).
Finally, I have come to realizing, after watching California melt down, that the fine structure of a government is very important to the functionality of a state. The founding fathers of America, worried about absolutism and the accumulation of power by an individual, set up a system which dispersed power to the detriment of functionality. (Compare this to the British parliamentary system, which was designed with effective governance far more in mind, set up on the principle that it should be able to change administrations without missing a beat while fighting the French.)
In keeping a lack of functionality, the Americans have succeeded. The result is that any legislation on major items with political consequences will be kludgy mess, less effective and more costly that equivalent legislation passed by other Western countries. When you have an increasingly complex society with new technologies requiring regulation, this becomes an increasing handicap.
If America could recognize its weaknesses and address them, its future would still be bright, but this is "the greatest country in world" remember so I don't rate highly any chance this will happen. Even in a cosmopolitan metropolis like L.A., interest in how things are done overseas is low. By the time you get into America's heartland, especially into the small towns, an understanding or interest of the outside world by the average citizen is completely missing, and there's nothing there to broaden their perceptual framework. (This is different from most other places in the world which get at least two points of view, theirs and the American one, loudly trumpeted in through the commercial media. Annoying as it is, this challenging of local assumptions is a very valuable service that America provides to the rest of the world.)
This parochialism is further reinforced by a commercial TV and radio news media that has given up all pretense of being a public service and instead works to maximizes it profits by catering to their viewers' prejudices and reinforcing its worldview (see para 4: Many of the powerful . . .)
America has its strengths, which has allowed it flourish in the past, but whether it can cut it in a resource-poor, intensely competitive future with the structural handicaps it has built into its system (the sort of world the German approach tends to thrive in) is a big question.
In terms of ability, Obama is the best the country's political system can throw up to address the country's problems. If he cannot overcome the political handicaps he faces and effect change, then, if you are writing Science Fiction set after 2050, better put China in as the major world power with America as brutish, parochial backwater working off its loss of power in a sullen, isolationist snit.

P.S. I like your rants. They seem to bring the best out in your blog viewers. Their contributions and replies are generally intelligent, and they dig up also sorts of really interesting sites--factual ones.

147:

Bruce Cohen@133: "Here in the US we've been raised with the idea that living is a zero-sum game; that the size of the pie is constant, and that whatever you get is stolen from me."

That assertion astounds me. If there was one major difference between teh US and the UK it would be summed up as:

In the UK, if someone drives past in a Rolls Royce the thought is that the driver got his money on the backs of the workers. In the US, if a Cadillac drives past, the thought is how do I succeed to get one too.

Social mobility has certainly declined in the US, apparently even below that of the UK, but the general view that people can make it is still embedded in the American psyche.

148:

The US in a nutshell;

Where almost half of the citizens believe a milliennia old book of fairy stories is the literal truth - except the part where the guy they are supposed to follow unquestioningly says people should be nicer to each other.

149:

I think you're very close to "right" (at least in my book) & I'm American. However, just so you know, numbers of actual rape in American prisons are much, much lower than people think (it's actually very rare.) But nonetheless, I get the point.

150:

Charlie, as an American I certainly can't speak for my fellow citizens, but I can make some observations in response to your comments, assertions, and arguments:

First, your statement that over the last century
our political class has lost the ability to comprehend mercy is wrong. Americans IN GENERAL have lost the habit of personal and individual mercy over the last 30-40 years. This is part of our larger cycle of history. Mercy, like so many other aspects of our society, waxes and wanes regularly. Sixty years ago the mercy (and cold blooded calculation) of our leaders caused us to spend significant amounts of effort and treasure to help rebuild Europe and Japan after the devastation of WWII. Today a significant portion of our populace lives in a state of barely suppressed fear. Fear is the engine that drives cruelty, suppresses mercy, and fuels hate. We've gone through this cycle several times before. I'm not excusing it, I'm just trying to point out that this cycle is part of our culture.

Second, our cultural DNA is composed of two alternating strands that were established by our earliest settlers: amoral personal greed and irrational moral puritanism. The engine of our cultural history is powered by the waxing and the waning of these twin cultural forces. At our worst parts of our cycles we get Salem witch trials, extermination of indigenous peoples, Jim Crow laws and so on. During the best parts we get open immigration ("give us your tired, your poor, your huddled masses yearning to be free"), advances in civil rights, and the push for world peace through global dialog (ex. The League of Nations and the United Nations). What we have seen for the last several decades is the bad part of the American cycle. Over the next couple of decades you will see a return to a more familiar "kinder gentler" America. At least to the extent that we have ever been kinder and gentler. We *are* an empire after all and empires by their nature are a bit casual when it comes to cruelty to outsiders.

Third, much of our current schizophrenic behavior is driven by the death throes of the so-called Culture War. The elements of the Culture War have always been present in American culture, but from time to time we get an idealistic generation that splits into two sides and slugs it out over this cultural horseshit, in this case that generation is the so-called Boomers. Their generation is marked by an emotional form of trench warfare. They've been stuck in those trenches since the sixties, fighting over ideologies. Both sides are cruel and want to exterminate the beliefs of the other. In this particular instance of our recurring flareup of idealism, the amoral mercantile factions have sided with the religious moralists thus creating one of the most monolithic and irrational political movements in American history (can you tell I align with the 'other' side?). Basically this won't get better until the Boomers start leaving power and dying out. Then we'll start the upswing for a few decades and then do it all over again.

I've got more, but this is your baliwick and I don't want to counter-blog.

For the record, when I first heard about Al Megrahi's I reacted about the same as the Obama administration: not happy about it and ticked off that the victims and the families certainly didn't receive any mercy, so why should Al Megrahi. Of course like most Americans, I was relying on the judgment of the Scottish court as to his guilt rather than investigating and coming to my own conclusions. It was a viceral "screw the bastard" reaction based on little or no facts. I'm not proud of that. Apparently I've still got work to do on examining some internal programming.

Thanks for the thought provoking post.

151:

I am an American and I don't have "big special words to use". Just an old fashioned American upbringing to refer to.

I don't want the poor to die and go away. I also don't want to pay for the healthcare of those who are too lazy to work. The only people who deserve free healthcare out of my tax dollars are children because they are innocent and its not their fault their parents won't better themselves.

You probably think "You stupid Americans already pay more on healthcare than we do.. " its true, we do pay more and I think we spend too much on it.

I work within the medical profession and I know how many people I see that are abusing the system. The general assistance and medical aid was designed as a safety net and most people who use it treat it like a couch they are going to be resting their fat asses on for a while because they can.

Instead of saying to the country "well, because we are already spending so much on these lazy people we might as well give it away across the board" we should be tighting guidelines and creating limits of usage.

This will limit how much the Government has a say in our medical treatment... Government provided healthcare is not something we should be praising it is something to fear. It's an end to that American dream of being self-reliant and minimal government intervention.

The only thing that the government should get involved in is keeping jobs stateside.

Too many people don't have work because of large companies took their jobs overseas.

The only thing I am ashamed of are those Americans who think they are entitled to handouts and free healthcare.

Mercy is not something a convicted terrorist deserves. And with a lot of Americans who had died aboard the flight we damn well are allowed to be pissed off that he gets to go home to die with his family. Mercy is something the victims in Pan-Am flight didn't have the luxury of.

152:

Sorry No@151, but you are reacting viscerally, not rationally in pretty much everything you say.

That's one of the big problems with we Americans, is that we tend to react from the "gut" rather than from the head.

I'd been wondering how to respond to this very interesting thread, and I have to thank you for providing the grist for my "Aha!" moment that crystallized my thinking.

Americans have always celebrated the emotional over the rational, most of our religions could be described as nearly non-rational, and for some time now, our politics almost certainly has been.

And while I don't agree with Charlie that Americans hate the poor, and are utterly without mercy, I will say that it seems that here in the US, mercy is not an instinctive emotional reaction like it may be in other parts of the world. The emotions that are most prominent in our dealings with each other and the world seem to be envy (of "cheaters", other races, etc.), rage (at criminals), and fear (of the unknown).

It doesn't help when our political leaders either play to these emotions, as the "right wing" have been doing at least since Nixon, or refuse to confront the irrationality of them and are content to appear impotent before them, as the "left" have been doing for many years now.

So we are easy prey when an emotional argument is made against mercy for "terrorists", criminals or other outsiders (illegals, drug-users, the mentally ill). And we are willing to believe that any change in our healthcare (even if we know that our healthcare is borked) will be a change for the worse, and we will believe the worst about the ones pushing for those changes.

I'm not going to try and reason exactly why we are the way we are, I'm sure it has something to do with religion and media, but I do think it has a lot to do with the initial reactions of the country as a whole. I do think that it's not utterly impossible for Americans to act in a rational way, but it does seem to be getting ever harder in recent times.

153:

Addendum-

I'm not about to stop reading Charlie's books either.

And now I'm going to put this blog behind me for the evening while I go off to mercilessly oppress the peasants, halflings, elves, and dwarves in the game Overlord.

154:

No@151

You really don't understand *why* our American health care system is screwed up, do you? People "too lazy to work" has nothing to do with it (btw, you may want to avoid that phrase. many use it as code for "lazy brown people").

What it has to do with is a) Providers charging too much for too many unnecessary medical services and more importantly b) Insurance companies doing their level best to squeeze as much money out of us as possible while providing as little actual care as they can legally get away with. To the extent that our 50 million or so uninsured citizens (your "too lazy to work") do get medical treatment, it is usually in the most expensive way possible: visiting emergency rooms.

What you don't seem to get is that America already HAS universal health care. Any uninsured person can walk into any emergency room in the country and get care for darn near any problem. That ER visit costs FAR more than if the person had insurance coverage and could go to a normal provider. Plus, when these "too lazy to work" folks (many of whom work 2 or more jobs trying to make ends meet) do go to the ER its usually because they waited until the condition got so bad that they had no other choice. If they had preventative care coverage or could see a doctor at the start of their problem, most of these problems would be resolved for a few hundred dollars instead of the multiple thousands of dollars that an ER visit costs. So because we don't want to provide universal insurance coverage for those "too lazy to work" folks, the hospital has to raise its prices across the board to cover it. Guess who pays for those higher costs? That's right, you and I do.

So basically you are saying "stop hitting me" while your own fist is bopping you in the eye. If you want to minimize your own damn costs, have a little charity and dare I say mercy and support universal health insurance. The wallet you will be saving will be your own.

Oh, and no one DESERVES mercy. Mercy is a gift we give ourselves by pouring it on others.

155:

ah yes, the idealists. for some reason people never learn that ideals are meant to be something that stays just out of reach. Without something to strive for, we are stagnant. Likewise, there needs to be competition, for without it we stagnate and die also.

Our health care system is not the only thing broken. I fear our political system is broken too. There's too many people pointing fingers and covering asses and not enough people sticking their necks out trying to accomplish something REAL. Things that need to be done. Our dear Pres is giving it a shot, but if the insurance companies stand unmolested through this entire health care project I'll know he's just blowing smoke.

156:

I don't think "hate the poor and want them to die" quite nails it.

Americans don't hate the poor, they just don't care.

Layer on top of this the perception that the poor are coddled by generous* social welfare programs, and the assumption that the poor have their medical needs taken care of in emergency rooms**, and you still do get not hate but resentment. Resentment not just of the poor, but resentment of the notion that they have to care.

--Stefan


* I did write perception.

** George W. Bush blew off concerns about health care for the poor by bringing up emergency rooms. Asshole. Ignorant, incurious, asshole.

157:

No @ 151
I assume you're planning to avoid both Social Security and Medicare.
Both of those programs are paid for by taxpayers and run by the government (and not too badly run, when the politicians can keep their fingers out of the tills).

158:

I don't think the healthcare issue is so much a lack of mercy but more about selfishness and greed. America has benefited from continual expansion of its capitalist foundations for the past several decades. As the famous movie quote goes, "Greed is good!" The profit motive was the cure to all our ills.

Well, except for those health-related ills, we're finding out. Insurance companies that deny coverage, or who have seemingly insane restrictions on payouts. One article I read recently said that a woman who had individual (not typical employer's group) insurance bought an extra rider for birth services. Turns out that rider only covered a few thousand dollars when a routine birth costs tens of thousands of dollars. There's a reason why the term "pre-existing condition" is common in the American society.

I think most Americans realize they're getting fucked over here. They are in favor of health care reform. But, there are some powerful interests that don't want that to happen. Insurance companies are HIGHLY profitable in the current environment. Big Pharma makes a ton of money researching treatments (note: not cures) to market to people. "Curing cancer" is a red herring in this debate under the American capitalist system; it's so much more profitable to treat symptoms over a longer period of time. These two industries alone are willing to spend a stupid amount of money to "set the tone" of the discussion because they know the gravy train will end if there is healthcare reform. They prey on fears (They'll kill grandma via a Death Panel! They'll give health care to illegal immigrants!) and try to make people feel that the situation is hopeless, don't bother fighting.

One comment, after reading all this to unholyguy: The U.S. may spend more on R&D, but what is being researched? As I said above, the profit motive means that if there's more money on treatment than a cure, then we'll see a lot of treatments and no cures. And, how much of that R&D is for things like Viagra? Take out the money being spent on treatments instead of cures, and on vanity drugs like giving boners to old guys, and how much is really left?

Anyway, I find it hilarious that people don't "want their money to pay for health care for someone else they don't know", even though this is essentially what insurance is. In the end, I have to ask myself who I trust more: the flawed government that is supposed to be serving the citizens or a money-motivated insurance company looking to make a profit.

The answer seems obvious, no?

159:

BTW, if anyone is looking for some very interesting insights into this issue from a very smart man, take a look at the last few months worth of entries on Paul Krugman's Blog at the NYTimes.

160:

No @151:
Also, there's no such thing as "my tax dollars" unless you've found some idiot to pay taxes to you for something. It's a big club, and you get a vote. But when time comes to pay dues, it's not your money anymore (And it never would have been to begin with if the society your taxes pay for didn't exist.)

161:

To say American's hate the poor is a very misinformed statement. The per capita giving to charity among American's is by far the highest of any developed nation(charitynavigator.org). Americans are generous and big hearted people. The current healthcare debate is not about the poor. It is about government control. The U.S. was founded on a basic distrust of government control. It is in the DNA of the nation. Americans have tolerate a lot of government infringement on personal lives in recent decades, but the healthcare issue has pushed many Americans over the edge. It is simply TOO MUCH GOVERNMENT. That, not mercy, is the issue.

162:

Another American here who will be happy for the next Laundry hardcover to simplify his Yuletide gift shopping for his gamer friends.

163:

Charlie, take a deep breath.... exhale.

Everyone! Take a deep breath... exhale...

First off, unless I missed a press release somewhere along the way, the White House has *not* criticized the release of al-Megrahi on compassionate grounds. They *did* criticize the unseemly celebration in Libya of his return "as disgusting" -- which I don't think is such an unreasonable position. So Scotland's actions have not been officially criticized by the US.

From a diplomatic perspective, I don't think you should take our FBI Director -- Robert Mueller's -- statement as being the unofficial position of President Obama. I seriously wonder how much longer Mueller will be around. And you certainly shouldn't take the statements of our former wingnut ambassador to the UN, John Bolton, as being reflective of the attitudes of the majority of Americans.

Having read both the Guardian the Scotsman online, it seems to me that there's a bit of uproar in the UK against the al-Megrahi release. It may have been triggered by US outrage, but it looks like the Tories and Liberals smell blood, and poor Kenny MacAskill's days in office may be numbered. I suspect that mercy in England and Scotland is as subject to political expediency as it is in the US. But I'm sitting here in America -- not in Scotland -- so I'm not attuned to the undercurrents of this controversy.

As for the quality of mercy in the US, imagine a Britain that has been ruled for the past eight years by an uber-Thatcher PM who has pandered to the worst elements extremist Tories and the BNP. Imagine, that only now, has a liberal (as in Labour) government taken power. What would Britain be like? You'd probably be spending the next few years undoing the mischief of these uber-Tories -- as are we currently trying to do in the US (please, wish us luck!). Some us were expecting our Dear Leader to declare a permanent state of emergency and appoint himself President for Life.

I can't help but wonder if the general spinelessness of the politicians involved (both the SNP and Gordon Brown) isn't exacerbating the problem. Didn't someone from the SNP publicly express their fear that this affair would affect tourist dollars coming into Scotland? Yikes! It sounds like there are people in Scotland who would sacrifice mercy for money. Although I was impressed with your First Minister Alex Salmond's statement that the US should just take a chill pill, his actions confuse me. Why is he reconvening your parliament for a offical turd hunt if he believes that MacAskill did the right thing? And then there are all these rumors floating around (in the British press, mind you), that Gordon Brown was working a some sort of deal with al-Gaddafi, and that his administration was leaning on MacAskill to release al-Megrahi as a quid pro quo. Goodness me!

Others have already pointed out that al-Megrahi *was* convicted in a Scottish-run court. If he was innocent, and the prosecutor, judge and jury let themselves be unduly influenced by the US and the CIA disinformation, then shame on the court.

best regards,
--Wulf

164:

To follow up my remarks in #161 ... I agree that the American healthcare system needs reformed. It is true that the cost of insurance is putting many entrepreneurs out of business. Something must change. But the idea of a government takeover of the healthcare system has many Americans justifiably concerned and yes, angry. If my family member gets seriously sick, whoever controls their healthcare controls their life. Do I trust my loved-one's life into the hands of a Washington, D.C. bureaucrat? I don't think so. As weird as it may sound to my European friends, I'd sooner trust a greedy health insurance bureaucrat, because at least he has the pressure of the free market to keep in mind. If he screws too many of us too often, we'll take our business elsewhere. If the government controls healthcare, there is nothing keeping them from screwing us all day long.

165:

A lot of Americans simply refuse to believe that their healthcare system is not giving them excellent, worldbeating results. It's not hatred of the poor for them, it's a refusal to accept reality.

166:

Don@164, oh really? We'll take our health insurance business elsewhere? How? Most of us have health insurance through our or our spouse's work. Changing insurance would involve a) dropping your work plan and picking up an expensive private plan b) waiting until your employer goes through their yearly benefits sign-up and hopefully changing to a better plan... if your employer contracted with multiple companies (a rarity) c) praying for a major life event so you can change your insurance out of cycle, which is usually restricted to adding a dependent to your current plan.

So exactly how do the majority of Americans who have employer-based insurance have more than a nominal say in their health insurance coverage? As a result there is no substantive free-market pressure that individuals have on the those greedy health insurance bureaucrats.

Medicare has a 65% approval rating by users and providers and a 3% administrative overhead. So why should paranoia about a government run health care insurance program THAT IS OPTIONAL if you already have a private plan prevent the rest of us from having a government insurance option when the good old USA has proven for 40 years that they know how to run a decent, efficient, cost-effective, and popular public health insurance plan?

If you are so paranoid about government controlled services, I suggest that you forgo using the US Interstate Highway system, don't eat any FDA inspected food, don't use any FDA approved medications, don't take Social Security when you retire, and for gods sake to apply for Medicare when you retire and hit age 65.

167:

@164 Do I trust my loved-one's life into the hands of a Washington, D.C. bureaucrat?

Of course I do, when you substitute D.C. to Seoul. People already trust states to have the military and the police. Why is healthcare any different?

168:

What I think you could be missing, because a lot of people in the United States are missing it, including some personal friends I have talked with who were supporters of the Democratic Party proposals, is that they do not in fact provide health care to the poor. The people who now cannot afford health insurance will be legally required to purchase it, even though they cannot afford it; if they fail to do so, they will be fined (the House of Representatives proposed rate is 2.5% of their gross income; one Senate rate is $250 per person per year). It's possible that they will be able to get it from a public plan, but by no means certain; in any case, if such a plan is created, it will be under political pressure not to offer terms substantially better than private insurance firms.

In other words, the health insurance industry will acquire 45,000,000 new customers who will be legally forbidden to say, "No, I'm not buying what you're selling, it costs too much." If they charge more than a maximum . . . which in the HR proposal is on a sliding scale, from 1.5% of income for the poorest people up to 12% for people at the high end of the subsidized range . . . the government will pay the excess (but will not exempt these people from paying the first part). That amounts to an open invitation to the health insurance industry to keep raising its rates, which hardly seems likely to limit medical costs. And it's at the expense of people to whom the required payments will come (since they are not now paying for insurance) as an extra burden that they will find hard to carry.

I'm one of those people; I'm right near the boundary that's currently proposed, so I may have my expenditures limited to 12%, or I may have to pay for insurance with no limit. Except that I can't afford that much. When I last had health insurance, I was paying that much for a bare minimum of catastrophic coverage (which makes me certain my rates will be a lot higher), and it left me chronically too broke to see a doctor or dentist, worried about paying my rent, and generally financially stressed. Instead, I'll pay the fine and go on paying for health care out of pocket, Because, to be blunt, not enduring that kind of chronic financial stress is worth taking the risk of having medical expenses I can't afford to pay. Quality of life, you know.

In other words, what we are looking at is not an arrangement for the benefit of people with modest incomes (the totally poor people already have Medicaid). It's an arrangement to guarantee increased economic rents to large established firms at the expense of the people it claims to help. Which is a recurrent theme in American political economy, of course.

169:

Bill: These are good criticisms. It would be really nice if Republicans were making them. As it is, it's up to that portion of the Democratic Party dismissed as left-wing loony to do so, and their allies further to the left, with a very few exceptions among some libertarian outlets.

Mandates are a fucking awful idea. No legislation with them should be acceptable. But meanwhile the organized opposition is focusing on denying Western history since 1945 or possibly 1890 and global morality since about 800 BC, along with principles of epidemiology and this and that. If I could find three prominent Republicans fighting on the ground that a massive, inevitably poorly supervised transfer of money in perpetuity to insurance agencies is just as bad as doing it for the financial sector, I would seriously reconsider my "no money to Republicans ever" stance. But there aren't, to the best of my knowledge, three such Republican officials or related voices in the punditosphere.

170:

Tim@166 ... I, like all of us, come from a particular framework. I work for a small company and am part of the management team. I would be part of the decision-making process to change insurance companies if we felt that our employees' healthcare coverage was being mishandled. So, yes, we would take our insurance elsewhere. I realize, however, that many people would not have that kind of influence in their workplace, as you stated.

As I stated, I agree that the system needs reformed. I also recognize that the government has a major role to play in that reform. My point is that the current debate is not about mercy or the lack of it. The debate is about the level of control the government should have over the healthcare system.

171:

Will you be trusting your health care to Washington bureaucrats or in reality will you be trusting your health care to medical professionals and the bureaucrats will be picking up the tab?

I think that is essentially how it works for those of us "suffering" under the jackboot of socialized medicine. We get sick, we go to a doctor and the government pays. What is wrong with that?

172:

First, I thought you sophisticated Europeans or Brits or flood across the pond were supposed to be able to have a political debate without people walking away angry. So, you know, don't nance about and soften your introduction to your denigration of 330 million people.

Don't get me wrong. You make some fine points. My problem is your language. You start by identifying the small populaion of people (CIA or people who hate poor people) and then extend your conclusion to Americans writ large. Isntthat part of what pissed you off about the health care debate or the release of the poor maybe-terrorist with ass cancer?

I don't disagree with you. My issue with talking down the release is that it kind of takes away from the severity of a prison sentence. I get annoyed that people think serving all but a few days of a life sentence is a trip at a holiday resort.

But, you say that's how Americans think. I've heard some fucked up up things come out of your country. And many others. But you ascribe problems to Americans that are from a small minority. Some of which are stereotypes that you have cherry picked your quotes to apply to a whole population. Which is fine in itself. Everyone is allowed their rants. But I take some serious umbridge when that is exactly idiocy that you are pissed about.

But I presume you wouldn't smash down my perspective because I didn't immediately apologize for some of my retarded countrymen as though I have anythig to do with them.

But, sure I'm mildly dissappointed with some of the rhetoric flying around these days. And concerned about others. But part of the reason for the stupid rhetoric coming from the right over healthcare is because they don't matter. Nothing they do, as a parry, can accomplish anyhing. So the political game is to um up the works. Scaring old people about death panels and government run socialized healthcare, who are on Medicare, is the work of a few people. And it sells newspapers, at least accordig to Rupert Murdoch. Who isn't a fucking American.

Your points are well received and I could give a damn about your political views in terms of your books. You write kick ass stories man. That's what matters for book sales. It's the small minded (conveniently located in every country) that can't tell the difference. But conversationally, don't call me a merciless dumbass because some other American said something stupid.

173:

The weight of most of the 170+ comments here plainly reveal that Charlie's attempt to make the healthcare debate about "mercy" is bogus. Americans aren't debating healthcare because they are "merciless," but because they have some very real differences of opinion as to the how and who of healthcare reform.

174:

#151: I'm an American who *is* willing to pay for the health care of those who are unwilling (or unable) to work.

Why? Actually, my personal rationale is that it's ethical and responsible to support alleviating the suffering and physical misery of human beings don't have the wherewithal to barter for medical services, themselves. Furthermore, I (we) can afford it with competently organized administration of public medical care.

But I don't expect that personal rationale to convince you. Here's the bottom line that I'm amazed you don't get:

Providing health care for individuals in the U.S. who don't have the financial ability to purchase it, themselves, INCREASES THE LIKELIHOOD OF MY OWN CONTINUED HEALTH.

Gah. What will it take for you to see that providing vaccines, antibiotics, and preventive disease counseling for indigent citizens is in your own self interest, because it decreases the likelihood that YOU will suffer?

175:

And, p.s., just because I like jokes about dead babies doesn't mean I think it would be hilarious if my baby ormy neighbors baby died. Like, what do you get a dead baby for Christmas? A dead puppy! But in reality, I'd be devastated if my newborn died this Christmas, only to be followed by the death of my dog. Humor and reality, very different. What's the words for it, like cognitive dissonance or something.

So, yeah, ienjoy the occassional ass rape joke, but I'm also not using my vote to advocate for the mandatory ass raping of prisoners.

And interms of Scotsmen and mercy, didn't that one retarded terrorist who got in a car accident, blown up and lit on fire in like twenty seconds outside an airport, and then started running around like a terrorist on fire, get kicked in the balls so hard that the kicker busted a tendon? I mean, Jesus, keep your mercy to yourself. Fucking funny though.

176:

Thanks Charlie for your keen observations, but as an American myself I have to remind you that there's a bizarre mobius strip between the noisy forum of the MSM and everyday people of the street - many whose daily identities, lives, and opinions are not reflected in that MSM. There are people who by their political natures will ally themselves with absolutely merciless policies, but also be the finest neighbors you'll ever meet, and have your back when times are tough. The MSM and the political theatre that has passed for governance for far too long (emotive absolutist button-pushing is the syntax of US politics) therefore are an odd caricature of US society, simultaneously drawing volunteers and throwing the gap between their beliefs and their actions into deeper ironic contrasts (e.g. how many conservative politicians have had how many liaisons?).

It seems to me this simplification of discourse (of which the latest healthcare reform phobias are only the latest expression) is symptomatic of another set of problems - a interlocking web of divested education, isolated diversity, and increasing complexity that challenges a single legislated solution for all. The Left cannot understand how gay marriage threatens the institution of marriage for everyone. The Right can't understand how urban crime should threaten their right to bring assault rifles to a Presidential rally. Federalism survives when a boiling disagreement can be sustained without topping the pot of civil order/rule of law - but that has broken down before, and will again.

177:

Thanks for saying this, Charlie. Listening to Kenny MacAskill's compasionate, lucid, if rather long-winded exposition of his reasons for releasing Al Megrahi I felt a rare moment of pride to be from a country federated with Scotland (neither the lucididy nor policy would have come from England). If I did not already have all your books I would go out an buy them.

178:

Great piece Charlie!

179:

It can be said that the message of the republican party has shifted a great deal since the founding fathers. Thats moving into Chomsky country.

My head hurts on the Libyan issue, but something is wrong (too many deals to get things arranged), but i don't think we know all the facts and i don't think we will ever know the truth.

180:

Don @164: speaking as someone who lives in a country with about the most socialist medical system you'll find anywhere (since the fall of the iron curtain), your concerns are misplaced.

Government bureaucrats don't decide on my healthcare. They just write the cheques that keep the system running. At electoral gunpoint. Messing with the national health service is a political third rail: politicians who touch it, die. (If the US gets a universal single-payer system, that, too, will become a political third rail -- precisely because of the fears of people like you.)

The correct analogy is healthcare run by the Postal Service. It's a bit grubby and bit utilitarian, but it's a lot cheaper than FedEx, and it's available to everybody, and if you've got a back pocket full of cash you can wander along to the FedEx office and pay through the nose.

181:

Dear Mr Stross

thank you for your defence of the Scots. They get a bad press - particularly (and strangely) in the Scottish edition of the Telegraph which my mum reads - but this is undeserved in my opinion. It was a very brave thing to do, particularly in the current political climate.

BTW. I have read all your books and will buy one one day.

182:

Reading the ringing condemnations of the concept of mercy (clue: if you think it needs to be justified, you are fundamentally misunderstanding the whole idea) I couldn't help being reminded of a classic moment of TV sf:

DALEK: ALL INFERIOR CREATURES ARE TO BE CONSIDERED THE ENEMY OF THE DALEKS AND DESTROYED.

DAVROS: No, wait! Those men are scientists. They can help you. Let them live. Have pity!

DALEK: 'PI-TY'? I HAVE NO UNDERSTANDING OF THE WORD. IT IS NOT REGISTERED IN MY VOCABULARY BANK. EXTERMINATE!

(Doctor Who, "Genesis of the Daleks", 1975)

When you're starting to sound as if you're taking the most calculatedly evil creatures in the universe as your role model, perhaps it's time for a little reflection.

183:

*sigh* Just to add some colour to the debate, here's some video links.

woman yells "Heil Hitler" at a Jew
http://www.youtube.com/watch?v=GVS4Zgjm8HE&feature=related

the same woman explains that she doesn't want to "pay for health care for illegal immigrants, God Bless Them".
http://www.youtube.com/watch?v=PcRr5xA-K80


184:

#174, asking "Why" to #151: Why I'm willing to pay for health, food and shelter of others, regardless of whether they are unlucky, incompetent or lazy.

Shit happens to everyone. This is the nature of life. But as hindsight is 20/20, you'll always know *exactly* what a person shit has happened to should have done different. Only, we cannot know what is the right course of action is *before* the results are in. So, among those people who had shit happening to them, 99% could be blamed for not being prescient, and 1% might gamble the system.

Say you want those 1% to starve in the gutter or die of the plague, and give assistance to the other 99%. So you set up an ever-expanding row of hoops that everyone applying for assistance has to jump through to prove they are worthy. And to your surprise, later rather than sooner, after you have created an insane overhead, abolished the right to privacy, and have a lot more people than you expected dying of the plague, you might come to realize that an energetic, amoral person who makes a living out of gaming the system will always do better at hoop-jumping than someone who has just been chewed up and spit out by life. You might also discover that desperate people are dangerous, and that the plague couldn't care less about your ideas of "moral hazard".

Trying to divide the worthy from the not, even if undertaken without any compassion or mercy, is a pointless enterprise, and throwing resources at it is a losing game.

185:

Most comments by far have been about US healthcare and its reform, but it was the first part the one that interested me the most, because I have been making myself a similar question for years now: When did Christians became so... well, merciless?

Christianism is supposed to be above all compassive. Pity, mercy, meekness, humility... the whole packet, up to loving your enemies, pardoning and forgetting offences and treating all human beings as brothers. It would be an incredibly tough path to follow if one tried it seriously but men that would at least like to achieve this ideal seem rarer than chicken's teeth.

And that's not an American problem, it's general. Just some days ago I saw on TV Spanish bishops meet and I was reminded of 'The Godfather', so unchristian do they seem.

186:

Charlie @180: The Post Office vs FedEx analogy doesn't work here - FedEx is less expensive that the USPS for almost any parcel other than a simple letter. So is UPS.

187:

Sorry - I should clarify that I meant less expensive when comparing comparable services - i.e. ground delivery. Sure, overnight is very expensive, but the comparable 3-5 day ground service is actually less expensive from FedEx or UPS.

188:

Surely the one of the most distressing and mystifying symptoms of this national emotional sickness is the fact that every few months now one or more heavily armed crazies walks into a school or university and starts killing America's children in cold blood. And no one in authority is prepared to do anything serious to stop this madness for fear of upsetting the NRA and legions of gun owners who seem to love their guns more than their children.

It's surreal and deeply disturbing how quickly this most horrific of crimes has become almost routine, just another story for the cable news nutters to chew on for a few days, apparently getting less attention nowadays than the death of a musician or movie star. I can't see how any nation that worries so greatly about whether it's children are too fat, watch too much TV, are having sex too early, are smoking dope or are being corrupted by the internet, can appear so little motivated to prevent them being slaughtered at school.

189:

Kerry: okay, so restrict the metaphor to "for ground delivery of letters".

Actually, though, the real thrust of the argument is that public funded healthcare works like the post office -- the post office isn't run directly by politicians, and any attempt to meddle with it runs the risk of a public backlash.

190:

Don @ 164:

Do I trust my loved-one's life into the hands of a Washington, D.C. bureaucrat?

The question is not whether you trust your loved one's life in the hands of bureaucrat.

It's whether you trust her life in the hands of a Washington bureaucrat or in the hands of a Blue Shield or whatever bureaucrat that has a yearly bonus based on his performance, i.e. how much he can avoid paying for your treatments.

That's the unavoidable fact of totally privatized healthcare: the incentive of the healthcare industry is not to offer you the best healthcare, it's to offer you the least healthcare they can manage before you go somewhere else.

191:

One thing I will say, as someone who lived in the US for 7.5 years, is that the US _Government_ has had a policy for spending as little as possible on international aid, home aid, healthcare etc. but that the US _People_, on average, give vast amounts to charity, whether it's international aid, funding scholarships at universities, funding medical wings and machines at hospitals, paying for the New York Metropolitan Opera etc.

It's part of the US psyche that once you have a certain amount of disposable income, there is an onus on you to help fund the university you graduated from, to donate to various good causes etc.

The one good argument I've seen on health care reform is that the option that could be tried is getting the government out of the way and supporting a basically "co-op" style healthcare system paid for voluntarily ...

... there are many hospitals and such that are setup and run by religious charities (hence all the religiously named hospitals in US medical drama) and that sort of charitable, socially-aware and responsive group could help a lot of people ... the biggest worry/gap is paying for on-going care and medication for people with long-term needs.

Personally I don't think it would work well, but I wouldn't be surprised to see it work better than the current system *or* a US Government run system ... in the same way US people are generous and good individually, by the time they put a government system together it seems to run on pork barrels and lard.

YMMV

192:

Isidro: When did Christians became so... well, merciless?

Around the time of Emperor Constantine.

193:

@187 : Well, if the NRA won't let you control firearms, maybe you could worry about mental health instead. I mean, if you take away the guns, you still have the crazies (and kitchen knives), but if you take away the crazy, well, problem solved, no?

194:

Vestige of slavery?

Jessica Mitford's book on the (US) American prison system pointed to some of the economic benefits derived from it.

195:

Don@170, You are right, well all come from a framework. In mine, I've worked for larger companies where I've seen my medical benefits steadily decline while my and my employer's costs go up dramatically, and watched across the board wage stagnation as a result. More recently I've watched both my son's neglect necessary health care because their small-business employer won't provide health care, had to help the older one pay the medical bills for his son's birth because his $800/month private insurance considered pregnancy a "pre-existing condition", watched both of my sons AND my daughter's fiancee build up massive hospital bills that have destroyed their respective credit ratings because none of them were covered by their employers when they had significant medical problems that required hospital stays.

Your original point didn't appear to be that Private insurance in the USA is broken. The US Government has proven over the last 40 years that they can efficiently and effectively manage a single payer health care system. Why are you so paranoid about letting us have an option of a public plan? It won't interfere with your small company's ability to provide private insurance to you and your employees.

Nobody is asking you to trust your family's health to the government. What we are asking is that in order to help control costs and help provide insurance to those that desperately need it, that a government-funded option be put in place. Please don't let your fear of federal involvement outweigh my children's need for proper health care insurance.

196:

Don@170, geez my post got screwed up. Sorry my post @194 went up before I finished editing it. Thought I hit preview. Didn't mean to accidentally accuse you of stuff you didn't post. It should have read:

Don@170, You are right, we all come from a framework. In mine, I've worked for larger companies where I've seen my medical benefits steadily decline while my and my employer's costs go up dramatically, and watched across the board wage stagnation as a result. More recently I've watched both my sons neglect necessary health care because their small-business employer won't provide health insurance, where I had to help the older one pay the medical bills for his son's birth because his $800/month private insurance considered pregnancy a "pre-existing condition", watched both of my sons AND my daughter's fiancee build up massive hospital bills that have destroyed their respective credit ratings because none of them were covered by their employers when they had significant medical problems that required hospital stays.

The US Government has proven over the last 40 years that they can efficiently and effectively manage a single payer health care system. Why are you and others like you so paranoid about letting us have an option of a public plan? It won't interfere with your small company's ability to provide private insurance to you and your employees.

Nobody is asking you to trust your family's health to the government. What we are asking is that in order to help control costs and help provide insurance to those that desperately need it, that a government-funded option be put in place. Please don't let your fear of federal involvement outweigh my children's need for proper health care insurance.

197:

Vincent Archer @189 brings up a good point. Insurance companies don't want to pay for more than they can get away with. They started by pushing for shorter post-surgical stays. Of course, new surgical technology shortens the recovery time, but there's still that point at which a potentially dangerous complication can take place. It happened to me post-C-Section. Scared the you-know-what out of me, and if my angel of a husband hadn't been there to help out, I don't know what would have happened.

Hey, I'm all for stopping fraud and waste, but scrimping on care just to increase profits is a bad idea. We talk about tort reform (a good thing, IMO), but perhaps fewer people would sue if the insurance companies would let doctors make decisions in the best interests of the individual patients.

198:

There are so many comments here; I don't know that I'll be heard over the noise of them.

I think you're right that too many of our arguments do not take mercy and decent human behavior into account. I try to argue from a humanitarian position, and that does not hold water with too many people, here; it's not cold, rational, and measurable, so it must not be right. (I exaggerate. A little.)

But I wanted to point out--expanding on comment 26, actually--one factor you did not consider, that ... well, it slightly mitigates the harsh view the American right wing--and more of the left wing than we'd like to admit--has of the poor. I'm not defending it, just trying to give you more insight into what's happening. There's this ideal many people have, that, no matter what your circumstances, with enough work, you can pull yourself out of them. If you work really hard, you'll be successful. So, conversely, if you're poor, sick, unexpectedly pregnant, or in any other way in need of help, you have clearly done something wrong--you haven't worked hard enough and are therefore undeserving of help. And this notion (the side of it that is supposed to instill hope and hard work is called "the American Dream," actually--and you've already put your finger on its darker side) is clung to with a fervor even stronger than religion.

The people who cling to this leave no room for mercy, because, if anyone "just can't succeed," the whole thing falls apart. If anyone "really does need help," what hope do the rest of us have? Apparently, there is no room for an American Dream if it is not absolute.

199:

Maybe we will have to wait for the end of John Brunner's "The Sheep Look Up" to come true before there will be any peace in this world?

200:

I'm in the US right now, and from what I can tell, the average citizen has no idea about what's going on in their "health care system."

The problem they're facing is that there are only two real options for running a health care system - corporations or government. Corporations have failed miserably - and most Americans trust the government less than the corporations despite the evidence. For some reason the fear of perceived incompetence is less than the fear of real malevolence.

(Basing health care administrators' performance bonuses on the number of people they DON'T treat has to be considered malevolence.)

201:

If it's possible for a country to have an illness than the US has a deeply rooted case of psychosis. Whether it's delusion or hallucination we decide to look at a collective set of facts and then ignore or explain them away until it fits our narrative (gov't health care equals nazism, death penalty equals justice, bank bailouts equals help for the poor). If we were a patient I wonder what the doctor would prescribe? Probably a few years of structured care in a mental hospital.

202:

I read your books =(

203:

I'm going to touch on a couple of issues I don't think people have referred to much in these comments.

On why there is a debate over health care reform. I don't think it has as much to do with class, wealth or government control as it has to do with our rapidly changing cultural ideals in America. Most of us are fine with it, but there is a fair percentage (probably around %15 or so, maybe less) who are really afraid of what or society is becoming.

They see gay marriage as inevitably becoming legal. They see a new generation of far more open, liberal, and secular youth. They see a black president. They see people moving to the cities where they inevitably become less conservative/traditional. They understand all of this as a degradation of our moral values and traditional culture (which of course is ridiculous since our country is fairly young and each generation has been quite different, but the change IS accelerating).

Thus many of the people screaming about health care reform aren't really screaming about that alone, in fact they often know very little about it (they don't realize Medicare is a government program for example). They are just using it as a new excuse to demonstrate their anger at a world changing faster than they can accept. A good example of this is the fact that many of these people who are upset are relatively poor themselves. A few moments of objective reflection would show them they are protesting something that will help them quite a bit, but they aren't thinking about that.

An entire set of cultural ideals (the hard working (physically) American man on a farm or in a factory, supporting his white-bread family) are evaporating in a very short time. We complain about outsourcing, not realizing how short term thinking it is to maintain a single type of industry which never adapts to a changing global economy. The idea that we can replace the American factory worker with an American innovator and scientist makes them think we are going to simply cater more to the "educated elite". They are freaking scared.

On the topic of the Lockerbie bombing. I don't know enough about the trial to decide whether I think he was innocent or not, however I don't think enough people know about the Iranian Airlines passenger plane which an American ship shot down previous to the Lockerbie bombing. That had a couple of hundred innocent civilians and many children as well. Yet we gave the entire crew of that ship medals, and never officially apologized to the Iranian people for our mistake. Where is our sense of justice there? If the Lockerbie bombing was in response to that, it certainly does not make it okay, but it should give us a sense of perspective on how we perceive or don't even know of our own evils, versus those of others.

204:

Charlie @ Um, moo? The numbers seem to have disappeared:

Surely the US isn't the only country to experience a problem with school murders. A quick ineffectual google gave me a list of shootings from '96 through '02, as many incidents from Germany as from the US, and one from Scotland.

I have no idea what the actual school murder rate per-capita rate is, but I'm sure it's low enough to be vanishing. I think you're misjudging the American response to these incidents, however: people are horrified and filled with extraordinary terror and fear over these incidents, and the response has directly led to the current insane climate in schools, where metal detectors go without saying, wearing trench coats is verboten, and a six year old with a squirt pistol must be expelled on the spot.

Surely you can argue that the American response to these incidents is moronic, ineffective, and illogical, but not that people just accept them out of hand. It's the concept of taking effective and appropriate action that people are incapable of understanding, not the concept of taking action at all over such incidents.

205:

Er, and now that I look more closely, I wasn't responding to Charlie at all. My apologies, with confusion.

206:

I'd like to add to such a succinct and powerfully spot-on summary of my nation.

Merciless behavior points to pride. Pride in a class that is more ideological than socioeconomic, ultimately pride in oneself.

And more often than not, that pride can be sourced from a heavy dose of fear. As an earlier comment duly noted, fear drives America in many aspects. Fear of change and fear of lawlessness, the poor usurping the Capitol, fear of others being better off than we.

Is it really a surprise after decades of fear-mongering amidst American chest-thumping echoing from our leaders down to every boy and girl in a classroom?

However, Charlie seems to indicate that America is beyond repair.
Rome was not built overnight, and surely tearing down the Great Wall of pride and fear and of the merciless will ravage many years of generations to come. But it is not a lost cause.

While many love to dispose of our President as the latest lackey untrue to his campaign promises, the truth remains that the America we so endear (now a fantasy of ideals we no longer uphold) has a black thick coating which requires tact and finesse to deconstruct. Any outwardly abrasive attack is akin to floundering in quick sand.

My generation has taken the first few steps by electing President Obama. My generation has pushed for progress and voiced tolerance when not long ago we'd be locked up as Red supporters. My generation is not done.

I still have faith in my generation. And we ARE Americans.

207:

But are you "Real Americans" from "Real America" ?

208:

As nearly as I am able to determine, it was the celebration of Megrahi's return to Libya that the Obama administration found objectionable, and not his release, although our President apparently feels that Magrahi should remain under house arrest for the rest of his life in Libya.

As I said elsewhere, if Dubya were still President, US forces would have seized Scotland by now and established US-style "democracy" there... *sigh*

209:

On a slight tangent, I was somewhat disturbed at the audience behavior during a local US showing of "Inglourious Basterds" yesterday. A number of the audience were cackling and laughing during the scenes depicting the committed atrocities. That struck me as particularly inappropriate and now makes me wonder if there really is a sub-set of people who are somewhat "merciless". Was this unique or have others observed this?

210:

It's worth remembering that, while the government of Scotland hasn't admitted to any errors, this compassionate release has established that they are not revenge-driven thugs. I'm no expert on what the Prophet taught, but this isn't going to hurt Scotland's reputation in the Islamic world . And it's an act of strength.

And compare this with the recent case of Ronnie Biggs. The English Home Secretary wasn't going to release him from custody, even when he was close to death. He's an old man, plagued by the frailties of age, but about a fortnight ago he was released from custody. All that means is that they stopped putting guards on him in hospital.

Well, it doesn't surprise me that his health seems to have improved a little. My parents have both had bad periods and better periods. But Jack Straw's attitude, based on what he's said about the case, seems very American.

And that's what might be making this a hot topic within the UK. That, and the apparent imbalance of extradition procedures, and the apparent connivance of the British goverment in the criminal mess that surrounds "extraordinary rendition". Is torture so different from piracy? Are the torturer, the pirate, and those who support them, all hostes humani generis?


211:

For the several commenters who have asserted that the US only objected to Al Megrahi's homecoming celebrations in Libya: No. The official US stance, stated several times over the week before the release, was that he should die in jail in Scotland, and that it would be "absolutely wrong" for him to be released or to be transferred to a Libyan jail. The US government has no time for mercy or compassion (except, as noted above, towards American war criminals).

http://news.bbc.co.uk/1/hi/scotland/8208755.stm

http://news.bbc.co.uk/1/hi/scotland/8201188.stm

212:

Dave Moore@146


Wow man I could not have said it better myself.

Makes me sad though. My fellow Americans are going to go thru a lot of pain, in order to find out that we need each.

213:

As an American I'm saddened to have to agree with your points about mercilessness. I recall after Katrina flying on a plane with someone who had absolutely no mercy for the people hit by it. She had no conception of how poor these people were and how incredibly difficult it would have been for them to flee, nor was she at all interested in considering what it might be like to be in their shoes.

I do think you're overreaching when you say "What makes me angry ... Well, to start with it's worth noting that the loudest denunciations came from the White House — an entity with no legal standing whatsoever in the Scottish judicial system. But we expect external interference from the White House: it's what the Imperial Presidency is there for."

Remember this was embedded in a blog posting that criticizes the barbarism of the US judicial system, and you are an entity with no legal standing there. However, if you have an opinion about an egregious abuse, I'm hoping you'll feel free to weigh in.

I'm hoping I can keep reading your books!

214:

Everyone uses obnoxious behavior, offensive language and cynical PR stunts to increase notoriety. In today's fractured media market, that is the only way to get noticed. Whether you work for Fox News or are a "new" atheist the PR methods are the same. Only people like Glenn Beck, Jerry Springer and PZ Myers get noticed in today's media world.

The technology has changed. My kids can't believe that we used to have only 3 tv stations (4 if you counted the fuzzy UHF channel), and no internet, no blogs, no cell phone video recorders, no video games, etc. In such a market only angry extremists get the eyeballs, and by doing so get the false inmpression that they are the norm. An intelligent, soft spoken man like Walter Cronkite wouldn't last 10 seconds in today's media market, let alone command +50% of the market share back when he was Uncle Walter. We can complain all we want about Limbaugh and Beck and Dawkins - but they are the ones with the market share becasue they use their obnoxiousness to stand out fro mthe crowd.

Fortunately they are unusual, not mainstream. Think about it. If America really was this bad, would we have elected a black man president in the first place?

215:

Hilarious! This *is* a joke, right? Surely you haven't formulated all your opinions of American values by watching TV, have you? No, I can't imagine you have. I'll go on assuming this was meant to be funny.

216:

As a Brit living the US - I have to say that Charlie is right on all counts. I work at a university and live in a small university town so I have very good health insurance and access to reasonably good health care.

My wife had minor surgery the other week and the nurse, the doctor and the anesthesiologist all asked us about the NHS and how it compared. My feelings were that we seemed to get faster care (and all the surgery we could use) over here while we didn't drop $2000+ on copays in the UK. The deductions from my salary in the US and UK were about the same. Of course in the UK that is a (relatively) progressive tax while here it's a fixed cost so professors and janitors pay the same. I also had to add the caveat that we were comparing large (northern) city in the UK against rural college town in the US.

A further fact of interest was that the nurse had such poor health insurance she "couldn't afford to be ill" - I just hope she washed her hands before we started.

217:

(We currently don't have comment numbers, and the Reply buttons don't yet work, so the links under the names go to the comment I'm referencing.)

heteromeles, there's no indication that organic food will help you lose weight. It may have less pesticide and such, but maybe it's the pesticide that helps you lose weight.

Alex Tolley, in my area, if a Cadillac drives by, you wonder what kind of drug they're selling.

Ian Turton, I had minor surgery last Monday and once I got the clearances from all the other doctors, it was scheduled within a week and my co-pay was $100. I may get that back because the billing person only put in my Medicare info, not my Kaiser info.

T.R. Reid had a short article on 5 Myths About Health Care Around the World in yesterday's WashPost.

218:

Here's a quick question --- a somewhat random thought.

Is it possible that what you see as mercilessness is as much a symptom as a cause?

I was just out fishing, which is an activity with a very large random component. It's also an activity that conduces to magical thinking. People develop very elaborate theories that attribute success and failure in this activity to decisions and actions by the person fishing, I suspect because people don't like to think that their success and failure are largely random.

Now, if you live in a society that has a less-developed safety net, is it possible that would conduce to magical thinking that attributes success and failure to individual decisions (and individual virtue) rather than to randomness? And that that would tend to lead one to believe that people who have lost their health care, for example, lost it because of bad decisions rather than because everyone is one (or at most two) layoff notice(s) from losing their health care?

219:

I think the number of Americans genuinely "merciless" in the sense of the title here is no more than the number among the British - perhaps 10-15% of the population.

It's just that here, they own the TV news network with the highest ratings. And a bunch of radio shows. And newspapers.

As for Al Megrahi, whatever it might have looked like from the British end, over here it was a blip, and I seriously doubt you would get a majority in favor of keeping him imprisoned. But that's a very boring view; it's "dog does not bite man". For the most part I think nobody except people rabidly searching for something to be offended or upset about was even paying attention.

I would say that the selfish ideology is just as ingrained in the UK as in the US, but that they have more of a media platform here owing to the more overt influence of corporations in politics. (I don't think the influence of British corporations is any less, they just keep it quieter.)

Now as to the health plan, there are the crazies, and then there is a larger group that 100% bought the Reagan myth of private enterprise always being able to do a better job. Those people are perfectly nice, but they believe in a religion. And like most religious believers, counterargument or facts are irrelevant. Unfortunately, what they're religious about is an important part of public policy, and they are profoundly mistaken. But they really do believe that this is the best we can do, and if it were possible to do any better, the free market would already have done so. Q.E.D.

However, that group is shrinking, and almost completely lacking in representation in the genx/geny cohorts. (Not quite completely. But close.) I am confident that that ideology is waning, but things move slowly in a country of 300 million. And it's a constant fight against corporate interests who really are merciless.

As many people above have noted, though, Americans are extremely diverse, especially by region, consume and produce a very diverse mix of media, and so even finding out what "most" people think about anything is not a simple process. From outside (and I know you've spent time here, but you're looking from the outside now anyway, as I am about Britain these days) what you are going to see are the most extreme spikes.

220:

Marilee @217, Here's an interview related to your last link, just heard it on NPR's Fresh Air. Worth a listen, if you have the time.

T.R. Reid: Looking Overseas For 'Healing Of America'

221:

Tim @196 ... You have valid points. I really don't have much desire to argue healthcare. My only reason for jumping in here was to express an opinion contrary to Charlie's suggestion that the healthcare debate is a matter of mercy or the lack thereof. Charitable giving is my first priority with every paycheck and I am a bit offended by the suggestion that I am "merciless" if I think healthcare reform should be carefully and thoroughly explored before congress railroads some radical plan just so they can thump their collective chest and say, "We reformed healthcare!" Yes it needs reformed, but debating the details is crucial. If certain people had their way, congress would have passed a sweeping and radical healthcare bill earlier this month without the public (and many in congress) even knowing what it said. That made many Americans mad. They just want to say, "Hey! Slow down! We're not willing to give the government a blank check and simply trust them to do the right thing. The process should be deliberate and transparent." Charlie completely misses the point if he thinks that is "merciless."

222:

Like Ed, I grew up in the UK but have lived in the US -- the Bay Area, specifically -- for decades. But my dad's back in the UK and I scan pretty much all the British media daily--- Guardian, BBC, Independent, the Times, all that -- and one thing has been striking about the difference between the U.K. and U.S. reactions to this Al Megrahi business.

Which is that, sure, you've had official complaints from the White House and Mullen at the Pentagon re. Al Megrahi, as per form. But it's hardly done more that drift briefly across a bottom column of a few front pages in the mainstream media for one day; in general, nobody cares that much at all.

In the UK media, conversely, the matter has been heavily featured and kept in rotation, with some people -- as here -- frothing about what the vastly diverse reality of America is and isn't. In many cases, these are clearly masturbatory anti-American fantasies, and as parochial in their assumptions that "the way we live is the one true way and Americans are barbarians for not adopting it" as are the parochial assumptions ascribed to Americans by some commenters here (often correctly, of course).

Still, why? Why do you all care so much over there? Because over here they -- we -- really don't.

The answer's obvious enough, though. Granted, I currently think we're living in a Pohl and Kornbluth novel in the US --- GLADIATOR AT LAW, most specifically. Yes, there's much wrong with America. Sure, because of the historical frontier context of lawlessness and ruthlessness, and a foundation ideology that remains strongly anti-government, there's a social ideal of self-sufficiency -- of overt cruelty, as you will -- that's as American as apple pie, and that's alien to you and many UK residents in 2009.

But it's not alien here in the US. And actually it wouldn't have been alien to the British, Scots included, of the 19th century and the Victorian era. Of course, those terrible Victorians with their imperialism, social darwinism, untrammeled capitalism, arrogant assumption of their own superiority, and all the rest of it -- who'd want a society like that again? Not you, I'm sure, and not me. And yet via the industrial and scientific revolutions that culture created and exported, alongside its sometimes crude notions about rule of law and free trade, arguably no other culture in history has so nudged the trajectory of the species upwards. Very few cultural eras have produced such a profusion of human capital, with the likes of the Macauleys and the James Clerk Maxwells, and all those similar figures. The UK of the Victorian era was where the action was, in short; today's UK not so much.

This is the same argument, in other words, that Graham Greene and Orson Welles had while making THE THIRD MAN. Greene, virulently anti-American, wrote that film's script and created Harry Lime, that archetypical American monster. In rebuttal, Welles wrote for Lime those lines comparing Switzerland and Italy under the Borgias. Since Welles was the star, those lines went in the movie over Greene's objections and -- partly because Welles plays them beautifully, and partly because Welles was right and Greene was wrong -- they're the best lines in the film.

Balls, you say, I'd rather live in a kinder, gentler society. Except, you know, it's not. I go back to the UK fairly regularly. I'm wary of generalizations, but the British people these days may be ruder, slightly unhappier, drunker and generally meaner than Americans. Certainly, UK politicans are worse than the stateside versions -- a class of careerist po-faced tossers prepared to sign off on measures like what was done to David Kelley (1944-2003), the former weapons inspector.

I'm not suggesting that thugs in the US government and covert services mightn't contemplate a clandestine hit on a figure equivalent to Kelley, if he didn't keep his mouth shut. But they probably wouldn't dare-- for a variety of reasons --and they certainly wouldn't put that fake suicide out in the open as a deliberate message to anybody else who might, as they saw it, stray. That was done with Kelley and it was truly disgusting.


223:

I've never read one of your books, but based on what I stumbled upon here, I might have to consider it.

@151

I am an American and I don't have "big special words to use".

...and you claim to work in the medical profession? May I suggest a new line of work?

I am an American who does have big special words to use, but I don't need them here. You're going for the folksy simpleton stating his opinion, as if that somehow impresses anyone. It doesn't.

224:

151 wrote, "Mercy is not something a convicted terrorist deserves." You may want to rethink you terms. "Mercy" by definition can only be extended to those who don't deserve it. If they deserved it, it would be justice, not mercy.

225:

Charlie: yea, that's pretty much how it is. Except anger is the appropriate response, not shame (if you're a merciful American).

Smug eurofucks: It wasn't so long ago that your civilizations were the Big Powers, and what did you do with that position? You colonized every scrap of land on the planet that didn't have the technology to resist. You stole everything you could carry off, and murdered any wog that tried to stop you. You started world war one basically because you thought it would be a hoot. You covered Europe with totalitarian nightmares. You tried to exterminate the jews. Europe is the all time world champion of merciless atrocity, and your grandparents were the generation that committed the worst of it. Do you care to be judged by the sins of your civilization the way you presume to judge me?

226:

[ Anonymous fucktard deleted by moderator ]

227:

I'd like to think that I'm an American who doesn't fit Charlie's mold. But I'm also opposed to adopting anything resembling the British, Canadian or other centralized systems.

I work with a large number of immigrants from the Eastern block, and if you ask any of them about "socialized medicine" they look horrified at the thought of it coming here to their new homes. They've lived through Socialism, and that's part of why they came Stateside.

I think the system in the US is flawed in some aspects. But we don't need to take a system that works for a LOT of people and toss it just to fix the small flaws that are present. We absolutely should find a way to get everyone into the system, and covered. But widening the gulf between the consumers of services, and those writing the checks is absolutely the wrong way to address skyrocketing costs. When people are completely divorced from seeing the costs of their decisions, and healthcare is essentially free, then there can be no real restraint by the consumer. And the whomever is paying is forced to put restraints in place, via rationing, either by price (US) or by queue (Canada/Britain).

Just one example of the finest in British Healtcare, in the recent news:
http://www.telegraph.co.uk/news/uknews/1578979/War-hero-refused-treatment-by-NHS.html

228:

I would read your books no matter what.

I read John Ringo's books and he is a total asshole.

My experience as a 25 year American health care worker:

our system is expensive because doctors here are RICH.

Even the lowest paid doctor here makes a ton of money.

Our prison system is a way of making people into slave labor for corporations. They make all kinds of stuff:
furniture, etc.

As far as an American lack of mercy: our culture glorifies violence and thuggish behavior. Combine that with a pathological, Puritan view of sex.

Result: Duke Nukem as a role model.

229:

@225

Ignoring the Tourettes, your 4th grade rendering of European history implies that the US was not acting in a similar fashion. Yuor rant also implies that Europe was a unified nation, but that's besides the point.

For your edudation here's what the US was doing at the same time:

Grabbing land from its neighbours by threat [Oregon] and force [Mexico].

Disposessing natives of their land [American Indians and Hawaii]

Starting wars of agression [Spanish-American War, Phillipine War]

Commiting massacres [American Indians, Phillipinos]

Interfering in the affairs of your neighbours [Various interventions in Central and South America]

Slaving, and then dumping slaves back in Africa and leaving them to rot.

Forcing treaties on nations under threat of force [Japan, China]

Engaging in excessive reprisals [American Indians, Destruction of Greytown by USS Cyane]

I'm sure the list could be easily extended...

230:

@Americans saying "but we're not all like that!":

I've read a number of Internet discussions about the latest insanity to come out of the Texas schoolbook standards committee, or whatever other source of craziness from that state. You'll always get someone pointing out that "All Texans aren't crazy reactionary religionists! Austin is cool and hip and liberal, and the Dallas/Fort Worth metro area votes Democratic too!".... which may be true and all, but you barely ever see or hear from those Texans. And whatever Texas seems to do- often affecting other states, especially with Texas schoolbook standards- it always comes out as crazy reactionary religionism.

So while part of me also wants to stand up and say "hey, we Americans aren't ALL like that!" ... that's certainly the side we're showing on the international front.

231:

After taking some time away to think about this post, and to read some of the responses, I still hold with my earlier sentiment. And I'd like to add something that I immediately thought of upon reading the post, but which I couldn't quite articulate in the moment, which is that Alan Moore made this same point in a roundabout way in 1986.


No. Not even in the face of Armageddon. Never compromise.

Because, if I'm reading correctly, the point Charie's making isn't just about mercy, it's about nuance. In the above quotation Moore, speaking through Rorschach, is satirizing a value many people -- Americans and otherwise -- think they live by, or even try to. The "never compromise" attitude is little more than a hack around nuanced thinking and response. Prisoners have cancer? Never compromise. Cancer causes communal resource expenditure when discovered inside the poor and uninsured who suffer and die without treatment? Never compromise. A public option might raise taxes? Never compromise. This is a shortcut through the hindbrain. No thought regarding anything outside the self -- the suffering of others, the benefit of the larger whole -- need ever penetrate the twisty, tangly areas of the frontal cortex once never compromise becomes the default setting. It's a zombie switch. And it gets a lot done: it's useful in communities where the continued standard of living of the in-group depends on the continued standard of suffering of the out-group. Or rather, it's necessary in communities where the dominant discourse perpetuates the belief that the current reality depends on that suffering.

Never compromise is how you get a lynch mob in Glasshouse. And if some readers can't see the relationship between the inability to take a moment and think from a variety of perspectives about complicated situations and the villains they've reviled all along, both in fiction and on the news, then that's their own tragedy.

Not even in the face of Armageddon? Don't worry; it's sooner than you think, if we keep this up. Remember: even Rorschach let the cancer patient live.

232:

As an American who is opposed to nationalized health care (though I really don't have much of an opinion on the recent actions of the Scottish courts), I'm sorry to hear that you don't want my money. For several years I've bought most of your books new in hardcover, and intend to continue on doing so.

If this causes you some small amount of emotional distress, why not take the dollar or so a year of "my money" that end up with to and donate it to some charity or cause you consider worthy? That way we both win; I buy and enjoy your books and you get to take that tiny amount of "my money" and use it to subvert whatever you think my political beliefs are.

233:

@229

That's kind of the point though. People in glass houses and what not. Merciless dicks and mushrooms, you know. They grow anywhere in any country. It isn't appropriate to fashion a stereotype for a large and diverse population based on a few outliers.

I'm white and from the south. I'm not a racist and I don't carry the burden or responsibility for something I took no part in. Granted, my ancestry is Dutch and they started the slave, enterprising bastards they were. But not me.

And the cherry picked complaints that prompted Charlie's rants originate from a minority. I'll not apologize for things I didn't say nor be held accountable for thoughts and actions I have not committed.

And reducing the healthcare debate in my country, that he is not a part of, to base emotions espoused by a few is EXACTLY the sin he seemed to be so pissed about. He's welcome to his opinion and his rant, much of which is accurate. What is ridiculous is the tired "ugly American" speech.

It's a fine conversation and I'm not troubled by it in the least. He had a rant to get off his chest. I do that too. But it is dissappointing to see that there are apparently alot of people who commented who don't mind calmly ascribing stereotypes to a population of 330 million people by moaning about how horrible and terrible all those stupid ignorant merciless Americans are.

I mean, Jesus, the enlightened came of the woodworks to comment and bumped their heads on the ceiling not realizing how high their pedestals had gotten. It isn't an American trait to be a merciless fuck; it's a reasonably common human trait though. But sure, let's all huff and puff about the bad Americans while we delight in the oderific smell of our own shit. That's a pretty enlightening conversation.

234:

I think the short answer to the statement that not all Americans are merciless fuggheads is the number of people who voted them into power. Again.

Saying it's a minority may be strictly true, but 45.7% voted McCain/Palin. Or maybe they voted for a party which has been subverted by a much smaller group?

It's next year you get a chance to vote the bastards out, right? If they're a minority, what's taking you so long?

235:

'The UK of the Victorian era was where the action was, in short; today's UK not so much.' (Mark Pontin)
I've seen it argued (by Corelli Barnett, at least) that it was in part the Victorians' near-Libertarian non-policies that lay behind the decline and fall of the British Empire, once others started doing the industrialization thing, only rather better.

236:

In rebuttal, Welles wrote for Lime those lines comparing Switzerland and Italy under the Borgias. Since Welles was the star, those lines went in the movie over Greene's objections and -- partly because Welles plays them beautifully, and partly because Welles was right and Greene was wrong -- they're the best lines in the film.

It might have been a good line, but it was total historical bollocks, which was why Graham Greene objected to it.

237:

Larry @225: entirely true ... and totally irrelevant. This might have escaped you, but the last of the first world war generation just died of old age. For the past two-thirds of a century we've been trying to do better. How about you?

Kent @227: you need to read for context; the newspaper you cite has a pronounced right-wing agenda. (Seriously. It's like Fox News, only superficially more rational, and therefore more insidious.)

I do not like the way this thread is turning into trans-Atlantic mud-slinging.

I started out with a post about mercy; where's all this hate coming from?

If it keeps on building up, I'm going to declare time out.

238:

Kent Bunn @227: I work with a large number of immigrants from the Eastern block, and if you ask any of them about "socialized medicine" they look horrified at the thought of it coming here to their new homes. They've lived through Socialism, and that's part of why they came Stateside.
Firstly, what colour is the sky on your planet? The fact that you believe that the health systems in western Europe resemble anything in the Warsaw Pact immediately rules you out of any sane conversation. I seriously doubt the existence of these "Eastern block" immigrants. Any immigrant from, say, East Germany, Poland, or Hungary, would have a much firmer grasp on the reality of (say) the German system than you do, and if you described it to them as "socialized medicine" they would either laugh in your face or say "so much better than the Communist system".

In any case, the US isn't going to get "socialized medicine". Your politics is way too screwed up to deliver anything as sensible as that. You're eventually going to get something a bit like the health systems in the rest of the civilized world, except yours will be slower, less fair, less efficient, with poorer outcomes, and much, much, much more expensive. Enjoy it.

239:

Kent Bunn @227

Huh? Isn't there a difference between Socialism as a form of government or political structure; and socialized medicine (that is a buzz word for basic health care for all citizens [and provisions for non-citizens visiting])? I wonder if the people you were speaking to knew the difference... or in fact if you know the difference?

240:

cod3fr3ak: "socialized medicine" is not a term used elsewhere on the planet. It's a smear-phrase invented by the American insurance industry's lobbyists, playing on decades of social conditioning that equates anything containing the word-stem "social-" with jack-booted totalitarian thugs breaking down their doors and stealing their property.

America: land of thoroughly ideologically indoctrinated and propagandized people who nevertheless believe they're three-thinking folks with a right to free speech.

(Sorry: couldn't help it. I know not all of you are like that, but this blog is prone to drive-by wingnuts.)

241:

Moderator - I'm the deleted anonymous fucktard @226. My response to Larry @225 was intended to be tongue-in-cheek, not inflammatory. I agree that this should not degenerate into a cross-Atlantic mud toss (although you seemed to start the whole thing by tossing mud in your original blog). In hindsight, my comment was reckless. Thanks for deleting it.

242:

@232
WHY& are you oppsoed to "Nationalised Health-Care" ???

EVERY OTHER CIVILISED NATION ON THE PLANET HAS IT.

Why not the USA?

Answers on a postcard please!

243:

Charlie@240

I know that, but I am wondering if Kent knows it. Its a shame how few do.

Just goes to show how poorly educated in critical thinking and logic we are. For example I listened to Sen. Orrin hatch this weekend equate the phrase "tens of millions" to "ten million" and then when he was called on it switched to the fall back position of "but its a lot of folks..." some folks would say he just made a simple mistake, but when the issues is as important as health care reform you would think he would attempt to be more accurate.

Pathetic. This is the current level of political discourse within my country. It is strange. Kinda like picking the scab off of a wound knowing it will bleed and cause pain, not not being able to resist. Its enough to drive a man to drink; and I do; copiously.

Lets hope the insurance companies can't raid my credit card purchase data to see how much I drink anytime soon. Cheers!

244:

Speaking of rationality I just listened to Glen Beck say over and over again that his show was an opinion based show (linkage):

"This week I'll be giving you some of my opinions. And they are just that, my opinions. But that's what this show is, an opinion show. They are certainly shaped by facts and research."

Many of my fellow citizens will confuse the inclusion of the words "facts" and "research" with accurate and unbiased information. Thus whatever Beck says will move from opinion to reality after it leaves his lips .The same folks undoubtedly voted for McCain/Palin because the former governor is so "knowledgeable".

245:

The NHS promotes a culture of vigorous financial risk taking, since we Brits aren't tied to our day jobs by strings of health insurance. This is a good thing for our culture.

(Re the bomber: US nationals were on the plane, it's legitimate for US citizens to comment. The nature of the comments is another matter. As for me - I'm disinclined to show much kindness to a convicted mass murderer who acted for political/ideological rather than psychological reasons. So, I'm with the poster who would have let him go home once he could no longer walk. But if his family want to visit him here, sure, show them kindness; they are not the enemy.)


246:

Given the number comments, maybe these points have been made before, but I thought I'd throw in my 2 cents.I think the American view of public morality & society probably started diverging from England/Scotland's about 300 years ago. Most of our culture comes from those two countries, but the split left us without the influences and changes the 18th, 19th, and even early 20th century brought to Europe. We're an alternate path society could have taken in Europe, so to speak. I think things are changing, modern communication means that there has been and will be a lot more two-way communication and exchange that will halt the divergence.

One of the biggest differences is how we view morality. Though it's not by any means universal in America, there is a wide belief that poverty is the fault of the poor and represents a moral failing on their parts. Which is probably why most people in the US view themselves as middle class -- both those making $30k a year and those making $130k. Because there's also a view that the rich are somehow morally corrupt, unless they are willingly giving back to society (via charity, not taxes).

The health care reform problem is a bit more complicated. I don't think anyone is happy with the current system, but there's a lot of fear as well. It is, after all, a matter of life and death. The Democrats in Congress (and Obama) seem to have made the same mistake they made last time they were in power -- trying to do everything at once, and this time in the middle of a recession. The political problem with a comprehensive reform is that there's going to be some part in there that upsets everyone.

If the reform had been done in small pieces, then those concerns could be addressed and you wouldn't get a feedback loop of fear and distrust. There are relatively simple fixes that could improve things, until collectively you've reformed the entire system into something that works and that most people are satisfied with.

No one wants their fellow citizens to get sick and die, no matter how poor they are. They're just afraid that a system that provides for them will somehow screw over those who do have health coverage now -- either by making their health care lower quality or by making them pay a lot more. Or both.

Because the other thing American culture values strongly, is individualism and individual freedom. Even at the expense of public good. People will make sure that they are providing for themselves and their families before they are willing to help others, and being on public assistance is seen as a failing.

247:

Oh, I should add that the attitudes about crime and the penal system here in the US disturb me too. The casually tolerated abuse of prisoners, and the continual punishment of offenders is something we need to stamp out. Finding jobs for ex-offenders can be very difficult, especially now that many employers are doing background checks. There are groups that help them get back into the workforce, but unless they can find good jobs they tend to fall back into crime.

Also a problem is the universal condemnation of sexual criminals, especially given what a broad category of crimes that covers. Technically a 17 year old taking nude photos of herself and sending them to her 18 year old boyfriend make them both sexual predators who will be on lists their entire lives and unable to hold certain jobs or even live in some cities or towns.

248:

For another satirical take on the subject of Scotland freeing Abdelbaset Al Megrahi, see: http://www.boycottscotland.co.uk/

249:

Andrew G@246

Good points.

"Because the other thing American culture values strongly, is individualism and individual freedom. Even at the expense of public good. People will make sure that they are providing for themselves and their families before they are willing to help others, and being on public assistance is seen as a failing."

I think the statement above is where the rubber meets the road. This is going to kill us in the end. You can not have a society if its every man for himself. You will inevitably get oligarchs and robber barons, who will harness all the wealth for themselves and seek to depress dissent - violently if needed.

I mean many Americans do not know that some robber barons hired thugs to kill or at least beat down union workers and organizers. They seem to think that type of stuff only happens in the "3rd world/banana republics". Trying to get thru to these folks is like trying to tell a teenager that the young woman or man they are "madly in love with" may not be right for them. It simply can't be done. They lack the life experiences that would allow them to see things from a rational perspective.
In this way I think we show our relative youth in comparison to other cultures of the world. The culture is young,and worse, nearly totally molded by mass media. I believe this breeds a lack self reflection, since the default mode is receive (from the TV).

250:

Prescription for a fact based reality anyone?

251:

John F: I'm not certain, but I think a good start would be to abolish the legal fiction that corporations are citizens (and are entitled to the rights of citizens). This means that corporations lose their first amendment right to free speech -- or rather: it means that corporate speech can be regulated.

A second good step would be to abolish the current US system of electoral funding and copy someone else's -- just about any other nation that has basic checks in place to prevent moneyed interests from buying electors.

Finally: mercilessly enforce net neutrality on the ISPs and telcos. (If they don't want to cooperate, fine: corporate death penalty time. Because net non-neutrality is an implicit license to violate the free speech rights of human citizens.)

All these steps won't suffice to fix the problem -- but they're necessary preconditions for such a fix.

(Oh, and while we're on the subject of unachievable utopian wishes, please can everyone have a sparkly pony and a free lifetime supply of peanut M&Ms?)

252:

IMO what seems to our host as a total lack of mercy is not a general trait of Americans, is merely the side effects of Authoritarian political combat, which simply works that way.

The health care issue is a big deal, and important, but it's a symptom. After all, Bush's "Medicare Prescription Drug, Improvement, and Modernization Act" got through with comparatively little complaint. The fight against "socialized medicine" is actually the fight against "the other party accomplishing anything." Several high level GOP folk have openly admitted this - see the whole "Waterloo" bit.

The core problem is that people have largely forgotten what rich nation authoritarianism looks like, and the accusation thereof is taken as an overused formulaic insult even when it is a serious charge. The supine posture towards the Leadership, aggressive denunciations of those who don't fall in line, the total disregard for the truth, the total lack of shame when caught lying, cheating, stealing, or other hypocrisy, the basic behaviors are all there. Heck, we even got corporatism in this batch, although that is not necessary for all types of authoritarianism. However, due to overuse of 'Nazi,' Commie, and 'Fascist' as insults over the past 65 years, accusations of authoritarianism in serious debate tend to auto-Godwinize. (Annoyingly, authoritarians can accuse their opponents of authoritarianism safely, because authoritarians don't care for serious debate.)

Consider the recent revelation that terror alert levels were manipulated to favor the GOP before the 2004 elections. The GOP is not ashamed of this, they are arguing that it was still wrong for the left to question the Leadership in time of Crisis. In the meantime, the GOP is calling the current leadership Nazi in times no less crisis-y (if you go by unmodified terror threat levels).

A significant fraction of the Left (I am assuming this includes the authoritarian fraction) wants to fight the same way. The Dems are not yet subverted by their own authoritarian wing, but they could easily go there simply as a method of dealing with the tactics of their opponents. It is one of the many ways to go there.

Which gets me back to the start: hard past experience has taught us how bad authoritarian first world states can be, but we don't seem to recognize it internally anymore. We currently have a significant fraction of the populace fighting tooth and nail for authoritarianism while shouting loudly that they must do it to prevent authoritarianism, without any detectable irony, and this is taken as run of the mill business as usual political discourse. It's like a joke where the punchline is a concentration camp, and I don't find it funny.

My optimistic side says that the authoritarian right is dying a demographic death, and the authoritarian left is currently well subordinate to the other branches. It is also clear the lots of the rhetoric is not internalized, since if a significant fraction of Americans really did believe that the current government was Nazis, there would be armed revolution.

My pessimistic side notes that many notable authoritarian take overs had much smaller fractions of the population loyal to them then the current GOP "base."

253:

Don't forget skittles!

254:

Neal Birch and his wife are wise people. Compassion, by nature, is a shared experience -- com (together) + pati (to suffer). If you see someone in a wheelchair, and you're not in one yourself, you're honest enough to acknowledge that you're one automobile accident away, and that the difference between you and the other person, in this particular case, is luck. So you think what you'd actually need if you were in that position yourself. It's not dissimilar to genuine courtesy.

Pity is a step down from this. It's a way of feeling safely distanced, of making another person into an object, and an exceptional one, since you don't want to think of bad things as happening to you. It might make you act demonstratively helpful, out of guilt or pride, and that may turn out to be useful, but as a way of avoiding empathy, it can also be poisonous. (It would be false, and infuriating, to be reduced to "that poor guy in the wheelchair.") A little like rote politeness, following the rules while not getting too involved.

But to lack even pity borders on psychosis. And there's a lot of that going around. It's usually associated with a bizarre sense of entitlement. Infantile reasoning made into a political principle, with any remnant of adult guilt or social obligation channeled into rage and punitive behavior. I don't claim to understand how this works, but there are plainly politicians who know exactly how to tap into it.

255:

the irony here is that the overwhelming majority of people who are against reform (Read: those with a net value of less than 50 million dollars) ultimately risk losing everything. Even if you think you're fine because you work hard, and your employer gives you great benefits, you still run the risk of developing something monsterous (leukemia). Sure, for a while your insurance will work as promised, then you'll be hospitalized for a couple of months (bone marrow transplant) over which time, you will lose your job (no they don't have to keep it warm for you) and subsequently your employer based insurance.

No other insurance company will take you on (Geelvec is $4,000 for a 3 month supply, are you kidding?) and no other employer will be able to take you on (Their insurers would never allow it). There, you've just gone from well off and hard working to bed ridden to on the street in 3 months and tens to hundreds of thousands of dollars in debt. You're screwed. Forever.

If you think this can't happen to you or someone you love, you're dreaming. If you don't care, you're insane.

256:

Let's not forget that America gets up every day and decides not to incinerate the world, which owes it everything, and for which the world should be grateful. Not that it isn't tempting when America has to read this kind of hateful cant against its virtuous and flawless character every day. The fact is that anyone convicted of a crime is screwed for life, no prospects of a job, benefits, family, outside of distilling and selling crystal meth and siring bastards by crack whores. The most merciful thing you can do for someone like this is to put them in front of a firing squad. Health care? Over time it is going to reduce the fitness of the species. Health insurance should be illegal so that the strongest, hungriest and most clever survive to breed and spawn ever stronger, fitter and more relentless specimens, the stormtroopers of destiny, leading us to a greater future and the stars where a universe awaits our imaginations and infinite exploitation. Anything else you need to know, Charlie?

257:

Paraphrasing something I read once:

Much of the American attitude is the triumph of the American Dream (~ anyone can become rich and great if they just work hard enough). Some people believe this so completely, that they know they can/will make it - and once they do, they'll no longer be in the trailer park, they'll have their success to protect.
Anything that is done that appears to threaten the very successful (higher taxes for the rich, nationalized healthcare) will threaten them "soon", so they oppose it.
Hence you end up with many of the poor completely dedicated to the party and ideals of big business....

258:

Anybody else find it ironic that religious America is far more Darwinian in practice than secular Europe?

259:

No but I don't think my country is very religious. I think we do a good job of "Keeping Up Appearances".

I used to drink with a buddy that told me I was going to hell. Then we'd chase skirt and trade "war stories" about it. Go figure.

260:

Don@221, Thanks. I made my points and you graciously acknowledged them. No need to debate further. Blessings on you and yours for your charity. It is a more common phenomena in America than many realize since many of us are taught from an early age to do so humbly and quietly.

I understand and respect your healthy skepticism about government. I firmly believe that we Americans need to drastically cut back on spending by the federal government and shift much of those responsibilities back to the states (google John Taplins "New Federalism" for examples of what I support).

I too want an open and full public debate. I believe part of the recent uproar over health care reform is *because* we have full access to the bills in progress. That many opponents are intentionally cherry-picking provisions and misinterpreting them (and sometimes bald faced lying about them) is what is preventing real debate. I think the Obama administration left this "sausage making" up to Congress in an explicit attempt to get constructive bi-partisan debate and compromise. Unfortunately it didn't work and now we have a messy public shouting match.

My earlier responses to you was driven by the fact that real debate about improving our current health care mess has been largely absent from opponents of reform. I would LOVE to see a real conservative alternative to the Democratic reforms be seriously put forward so that we could debate the relative merits and synthesize a mutually acceptable plan. I would encourage you not to back away from the debate, but instead to ask "how would my side fix this mess" and then start talking about it. We need real practical solutions, not just a one-sided plan that half the country will hate.

As to Charlie's comments about mercy, it bugged me when I first read it too. I tried to look at it from his perspective (this is his baliwick after all) and found that while some of his comments were I think more emotional than logical, he did have a point to make and we Americans should reexamine some of our premises when it comes to public mercy. I think we have as much or more private mercy (for example, your regular charitable giving), but we are indeed short on public/cultural mercy. As I stated in an earlier post I believe this to be part of a cyclical cultural phenomena in America.


261:

@242

Why am I opposed to nationalized health care? To put it on a postcard (as you requested):

I don't trust the government.

If you think that's irrational, let me ask you this: do you trust the US government?

262:

Carl @261: I would not trust the government to run nationalized health care, but Charlie made a good point yesterday about the Post Office. While it is a government agency, it is not run by the government. I think the same sort of operation could be set up for a nationalized health care and it would work just fine.

263:

Hey, it said "invalid request" and put me back here without what I wrote! Let's see....

JamesPadraicR @220, thanks! I put in a request for his book at my library, but it's still in acquisition. I'm first in line, though.

Carl Henderson @232, you're not going to take Medicare?

The WashPost has a POTUS tracker where you can find out what he's doing on issues, like health care, and who he's talking to, and where he is, etc.

264:

I overheard an interesting comment today, that the US is the only major nation where the Corporations provide the Welfare State.

Which is interesting, if you think about it. The government's role is rather limited -- Social Security and Medicare aside, things like healthcare, life insurance, disability insurance, pensions, education are often funded by corporations for their employees.

Untangling things would be complicated though...

265:

Carl@261

Important and visible public services and infrastructure are one of the few things governments can do fairly well. You can't classify health care as secret (OK, it's unlikely in a free society), so everyone can see what's going on, freak out as appropriate, and vote accordingly. This is how the moderately notorious UK bureaucracy can run the fairly decent NHS. I don't think the UK govt is particularly better than the US govt, but their health care is better than ours.

The things it's dangerous to trust the govt with is stuff where they can lie easily, like pretty much everything the CIA does, or where they can cause a lot of trouble via entrenched special interests having much more passion than the general public. Luckily, the public tends to be passionate about health care.

266:

Any attempt at a publicly run health care system would be provoke massive looting of the sort that would make Iraq look efficient. The hospitals and doctors would game it into bankruptcy in a matter of a few years because they know their services are worth any multiple of what the hated government will pay them. Therefore, full-bore looting is not only fair but just. White Americans hate the public insurance concept as it would be mean white people's money would be used to pay for the health and wellness of non-whites all of whom they want to die. If it passed the Congress, neonazi brigades and militias would join up with the Republicans and mount a race-based tax strike and call to arms. It would only be a matter of weeks before there'd be reports of sniper fire and bombings at minority-neighborhood hospitals.

267:

@265 ROTFL

wait ... were you serious?

268:

I like your prescription Doctor Stross. So what you're saying is we, meaning the Ol' U.S. of A., need a new bill of rights suited to life in this century (or at least the next 3 or 4 business cycles). Just rewriting the bill of rights gets around the need for a constitutional convention which would then open up the whole foundations of the country to be remade in the image of our corporate overlords and any wingnuts who can shout loud enough to be heard. Alas, we can't even get an equal rights amendment passed (although the fact that we need one is sad by itself), so a rational bill of rights is the political equivalent of dragons appearing in the middle of London tonight.

I'm a proponent of the corporate death penalty. How they get the rights of citizens but none of the responsibilities (heck, even paying taxes is something corporations try to avoid) is beyond me.

@254 Exactly. Having previously been involved in politics myself, there is this odd disconnect you get between when you are wishing you are in power ("I can change the world if given the chance") to when you are in power ("must maintain the status quo or everything will collapse"). There's no document with terrible secrets handed out that makes politicians make that conceptual flip, rather there it is something in nature of humanity that enforces it. To that end, any changes we seek must come from outside the halls of Washington D.C. and local governments.

@261 Yes I trust the government. Especially when it comes to providing for the common good (of which I believe a right to healthcare is). I definitely don't trust companies when it comes to providing for the common good. I think we can both agree that corporations are only in it to make money for their shareholders. If that conflicts with the common good, they won't bat an eyelash before they walk all over the rights of you and me. 200 years of "free-market" has yet to generate one for-profit model that provides for the common good without some sort of government assistance or mandate.

269:

@266: No, of course not. This is the US, the most violent, racist psychopathic house of horrors to ever be imagined outside of Nazi Germany. The nightmare hasn't even begun.

270:

Charlie @237:

Of course my little rant was unfair. That was the point. The smug, mean-spirited anti-Americanism on display in this comments section would be instantly recognized as bigotry if it were directed at anyone but us. The rant was an attempt to turn that same (flawed) logic around on the anti-Americans to see how they liked it. I thought I made that clear with the last sentence, but I guess I didn't.

People are individuals (even Americans), and they deserve to be judged based on their own merits, not their demographics, and certainly not not asinine stereotypes about their demographics.

Also, it occurs to me that you didn't have it quite right. That "small but significant proportion" doesn't actively want the poor dead. They just don't care if the poor live or die.

272:

@269: I'd disagree slightly, Larry. It's not that They (the health insurance companies) don't care if the poor live or die, it's that they "have a fiduciary duty to their investors to maximize profits." When they can make money off the poor, they care about making that money.

Two anecdotes from the US: I have a lot of friends who work in a hospital. Here's a neat trick. If a patient is seriously ill and requires a really, really expensive operation to save his or her life, why don't you "accidentally" slow down the paperwork until the patient dies? Then you don't have to pay! Yes, this happens. It's called minimizing expenditures to maximize profits.

Another anecdote. I recently had to switch doctors. It took five tries (during business hours, when I had a deadline) to find a doctor who took my particular insurance, even though the only people I tried were those listed in the database of my provider. According to the nurse, this was normal, as they only update their database every few years or so, and given their payment issues, it's financially difficult for the doctors to accept some of these payments (i.e. it takes so many calls to get partially reimbursed months later that they lose money on the deal).

Personally, I'd be just as happy with a single-payer plan, as they wouldn't have that blasted fiduciary duty, and I don't think they'd be much more inefficient. The problem is that we have a whole health care bureaucracy, which consists of millions of ordinary people with ordinary families and ordinary jobs who would all be out of work if this happened, as the government bureaucracy that replaced them would not have jobs for them all.

So there is something merciful about American health care. It provides jobs to paper pushers through inefficiency. Hopefully some of them buy Charlie's books to spread the money around.

Anyway, getting back to the topic of this thread, why can't we boo the Libyans. None of this mattered until they insisted on giving the bomber a hero's welcome. They've also successfully pressured Switzerland to drop charges in a battery case (important Libyan battering a servant, I believe), and there's this kerfuffle about Khaddafi visiting the US and wanting to pitch his tent somewhere in New Jersey, since he doesn't want to live in a building. Oy.

273:

@ 268

Sorry, Poe's Law (or a close relative thereof) is in effect.

274:

Charlie, I think you make a really good and insightful point about American culture, especially as it concerns the healthcare debate.

But I also don't think it's fair in the context of this particular story. I don't think it's fair to minimize the horror and grief the families of the Lockerbie disaster must've felt seeing this man who was legally convicted - questions or no - of killing innocent people, being given a hero's welcome and getting to see his home again.

This seems to have been compounded by the fact that the same country which had originally put him away for life went back on that sentence. All well and good to say there are questions of the man's guilt, this long after the fact, when the conviction was not actually overturned - only the punishment was reduced. If there are questions on his conviction, let them be aired and decisions made accordingly--that isn't what happened.

Instead, it is as if the government said to the family of a Lockerbie victim, "we know you have suffered because of what we have told you--and inferred by our actions since--we believe this man did. But now that he is suffering, we will show him more mercy than he ever showed you, or the family member we have told you--and inferred by our actions since--we believe he killed."

Either that, or "We know you have found some solace in the fact that we have told you--and inferred by our actions--that this was the man responsible for killing your loved one, and that he has been punished. After all these years, we're not so sure about that, and he's really sick, so we're going to let him go home." In that case, there would still be justified anger at the government about this, wouldn't you say?

All well and good to say that person should realize that punishing the killer(s) won't change their own suffering. If you can walk a mile in their shoes and show that kind of Buddha nature, good for you. But you'd be a rarity on Planet Earth.

Let's not forget that there is a very real crime here, and very real grief being reopened with these events. As an American, my objection to the Scottish government's decision has to do with *compassion* for the *victims of the crime*, rather than sadistic mercilessness toward the prisoner or a desire to see him suffer for no reason. There *is* a context here.

Had this been something that happened in America, and the prisoner in question was, say, a Saudi Arabian participant in the 9/11 attacks, the world reaction might be the same in terms of questioning the obvious oil connection and reasoning of the person making the decision. In this case, there are people in the UK who object to the decision with the same fervor you identify as uniquely and bloodthirstily American. The implied dichotomy here of American = merciless reactionary and European = mercifully civilized is a broad generalization, and not necessarily a fair one.

However, I will admit, as an American, that the American standing in the world is such that our motivations for criticism are now subject to this kind of cynicism and pigeonholing, which I acknowledge is a problem entirely of our own making, particularly in recent years.

275:

Beth: an important point to note is that the Scottish prison system doesn't have the facilities to care for terminally ill prisoners. It's normal for them to petition for release on compassionate grounds, and of the past 30 to do so, only 4 have been refused -- the justice minister has to believe that they continue to represent a clear danger to the public. (If they are refused release, what happens then is that they die in a private room in an NHS hospital, with a prison officer on the door. Keeping him inside a prison to die? Not an option on the menu.)

276:

Charlie @ 237:

The Telegraph is nothing like Fox News. The Telegraph is explicitly Tory supporting; it doesn't claim to be "fair and balanced; we report you decide" and so on. Faux News is much further to the right than the Torygraph (as befits American politics, I suppose) but pretends to be central, unbiased, impartial. Faux News uses symbols of patriotism (the number of American flags and logos made to remind you of the flag is astounding) to influence you. (Yeah, all news sources will pull jingoism at times, but Faux News has been at it solidly for almost 8 years now). I won't go so far as to say Faux News lies, but I know people who would say that.

The Torygraph simply turns anything into an attack on Labour. This story is a great example; the BBC reported it thus: http://news.bbc.co.uk/2/hi/uk_news/england/devon/7250141.stm . The Torygraph automatically focused on Gordon Brown and tried to make him central to the argument. If anything they weakened the story to make that point.

Yes, both Faux News and the Torygraph support their mainstream right-wing party (Torys, Republicans) but that's pretty much where their similarly ends.

(Of course this whole story was an edge case - all policies have them; I've heard of many more stories like this about US insurers refusing coverage - and was resolved so the treatment _was_ provided on the NHS...)

277:

While I think this was a tremendous post which gives great insight for Americans in how their country is viewed in even fairly capitalist countries like Britain. I would like to point out, in defense of the American public, that there isn't really a democracy in the United States. The elections are based not on who the best candidate is--the American public for the most part disagrees with the democrats and republicans according to polls--but who has the best ad campaign. Quite seriously Obama campaign won an award, it beat out Apple, for the best advertisement of the year.

And who is paying for these campaigns? As you know, they aren't publicly funded. So what you get is a winning candidate that has a debt to pay to all the private organizations that donated to their campaign. So of course Obama isn't going to support single payer health care, of course he isn't going to withdraw troops from Iraq, of course he's going to support the drug war. There is money in this!

The problem isn't that the public is merciless. It's that the tiny group of people that get these candidates elected make lots of money on being merciless. If the system isn't broke don't fix it and it is isn't broke for that tiny group of people. You may say, “well I understand how these people make money off healthcare and war, but how does the mistreatment of prisoners help?”

Look at the recidivism rate in the United States. It's higher than anywhere. If we tried to reform prisoners instead of punishing them. That would go down. And what many people aren't aware of is the privatization of the U.S. prison system. More prisoners equals more money. Just like more sick people equals more money for pharmaceutical companies.

If you want to understand why the American public doesn't do anything about this... it's because they are entirely ignorant of it. As you stated in one of your comments, we are a “land of thoroughly ideologically indoctrinated and propagandized people.” This isn't easy to overcome.

278:

Beth @273: Mr. al-Mehgrabi was sentenced to life imprisonment, but that does not mean he was going to stay in prison until he died. He faced a tarriff of, I think, 27 years imprisonment after which he would be considered for release on licence, effectively a very stringent parole. That 27 year tarriff could be reduced for good behaviour and it would be reviewed in due course. In the end his cancer caught up with him and he was released on compassionate grounds as is normal in what we in Scotland regard as a civilised society. As Charlie says the standard is to release such cases to their homes and families unless there are good reasons not to, for example public safety or the offender not having any family or support outside the prison service (not unknown for prisoners serving long terms of incarceration).

279:

Charlie: I'm wondering if your aware of how regimented and formal American public political discussion actually is. There is a unwritten set of rules about what can be said, what must be said, what one must not contradict, and what must never be said. Most people that publicly participate in American politics (politicians, news media, people interviewed by the news media) will never ever break these rules. Anyone who does is quickly labeled a "loony", or not "serious" and they are utterly ostracized from the mainstream political discussion. If the existence of such a "loony" person is acknowledged at all, it is only so they can serve as the but of jokes, or as a bit of contrast to put next to the"serious" participants. (of course one of the most important rules is that a "serious" person must never take a "loony" seriously)

Do you want to know what I thought when I heard what Obama said about the Megrahi issue? I thought "damn, that was mild". I'm not sure if you're aware of this, but Obama's reaction was pretty much the absolute minimum he could get away with without breaking the protocol and provoking a controversy.

280:

Charlie@237: Context aside, unless you're accusing the Telegraph of openly lying in print, the NHS provision of "service" to that person is woeful.

Nick@238: I work for a nonprofit, with a large number if Russian and other Soviet block immigrants. Many of whom have less than fond memories of what it's like when the government runs things. I'm not suggesting that a government health plan would be quite the same. But I don't see ANY need to move along that path at all, frankly.

Does the US need to find a solution to providing services for the very small percentage of the population that is suffering a long term, unwilling lack of health care? Absolutely. But taking a system that already had serious inflation problems, and giving it carte blanche to spend taxpayer money, is a recipe for disaster, writ large.

My preferred solution is more along the lines of what the CEO of Whole Foods has proposed. Frankly, I think he's got a FAR better idea of how the system works, than any congresscritter who is swarmed by lobbyists will ever know.

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

I have a complete distrust of the political system here in the US. And I have every expectation that any system run by bureaucrats will be run horribly inefficiently. It's just how the "system" is built, with regards to politicians, and the public sector.

And in a somewhat related vein, I'm appalled that this "new improved" administration has gone and reappointed one of the architects of the current financial ruin in the US (Bernanke) to another term. To quote an article I read earlier today. "Re-appointing Bernanke sends the worst possible message to both the American public and to government in general: not only will failure be tolerated, it will be rewarded."

I didn't vote for Obama (Or McCain). I think that his ideas were generally not the right path for the US either. I'm even more disappointed that he's fallen so far short of the mark, on things that he promised, that I was in favor of.

281:

Al lot of the posts have made generalisations - Judging the US by the few, the vocal, the Fox watchers.

Most of us are decent, caring folks.

However, there's a growing number of us (and I think it's not just here in the US) who have never learned to step out of ourselves enough to even begin to see a differing POV. A total lack of empathy doesn't even come close to describing it.

It's like their ultimate archetype or role model has become the corporation, which, by some definitions, is psychopathic.

An interesting hypothesis, I think, worthy of study. Or punditry.

My biggest fear (wake up sweating) is that my son will somehow end up one of them. Like a zombie flick.

And, what's worse, our political class has a vested interest in coddling them. Public opinion, and the response to it, has nothing to do with rationality. It's all about identifying the loudest voice and answering it, or being it. The only format of discourse that works on TV. I bet you could make a graph of the intellectual content in Obama speech and see it fast approaching 0 since Jan 20 (no cracks about _before_). There's no payback for actually challenging perception.

wtfdwd?

282:

I blame Calvinism---a seriously stupid version of it, but Calvinism nonetheless. There are Elect and Preterite, these are unchangeable categories, all is allowed for the Elect (so Good Guys stay Good Guys no matter how much they torture) and all is permissible to be done _to_ the Preterite (so it's right that they be tortured).

Add to that the natural hatred for murderers and rapists, and you get idolisation of Dirty Harry. Add instead the belief that anyone can make it, so if you don't you're a Damned Loser, and you get the studied callous cruelty to the poor and the ill.

(Note that the rabbis of the Talmud were certain that the Cities of the Plain were condemned for callousness, which they interpreted to also include preversion, but which they thought to be much more...those who say 'What is mine is mine, and what is thine is thine,' are accounted variously as 'normal' and 'guilty of the sin of Sodom'.)

And on that subject: Add to this TULIPian Divide the rules of Leviticus as interpreted by morons, and you get the hatred of faggits, libruls, women, and all other un-men, including most secular Jews (though not Israelis). Just ask any Good Merkin what he thinks of 'New Yorkers'---on 2001-09-10, that is, before we became an occasion and excuse of violence, and so dear to their hard hearts.

283:

Kent:

" Context aside, unless you're accusing the Telegraph of openly lying in print, the NHS provision of "service" to that person is woeful."

On what basis is the service woeful? Did you research this? Did you read the BBC version of the story outlining the issue under consideration and the clinical reasoning taken for the decision?

The MacKey article doesn't even begin to address the real problems - not least of which after he said this: "Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America..."

Just because you didn't have something in the past doesn't mean you shouldn't have it now.

Besides, he doesn't address the core problem. Insurance isn't the right model for healthcare because you can't insure against something you already have and, for the most part, most of us will have something chronically wrong with us by our 40s and 50s. If you get a cancer, then no "insurance" would realistically cover you ever.

He goes on to them say that levels of cover should be decided by the INDIVIDUAL? Is he for real? I'm pretty bright, I like to think so anyway, and I don't think I could make a credible decision on what cover I'd actually need.

And, finally, how many absolute horror stories would you like about refused treatments or families who are destroyed by medical debt to counter your 88 year old who _might_ lose the sight in one eye?

284:

In the US, life is generally conceived as a competition. If you're healthy and your neighbor is not, you win points. If you're rich and he's not, you win points. If you've got a bigger house, you win. Winning gives you power. Power feels good.

Apparently elsewhere there's the notion that you and your neighbors compete against external threats. In the US, your neighbor _is_ the threat. People who aren't even your neighbors? They're clearly outright enemies.

To say nothing of the fact that sadism is generally a form of entertainment here from childhood on.

285:

Charlie @274 - thanks for that tidbit of information. That definitely helps shed some light on the subject. I'd also have to second Larry's point at 283. Lines of public discourse in American politics are definitely very strongly regimented ( an interesting conversation in itself) and I'd agree the white house said about the bare minimum. But beyond that I'm curious why you think the white house has no right to comment. In the US it is entirely common for victims to provide witness testimony at a criminals parole hearings. Given tha more than half the victims of the attack were American, in what way would it be inappropriatw for their political leaders to offer up a comment, of any support? And that goes for the leaders of any country with victims in such a crime. Of all the things you could look at and cite as an example of the imperial American presidency, I don't think that's one of them.

Anoter question, as I dont understand the intricacies of living as a part of a United Kingdom, is it frustrating to hear suggestion that a new Scottish minister might be accused of bowing tothe whim of a minister in Britain? I think that may be worded antagonistically, but it isn't meant to be. I could see how that might be pretty rankling forthe nerves.

286:

"Had this been something that happened in America, and the prisoner in question was, say, a Saudi Arabian participant in the 9/11 attacks, the world reaction might be the same in terms of questioning the obvious oil connection and reasoning of the person making the decision."

You don't need to use hypotheticals. There's that Cuban guy who blew up a (Cuban) plane. The US govt is keeping him safe. The commander of that Intruder squadron who shredded the tapes after one of his boys killed a cable-car load of Italians. Lieut Calley, who served a couple of years house arrest then got pardoned (while the chopper pilot who stopped the massacre was victimised). The commander of the Vincennes, who shot down an airliner. Cheney.

No hypotheticals are necessary - but I can see your point. It sticks in the craw somewhat to see a murder go free (assuming for just this moment that he did it), but that's liberalism for you. Love it or leave it. If you want to sample the alternative, I understand that Somalia has pretty lax immigration controls. Saudi Arabia, not so much, but you could try there too.

If all prisoners in Scotland are treated on an equal basis, this strikes me as a good thing, and in the tradition of C18th republicanism which I understand is popular in the US. Equal before the law, remember?

287:

The reason for a plan like Mackey's which has been working and driving down costs for his employee's is that absent a connection between consumer and costs, inflationary pressures are inevitable. And once those pressures start to push, some sort of rationing will have to kick in. You can't possibly provide every desired service to every claimant, at no cost. Demand is guaranteed to outstrip supply in any "free" system. Hence the long waits you hear about in Canada and the UK.

On some level people need to take *some* responsibility for themselves. I don't want to live in a nanny state. And I shouldn't have it forced on me either.

288:

@ 279
& ALL the other few 'merkans who "don't trust the guvmint to run anything" and who don't trust universal governent-funded healthcare.....

A question and a sarcastic remark.
The Q:
How come, therefore, that EVERY OTHER CIVILISED COUNTRY on the PLANET ...
Has a government-funded Health Care system of some sort, all much more cost-effective than the US one?
Subsidary for those comparing "socialised" - meaning "Comminist" - remember that a communist-run healthcare system is indistinguishable from one run by the RC church ... the "virtuous" get care, and the rest can get stuffed.
Elsewhere, just because medicine is "socialised" DOES NOT MEAN that it is "socialist".
Not that socialist means communist either, but I don't expect the US readers, even here, to be aware of that, or say the history of the Korean War, where a socialist Brit guvmint sent troops against the evil of Kim Il-Song.

Sacrastic rem:
"Don't trust guvmint to run anything large" huh?
Like the US Navy?
Ahem.

289:

The answer's simple-- most other civilized countries presume you have some sort of duty, however rudimentary, to further the wellbeing of your fellow citizens. In the US, this view is only moderately common. Mainly, we tend to assume we are not our brother's keeper-- if he lives, he lives, if he dies he dies, but there's no moral onus to make sure it's one rather than the other.

290:

Kenn Bunt # 280, re "Whole Foods":

The Whole Foods guy seems to say, "Shop at my store and you'll never get ill". Which is quackery so common that it's not even interesting.

#287: On some level people need to take *some* responsibility for themselves.

I guess you can always meet Death in a pub and convince her to make you immortal and unaging on a lark. Or you kill yourself when your health care needs exceed your ability to pay for them, saving your family the shame and hardness of bankruptcy. Contagious diseases are easily avoided by locking yourself in your castellated abbey while the epidemic lasts. Only don't invite all your friends to party. With the advances in DNA testing, you need never have (and pay for) a child of yours having a genetic tendency towards certain illnesses. Unless you are a woman, you do not have to worry about difficult births either. And in case of accidents, you can always sue.

... eh. This was about mercy?

291:

The thing about the telegraph article is that it doesn't explain that the reason why teh EVULZ NHS has been teh EVULZ towards the sick war veteran is because the veteran has decided, out of desperation and fear of his condition's effects*, that the advertisement blurb of a drug company is as good as a verified study to see whether the drug in question actually works. And the NHS, being teh EVULZ, evilly decided to not spend money on a treatment that might not work and which might have quite nasty side effects.

Fun factoid also not conveyed by the telegraph (as it is somewhat unrelated): BUPA and other british private medical insurance schemes also don't cover nor are willing to pay for the treatment.

* yes, a drug company found a war veteran who's scared and frighened enough to do a drug they make and hope that by getting enough publicity about it they can force the NHS to buy the drug through political pressure and avoid the whole pesky business of rigorous scientific study to ascertain whether the drug is a useful treatment of the condition. Clearly the NHS is the evil one here.

The specific drug that the NHS isn't paying for is more usually used to treat, to put it in layman's terms, cancers of the arse - so basically the NHS is refusing to squirt arse medicine into a war veteran's eyeball.

292:


Fred Davis @ 291: "so basically the NHS is refusing to squirt arse medicine into a war veteran's eyeball."

If that isn't the funniest fucking thing I'm going to read today, then I'm in for a very entertaining day.

Cheers!

Jim

293:

Kent@280

"Does the US need to find a solution to providing services for the very small percentage of the population that is suffering a long term, unwilling lack of health care? Absolutely. But taking a system that already had serious inflation problems, and giving it carte blanche to spend taxpayer money, is a recipe for disaster, writ large."

Stop reading the WSJ and go out and talk to some folks. Do you even realize that most Americans (myself included despite my well paying job) are 1 major illness away from total financial collapse?
How can you get health coverage if you have a cancer or some other heavy duty disease if it prevents you from working. As was pointed out earlier, no employer will hire you because their insurance payments would rise. Meanwhile you still need the drugs to keep you alive.
So while you wait to get on medicare or medicaid, you eat through your savings, leaving you bankrupt. As Americans we gain nothing from the bankruptcies of our fellow citizens. It weakens us a a whole.

Why do you assume that people chose not to get health insurance because they are "unwilling"? If you are on a fixed income there are very real choices you need to make.

294:

Two points from an American:

1) The reason the political right in the U.S. is so set against what is actually good for the people is that our Republican politicians are all Social Darwinists. This warped socio-economic philosophy holds that government programs that help individuals overcome obstacles in their lives (like providing job training, or affordable healthcare, or childcare while in school) are all welfare, and therefore anti-capitolist. In the Social Darwinist mind, if you didn't work and claw for it (even if it is a silver spoon athte you carried out of the womb), no one should help you get it.

2) Many of us on the Left side of America's political Aisle are aghast at what has happened to our country - myself included. If you have a few minutes, read my blog - and see what a real Americna Liberal thinks (and thus why we're getting marginalized).

295:

The Irish Times's resident satirist Newton Emerson has a stinging piece in today's paper very much in line with Charlie's opening piece on this thread.

He's writing as an American outraged by Britian's 'terrorist healthcare system':

"Few Americans realise just how medieval treatment can be under Britain’s National Terrorist Service. Most terrorists have to wait for years just to get arrested.

It is not uncommon for terrorists to die of old age while waiting for a court appointment. If they are referred to custody, they are denied lethal injections and discharged at the first available opportunity. The whole system is administered by a nightmare bureaucracy of judges, juries, lawyers and legislators."

...The fact is that the British simply don’t place the same value on life as we do here in the US because, like all foreigners, their lives are simply not worth as much."

This is the link: http://www.irishtimes.com/newspaper/opinion/2009/0826/1224253267086.html

Good satire is sometimes the only way to relieve blood pressure!

296:

Anybody else find it ironic that religious America is far more Darwinian in practice than secular Europe?

"survival of the fittest" (differential reproductive success causally correlated with hereditary traits) does not entail society red in tooth and claw. In other words America is not more Darwinian that Europe - it is more Social Darwinist (which has very little to do with evolutionary biology).

The irony is in the complaints of the American religious right about the ill effects of teaching evolution, when they are at least in political bed with Social Darwinists themselves, the current healthcare propaganda fest being a case in point

297:

Hey Charlie - could you UK folks reanimate Charles Dickens and send him over for a couple of decades? The USA kinda needs his unique and unintuitive insight that being blamed for misfortune sucks.

298:

cod3fr3ak @ 293: "As was pointed out earlier, no employer will hire you because their insurance payments would rise."


You realize that's illegal, don't you? http://www.avvo.com/legal-guides/employment-discrimination-medical

Any employer that refuses to hire someone because of a fear that their insurance costs will go up has broken the law and can be sued and fined.

299:

@296

Thanks for pointing the distinction between Darwinism (as an umbrella label for evolutionary biology) and Social Darwinism (as a seriously skewed transposition of ill-understood biology dynamics into the realm of politic dogma).
Just like the difference between 'socialism' and 'socialized', this should go without saying, but apparently warrants the occasional reminder.

In the same train of thought, wouldn't it be helpful to forgo the "survival of the fittest" catchphrase in favor of the (more scientifically accurate, and less susceptible to wingnut political hijacking): "survival of the just good enough" ?*

As for the main rant, I can see where you're coming from, Charlie, yet I don't think the large fraction of sensible, level-headed USA'ers need the extra aggravation of being lumped together in spirit with the bigoted loudmouthes they have to share a nation with, especially not from those sensible, level-headed types among old-worlders (that'd be you) whose sympathy they could use instead.

As for the root of all ebil in 'Merika and my 2c on topic, I personally blame France and Britain for exporting Humanist utopianism and Puritanism (respectively), the lethal combo of which resulted in what passes for democracy in the USA.
…not to say democracy on the whole has been a dazzling success anywhere else, obviously.

[* To paraphrase Robert J. Full's: "Evolution is not a perfecting principle, it works on the principle of 'just good enough'".]

300:

It would appear that Mr. al-Megrahi may not have actually been as close to death’s door as was originally thought.

http://thescotsman.scotsman.com/latestnews/Medical-advice--on-Libyan.5587119.jp

At the risk of appearing callous or even merciless I would have to say that if Mr. al-Megrahi is still above ground when the Jan the 1st rolls around the Scottish Government is going to have a very unhappy Hogmanay.

301:

Any employer that refuses to hire someone because of a fear that their insurance costs will go up has broken the law and can be sued and fined.

Happens, though.

http://www.scientificamerican.com/article.cfm?id=pink-slip-in-your-genes


Any non-stupid employer would find another reason to terminate (or not hire you), and if you have a serious medical condition (that requires expensive treatment) how can you afford to pay for the lawyers to take them to court?

302:

Robert Prior @ 301:

Yes, there are "creative" ways to fire anyone if you're willing to take the risk. A lot of it is people not being aware of their rights, or convincing themselves they don't have a chance of winning. I can say that the lawsuits are common enough that most employers are afraid of triggering them, it's a common issue in HR publications.

I'd be wary of surveys that just ask people if they've been discriminated against, as opposed to tracking numbers of actual violations reported. People will search for any reason when they're turned down for a job, or laid off. Ageism is another common complaint, when the truth is that the younger candidate just as a more relevant skill set that the employer needs more than experience. Often the two are found together -- medical conditions increase with age, so people who are sick or older will find themselves turned down for jobs more often for reasons untreated to their age and illness but still see a pattern.

That said, I think we absolutely should separate insurance from employment in the US. It's a gimmick to get around wage controls during WWII, and it's somehow carried on zombie-like for 60 years longer than needed. Private plan or public plan, it doesn't matter -- just don't tie insurance to employment. Even if you're perfectly healthy, it makes relocating harder and reduces labor mobility.

303:

Beth @274 "But now that he is suffering, we will show him more mercy than he ever showed you, or the family member we have told you--and inferred by our actions since--we believe he killed."

Last week I was at a funeral. Bill had been diagnosed with cancer a bit over a year ago and had spent the time since (except when in hospital) generally sorting out his affairs - updating his will, making funeral arrangements, seeing his family (including rather sadly going to his Father's funeral) and friends, making sure the financial provisions for his wife are in order, and so on. He died quite suddenly, but he'd done what he could and what he had to to make a civilised end.

Assuming he did it, which are the grounds under which he was released, Al Megrahi doesn't deserve that. He should stay in prison until he rots, or possibly die 270 times. But rather than do that and exact the last inch of punishment, he's been released to make a civilised end of it. The Scottish Justice System has done a good deed, to allow Al Megrahi to do some good at the end of his life rather than die* in custody. We do it because we're civilised people and so release dying men rather than blow up airliners**.

Frankly the Libyans have taken that good deed and made it into something else entirely, but maybe some of them will be able to see that we did justice on this man, and then showed mercy at the end, and learn something from it.

* In an NHS hospital presumably
** Or at the very least, we release dying men from prison as well as blowing up airliners.

304:

Andrew G: turning this around: why on Earth should an insurance company be forced to carry somebody who is uninsurable? They're a business with a fiduciary responsibility to their shareholders!

Kent:
"The reason for a plan like Mackey's which has been working and driving down costs for his employee's is that absent a connection between consumer and costs, inflationary pressures are inevitable. And once those pressures start to push, some sort of rationing will have to kick in. You can't possibly provide every desired service to every claimant, at no cost. Demand is guaranteed to outstrip supply in any "free" system. Hence the long waits you hear about in Canada and the UK."

That's an assertion without a shred of empirical evidence to back it up except to admit that American's can't run a healthcare system as well as other people.

Yes there are "long" waits - although a degree of that is hype, it has to be remember that the waits are generally for non-emergency treatment. Yes, living without a hip replacement might be unpleasant but you're alive and you WILL get it on the NHS. AND, most importantly, if don't want that wait you are free to pay for it yourself, OR, to have catastrophic insurance cover to let you jump the queue.

How nice and market driven is that?

As others have pointed out, the insurance market in most of Europe is stronger than that in the US...

If you don't have insurance and need a hip replacement what exactly are your options in the US?

305:

As a separate, and I thought interesting, issue. I thought I'd look up the costs of having private surgery in the UK versus the US.

So, a private Hip Replacement in the UK runs to about $15,000, in the US it's $50,000... now it maybe that the US replacement is 3 times better, alternatively somebody is doing rather well out of illness.

306:

Dave O'Neil @ 304: "turning this around: why on Earth should an insurance company be forced to carry somebody who is uninsurable? They're a business with a fiduciary responsibility to their shareholders!"

That depends on whether you adhere to shareholder or stakeholder theory on business ethics. In the standard shareholder paradigm, you'd be correct. In the stakeholder paradigm companies should take into account other stakeholders, including the community.

Theory aside, if you don't want to force companies to take everyone, then you'd need a public system specifically designed to cover the poor and the uninsurable. Unless you are willing to leave some people with no insurance (as in the current system), there's no way around the fact that the healthy and employed will end up paying for the poor and very sick. Either via higher premiums or via higher taxes.

There are a couple ways to do this. You could have a public plan such as an expanded Medicaid or modified Medicare. You could subsidize the premiums directly so that insurers aren't actually losing money and the poor and very sick can still get coverage. Or there's the Republican plan -- make heath benefits taxable income but give everyone a tax credit to offset the cost of buying insurance on the open market.

307:

Codefreak@293:

I never suggested that the people that don't have insurance are unwilling at all. But if you look into the stats of who does and doesn't have insurance in the US there's a significant number of people that willingly opt out, who are completely capable of getting it. The 50million number that gets tossed around so freely, is a great marketing tool if you think that the government "needs to do something" about it. But it's not the case, at all.

http://www.businessandmedia.org/printer/2009/20090623160905.aspx

Dave@304:

It's simple economics, that demand will outstrip supply, when you drop the cost to "free". The price of something is a useful tool, to help manage demand, and allocate resources.

308:

Andrew G: If they're for profit entities the problem remains, making them non-profits does solve the problem.

As I've said before, the insurance model is plain dumb for medical help because, at the end of the day, unless you're really really lucky, everybody needs medical attention over time.

Kent: So, again, if that's a simple economic rule, why don't we observe this in other "universal" systems which spend less, cover more and get broadly the same results as the US system?

Or is there some rule that economic rules work in the US but not elsewhere?

Secondly, have you tried to get insurance yourself outside of the workplace? Do you have a pre-existing condition? I know a couple with Asthma who have a high deductible policy costing them almost $1000 a month, they're not badly off but it's pushing 8% of their income for a policy that will leave them thousands out of pocket if they need it.

I just find it ironic that in most circumstances it will be cheaper for me to buy a Business Class ticket back to the UK than have surgery in the US.

309:

The insurance model is stupid for things like preventative care and regular check ups. A healthy person will certain pay more in premiums than they would paying cash out of pocket for doctor's visits.

It does, however, work well for more expensive illnesses or problems. I will probably pay around $500,000 in constant dollars for health insurance over my working life -- though most of it will be hidden because it's paid on my behalf by my employer. So I am insuring against the possibility that my family will need more than $500,000 in medical care. The insurance companies, meanwhile are figuring that my family will probably cost less than that $500,000.

(Though I'm actually a special case where my employer is my insurer and my medical care provider. But that's what they estimate the market value at.)

310:

Dave O'Neill @308 As I've said before, the insurance model is plain dumb for medical help because, at the end of the day, unless you're really really lucky, everybody needs medical attention over time.

I disagree. However, rather than home or car insurance, the model is closer to life assurance* - you know that someone is going to die, but you don't know when.

(Although I've studied for actuarial exams, I didn't take any health or life insurance exams so am not an expert on this topic).

* Or life insurance - the wikipedia page explains the difference

311:

When civilization ends, the world will still have rats, cockroaches, coyotes, and insurance companies. Of course, the coyotes and cockroaches will need a "co"-pay.

And what is a "family" for family insurance purposes?

Cloning trumps "Heather Has Two Mommies" -- that children's book written by Lesléa Newman with Diana Souza's illustrations, first published in 1989.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/26/AR2009082602095.html

"With this you have potentially three genetic parents," said David Magnus, director of Stanford University's Center for Biomedical Ethics. "This will create the potential for legal and social conflicts."

312:

(Forgot) Heteromeles @140 If you're for civil rights and democracy, how many books have you written where the heroes work within the limits of the law, for democracy and civil rights, and win?

Halting State?

313:

Andrew G: Providing there is a system to handle regular checkups and preventative/basic care I would tend to agree with you - that's essentially the system in most of the world.

But without a system to handle regular checkups and tests, the probability of catastrophic problems will mount.

Most places seem to find that a public option for the poor with a market in private insurance for the rich works. It defeats me that the US isn't looking at models like that and when this is debated they look at the completely "socialist" British system and not one of the many other systems that seem to work.

314:

The US does have a public option for the poor -- Medicaid. It's just not very good. Reforming that would go a long way toward providing coverage for the uninsured.

315:

@310: I'm not a writer. Besides which, two (if not three) of the heroes in Halting State get suborned into black ops by the end of the book, which doesn't strike me as a win for democracy.

The unsubtle point in this is that Charlie, along with most other sci-fi and fantasy writers, routinely use worlds where going outside the bounds of law (and/or normality) is the only way the hero wins, and strongly hierarchical political systems are the norm, although the "good guys" are usually ruled by genuinely benevolent dictators.

Conversely, real life suggests that black ops are often run to cover up illegal activities that are not terribly effective at achieving their goals. For every SR-71 you point out, I can point out multiple, multi-billion dollar failed surveillance satellites, lives lost at Area 51 not to aliens, but because they felt that they didn't need to abide by conventional hazardous waste disposal practices, and so on (That from Trevor Paglin's Blank Spots on the Map).

I could also simply point out the inspector general's report on torturing prisoners in the war on terror (i.e., http://www.salon.com/opinion/greenwald/2009/08/24/ig_report/). We've known since the time of the Witch Hunts that torture wasn't a great way to obtain accurate information, yet that didn't stop us from running (and continuing to run!) this stupid, "secret" operation. It's shameful, both on moral and pragmatic grounds, yet we can't seem to find the political will to stop.

In any case, I'd really love to see a well-known writer take on the challenge of having the hero win within normal democratic processes. One way to do that, I'd suggest, is to portray black ops a little more realistically.

316:

Dave@308:
You do see it in systems like Canada and the UK. Queue's do serve as a limit on demand, in the absence of price controls. And saying that care is the same as in the US for less money is rather disingenuous, given that the populations are not the same, and the demands on the system are different as well. I'll freely admit (as a somewhat husky person myself) that the US has things like rampant obesity that drive up costs and drive down results for our systems. The US has a far higher prevalence of guns and related crime, and heath issues as well. On top of that, there are different systems used to measure outcomes from country to country too. So you're not necessarily making any kind of apples to apples comparisons really.

http://pajamasmedia.com/blog/the-doctor-is-in-infant-mortality-comparisons-a-statistical-miscarriage/

And don't blame the "market" for the fact that you can't get health insurance outside of the workplace. That's a relic of past policies of social engineering.

http://socialismdoesntwork.com/the-origin-of-employment-based-health-insurance-in-america/

How do you explain that there are segments of the health care market, in the US, that actually do succeed at driving down costs, wait times, etc. Specifically, the parts of the industry, that are actually subject to market pressures. Plastic Surgery, and Laser eye are both paid for out of pocket by consumers, and thus they are incented to look for the best "bang for the buck" they can get. Forcing providers to work down the cost curve.

http://books.google.com/books?id=HNlm0ZOny1gC&pg=PA7&lpg=PA7&dq=inflation+laser+eye+surgery&source=bl&ots=jmH3Q5tgiR&sig=r4ckIHCh2X0Xovo8BPQF9qSKyWc&hl=en&ei=vqCVSrPrAomoNsCRifoH&sa=X&oi=book_result&ct=result&resnum=2#v=onepage&q=inflation%20laser%20eye%20surgery&f=false

The market CAN work, if it's allowed to. Sadly in the US we've crippled it, horribly.

Andrew@309: allowing the market to work, with some necessary regulation has allowed things like low cost clinics to appear and function in places like WalMarts. And that is a VERY good model to pursue to increase availability of care, at a reasonable price. Again working to push back against inflationary pressures as well.

317:

heteromeles @313: I'd really love to see a well-known writer take on the challenge of having the hero win within normal democratic processes.

Then you want to read a police procedural about a non-corrupt cop, right?

(Hint: I'm working on one. With a few twists to keep it interesting. Sequel to "Halting State" ...)

318:

I notye that my question @ 288 has STILL not been aswered:
Namely ...
If every "civilised" country on the planet, excepting the USA, has a successful "socialised" (NOT "socialist") medical system....
WHY do a large proportion of the (possibly brainwashed) US population not want htese obvious benefits?

319:

I'm reading Reynolds' "The Prefect" at the moment, and it seems to be showing exactly a world in which those defending democracy within the law are the good guys, and will hopefully win, whereas those bending or breaking the rules, going outside the system, are distinctly the bad guys.

No spoilers, please; I'll finish it tomorrow or Friday.

320:

Greg @316:

A partial answer is that: in the UK, 80% of the population hold passports and use them for foreign travel. In the USA, only about 20-25% hold passports -- and of those, half only travel to Canada and/or Mexico.

Granted getting to see other cultures and other ways of doing things is easier distance-wise from the UK ... but it seems to me that the insularity of the US population is a large part of the problem.

Solution? Abolish passports!

321:

Sorry Kent, , but as they say, that dog don't hunt.

The UK has pretty rampant obesity too, and yet spends less than half the amount on healthcare for basically the same results.

The con job that Pajamasmedia does with those numbers is one of the many reasons I don't read them too much. Yes, there is a statistical problem with comparing like with like. However, if you ignore the phrase "infant mortality" and instead look at premature or early birth rates, you find the US has some of the worse rates of that too - something, I suspect can be laid full square on a lack of sensible, quality pre-natal treatment.

It's also interesting to look at those number broken down for race and socio-economic class.

And, it doesn't matter if something is a relic of something else. EVERY SINGLE other OECD country manages to do this for LESS than the US spends.

I don't have to explain the Lasik or Plastic surgery markets because they aren't part of any other public health option either. In fact, a quick googling suggests a boob job in the UK costs about the same as the US.

It doesn't really explain to me why my wife's hysterectomy cost $30,000 for a 90 minute procedure....

322:

Dave@319:
The point I was making with regards to Lasik and Plastic Surgery, is that is a perfect example of where the market works. You let market pressures come to play, without tying them in knots like the US market has been, and suddenly costs have a reason to go down, not just up the way they have. I wasn't asking you to compare them to the UK, I assume you have a "free market" in those there as well. Again, and with much the same results. A well regulated free market is a beautiful thing. A system tied up in knots, is one that's going to get gamed by the insurance companies, and others.

And for another, deeper look at how the US is not getting shortchanged necessarily:
http://www.cato.org/pubs/pas/pa-613.pdf

323:

Kent: you have a choice with elective surgery. I don't need Lasik or a boob job and have to pay for them if I really want them.

If I have a ruptured appendix I can't shop around for these things or work out where the best place to have the surgery is because I need it pretty soon. (Mine was removed about 4 hours after I saw my Doctor.)

Here's a nice story: http://www.oralchelation.com/calcium/DegenerativeKneeJoint/p28.htm

You still haven't explained why the universal systems enjoyed in the UK, Canada, Australia, France, Germany, Japan, Norway, Switzerland, etc... are not having the problems that you claim they should.

324:

Kent, you are getting shortchanged. Badly. You're talking to people who know how much decent healthcare costs on their planet, and we think you're being ripped off. Heart transplants in the UK -- paid for by private insurance, just so we're comparing like with like -- cost 40% as much as they do in the US. Other treatments: even cheaper. (Oh, and you want to know something else? The NHS had a therapeutic heart transplant program up and running at Papworth in the early 80s before the US got one. Another side-effect of an insurance-driven medical establishment is extreme conservativism.)

Again, I know what my monthly drugs bill is in the UK, and what my deductible and co-pay are. (The equivalent of US $55 a year, period.) In the US, I'd be uninsurable. And the meds cost four times as much, too.

Citing paper studies by the Cato institute (who have a very large knife to grind: hint -- they're not exactly politically neutral) doesn't really help. (Again: I could take the time to go over them with a fine toothed comb, but that's time I'll never get back, or get paid for -- and I've got a book to write, so why bother fisking libertarians and playing hunt-the-bogus-source? Just get yourself a copy of "How to lie with statistics" and internalize it.)

325:

Charlie@321:
How much of the cost of heart care in the UK is driven by the legal structures as well? It's pretty widely acknowledged that in the US a LOT of care is driven by legal necessity as well. Doctors have to live in fear of outsize malpractice lawsuits. That is something that can be addressed w/o trashing the entire system as well. Fixing what we have, by working on the parts that need it is a MUCH better path than trashing it wholesale to adopt a system that while may be working in other countries for now, is not without it's own systemic faults as well.

To quote John Mackey from my earlier posts: "At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country."

So if the Canadian and British systems are supplying everything you need, why is it that employees are demanding supplemental care above and beyond what the system provides?

Does Cato have an axe to grind? Absolutely. But if you read the report, you'd find they actually find things to like about the systems in place in other countries like France. But they also point out some of the long-term system issues that are building as well.

326:

Kent, John Mackey can't be trusted to speak for the UK or Canada because (a) he's cherry-picking to support his case, and (b) (this might have escaped your notice) Whole Foods barely have a toe-hold in the UK -- they're restricted to a grand total of four up-market stores in central London. Which have rather different healthcare requirements and needs than, for example, Vancouver or Toronto -- or even the rest of the UK.

As for malpractice suits, that's part of your problem -- AIUI medical malpractice insurance for doctors in the UK reaches the dizzy heights of £1-2,000 per year, compared to US $60-90,000 depending on speciality in the USA. But it's not all of the problem. Ask yourself, for example, why hospital procedures that don't involve doctors -- such as being wheeled between wards -- cost about three times as much for the uninsured as is charged to an insurance company account. Everything is overpriced in the US medical system -- systematically inflated to well over cost.

(Going to bed now. Can't be arsed staying up to argue with a flat-earther.)

327:

Kent: there are so many errors in the clip you posted from MacKey that it's genuinely hard to work out where to begin.

But at the core of this is you are being extremely disingenuous in your arguments and you're ignoring what people have been saying. Nobody here has claimed that there are situations where people might want treatment faster than the national system provides.

As we've said a LOT, there is a thriving private market for additional top up insurance in the UK (I can't speak for Canada) and additional Private Cover is a common perk for employees in the UK.

You will get a Hip Replacement and to see a specialist, but you'll probably have to live with a delay. BUT you WILL get your new Hip.

If you don't want to wait, you are free to pay for yourself or have insurance that can pay for you, and make sure you get a nice private room etc etc etc...

That sounds pretty reasonable to me. A universal system for everybody and a means to pay for what you want if you can afford to. In fact, that seems to be the basis of EVERY SINGLE OEDC health system apart from the USA.

The economic benefits of a single payer, universal system alone make it a complete no-brainer.

328:

Dave@327:
You're certainly welcome to your opinion about the "benefits" of a single payer system. But from my perspective I can see the flaws of that same system. The only limits imposed on inflation in a system like that, are by mandate. A market based reform, where people actually see the costs of their decisions, and are thus steered to change behavior because the benefits of that change accrue to them directly, is a far better way to control inflation. It's direct, and it works.

You all seem to think that single payer is an ideal system for something as critical as health care. Here's a proposal. Health care is important, and vital. But try and live w/o food. You can muddle through a lot of stuff w/o a doctor. But it's MUCH harder to muddle through w/o eating. Obviously food is a "right" since it's so necessary to life.

So why is it that delivery of food, wouldn't be far better provided by the government as well? Perhaps a single payer food service. Where your taxes go to provide all the food that the government deems "necessary". A nice chunk off the top of your paycheck every week, and you can just wheel by the local dispensary and pick up your ration. Granted, your choices may not be stellar, but that's the price you pay for getting provided your right to "free" food.

God knows the free market system of competing grocery stores, and restaurants has been woefully inadequate all these years. It's a wonder we didn't all starve to death ages ago, while the bastards got rich off our withering frames.

329:

Chris Williams @286, Calley has finally apologized, although that's not quite the same as being held responsible.

cod3fr3ak, @293, How can you get health coverage if you have a cancer or some other heavy duty disease if it prevents you from working.
-- I spent up all my credit cards and closed out my mutual funds and retirement account before Medicare & Social Security picked me up, but that's how you get health coverage. It would have been a lot easier for me if I had had something like cancer that is more quickly recognized. The nephrologists thought I was one of the first 50 people to get this kind of renal failure, and it wasn't in the lists that SS & Medicare had.

330:

OK, let me explain why things are so screwed up in the US in one word: corporations. American culture has become one of mercantilism, red in tooth and claw.

Who is opposed to health care? The main opponents of health care are, in fact, the drug and insurance companies- companies that are currently making billions of dollars a year in profits ("gross" in all meanings of the word), and who stand to see those profits substantially cut should health care reform become reality. The reason there are fifty million people in the country (a population almost the size of that of Great Britain) is because it's not profitable to insure, or care for, those people. The point of insurance in America is not to give health care to those people who need it, the point is to generate huge profits for the insurance companies. And the insurance companies are quite willing to spend millions to protect billions, and damn the suffering.

Prisons? A profit center of huge and growing proportions. Who are, again, willing to spend millions to enhance their bottom lines. And reforming inmates instead of just incarcerating them? A loser issue on two fronts- one, it costs more, and two, is reduces repeat "customers" (aka recidivism).

Our foreign policy is basically entirely driven by commercial interests.

Our media is entirely controlled by corporations as well- both directly (it's owned by big corporations), and due to the fact that big corporations dominate advertising spending. Remember, the media isn't in the business of providing entertainment and/or news to the viewers/readers, it's in the business of providing eyeballs to advertisers. So the media not only allows, it actively promotes, those falsehoods which serve the corporate interest (like, Iraq had nukes, or Health Care Reform has death panels). You should no more trust CNN or the Wall Street Journal or the New York Times than you would have trusted Pravda back in the day, and for the same reason. The difference is that the Russians knew, generally, that Pravda was propaganda, the US hasn't (quite) figured that out yet about their media. Of course, we have slicker propagandists, er, advertising consultants.

Over the last fifty years, it's become obvious that a politician with a friendly media environment (i.e. support of the corporations) and a large campaign war chest (filled by corporate lobbyists and rich donors) is very highly likely going to win election. Everything bad they do will be conveniently forgotten by the media, and everything good trumpeted by the media, and the large war chest allows a lot of media buys to tell your side of the story. Likewise, lacking both of these means a politician is very likely going to lose- the media will trumpet everything bad the politician has done, forget everything good, and the lack of the war chest means no big media buys to explain your side of the story.

This isn't 100% either way- occasionally someone liked by the media and with lots of money will still lose, and occasionally someone hated by the media and without the war chest will still win, but those are the exceptions. So it's natural that politicians will start to treat the media and corporations as their real constituency. This is why, despite the fact that 80% of Americans support a public option, it's having a real hard time passing.

Again and again: if you see America doing something stupid and deadly, look for who benefits.

331:

It's pretty widely acknowledged that in the US a LOT of care is driven by legal necessity as well. Doctors have to live in fear of outsize malpractice lawsuits

No kent, that's an outright lie that got peddled about back in the 90's during the last health care debate you americans had, and the tort reform canard that was put forth as an alternative to a working health care system never came about back then, as it won't this time around - the difference in costs between insurance based health care and single payer systems is mostly administrative (i.e. the costs of the bureucracy needed to organise several hundred other bureucracies so that they can cover medical care) with a bit of outright price gouging on the part of the insurance companies to maximise their profits. end of discussion because that's the reality of the situation and you can't disagree with reali...

So why is it that delivery of food, wouldn't be far better provided by the government as well? Perhaps a single payer food service. Where your taxes go to provide all the food that the government deems "necessary". A nice chunk off the top of your paycheck every week, and you can just wheel by the local dispensary and pick up your ration. Granted, your choices may not be stellar, but that's the price you pay for getting provided your right to "free" food.

I'm sorry.

...

What?

...

You do realise that your country operate a system of FOOD STAMPS right? You do understand that you have a welfare system in your own country that... You do understand that britain had a system of actual food rationing during ww2 as well right? And that every MEDC in the world including your own country operates a welfare state that is designed to allow people with no or little income to obtain things like food for themselves, on the grounds that it's bad for a MEDC to have people routinely starving to death in the streets right? In much the same vein most MEDCs have national health care programs of some kind to avoid having their citizens routinely being made homeless and/or killed due to easily preventable diseases? Right?

...

Is it web 3.5 that'll have the "Punch The Stupid Over Internet Protocol" functionality implemented? When are we getting that again?

332:

Brian@330
The corporatist nature of America is a HUGE reason to fear putting control of ~16% of the economy in the grip of the government. That's a HUGE pile of cash in a fairly limited number of hands, really. And an amazing opportunity for lobbying. As evidenced by the army of them swarming over Washington to steer the debate now.

Part of a well regulated market, is regulating when an entity within it is too big, and has outsize power over that market. A level of regulation that has been sorely lacking for years.

333:

Kent: Fred probably said it better than I did, but what you did there, with the food service thing, that's what's called a STRAWMAN where I come from.

For a start, as Fred points out, there is a government food service for the poor, because, as Fred points out, people generally don't want to see people starving in the streets.

The choice of goods available on welfare, whatever you want to call it, might not be great, but you won't starve and nor will your children.

So - now we've established that for the poor there are government food programs because we're actually social, empathic animals at heart, let's look at the reasons that this isn't like healthcare.

With food I can chose what I eat - I can eat cheap, I can eat nice, I can eat rich - entirely up to me.

With my hypertension, on the other hand, I can have Lisinipril or Ramipril or... actually, they're the best two for my form of hypertension - without them, sooner or later, I'll probably have a Myocardial Infarction. Where's the market going to help there? I probably have to stay on them for the rest of my life, which, I hope will be at least another 40 years or so. "Muddling through" isn't really an option for me.

If it was worse, and I have friends with much worse genetic conditions for hypertension, I might need 3 or 4 drugs to keep it at a sensible level, again, without those one of my closest friends would probably die sometime around the time all his male ancestors did - about 60-65.

You can't muddle through Diabetes either, sooner or later you'll probably lose a foot, or both feet and your vision...

A lot of people have depression - they can "muddle through", but they'll have a miserable time doing it, they'll miss work, have family problems, and some of them will commit suicide. All for a want of a simple drug that they might struggle to afford themselves.

Finally, how about them vaccinations eh? I mean, you can "muddle" through without those too, until a major public health crisis reaches a critical mass.

The market doesn't work for essential healthcare - every single other industrial nation on the planet (count them) worked that one out. Wake up and get on the clue train will you?

334:

Fred@331
There's a world of difference between food stamps, and single payer tho.

In previous posts I've been in favor of a "Safety net" to catch those that don't get basic level services through what is in place. I'm just opposed to a single payer revamp of the entire system.

Fix the holes, and the problems. Don't gut the system. And part of fixing the holes, is to actually let the market work as it should.

You don't object to the main part of a vital service like food delivery being a market driven system that encourages choice, and variety, as well as working to contain costs. Why is that so bad in health care? Why do I need centralized government control of one, but not the other?

335:

Greg @ 318: "WHY do a large proportion of the (possibly brainwashed) US population not want htese obvious benefits?"

Two reasons: One, when Americans look at the rest of the world, they don't like what they see. Most Americans look down on everything across their borders.

Two, we do have a partially socialized medicine system -- Medicare, Medicaid, and the VA. People see these and they're unhappy and have no reason to think that any other program would be better.

In sort, they aren't benefits, obvious or otherwise.

336:

Andrew: So why all the seniors with the "Keep the Government Out of My Medicare" signs?

In fact, the opinion polls suggest that Medicare and the VA are enormously popular. Bill Crystol (not exactly a left wing shill) was waxing lyrical about the VA on The Daily Show a week or two back.

But in the interest of debate: what don't you like when you look at the French system in particular?

337:

Dave @336:

Because we Americans are a perverse people. An example from 2005, before the recent political controversy:
http://www.harrisinteractive.com/harris_poll/index.asp?PID=620

Medicaid which enjoys the support of 71 percent of all adults is rated 73 percent negative, 27 percent positive.
Federal aid to public schools which is supported by 69 percent of adults is rated 74 percent negative, 26 percent positive.
Social Security, which enjoys very strong support (76%) is rated 73 percent negative, 27 percent negative.
Medicare, also a very popular service (76% support) is rated 73 percent negative, 27 percent positive.


So you have people saying they support something, while giving it a negative rating.

Americans are pessimistic about government, we don't like what we have but we think anything else will be far worse.

338:

i think charles bukowski said it best: "a nation whose cities have never been bombed, and whose mothers have never been told to shut up"

339:

You're missing the central point, which oddly enough was Stross's thesis-- Americans are basically sadists. We enjoy hurting, dominating, and killing others for pleasure. Because it makes us happy.
Not all of us, true, but apparently a far greater percentage than in many other developed countries, and we elect those people to office as well-- state and national.
So why don't we have a national healthcare system? Becuase we enjoy a sense of smug superiority when watching the sick and poor suffer. Why capital punishment? We like killing people. Why the big military budget? Same reason.

340:

Also, Charlie-- you probably asked your implied question to the people least likely to be able to answer it becuase they're some of the people least likely to agree with the status quo. Might as well ask a bunch of hippies in a commune why Wall Street thinks the way it does, or PETA members about the inner mindset of a cattle rancher.

341:

@317: Charlie, I thought you didn't want my stinking money. Sheesh, here I was going to wait until the sequel to Halting State made it into the local public library so I didn't have to pay for it....

Looking forward to it.

342:

Charlie,

I can't claim to have read every comment posted so far, but I have read all of *your* comments on this thread, and I haven't noticed this issue come up. I do agree with you on the basic premise that a significant minority of Americans subscribe to a particularly merciless brand of politics. I attribute this to the culture of honor we inherited from the wild west, inflated by a conservative movement that relies increasingly on its masculinity in response to the rise of secularism, along with attitudes that trickled down from an elite who view the *majority* of Americans as lazy suckers.

However, on the issue of health care, there are legitimate reasons people are scared. And as much as I'd like to blame the republicans for their fear mongering, it seems as though the Democrats are asking to fail. Despite the fact that 65% of Americans support a single payer plan, somehow it's not even in the debate. (It will show up for a vote, but nobody's taking it seriously.)

Instead, they are proposing a plan that will tax Americans who refuse to purchase insurance, and they will offer a public option that is legally bound to cost the same as private insurance. If this plan were proposed in your country, the ensuing riots would make our townhouse protests look like a tea party (pun not intended.)

Yes, it will force insurance companies to show a tiny bit more mercy than they do now (which is to say none), but by forcing Americans to purchase insurance it will permanently entrench these insurance companies into the establishment, the way the banking industry went (and we all know how that turned out.)

There is a shared culture in America that tends to view any expansion of government as an attack on our liberties. Generally speaking, I think that aspect of American culture is a good thing, because the way it works over here, it almost always is.

343:

Kent & @ 335
WRONG
Maybe "Not even wrong!"

I REPEAT.

EVERY OTHER civilised country on the planet has NHS-style medical systems.
THAT WORK.
That cost LESS than the US system.
And which are NOT in the hands of corporate lobbyists - yes they exist, and they make a lot of noise, but they don't seem to get their way, as they do in the US.
PLEASE re-examine this comparison (assuming that you have looked at it in the first place)
AND THEN

Tell us why a tax-funded national medical system is such a terrible idea?

Remember it works in:
UK, France, Belgium, Germany, Denmark, Switzerland, Italy, Norway, Sweden, Finland, Canda, Australia, New Zealand, Singapore .....
But it "can't possibly work in the USA"?

Don't believe you.
Answer the questions, please, or be called liar....

344:

@335- You'd claim we'd come in a strange ideological circle-- the "culture of honor" and assorted violence didn't come from the Wild West, it went _to_ the west from Appalachia...where it came from Ulster...where it came from, mainly, Scotland and areas close to it. Where apparently now they practice mercy.

345:

Allow me to answer you-- it doesn't work here, because it puts the haves in the same boat as the have-nots. Medicare is fine, because we expect the elderly to be feeble and need care. Medicaid is fine in a way because it's essentially a charity.
But to presume that someone who works and makes money should have no better medical care than a random bum from the street? That is anathema. Essentially, single-payer healthcare mingles the castes, and in the US the upper half or so of the castes do not want to mingle.

346:

Let's see ...

Kent @328 is completely and utterly wrong. But why?

Well, he seems to think that a single-payer system will be subject to unlimited cost inflation, because (a) there's unlimited demand for the service, and (b) the medics can charge what they want.

The big mistake is buried in assumption (b). Single payer systems are monopsonies; they can pick and choose what they buy. Meanwhile, the medical professions are not monolithic -- there are usually multiple treatments for any given pathology, and multiple brain surgeons. A treatment or practitioner that's too expensive runs the risk of being priced out of the single-payer market. This exerts a downward pressure on costs.

Which is how things work in the real world, i.e. outside the United States, where developed nations with single-payer systems enjoy significantly lower healthcare costs than the US.

As for the "single payer for free food" argument, see Fred's comment at @331.

C @344: you didn't finish the "culture of honour" historical world tour off, so let me add: it came from those elements of Scottish highland (tribal culture) that left Scotland -- i.e. those that either emigrated voluntarily or were deported during the highland clearances. Scotland today is the product of ethnic cleansing during the 17th through 19th centuries. Not the same culture, for the most part, and probably a good thing: the highlanders were extremely violent tribal raiders with a taste for the blood feud.

347:

@346- Not unlike the US, then? Take people who were used to fighting the English/Scottish/Vikings/whatever, transplant them to a place where they fight the Irish, let them move from there to a place where they fight the Native Americans (and each other), give the resulting country they wind up in a major war every generation and minor ones here and there, and you have to blink in amazement that the culture is somehow low in mercy?

You might as well note that people are a little touchy in Kashmir and somewhat less than omnibenevolent in the Middle East.

I'm going to assume you get shocked by it because you seem, as near as I can tell, to be a very, very nice person. I imagine you've never looked at someone and thought "I will be unhappy if this person is not suffering". You probably don't think the world would be a better place if certain people who disagree with you happened to no longer walk the earth.
But I've seen pleasant, functional people happily espousing swaths of humanity whom they suggest need to go. I've seen my office crowd around a computer monitor showing video of Saddam Hussein's hanging with all the excited glee of kids watching a petting zoo. (Most memorable comment from a sweet mother of two-- "Ooh, I want to watch him dangle"). The topic of the destruction of Fallujah got delighted laughs at the thoroughness with which it wsa done.
And these aren't sociopaths-- they function, they love, they socialize, they work and play. But anything in an out-group is a potential victim, in a manner somewhat akin to cats with mice.
So, suffice it so say, we're not just living in geographically different places, we're living in very different societies. The surface-level similarities of language, dress, food, and such may serve to disguise this, but it's there, it's deep, and I can't think of a good way that it's bridgable.

How would you explain the sensation of mercy to someone who doesn't have it? How would you explain its lack to someone who has it?

348:

Why would they want such additional health-care benefit dollars if they already have an "intrinsic right to health care"?

1) It's a status perk - like a company car or a golf club membership or an integrated BlackBerry-vibrator covered in purple diamonds.

2) It's tax-deductible.

349:

@83 ...hello Zach

"the release was a clear attempt to curry favour with Libya's regime..."

on the part of whom exactly? A minority nationalist government in Scotland being leaned on by an ailing Labour government at Westminster? Are you saying that the SNP did what they were told by their political opponents? Conversely, it might just be that the democratic devolution of power sometimes throws up issues that the big players don't like (like a cabinet minister for justice acting in terms of legal advice, Scottish law and his own conscience as an elected representative) but hey, that's self determination for you...

"... and had little to do with the twisted sense of "compassion" that was trotted out by Scottish leaders..."

Speaking as a Scot, letting someone out when they're a few weeks from death doesn't seem particularly twisted; and we don't have leaders, we have representatives (or at least I like to think so, personally; leaders are for people who like being led) ...

350:

Kent, I suspect you're wasting your time here. You seem hold a religious belief in the magick of 'free market' (apparently a very fuzzy and self-sorting version thereof, at least), and are trying to peddle your faith to equally strong believers of a different church …neither of you is very likely to win the opposition over.
A subtle but significant difference between the two sides of the argument is worth mentioning, however: the Church of the Single Payer beliefs are backed by the same empirical evidence your wishful thinking flies in the face of.

Seriously, please do yourself a favor and drop it, or (better) come up with a seemingly workable alternative to a civil-service based healthcare model, so there's something real to discuss.
Socialized healthcare works, it's empirically verified on a large scale and in a variety of flavors (including Medicare/Aide and VA in the US) ; as established both by the general track record of USA and the many underdeveloped countries that share your health-as-a-FFA approach, the magick of 'free market' can't float this boat.
Thus the onus is on you to bring up a third angle (if you really can't make your peace with pinko-commie working solution), but this dead "health is like food/iPods/shoes" horse won't run, no matter how hard you flog it.

As a sidenote, how every country that can afford it hasn't taken the step to 100% 'free' healthcare yet is grating enough (considering the social benefits and public money savings that come with good preventive/palliative care and early detection), but opposing the very notion of a better public health program based solely on aesthetic prejudice is bordering on criminal.

Dave @336: I've lived in France a great deal of time, the healthcare system over there is pretty good (and stellar compared to the USA) but nowhere near perfect, with some gaps in how it reimburses the lower-income-but-not-quite-off-the-wagon segment of the population for their medical expenses — more a matter of tweaking/balance than a core design flaw really, but worth keeping in mind if one wants to draw inspiration from it.

Andrew @337: Notably, there is a misconception in France that they get the best healthcare in the world, when by objective standards, UK for example provides better service on many levels, yet the British NHS garners lower satisfaction index than French Social Security in polls.
Perception matters, indeed, if only so that it doesn't blind one entirely to factual reality.

351:

Armchair @350 "yet the British NHS garners lower satisfaction index"

There is a wide disparity between the general population and those who have recent experience of the NHS when it comes to satisfaction surveys. The general population clings to the "old , dirty hospitals; long waiting lists; poor service" view of the NHS which is promoted by the press (and any politician trying to score points), while those with recent experience tend to be much more positive.

The press in the UK is largely anti-NHS, except when defending it against criticism from abroad.

352:

Jim, apropos comment 351, I have regular and ongoing contact with the NHS (due to hypertension). You're dead right. My experience is of prompt, efficient treatments in modern-build group practices and hospitals, by highly professional staff. There are cracks you can fall down, but that's true of all healthcare systems (not least the American insurance system, with its endless paperwork and form-filling).

353:

Greg @ 343: "EVERY OTHER civilised country on the planet has NHS-style medical systems."

That's oversimplifying things to be polite. No, every country doesn't have an *NHS* style medical system. Relatively few do. There's a number of different public health care/insurance systems out there. The UK, France, Austria, Germany, Swizterland, Italy -- all have different systems aimed at the same goal.

Which is something at seems to escape both sides of the debate here in the US, I'll admit. Maybe it's because we don't bother to consider things not written in English, but the only systems we look at are Canada & the UK and assume it's either that or our current system.

354:

Charlie @ 346: That's true, most of the immigrants who came to the US were from groups that weren't especially desirable back home. A good portion of my immigrant ancestors were or were descended from Puritians, poor Irish, and Border Reivers. With a couple of Bavarians and Veronese for good measure.

355:

Charlie @ 346:

I forgot to add that most of those Scots you mention tended to end up in what's now the US south. The Scots-Irish too, or Scottish settlers in Ulster. They didn't like the old English Planter families that held the power there, so they kept heading west. Basically most of the white Americans from the Atlantic to the Colorado River and south of Ohio are descended from them.

The rest of America has different sources -- Germans, Poles, and Scandinavians are a big portion of the Midwest. Irish, Italians, and English are a big portion of the Northeast. The West Coast tends to have gotten a mix of everyone.

356:

Marilee J. Layman@329
Sorry to hear that. What I do not understand is why people think this is a good outcome? The same people holler about wealth creation being a priority, when the policies they support effect heavy duty wealth destruction --- for the middle classes. For the rich life is good, with every schmuck that pays premiums, but never gets the coverage when they need it is a plus.

Andrew@298
How would you prove it? And would you be able to support yourself through the legal battle to get your justice?

357:

Just an observation: I had heard that the US government, spends more per capita on public health care than the English government. Things are certainly messed up here, but that seems ridiculous. So I checked, and it's right. By my calculations[1], UK public expenditure is just under $3k/capita, USA public expenditure is over $3350. (US numbers are sloppier, I used the lower bound.)

That is to say, the USA's public health care system already spends more on each American (on average) than the UK's spends on each English person. *On top of that*, the USA has a private insurance market that costs about as much as the public sector and acts like a corporation being asked to cough up money when people actually need expensive health care (it's not hard to find anecdotes, known policies, and statistics as needed for this). *To make it even more astounding* this system doesn't cover 1/6th of the American population. Best part? By most measures this system is less effective than the UK system.
Observation: The USA could spend no more public money than they do now, completely drop the private aspects of US health care, and increase its standard of care by simply stealing the UK NHS wholesale. (Note to UK, you might want to remember to lock up the NHS at night.)

Additional Observation: The folks objecting to US public health care on the grounds that the USA is somehow completely incompetent at health care have some pretty strong supporting evidence.

[1] Shameful admission - I took Wikipedia numbers as correct. Also, as the NHS is apparently somewhat subdivided, I used NHS (England) numbers.

358:

Martin: "England" doesn't have a government. You might be thinking of the "United Kingdom" (consisting of England, Wales, Scotland, and Northern Ireland). Hint: we're touchy about that sort of thing around here.

Other than that, you're absolutely right.

359:

Charlie@346, & Armchair@350.
You're right in some respects. I do have faith in the free market, when regulated. And much as I have faith in that, which I'd be happy to explain in detail why, you have your own set of beliefs that you are just as fervent about.

Can I try to draw references that are critical of your side of the argument? Absolutely. Unfortunately ANY reference I draw on that doesn't fit your worldview, you immediately dismiss as being biased, unreliable, rubbish. So what's the point.

You don't want to have an actual discussion, or accept any facts that don't fit your worldview. You want to preach to the foolish Americans, about how wrong and ill-advised we are.

360:

Charlie @ 358
The NHS is divided up by region, at least according to Wikipedia. I would have actually preferred to use overall UK numbers, but the data on WP is divided out by NHS(England/Scotland/Wales/NI).

However, my use of the term "English government" was certainly sloppy. The article clearly states that while the non-English UK NHSs are responsible to the local governments, the England branch is responsible to the overall UK government. It seems to me that it would make sense for England to have a regional government of its own, but I'm sure there are all sorts of interesting political reasons why it doesn't.

"The National Health Service (NHS) is the name commonly used to refer to the four publicly funded healthcare systems of the United Kingdom, collectively or individually, although only the health service in England uses the name 'National Health Service' without further qualification. The publicly-funded healthcare organisation in Northern Ireland does not use the term 'National Health Service', but is still commonly referred to as the 'NHS'. Each system operates independently, and is politically accountable to the relevant devolved government of Scotland (Scottish Government), Wales (Welsh Assembly Government) and Northern Ireland (Northern Ireland Executive), and to the UK government for England."
http://en.wikipedia.org/wiki/National_Health_Service

361:

There used to be a middle tier of NHS administration -- Region/Area/District -- but Maggie the Thatch axed the Area level round about the early-to-mid 80s, a couple of years before I was working in it.

It seems to me that it would make sense for England to have a regional government of its own ...

This is a huge can of constitutional worms (as far as British politics is concerned) -- big enough to have a name: the West Lothian Question. (See also: why Washington DC is a district, not a state.)

362:

One amusing thought strikes me, about much of this discussion. At least with regards to the Europeans who are trying to "help" us American's to a better solution/system.

For at least the last 6 1/2 years (Since the start of the Iraq war. Possibly going back to days after 9/11/01 even, the rest of the world, including major portions of the UK have been highly suspicious of the US government. You didn't trust anything they were doing. Motives are suspect. Actions are viewed w/ a jaundiced eye. The federal government in Washington was pretty widely viewed with distaste for ~7 years. Not that I'm questioning that view at all. I can absolutely agree with most of it.

But if you've spent the last ~7 years questioning the motives of virtually everyone in Washington, and the federal bureaucracy, why are you so eager to get us to embrace them as the saviors of our medical system? Isn't this the same institution that you've been roundly criticizing for years now?

363:

Perhaps because the bit of the US medical system run by the Feds, the VA, is more efficient even than the NHS?

364:

There are actually alot of efficiencies to be gained by switching to completely public healthcare that aren't immediately obvious.

In the United States (Not sure how it works across the pond) Hospitals are businesses that compete with each other. One side effect of this is that hospitals have compete with other hospitals on a department by department basis. So even if your hospital is famous for it's radiology department, you still need to have beds for pediatrics, trauma, the elderly etc... The net result is that most hospitals have large swaths of beds and departments that are mostly empty most of the time. What's more, most of the staff need to be ready to deal with anything that roles through the door, and specialization of care becomes extremely difficult.

Compare this with the Japanese model, where instead of only having lots of swiss army knife hospitals, you have specialized care centers. If you break your leg, you're going to a center where everyone who is involved with your care is going trained for exactly your situation, and prepared for whatever needs come with it. You don't have as many empty beds, and you also eliminate the risk of catching some horrifying disease from some other patient if you came in for a sprained ankle.

That sounds pretty kick ass to me, but I don't see how it could happen through the "magic of the market"

365:

Chris@363:

I assume this is the VA system you're referring to, as a model for efficiency, and what we should be striving for across the board?

http://en.wikipedia.org/wiki/Walter_Reed_Army_Medical_Center_neglect_scandal

366:

Jim @351,

If the only thing to come out of this furore is to swing the British press and public opinion solidly behind the NHS, our American friends have done us all a huge favour. Thanks, guys!


367:

Not sure you can read to much about a country from the fact that vested interests defend their status (quo) when threatened. Didn't we get exactly the same behaviour when we set up the NHS?

On the other hand, the arguments that they choose to strike a chord may be more revealing.

On the other other hand, very similar arguments are deployed here in the UK. I read the Daily Mail, so I know. And yes, I am ashamed. No Merchant Princes for Will, I fear.

368:

@364 Ben- If you think hospitals in the US actually compete anymore, think again. If you wanted to build a new one, you'd effectively need state approval (called a Certificate of Need) saying that there was really some sort of need that existed that current hospitals weren't meeting. The same applies if you try to start up a major area of care-- if you try to put up a childbirthing center to complete with the one next door, don't hold your breath on getting it approved.

The problem with specialty hospitals here might involve population density-- if you happen to need trauma care, or have a pediatric emergency or obstetrical services, how far do you have to go to get those treated? Can't go too far with that gunshot or heart attack, after all. In high-density urban areas, that's not much additional space between hospitals. In suburban ones...might be too far.

369:

Kent@ 358/9

you haven't answered my question.

For others ... When I used "NHS-Style" that was shorthand for a state-provided full-cover medical system, as used in all of Europe and other civilised countries.
Stop bloody nitpicking, just becaue you don't HAVE an argument!

370:

Not sure you can read too much about a country from the fact that vested interests defend their status (quo) when threatened. Didn't we get exactly the same behaviour when we set up the NHS?

On the other hand, the arguments that they choose to strike a chord may be more revealing.

On the other other hand, very similar arguments are deployed here in the UK. I read the Daily Mail, so I know. And yes, I am ashamed. No Merchant Princes for Will, I fear.

371:

Greg@369
Actually I did more or less respond to your question, in 359.

This is not a discussion, or a debate, really. Because any evidence presented in opposition to your view is dismissed as biased, and unreliable. News flash, everyone has some kind of ax to grind, or they wouldn't write about the subject at all. And you're unlikely to find anyone publishing information on the subject that doesn't support their view of it. So I *can't* back up my side of the argument with any sources, since they are all biased, suspect, and discarded. So there's really no point in trying to discuss it with you.

You've got a system you like. Good for you. I'll pass, given any opportunity to do so, thanks anyhow.

372:

I don't understand why you (and a lot of other people) compare pharma marketing budgets to their research budgets. The suggestion seems to be that it is a zero-sum game, and that money spent on marketing is not available for research, with the implication being that pharm companies care more about making money than about discovering drugs. But the two investments are really apples and oranges. Marketing is a short term investment that pays off right away. Successful marketing brings in more money than it costs, so it costs less than nothing. Marketing makes more money available for long-term investments like discovering new drugs.

Of course, this is not to endorse the way in which drugs are marketed, or to whom they are marketed; I can think of a number of examples in which those have been inappropriate. However, it is worth noting that the biggest component of the marketing budget is for free samples. That has at least some positive aspects in providing free drugs to patients (although it also gets people started taking new, expensive drugs, when often they really should be taking older, cheap ones that have a longer safety record). Of course, with a decent health care system, the value of free samples to patients would be diminished.

373:

Oops, Kent Failed the Turing complete test somewhere around #359 and has been demoted to NPC:
"I do have faith in the free market, when regulated."
Syntax error: Oxymoronic statement halted parsing.

The bot performed ok-ish until it was asked to produce original content, at which point the suspension of disbelief on the user end quickly waned, as nothing but "No, you !" came out from Kent 0b6 standard output — by then falling back to autotroll routine.

Suggested fix: upgrade the script with some detection code to cope with the absence of causal reciprocity between facts and opinions outside of art critic and theology (quit gracefully ?).

———————

Jim @351, Charlie @352 — Not sure the clarification is warranted, but just in case: yes, that's what I was hinting at. You can have a good system with an excessively positive perception from its public (France) and a close-to-great one that goes under appreciated (UK).
Although how the public perceives the local healthcare service is certainly interesting and useful to know (and address), the facts of how fast/well/cheap the public is served should remain the defining factors when gauging the worth of a healthcare system.

Full disclaimer:
I am no fanboi of either British or French system, just like I can see serious issues with how welfare, unemployment insurance and many other social services are designed and operated even in the most aggressively progressive industrialized countries (I guess I'm some weird hybrid of libertarian socialist), but the fact remains: even imperfect socialized healthcare gets the job done orders of magnitude better than any real-world example of merchandised healthcare to date.

Whether a given society should want its population healthier on average may be open for discussion, but that's a different debate: if we accept the goal of the best bang for end users' buck on the whole as a postulate, corporate control over healthcare is a contradiction in terms (unless you can mandate boards and shareholders are only populated by friggin' saints).

374:

Greg @369 -- is it nitpicking to point out that "Europe" isn't a country? (as in "Europe and othe civilised countries).

And it's very pretentious to indicate that you would gracefully indulge a conversation with such an uncivilised group of people. If only we weren't so boorish as to have been fooled by propaganda.

Your health care doesn't seem to benefit your manners, sir.

But you are right. This is all either I'm for a single payer system or I'm fighting for my right to be broken or murdered by bad health care.

375:

Greg @ 369 - just because you don't like you're opponents argument doesn't mean they don't have one. Liberals have blocked real reform and change to the healthcare system for decades because it wasn't the European style system they wanted. There are plenty of alternatives that would likely be better than what's currently being pushed.

I'm all for health care reform and providing care to my fellow residents of the US (even non-citizens), I just absolutely hate everything about the plans currently under discussion.

I think there are a number of arguments that can be made in favor of the government providing health care, from different ethical schools. Even from a libertarian perspective -- it reduces overhead costs that favor big businesses and promotes entrepreneurship. It promotes labor mobility. It reduces the risk of people needing other forms of state assistance. Or from a utilitarian one -- it creates a more productive workforce that generates more wealth and thus more tax revenue. Or any number of religious arguments.

But I care about efficiency, cost, innovation, accessibility too. And I think private enterprise supplies those things vastly better than the government. Everything I've seen where the government and private industry provide similar services, the private industry comes out better. The only way the government can come out on top is via it's monopoly on force and hobbling competition.

376:

Other Bill @ 374 -- It's an old rhetorical trick of Marxists, called "false consciousness". If you don't agree with them and they think you should then you're obviously blinded and deluded and not worth talking to. Either that or you're a class enemy and not worth talking to.

377:

Armchair@373:
I'm sure you're quite pleased with your cleverness. Unfortunately it just doesn't do anything for me. It's possible to have a free market, and still have regulation to ensure that the rules are held to. That's the proper role of government. The government's "core competency" is regulation, not management. Regulating the market is what it's able to do with some measure of competence. Managing the health care industry, not so much.

I was never asked to produce original content. I was asked to cite references to support my thesis. Unfortunately any reference cited, is immediately shot down as biased, and unreliable. Then rendering the whole exercise pointless.

Perhaps now that I've explained it a THIRD time, you'll register what I'm saying, and understand why I'm bailing on the lack of debate.

This isn't a debate or discussion. It's a bunch of religious zealots shrieking at the unbelievers. I've got a cat that I can work on teaching algebra to instead.

378:

Andrew @375: Have you actually worked for a large private enterprise?

As a friend of mine is keen on saying, there's a reason why Dilbert is set in the private sector.

379:

Dave@378:
The reason it's set in the private sector, is because that's where he was working (sorta) when he started writing it. He worked for the RBOC in California.

You write what you know. And you shouldn't assume that he's in any way endorsing the government as being a more efficient way to do things, just because it's not set there.

380:

Dave @378 - Ha! Agreed. But, you know, there are a pretty fair number of comedies that revolve around dysfunctional government bureaucracies.

Andrew @376 - I know it. Honestly, I'm not sure this discussion of healthcare is any differnt than they way it's being carried in public here in the states. I'd like an honest debate tha acknowledges the merits and faults of both sides. Itdoesnt really matter what side of the coin youre on in a debate if all you're doing is deliberately debasing the other side as inhuman or uncivilized. That is very much as effective as teaching cats algebra.

I'm not even saying I hate the single payer system idea. But I certainly don't appreciate a nuanced approach being derided as socialist death panels or suggesting I'm unknowingly inviting myself to be sodomized by corporate dicks.

This conversation started as a complaint about just that and almost immediately devolved right into a youre either with us or you just happen to be dumb enough to be advocating gfor your right to get dead quicker and more painfully.

381:

Dave @ 378: Sure, but I left -- too much pressure and demand for results. Government looked nice, but I decided to join one of the "family trades" -- higher education*. So now I'm at a private nonprofit. Nice pace, good benefits, low stress. Bit lower pay than I could get in private enterprise though. Government is a great place to work, precisely because it's less efficient than private enterprise. Not so great to have as a service provider though.

*The other is Florida real estate, so I think I made a good choice.

382:

Other Bill @ 380: Yeah, both sides (voters and politicians) have become way to entrenched on the issue and are talking past each other getting themselves worked up. That's why I don't think we will pass health reform even though I and most Americans we need something.

Admittedly, it has never been a major priority for the Republicans. They do have their own ideas and plans despite what the Democrats say, but they have never pushed very hard when faced with opposition from the Left.

The current mess I blame on the Left. The Democrats really have no excuse for not passing something, they completely control the government right now and the best the Republicans could do is delay things a little. But the Left is pushing their particular plan so hard that they've alienated their own allies. It would be perfectly possible to pass a series of reforms and changes over the course of Obama's Presidency. But they (and I think Obama) want a big shiny reform package that they can herald as the next New Deal or Great Society and the crowning triumph of the Left. And that's what people are opposing.

383:

Something I really enjoy about American political discourse: if you don't accept that the other side is half right, you're some sort of unreasonable dogmatic. This is good if being a zealot is something you're fine with ("I don't care about your facts, I am stalwart in my beliefs"), bad if you want to be perceived as reasonable and the other guy is arguing for an "eat all the kittens" plan.

"Well buddy, what is it going to be? Are you going to eat half the kittens, or are you some kind of unreasonable fascist?"

384:

Andrew: The reason I made the point is that I've spent a lot of the last decade working with large technology companies and the level of waste and general incompetence puts a lot of government run organisations to shame.

I don't think the problem is government, I think it's a scale issue. However, some things don't work on a small scale - healthcare, utilities, police, fire services etc...

Kent: If you cite biased and poor references to support your arguments you'll be shot down. If you can't find references that aren't tainted, you should think seriously about what that tells you.

Second, you've not once addressed the core issue. Every single other OECD nation provides universal health coverage for all their citizens for less than the US spends.

The market doesn't work for all things, not even a regulated one. Go and read what Warren Buffett has to say on the subject.

385:

Dave @384 - Okay, you've said every other OECD nation provides some fashion (they all aren't exactly the same, I don't think) for less than what the US spends. Let's push past that. What are the most common failure points? I'm not asking a question I k ow the answer to, but I'm asking one I'd like some info on. The argument has so far been socialized health care costs less and the us system is by and for sadists.

A couple comments back there was a mention of the French having some trouble with the bottom rung of the population staying on the health care bandwagon. I'm not sure what that means. But I do also recall that most of the bottom rung in France is not white (i remember the Muslims rioting a couple years back and the youth in general) which makes it sound as though French health care works great for whites.

My point is most certainly not to say that universal healthcare is Aryan run in Europe or anything like that. But I really would like to know the failure points. I mean, in line with what Charlie has been saying, my experience with health care in the us of late has been great. My wife and I just had a kid. The hospitals were great, the doctors helpful and skilled and the nursing staff absolutely a breath of fresh air. And the birth was by no means easy for my wife. We've had no problems with our health insurance covering the entirety of our needs. Now you may say yeah but wait till you get leukemia and they drop your ass. And that may be. But in what way is that comparing apples to apples, like regular visits to the hospital for hypertension.

So, the question back to the euro bretheren, or those educated in such things (I know about conflict and peace holding for my job, so definitely not a subject matter expert) is: tell me where single payer systems fail.

386:

Well, Other Bill@385, the NHS was failing when government failed to fund it adequately over a number of years. Waiting lists for fairly routine operations could stretch for years. You would routinely spend hours waiting for emergency treatment. People were stuck on trolleys fr days for lack of beds.

The present government has been criticised heavily for the amount it has spent turning this round, to the point where my son had remedial (emergency) plastic surgery at 9 pm on a Sunday night, two hours after I took him in. (OK, we did have to visit a couple of hospitals and we were lucky that the surgeon waited for us after his shift)I can't see that happening in 1990.

It is actually quite rare for a British government to have both the political capital and the will to make this sort of strategic investment. And it'll be back to business as usual after we have voted them out at the next election.

387:

@ 371/4/5
No.
EVERY OTHER civilised country has a "socialised" heathcare system that works, and for less money than the US one.
So WHY are you so against the proposals being made to bring the US up to somewhere approaching others standards?

There is, of course, Another approach to the subject which suggests what is wrong.
There ARE nutters like Theodore Beale (his real name) loose over here, including muslims encouraging wife-beating.
But they get slapped down.
Meanwhile "Day" is thought of as a slightly more-than-usually rightwing semi-mainstreamer.
Uggggh.

388:

Greg @387 - no what? It's like that moment in Waterboy right before Adam sandler tackles that dude.

I can say that I'm certainly not against proposals. What I'm against is that everytime someone says they aren't gungho about some people go straight to the "stupid corporate shills" speech. And I'm also getting annoyed with the raise your standards nonsense applied writ large to the entire of health care in America. In terms of actual service rendered the US has the best doctors in te world.

Access and cost are the twin problems of our system. And just immediately switching over to a single payer system doesn't fix those. There isn't a magic button the government will push tha will automatically alleviate those problems. They are a pretty complex plate of noodles that. Need to be straightened out and sorted accordingly. And ithink those are the problems of more or less every country with a modern health care system. So, wanting to talk more about how to address those problems in a more complex way than just a simple check yes or no: single payer system love letter is responsible and appropriate.

People are running you folks down for stepping in and acting like fools. Single payer system or death. Yeah, but what about... Single payer system or death!

389:

Kent Bunn @365: Walter Reed is not a VA hospital. It is an army hospital for serving soldiers. The Veteran's Administration is for, well, veterans (the clue is in the name).

So no, the care scandal at Walter Reed says nothing about the VA.

390:

Andrew @375 - All things being equal, it is true the private sector is frequently more inventive and reactive than a state run system, and that's exactly why most countries that have socialized medicine coverage still have a thriving private medical sector — the very existence of which some try to spin as a proof commie-pinko healthcare is broken, when in fact private practice and public programs can gracefully coexist.

Have you considered the possibility that on some specific markets (such as health) the presence of a strong public service is what enables the private sector to provide good offers to the public ?

Solid public health services set a standard and create an alternative, protect consumers from corporate abuse (price gouging, unfair terms of service, denial of service, unacceptably awful service) in a field where cartel effects can otherwise be deadly because consumers don't really have the option to just 'pass' on medicine (well they can, but short of a few crazies, rare are those willingly forgoing all medical assistance given the option).

In short, a reliable, accessible, affordable-for-all platform of public health care is a good way to ensure whatever private sector flourishes in the field does so with the satisfaction of the consumers/users/public at heart ; it's not an either/or choice between public and private sector, but if forced to choose, public health care makes for a safer choice.

Martin @383 — Is by chance that kitten metaphor copyleft ? I'd be happy to reuse it sometimes, its the best short nail I've seen so far for this ill-guided "let's play nice with the crazies" fad.

Other Bill @385 — "But I do also recall that most of the bottom rung in France is not white (i remember the Muslims rioting a couple years back and the youth in general) which makes it sound as though French health care works great for whites."
I understand your first impression , but it's actually quite off-the-mark, because of very dissimilar contexts.

Short version: white in france is a variety of colors, and although many of the first-generation immigrants tend to be poorer than the average French, the lower bracket of revenue in France is ethnically agnostic (not to say the elites aren't overwhelmingly 'white', but that may have something to do with the fact France wasn't depopulated from its natives to make room for colonists three centuries ago).

Race in France and USA are two entirely different animals, both on the political scene and in local culture. Without delving in details on that specific issue, let's just say the French model emphasizes 'integration' (meaning everyone's supposed to be treated the same, the KKK and racist discrimination are illegal, and playing the race card lands you in jail or at least out of office presto), as opposed to UK or USA where religion and ethnicity get much more pull in politics and in social life (relative to France, obviously race is not the same game in UK and USA either).

The riots (I guess you're thinking 2005) were not about 'the muslims' (to date, France is one of the few constitutionally secular countries, with a very real separation between church and state), and indeed about a fraction of the youth that feels disenfranchised, largely as a result of growing up in ghetto-ish projects (tone down by a few orders of magnitude if you're thinking Philly or Detroit here), largely as a result of poor urban planning during the post-WWII reconstruction and through the 60's.

Population in those boroughs is typically low-income (of note: they still get pretty good and near-free healthcare) racially diverse, especially considering mixed-race breeding is not a mortal sin against the invisible man in the sky in Frogland (see above the 'integration' bit), and the overwhelming majority is neither muslim nor christian (or religious in general), although they often like to identify themselves as muslims to emphasize their underdog posture in the 'fight against The Man'.
This last bit can be explained by a strong current of sympathy for Palestinians in French pop culture, and by the fact a good chunk of the youth in France is of Maghrebi descent (north african arabs, traditionally muslim region).

Although the riots were arguably poor form and ill-guided*, they were somewhat justified by disenfranchisement from mainstream society, lack of jobs and lack of prospects of a future for a fraction of the youth, but certainly not healthcare: most families in these boroughs live on welfare, which by itself is grounds for CMU healthcare benefits (free state-sponsored insurance).

So what's the problem with French healthcare and the poor ?
Although the system is color blind (good), it's possible to fall through the cracks (bad) if you have a job but not enough of one.
The middle-class, the comparatively rich and the welfare-poor all have pretty good coverage from a combo of state-sponsored 'Securite Sociale' (Medicare for all)/Mutual Health Insurances (private sector strongly regulated optional insurance)/CMU (Medicaid, yet much better).

If you happen to have a low-paying job (a frequent occurrence if you have a 2/3 time job as a department store cashier, say), you may fall into the cracks by not qualifying for 'premium' state-sponsored benefits, and yet be too tight on cash to comfortably afford a good Mutual Insurance.

That's a bit oversimplifying the model, but that was the gist of the issue last time I checked.
As I said earlier, it's mostly a matter of tweaking, as the system is lagging behind the evolution of the job market : more people have part time jobs than in the past, leading to more cases of "I have a job but I can't make ends meet that well" (decent minimal wages make the calculation of revenue thresholds simple if based on full-time employment, but say a 1/2 time plus a 1/3 time minimal wage jobs combined can leave you with less, yet off the radar).
No big conspiracy against poor black people (of which there are very few in Frogland, as a sidenote), I'm afraid. :)

[* Since after all the rioters mostly stuck to their own boroughs when they should have crossed the beltway and molotov'ed the left bank of inner Paris if they really meant to send The Man a message]

391:

Will @366
"If the only thing to come out of this furore is to swing the British press and public opinion solidly behind the NHS, our American friends have done us all a huge favour."

I'm not certain it will. My anecdotal impression is that there has been an uptick in 'NHS scandal' headlines in recent weeks. It's prolly just an artifact of shifting news priorities given the current Stateside kerfuffle, altho' the paranoid cynic in me does wonder if some of it is intended as chum for the RW noise machine on the other side of the pond.


I'm another who can only speak well of recent encounters with the NHS. My g/f was at our local clinic only yesterday to have her ankle looked at by one of our GPs (it's a polyclinic so we have about eight to choose from there). As it happens she'll be getting it sorted privately because orthopaedic stuff is one of those areas which play well to private medicine's strengths (and I get a good deal on private medical cover for family members from my employer) but it wouldn't be a catastrophe if we didn't have the private option on tap, just a bit of a hassle and a bore.

Contrast this with going private for Ob/Gyn stuff which is much more of a status marker purchase for London-siders of a certain stripe ('Too posh to push' as the saying has it). My g/f's parents offered to pay for a private hospital birth for our first, but we thought that was just a crazy idea. Either the birth was going to be fundamentally unproblematic, in which case you've just paid several thousand quid for a hotel stay; or the birth was going to require medical intervention, at which point you've just paid several thousand quid for a hotel stay plus an emergency ambulance ride to the nearest NHS obstetrics unit.

Regards
Luke

392:

Just to address some of the claims that people made about US demographics: the plurality of Americans are of German descent. In particular, they were the Germans who lost the wars of integration or were afraid of war in general. They tended to be pacifists and more friendly to social/communal approaches than the hegemonic Anglo structure. One of the reasons the US entered WWI, over the protests of its German/Irish plurality (majority?) was to break the power of German American communities and reassert the old order. The culture war against everything related to Germany conveniently destroyed the burgeoning bilingual community America was at the time; its newspapers were shut down; people were forced not to speak German or to follow other cultural practices. Guess where the major support for unions and other "socialist" ideas lay: in the German and other Central European ethnic communities. The ethnic wars of the early twentieth century are largely unremembered today because hey, we're all "white" now. Or those memories are focused on romanticized, more marginal strugges like Italians and the Mafia, Irish gangs, etc., while the main, much more brutal suppression of an alternate culture that actually threatened to supplant the hegemonic one is a footnote in a history class. Obviously, WWII makes it much harder to look back on 1916 with an objective memory, but you also have to remember that German Americans were the people who were victimized by the war mongers in their native land. (Just to keep things clear, as a Polish American I don't have any sentimental stake in this lost culture, except to the extent that its destruction blocked acceptance of other ethnic subcultures and was another phase in the Othering of the American Left.)

393:

And to address our "mercilessness": the hey day of somewhat more merciful American politics, 1930's through 1970's was also the hey day of politicians who were raised in Catholic subcultures. I don't regret our subsequent secularizaion per se, but it was accompanied by homogenization with the standard [Protestant] American model, which has its virtues and its giant flaws. Why we couldn't keep the love while losing some of the superstitions is a question I leave to the anthropologists, those wankers. And by some great coincidence, Teddy just died..bye bye Miss Liberal American Pie...

394:

Andrew # 375: Liberals have blocked real reform and change to the healthcare system for decades because it wasn't the European style system they wanted.

"the European style"? Which of those? Single payer plus private, fully state-run, regulated private insurance, any other?

Everything I've seen where the government and private industry provide similar services, the private industry comes out better.

IME private enterprises have a tendency to desire profit and externalise cost. I have been fortunate enough not having to deal with private roads or private water supply. I have dealt with privatised garbage collection and with a privatised energy market. The private industry came out better in that they were raking in profits while offering worse service and employing fewer people at worse conditions.

With garbage (my current pet peeve) it's the difference of "getting it to the curb on a set date, next day it's gone" and needing a bunch of phone calls, a bunch of paperwork, you need to disassemble everything, and then it might get taken or might not". I pay the same, but I put in three hours of work that I do not get paid for, to create the private company's higher efficiency and profits from.

When privatising the energy market, it was expected that prices would go down. Instead, when the oil price went up, prices went up, and when the oil price went down, prices went up, too.

Telecommunication is a two-edged sword: With privatisation came lower prices and vast technical progress (which might have come anyway, hard to say, but for sure a lot slower), together with less equality (broadband for exurbs is not profitable), bad service that has become proverbial, shady business practises and outright scams.

Trains have become faster, but a lot more expensive, and inequality has grown, too. Postal service has not suffered in its substance (your letters still get delivered mostly on time), but vastly in service: Again, efficiency is created by moving work from paid employees to unpaid customers.

Moving pensions and health insurance drifting out of the public and into the private sector benefits the banks, because everyone needs to save money they would otherwise have been free to spend. (If I have fire insurance, I do not need to save for a replacement house, just in case.)

Even if we ignore the advantage private enterprise gets when taken over from public in being gifted with property they neither earned nor paid for, at the very best private enterprise breaks even with public on infrastructure.

395:

In regards to the price argument -- that is, that the other developed nations spend less than the US using a socialized medicine system of some sort -- I'm not sure that's a good thing.

I don't really see health care spending as wasted -- good health is one of the things everyone can enjoy, and I don't see why other sorts of consumer spending would be better use for the money.

The US has a problem of access more than cost. There are a number of ways to address that -- the Republican idea of tax credits or the Democrat idea of vouchers, for example. Reducing regulation at the state level is another -- there's no nation-wide insurance market in the US, a company has to be approved in each state it operates in which means following 50 different sets of regulations if it wants to operate nationwide. That's a huge source of overhead. Removing the tax benefits to employers for offering health insurance is another, so that people aren't trapped in their jobs because of insurance. Or you could just beef up Medicaid and open it up to more people with a sliding scale of premiums based on income.

396:

Other Bill, the principal failure mode of universal public sector suppliers funded by progressive taxes, operating in parallel to a private sector, is this: The rich don't like paying taxes, they take over the government and lower their taxes while starving the public health system. This results in a situation where the public option is hard to get, and the private option is too expensive for large percentages of the population.

Notice that what I have described as the endpoint of a failure process is in fact the American status quo ante. When you consider that the US government has Medicare, Medicaid, and the VA, it becomes less sensible to describe America as "fundamentally different" at all, and simpler to describe it as just another one of those countries that has a public option funded by progressive taxes, in parallel with a private sector. It's just one that is failing more catastrophically due to right-wing government capture than all the others.

397:

The US already spends something like $800 billion on public health care options. It's just broken up between the VA, Medicare, and Medicaid. I think it would makes sense to just combine the three and change a premium on a sliding scale based on income, age, and veteran status. Open it up to everyone, as long as they want to pay what's appropriate for their income level. Not to mention the insurance plans provided to the millions of government employees.

398:

Armchair @ 390 The kitten thing better be copyleft, or the guy I stole it from is gonna be angry. (Note I don't remember who it was, I just remember that it wasn't original. I doubt it is substantial enough to be beyond fair use.)

inge @ 394 Yes. Wikipedia, as usual, has some good discussion about the economic issues with heath care:
"The U.S. health care market has relied extensively on competition to control costs and improve quality. Critics question whether problems with adverse selection, moral hazard, information asymmetries, demand inducement, and practice variations can be addressed by private markets. Competition has fostered reductions in prices, but consolidation by providers and, to a lesser extent, insurers, has tempered this effect."
http://en.wikipedia.org/wiki/Health_economics

I will note as a personal observation that the US market has failed pretty badly at keeping costs down.

Andrew @ 395 Less spending would certainly be problematic if it produced worse results. However, the US spends more and gets less. Sounds like a problem to me.

Andrew @ 397 That plan sounds acceptable to me, especially if coupled with some fixes to the system. (Medicare currently hoses over GPs, and this should be fixed, for example.)

399:

Seems like the Americans don't have a monopoly on mercilessness (??) http://news.bbc.co.uk/1/hi/scotland/8226585.stm

Perhaps we should focus our anger nearer home?

401:

There are reports that per patient costs vary enormously across the USA, even within the same state and in places with similar populations and circumstances.

Ah, here it is.

A particular point which sticks in my mind from that story is that world-class hospitals, such as the Mayo Clinic, are doing better jobs for far less money.

Now, the author of the article suggests reasons. But part of it seems to be a sort of ignorance which leads to a failure of competition. The "customers" can't really escape the local high prices anyway. But the administrators seem not to know how extreme McAllen is. And while these high prices show in Medicare figures, nobody on the Government side seems to want to rock the boat by doing anything about it.

Healthcare has to be open-ended. We can't cap the expenditure on an individual without provoking criticism. We have to keep the decision-making medical rather than financial. So how can a market-driven system work?

402:

Armchair @390 - thanks much for the info. I didn mean to come across as strong on the issue of race, as class would have been equally fit forthe example. I was just tryin to pull an example of what might be a failing point. I would quibble that the rioting wasn't entirely race unrelated. Wasn't it at he same time the Danes published the Mohammed cartoons and women in France were told they couldn't wear a hijab in their ids? Only a half hearted quibble though, as my knowledge on that particular subject is largely what I recall gleaning fromthe papers some four years ago.

Del @396 - thanks to you for the information as well. I'm not sure I like the fundamentally different terminolgy either. I do think it's different, but a fundamental difference... Everything seems tnene fundamental this and fundamental that these days. Like fundamental radical Islamic terrorists. How many adjectives do we need to water down to the point of uselessness in order to make simple statements.

I do think there is a much bigger gap between private insurance and Medicare than in other countries, making it much less accessible an option for the population that might be in a position to require exercising it.

Derek @400 - sure. But I'm not sure from where the Scottish representative pulled his assertion that everyone agreed it was the proper thing to do. The numbers cited indicate only that, of those expressing an opinion, the majority disagreed with the decision. I'd let it slide if he clarified by suggesting he meant only that there was a popular impression that there was no unethical backroom dealig, but it sounded like political double speak to me.

Where are the articles on the opinions of the families of the Scottish victims? I haven't seen any coverage of that.

403:

Derek @400: we've had a bit of a poll-fest this week, haven't we? I'd say even 37% adds up to a fair few merciless Scots, though. And this is at the generous end of the poll spectrum.

404:

Mr Stross,

Something has been niggling me about your otherwise excellent post. I've just pinned it down.

You dismiss the Banque Nationale de Paris and (all who sail in her) with a casual, drive by brutality that has no place in a civilised society.

Now, I know that bankers are the easy target du jour. And of course, no-one likes the French. Except the Scotch, of course, with their Auld Alliance and their petticoat tails (petit gateaux) shortbread.

But taking cheap shots at an out-group is too easy, and at the intersection of two is inexcusable. This is flabby and, frankly, beneath you. You have let yourself and your many admirers down: I hope you will reconsider.

Yours more in sorrow than anger,

TBK

405:

@402: There was a radio discussion in the UK about the release of Mr. al-Mehgrabi which was broadcast before the decision was announced. They interviewed an American and a British person, both of whom had lost relatives in the bombing. The American avowed his life had been destroyed by his loss and opposed the release, the British person explained he still grieved for his lost one and agreed he should be released.

I think that sums up the corrosive effects of victimhood and the desire for revenge at all costs. Mercilessness affects both sides of the equation.

406:

Twisted @404:
Considering the recent scandals about BNP executives granting themselves impressive boni out of bailout money (yep, same thing happened in Frogland as in USA on the banking front, on a slightly less egregious scale, relatively), Charlie's wrath is somewhat excusable, although he should maybe have reserved his outrage for the incentivized high ranking members of the organisation as opposed to the rank and file.

If, on the other hand, you were referring to that British National Party group, I'd wager his leniency would only extend as far as the totally illiterate who signed up with an 'X', under peer-pressure — but those would not buy his books in first place, so that's largely moot.

407:

Ugh, the British National Party: what a horrid thought!

I probably ought to try harder to understand their mindset.

It's just so depressing: I can still remember a time when the flag of St George evoked a lovely warm fuzzy patriotic pride in our identity, rather than shame and disgust.

408:

Given that Charlie's original launching off point, was how the US citizenry is brutal and merciless. I was amused to hear that his people must fit the same category...

http://www.google.com/hostednews/ap/article/ALeqM5jWGxoGQV0sObX6i9Sv8DvodpQpzQD9AC0UA02

409:

Robert @405, the WashPost picked two relatives of people who died in the bombing to give their views after the release and I thought it was interesting that the one who wanted revenge was a rabbi.

410:

It's not just that they hate the poor, because many of the haters are poor. It's that they hate the less fortunate, more generally, which in the US usually means blacks or immigrants. If you're rich or middle-class in the US, you can just blithely hate those poorer than you -- ie, think that they are inferior, and deserve their situation -- but if you are poor -- and a lot of us are -- you need a more nuanced system, which entails hating the poor blacks and mexicans, who are yet worse off than you, and who deserve it. (Incidentally, some of the vigor of the hatred comes from hating yourself because, whatever your misfortunes -- and we all have them -- you deserved them, you failure... though rationalization can exculpate you (and only you) from some of that blame.)

Cf. Dylan's "Only a Pawn in their Game" -- http://www.bobdylan.com/#/songs/only-pawn-their-game

411:

wonderful and timely piece, mr. stross. i have been writing a story set in new orleans ten or twenty years hence, and mercy is something to which i have given much thought. as a former resident of the city, it was heartbreaking to see what happened there, and doubly so to hear and witness how my countrymen responded, or rather, didn't. here's a snippet. follow the link for more if you like, but even if you don't, i thank you for sharing your piece with us.
peace,
kurt

The floods came and went.

And then they came back again. And again.

The water and the winds returned. But even the tardy, begrudging mercy the country showed New Orleans after the first flood did not. Mercy was already in short supply in those days.

It’s even rarer now.

Mercy does not age well. It must be consumed on the spot or it immediately begins to decay. Like when a stranger offers to buy you a shot: drink it down, lad, drink it down. The offer may not come back around. There are no rain checks on mercy.

412:

So what's wrong with Health Care reform in the US? Bill Moyers, whom I respect greatly, says whats wrong is the Democrats and Corporate personhood.

Check out his interview with Bill Maher this week.

http://videocafe.crooksandliars.com/heather/real-time-bill-moyers-health-care-human-ri

The corporate money flowing into the election coffers of Democrats and Republicans alike means that those in power now are beholden to them to get re-elected. Gotta solve that problem soon, and I think it's going to take a constitutional amendment.

413:

@396, 397: The thing about the VA is that it is:
1. Not, in fact, insurance. It honest-to-god runs hospitals just like I understand the NHS does. Merging it into some kind of pan-governmental health-care program would be problematic because of that--what do you do with the buildings, doctors, nurses? Turn them over to the local hospital agency or something?

2. A lot more than just health-care. It manages GI Bill benefits as well, such as college tuition payments. That makes things more administratively complicated. In fact, it's actually a cabinet-level agency, just like the Department of Defense. Medicare and Medicaid are most emphatically not. Why it's like that, I don't know.

The thing about Medicaid is that it's run by states. That means that you can go from state to state and get dramatically different qualities of service.

For example, in Texas a few years back the legislature decided for some reason that it would be a good idea to turn over administration of some parts of our Medicaid system (along with some other bits of welfare) to a private company. For some reason or another, at about the same time they decided that recipients would need to file a lot of paperwork twice a year to prove eligibility--to keep those Cadillac-driving welfare queens from having health care, I suppose. Funnily enough, this resulted in a sudden drop in the number of families registered. Mission success! The Democrats (yes, there are in fact liberals down here! Lots of them, actually!) complained, and I think they returned administration to state control after a few years.

So, merging Medicaid into some federal system would also generate problems. States with good Medicaid systems would not like to have some smeared out average program, since it would reduce quality of care. States with bad Medicaid systems would not like to have...some smeared out average program, since it would increase quality of care (or more pertinently, increase their federal tax bills. Never mind that it would probably save on their insurance premiums...)

414:

[ ABUSIVE FUCKWIT censored by moderator. Next time you post here, Bill, read the moderation policy first. ]

415:

Mr Peschel@385, please bear in mind that not all individuals convicted of murder actually are murderers.

Madeleine@231, lovely Moore reference.

416:

@412
You also are ingnorant and uninformed.
There is SUPPOSED to exist a mutual "indicted-charged-prisoner" (I can't remember it's proper name) treaty between the US and Britain.
Only Britain has ratified.
So Gary Mackinnon will almost certainly be jailed for life, for proving that US computer security is crap - and they want to jail him because they are embarrassed.
Meanwhile IRA mass murderers, who have NOT been covered by the Good Friday agreements, are walking around free in the US.
Before you open your ignorant mouth about terrorist bombing again, I suggest you look up our recent experiences.
And how we react to them.
[ Incidentally, my wife was VERY close to the Liverpool St/Aldgate tube bomb on 7/7/2005 - business carried on. )

No, your cities have never been bombed, ours have, we're used to it.
And, judging by your comments, your mother was never told to shut up.

Tu quoque

417:

Armchair designer @406: I'm talking about the British National Party. The French bank with the same initials -- feh, they're just bankers: tax their bonuses.

418:

Greg @416, apparently the US Senate has ratified the Treaty now.

But the whole thing still looks a bit dodgy: it seems to take away any requirement for the US to show a credible case to a UK court, and that wasn't changed by ratification. Has anyone been extradited from the US yet?

419:

@417 In retrospect, "...and voters..." was a bit of a clue.

I am cursed with a trivial and facetious nature.

Sorry.

TBK

420:

@414 Abusive, yes. But fuckwit?? I fear our Invincible Overlord does not care to lead by example.

Still, that's Invincible Overlords for you.

Move along, nothing to see here...

TBK

421:

Charlie@0
I am curious how you feel up on your high horse, talking about how much more compassionate the Scots are than the "merciless Americans" now that the polls show that the Scots aren't so happy about the release either.

http://www.google.com/hostednews/ap/article/ALeqM5jWGxoGQV0sObX6i9Sv8DvodpQpzQD9AC0UA02

422:

Kent: I'm not happy with the Scottish street either. I demand a replacement population!

(Hint: trying to convince me I'm isolated in a matter of moral principle isn't going to work; "eat shit -- a million flies can't be wrong" is a lousy basis for changing your belief structure.)

423:

There are (in my opinion) a few reasons for the insanity and cruelty that Americans are exhibiting over the health care debate.1)Most of my fellow Americans have been seduced by a myth: the Horatio Alger Myth. No matter what, most Americans believe that they are in charge of their own destiny. 2)The heavy intertwining of religion and politics. 3) Astonishing scientific illiteracy and a shocking amount of innumeracy. 4)A complete corruption of the American political process by the wealthy. Many of the townhall protestors and "tea-baggers" are subsidized by corporate special interests. 5) A hijacking of the (U.S.)term Liberal by third wayers and paternal libertarians like Obama. America is now a Predator State and is ill-positioned to deal with the consequences of global climate change, peak oil, rising health care costs, and Christ knows whatever other challenges await us.

424:

Kent @421, fair point.

But for those of us who don't live in either of those two great nations, the sad fact is that the state of America matters more.

And it isn't about the people themselves: it's about how the system is encouraging them to think. We all need to be watchful for signs that we are tipping into the kind of fury that swept the Germans away seventy-five years ago. Always. Sometimes that is easier to spot from outside.

So it isn't "we are better than you" so much as "watch out, you're in danger".

Or perhaps I'm rationalising and Charlie is just fed up with American politicians thinking like Americans rather than Europeans. Anyway, a worthwhile debate.

FWIW, I don't see that the American body politic is much less merciful than it was earlier in my lifetime. Not that I've been watching it too closely.

Has anybody raised the question of the amount of private charity in the US? I rather get the impression that in a land where independence is so important, many people take responsibility for doing something to look after the less fortunate where in Europe, people in a similar position would leave this to the government.

Is this true? I know there is a thriving voluntary sector in the UK: how does this compare with the way such work is done elsewhere?

425:

Charlie@422
I've never spoken in favor of keeping him locked up. I don't have a real problem with compassionate release. I'm not familiar w/ details of his conviction to make any kind of educated verdict on the morality of his conviction.

I'm just not so sure that the behavior of the Scots really supports your original thesis that Americans have some kind of monopoly on merciless behavior.

426:

Charlie@320

Until *very* recently, Americans didn't need passports to go to Canada, Mexico, and a few other countries not too far away. The Bush administration forced that change, and the Obama administration has continued it.

Those of you living in Schengen accord countries should have some of an idea of how this works in practice: for a lot of the places you want to travel to, you theoretically don't need a passport, and travel to the others is expensive and much more time consuming.

As for the lack of mercy, I don't think you're right about that. What has happened is that we Americans adopted certain attitudes during World War II, as expressed in the film 13 Reu Madeline: we must abandon the rules of fair play, because the enemy has!

It was a liberal Democratic administration that first embraced that idea, but Republicans (except for Dwight D. Eisenhower towards the end of his administration) love it, too, and the ethos has seeped deep into the minds of the American public, with the exception of some very small fringes on the right (some, but not all, paleoconservatives-Pat Buchanan is currently an endorser of torture, but he is in a minority among the writers and readers of The American Conservative, as the comments to his screed show) and the left (places like Counterpunch.)

The problem with the United States isn't lack of mercy: it's too firm of a belief in our own moral righteousness, to the point where we are unwilling to take a hard look at why we do objectionable things. The tendency to only see wrongs when committed by Presidents of a party you don't back exacerbates this: I know way too many people who refused to believe that a lot of the nastiness of the Bush admin was simply an extension and/or intensification of things done by the Clinton administration.

I think you've hit the nail on the head by referring to us as the Empire. Empires pretty much always suffer from this disease, don't they-the British one sure did, and so did the Russian.

I think we won't change until the empire becomes untenable-and much as I wish the end of our imperium would resemble the end of yours (or, better still, the end of the Swedish one), I'm increasingly inclined to think the collapse of our empire will resemble yours, with China playing the same role with us that we played with you Britons.

427:

In Friday's WashPost, Business columnist Steven Pearlstein talks about Kennedy's disagreement with Nixon on healthcare. He said:

Asked about his greatest regret as a legislator, Ted Kennedy would usually cite his refusal to cut a deal with Richard Nixon on health care.

Pearlstein goes on to describe the Nixon-Kennedy discussions and how he thinks things should work.

428:

You're opposed to national health care because you don't trust the government to run it?
Get real, wacko: 90% of Europe has national health care, and it's run by the resp. governments - nowhere is it run perfectly, but it gets the job done for LESS MONEY than your wholly privatized system.
And no, we don't trust our governments, either (but at least most of them are not elected by whomever throws the most money at the election circus, which helps).

429:

@424: America's government-funded support of the poorest of its citizens is not that good compared to European social systems. US charities make up a lot of the difference but they have no mandated requirement to provide that support. If a US foodbank someone relies on doesn't have anything in stock for a couple of weeks because donations are down then the recipient of that charity may starve unless they can get food some other way, by shoplifting for example. In a government social program the funding is mandated and presuming an applicant has jumped through the hoops it will be made available to them.

The major British charities collect funds for overseas operations -- Oxfam, Save the Children etc. The others are typically groups like the National Trust and the RNLI, the RSPCA etc. which are not targeted at helping out poor and indigent folks in the local community. There are no foodbank-type organisations per se in the UK that I know of, although the Salvation Army, the Bethany Trust and others like them work to help homeless people who are often mentally ill or drug and drink-addicted or have fallen through the existing social safety nets for various reasons.

430:

Charlie @417 — Yes, I realize you didn't meant BNP: the bank… besides, you linked BNP-the arses in your original post.
I just happened to enjoy TwistedByKnaves unintended pun (@404), and rolled with it (@406), because I found it humorous.
Sorry if the deadpan joke was misleading.

431:

Charlie @422 - no one is suggesting you change your position that merciless behavior is wrong. The point is that America most certainly does not have a monopoly on it. Now concede or die. Which, FYI, is how we conclude a friendly debate in the states.

I did catch some footage of the Scottish parliament doing some q and a time with the minister that made the decision to release magrahi. It was refreshingly quick and direct. You scots definitely have a fairly orderly parliament, if some ugly desks.

432:

@430 I'm afraid it was intended.

@431 Right on all three points. Though right now, America is in a position to do more damage than anyone else.

433:

Another @426. But the next evil empire probably won't have a constitution specifically designed to curb such excesses.

Even though human nature seems to strong for the provisions which would really have made a difference (no standing army, the duty of all citizens to bear arms and engage directly in any dirty work that needs doing, etc), it still provides a focus for protest and a basic direction.

434:

@433 Blast! Should have been "...too strong..." . A repeat offence, I'm afraid.

435:

Aplogy & question.

I meant "414" in my comment @ 416, of course.

Q:
WHAT ABOUT Gary McKinnon?Noew THERE is a case of completemercilessness being shown by the US authorities to someone, who, at the worst, has committed what used to be called a "misdemeanour".
Yet they seem determined to treat him as a terrorist, and bang him up for ever.

More comments, especiallly from US residents might be interesting.

436:

I think a part of the problem is that we don't have a good handle on the problems ot territoriality and the internet.

McKinnon was in the UK when he committed the acts for which he faces criminal charges. The computers were in the USA. Which country's laws?

We have the Computer Misuse Act (1990). If somebody hacked into an MoD computer from the USA, that law allows for charges to be brought. Has that ever happened?

Here in the EU we are building a system to cope with the problems. The European company for Paypal has moved at least once that I recall, for tax reasons, but it's still under the European system of banking regulation, and still covered by Europe-wide personal data protections.

But the impression I have is that the USA is inclined to disregard foreign systems of law and regulation. Look at the problems over Internet gambling. At best, they apply the solutions developed to cope with differences between US States, but that doesn't work so well: US States aren't sovereign nations (though there's some reason to argue about what happened to Hawaii).

And, according to some things I've read, US Courts don't seem to pay much attention to what happened that brought a foreign criminal before them. Whether the informal extradition procedure was personal, or required major operations by the US military, doesn't seem to matter.

I don't have an answer about McKinnon, beyond a general observation that the US has a tendency to exaggerate the consequences of mere hacking crimes, when they are brought to court.

And I can think of frauds, using the internet to find their targets, who would be a better target for all this hassle.

437:

@ 436.

Thanks - that was about what I expected.
The US has a very bad record of signing and adhering to, international treaties (though they DO seem to observe the rules on the few occasions that they DO sign)
You would have thought by now, that they would have learnt that is is not a clever way to proceed, but they still do it.
There is this obsession that signing a treaty obliges to US to do what "other" states want...
Famous example, which SHOULD have taught the US, and didn't was when they refused to sign the treaty (about the end of the Napoleonic wars) which banned "privateering" - that is, Private ships of War, with Letters of Marque.
They finally signed, after the end of the US civil war, having been badly bitten by the CSS Alabama and the CSS Shenandoah .
But they don't seem to have got the message - their motto might almost be Sinn Feinn (Ourselves Alone).

438:

I'll preface this by saying that A) I'm American, and B) I agree entirely with your stance on the American health-care kerfluffle and the American tendency toward cruelty over mercy in general.

That said, in light of what you've said above about the Lockerbie bomber, what's your opinion on the article in The Times this morning that the bomber was set free not out of mercy, but because of a deal between BP and Libya for oil drilling rights:

http://www.timesonline.co.uk/tol/news/politics/article6814939.ece#cid=OTC-RSS&attr=2015164

While I don't think that it in any way invalidates your position, it (IMO) certainly casts a sour light on things. Assuming the article is factually correct, it means that people were lied to about the reasoning for letting him go from the very beginning.

439:

Jennifer @438: it's bullshit -- politically-motivated astroturf. The Times is a Murdoch paper -- owned by News International (see also Fox News) with a political axe to grind in favour of the Conservative Party. This story puts Labour and Scotland in a bad light. However ...

First, some background: the Scottish justice minister, Kenny McAskill, is an SNP minister -- Scotland's government is a (minority) SNP government. The SNP and Labour are both socialist parties (nominally, in Labour's case) and hate each other's guts. (Labour are currently the largest opposition party in Scotland.) So: conspiratorial cooperation between Scotland and Westminster -- not terribly likely at present.

Secondly, a Prisoner Transfer Agreement (such as the UK/Libya one that the Scottish government declined to apply to al-Magrahi two years ago) is a very different arrangement from a compassionate release on health grounds: it's bilateral and an international treaty, whereas the compassionate release is basically a unilateral internal decision taken by one country's justice system.

Having said that ...

It's entirely possible that Jack Straw wanted Megrahi sent back to Libya a couple of years ago, to further a course of diplomatic normalization -- but the SNP refused to play ball. And now the SNP sent Megrahi back for an entirely different reason, and Murdoch's press are using the change of circumstances to stir shit.

See also Fox News; Film at Eleven.

My personal belief is that (a) the evidence that al Megrahi was framed (and that the destruction of Pan Am Flight 103 had nothing to do with Libya) is disturbingly plausible, (b) he was handed over to the west for trial by Libya purely for reason of realpolitik (i.e. to permit normalization of relations with the west in order to sell oil), (c) Kenny McAskill is of the same belief, and (d) his motivation for releasing al Megrahi was guilt at the prospect of forcing a possibly innocent victim of a miscarriage of justice to die of cancer in prison.

I can't prove this and we'll probably never find out, given that al Megrahi withdrew his appeal against conviction in order to proceed with his petition for compassionate release. (His appeal hearing would have taken months to years to proceed -- by which time he would have died.)

440:

@432 — Even better. :)
I thought it was meant as jest at first, then you got me with your #419 post.
Good one.

442:

Greg @437 - I'm not sure the Confederate States of America would have cared very much about a treaty signed by the United States of America. China and the US were the only countries for a long time to not sign the ban on Child Labor. That's maybe a better example. Although we do have our own child labor laws.

Or, more relevant to the discussion, the torture of prisoners is against us military law. US law. And international law, of which we are signatories too.

443:

... perhaps it's worth mentioning the Crypto-AG (Swiss encryption machine company) affair as reason why USA chose not to finger Iranians. In short, doing so would prove to Iran that their encryption traffic was being routinely read by NSA. (.. and traffic of every country of interest that used those machines)

That hasn't been proven so far(though the case is good, it's still officially a conspiracy theory), what is known that a few years later Iran got irate and threw the Crypto AG salesman into prison. Then they let him out after Crypto AG coughed up 10^6 $. Crypto AG then fired the salesman and charged him 10^6 $.

445:

@ 442
The point is that the UK did not recognise the Confeds, BUT
It was known that the US had NOT signed the treaty.

So, in short, for the confeds wanting the CSS Alabama as built by Laird's in Birkenhead, the dialogue would have gone like this:
Confed: We want a warship built.
Lards: Right, who for, guvmint approval, please?
C: We're the confeds (reads "Officially" US) to Lairds) and it's a Private Ship of War.
L: Can't do that, international treaty.
C: BUT - we're from (officially) the US, we HAVEN'T SIGNED the treaty!
L: No you haven't have you? Hmmm, that makes it legal (just). Are you sure you can pay?
C: We've got gold.
L: It will cost you $BIGNUM.
C: Sold!

446:

Ya know, there's this animal called the sea squirt. When young, it has a notochord and swims about, presumably energetically and full of joy. Then one day, it finds a rock and decides this is the place to settle down. The larvae glues its butt to the rock, and since it no longer needs a notochord, it eats it, subsisting as a sedentary filter feeder thereafter.

Professors getting tenure have been compared to sea squirts, among other professions.

To that list, I think we can now add the Scottish parliament, at least based on their vote to symbolically condemn the release of a certain Libyan.

http://www.telegraph.co.uk/news/newstopics/politics/scotland/6127784/Scottish-Parliament-overwhelmingly-rejects-Lockerbie-bomber-release.html

447:

I wanted to comment on this story the moment you posted this, but I thought I should wait it out a bit. Now this seems to be the most commented post you ever did on this blog... Amazing.
Bulgarians have a different perspective on this whole brouhaha, as you know, due to the affair with the medics, when it was implied their freeing was tied to an eventual freeing of Megrahi, which didn't happen immediately. Somewhat surprisingly for me my countrymen are not all hysterical about it and many seem to recognise the murkyness of the Megrahi trial. Here's a very good blog post from a Bulgarian blogger that often blogs on Arab and Muslim issues:
http://mayas-corner.blogspot.com/2009/09/reflections-on-megrahis-release.html

448:

I think the thing that this post can contribute most to this discussion here is the idea that whether Megrahi was or was not guilty, he was a feared and hated officer of the secret services, guilty of many crimes agains ordinary Lybians and dissidents.

449:

At what point do you stop granting your enemies clemency so you can continue skipping blissfully through the ripe poppy fields of liberal morality?

How much death and destruction has to be sewn before someone deserves no forgiveness?

There's no virtue in letting that man go. None.

Nor was it done with ostensibly virtuous intent.

450:

@ 449
When it becomes more and more apparrent that he didn't do it ....
Syria & Iran did do it.
THEN what?

451:

@448 We all agree that he may well be a bad guy who doesn't deserve clemency. But we give it to him anyway, because we are good guys.

If he deserved it, it wouldn't be clemency.

Why is this hard to understand?

The question of whether he is in fact an innocent victim is quite separate. If that is the case, we can only hope for clemency from him.

452:

krum @447: no, this is only the second most-commented blog posting here. To hit the jackpot you need to read The High Frontier, Redux. Now that was a comment thread and a half!

@451: No we don't, actually. I've been trying not to make a point of this but Megrahi is almost certainly innocent. The appeal he was proceeding with prior to his release was in progress because ...

the Scottish Criminal Cases Review Commission referred Megrahi’s case for appeal. "The commission is of the view," said its chairman, Dr. Graham Forbes, "that based upon our lengthy investigations, the new evidence we have found and other evidence which was not before the trial court, that the applicant may have suffered a miscarriage of justice."
This was, as John Pilger notes, extremely embarrassing to the British (and Scottish) governments, but there's a damning chain of discredited and mismanaged evidence documented by Paul Foot (who covered the trial). More here.

Megrahi was required to drop his appeal against wrongful conviction before he could apply for release. The Scottish court of appeal shamefully dragged out the appeals process for nearly two years before he agreed to drop the case -- after he'd been diagnosed with terminal cancer. So we'll probably never get the public enquiry that will tell us who really blew up Pan Am Flight 103. (My money is on elements of the PFLP-GC, at the behest of Iran.)

Which means the real murderer(s) are walking around at liberty, years later.

(The end. Of the comments thread, too, because I'm exercising my soapbox prerogative to have the last word.)

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