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June 9, 2009 3:49 AM   Subscribe

Solving America's hunger crisis is an article by Sacha Abramsky
Feeding America has a Hunger quiz and Hunger 101 - Feed your mind.

A comment from the Guardian link:
If America can't get it together to look after their sick and ill people ( no NHS )
then what makes anyone think they give a damn about their poor?
Has America a good track record on equality issues? No.
Has America shown economic benefit of its vast wealth to all ? No.
Has America developed good social safety nets for its poor? No.
Why not? Because they just don't want to. It's just the way Americans are.
Anything that sonds like a National health system or decent state benefits is still seen as Communist, or nearly as bad - Socialist.



ClubOrlov comments on American Socialism.
posted by adamvasco (66 comments total) 1 user marked this as a favorite

 
If ensuring that no one in a land of plenty goes to bed hungry is Socialism, then paint my ass red and call me Ivan
posted by ElvisJesus at 5:09 AM on June 9, 2009 [9 favorites]


Has America shown economic benefit of its vast wealth to all ? No.
Has America developed good social safety nets for its poor? No.
Why not? Because they just don't want to. It's just the way Americans are.


I agree that we can do more to help guarantee healthy and livable conditions for everyone in the US (especially through universal health care) and that a certain contingent of people will always be against any social good that doesn't directly benefit themselves, but the claim that Americans are all selfish libertarians who don't care about other people misses the mark.

The reality is that a significant amount of money goes toward providing food to people in the US. Around 10% of the population receives benefits in the form of government food stamps, and non-profits like Feeding America and smaller food programs are financially supported and run by Americans. Making sure that everyone in the US, especially young children, have access to enough nutritious food to be healthy and lead normal lives is an important goal that we should always try to improve on, but blaming the current problems on "the way Americans are" mischaracterizes the situation doesn't help further the objective of getting food to the people who need it.
posted by burnmp3s at 5:21 AM on June 9, 2009 [1 favorite]


but blaming the current problems on "the way Americans are" mischaracterizes the situation doesn't help further the objective of getting food to the people who need it.

And is a bit arrogant, besides.
posted by spirit72 at 5:26 AM on June 9, 2009


And yet true, because along with the bright streak of individuality, Americans also have a dark streak of personal determinism. As in, "if you're poor, it's your fault. I picked myself up off the street by my own bootstraps, why should I help you? Get up, man, have you no pride? What are you, some kind of a slacker? Lazy, layabout bum, you'll get no help from me!"
posted by seanmpuckett at 5:33 AM on June 9, 2009 [1 favorite]


the claim that Americans are all selfish libertarians who don't care about other people misses the mark.


Not all Americans. I'd say it's mostly confined to the wealthy, media pundits, big business, politicians, and the other 'ruling' segments of society. Think about how we as a society treat non-violent drug offenders vs how we treat non violent white collar criminals like Madoff.
posted by anti social order at 5:57 AM on June 9, 2009


Not all Americans. I'd say it's mostly confined to the wealthy, media pundits, big business, politicians, and the other 'ruling' segments of society.

so the rest, this majority you speak of are just too stupid to realise they are being screwed over and vote the selfish capitalists out are they?
posted by mary8nne at 6:36 AM on June 9, 2009 [1 favorite]


Lovely. So a socialist post about the failures of America to look after it's poor results in comments about how while true the article is "not furthering the causes" and is "arrogant" and "Not all Americans" are to blame.

This leads me to believe I have actually accidentally stumbled into a Democratic National Committee health care reform strategy meeting.

America is in some kind of strange denial and it is very weird to be on the outside looking in. Things are going very badly wrong and there seem to be about 300 Million Americans saying "Wasn't Me" while crumbs of cake dribble off their chins.

Sure there are degrees of culpability but lets use the correct baseline. All American's are responsible for America. That is what democracy means. You, the people, make the country what it is.

So if a socialist tells you that America is the way it is because of the character of the American people you should just nod because it is a TRUISM.

If people starve, go uninsured, go uneducated or any other bad result you have to accept that it has happened because the American character contains in it the willingness to allow many to suffer so that many can be prosperous and has created a society that does this.

It is not an accident or due to magical forces (the economy!). It is not an unforeseen consequence. It is not a bloody surprise. It is a reasoned collective choice reflecting the values of the people who made it.
posted by srboisvert at 6:37 AM on June 9, 2009 [8 favorites]


Not all Americans. just MOST Americans.. say a voting majority?
posted by mary8nne at 6:37 AM on June 9, 2009


Abramsky publishes in several magazines, but why does he choose to publish this in the UK news? What, exactly, is the average UK citizen supposed to do, other than feel general outrage that the US neglects its poorest people and perhaps feel smugness that they do not have hungry people of their own? What is his call to action for this audience?
posted by Houstonian at 6:38 AM on June 9, 2009


the claim that Americans are all selfish libertarians who don't care about other people misses the mark.

I'd guess that generally they are caring and loving like anyone else, but there are few well-spread intuitions about nature of government, work, money, ownership, freedom and taxes that are more easily held as general truths in public discussion, where in other places they are more easily recognized as just points of view open for questioning and change. A nation based on ideology cannot question ideology as easily as nation based on generall sameness of population.
posted by Free word order! at 6:39 AM on June 9, 2009


srboisvert just said much more elegantly what i was trying to get at.
posted by mary8nne at 6:39 AM on June 9, 2009


I, as a Canadian expat, accept full responsibility for my apostrophe catastrophe.
posted by srboisvert at 6:39 AM on June 9, 2009 [1 favorite]


Lovely. So a socialist post about the failures of America to look after it's poor results in comments about how while true the article is "not furthering the causes" and is "arrogant" and "Not all Americans" are to blame.

No, I don't think that a post about the failures of America to look after its poor is arrogant.

I think that dismissing those failures as being "It's just the way Americans are" is arrogant.

Aside from that, I think he made some very good points.
posted by spirit72 at 6:47 AM on June 9, 2009


More specifically: what have YOU done to help someone, anyone in the past few weeks? Given money, food? worked as volunteer in shelter etc?
posted by Postroad at 6:49 AM on June 9, 2009


Abramsky publishes in several magazines, but why does he choose to publish this in the UK news? What, exactly, is the average UK citizen supposed to do, other than feel general outrage that the US neglects its poorest people and perhaps feel smugness that they do not have hungry people of their own? What is his call to action for this audience?

After The Wire American poor people are way more interesting to the Guardian.
posted by atrazine at 6:49 AM on June 9, 2009


If people starve, go uninsured, go uneducated or any other bad result you have to accept that it has happened because the American character contains in it the willingness to allow many to suffer so that many can be prosperous and has created a society that does this.


I'm not defending capitalism or The American Way or anything like that here. What I'm saying is that specifically on the issue of getting food to low-income families, Americans are in nearly universal agreement that it's a good idea and very large numbers of people support these kinds of initiatives. For all of the backwards right-wing political blustering that goes on in the US, I still dare any pundit to go on TV at Thanksgiving or Christmas and say that people should cancel their food drives or shut down the food banks. That rhetoric would go over like a lead balloon for Americans of nearly all social and economic classes because everyone knows that giving food to people who need it is a good idea.
posted by burnmp3s at 6:57 AM on June 9, 2009


Or, the internet's ability to distribute information, the fact that The Guardian is free content and the overal macro trend towards reading online lead me to surmise that it is beginning to matter less where the head office of a newspaper maybe based, in the overall scheme of things

srboisvert, you sir just wanted to colocate those absurdly rhyming words...
posted by infini at 6:58 AM on June 9, 2009


btw,

White House announces the formation of an office of Social Innovation.

“The idea is for the government to work with nonprofit organizations to identify programs that have had proven success in tackling social problems, such as homelessness and joblessness, and then to expand those programs across the country. The office will in effect provide seed money for the most innovative ideas”.
posted by infini at 7:00 AM on June 9, 2009


Finally, a government program to solve the problem!

Oh, wait.
posted by ostranenie at 7:06 AM on June 9, 2009


If America can't get it together to look after their sick and ill people ( no NHS )
then what makes anyone think they give a damn about their poor?
Has America a good track record on equality issues? No.
Has America shown economic benefit of its vast wealth to all ? No.
Has America developed good social safety nets for its poor? No.
Why not? Because they just don't want to. It's just the way Americans are.


Actually, if you actually look at our very short history, particularly in comparison to the very long history of other nations, our track record on all these points is spectacular. Sure, our pace of progression has slowed greatly in the last 40-50 years, especially when compared to those same nations' rapid pace of development, but hey, we don't have millenia of feudalism, tribal warfare, and ethnic and religious cleansing on our "track record" to smooth over either. I wonder if the author is aware that more Americans have fought and died in wars for other people's rights than for any territorial conquest or border dispute or ethnic conflict or any other cause combined? I wonder if the author is aware that 100 years ago blacks in the US had an 11% literacy rate and now that rate hovers around 98%? I wonder if the author is aware that the luxury of the European socialist (small r) revolution and half century period of calm and egalitarian enlightenment was founded and funded on the back of America's vast wealth to keep his breatheren from tearing each other apart once again as their horrific track record of chronic and repeated atrocities had shown?

I hate to beat this stupid jingoistic American rah-rah drum, but I just don't need people to tell me that my country has fucked up problems. I know. Really, I do. I live with our fucked up problems every day. I loath the problems in my country and I wish we could and would do more to fix them. I wish we would implement more "socialistic" style programs, look for long term solutions to problems like poverty and climate change, and better support and defend human rights. I certainly don't think we are special or above the need for these programs or somehow morally superior in any way.

But, by the same token I certainly don't need someone (whose country just openly elected fascists to represent them mind you) to tell me once again that my country is the one with the shameful history on equality and wealth distribution, conveniently ignoring the entire history of human kind (especially that particularly bloody, tribal, barbaric, colonial, nationalistic, feudalistic, racist, sexist... Western "Civilization" part).

All that aside, had you looked only 10 years ago at insurance or pensions or housing or lines of credit or banking or investing in America you might have thought that placing your future with them as opposed to a more socialistic nanny state was the safer, more rewarding and reliable bet. Even as the dot-com bubble was bursting, no one, imagined that massive blue-chips like GM would not be safe, steady long-term (read: eternal) stock and bond bets. Why create a "welfare state" for pentioners when a 401k will more than suffice for Baby-boomers to retire at 55 to Costa Rica? Of course we know with certainty now, when you don't really produce anything, your actual means of production and employees are somewhere in the Pearl River Delta, and your economy is based on shuffling consulting and financial services from one company to another, the paper and string that holds it all together is a bit less solid than it appears.
posted by Pollomacho at 7:10 AM on June 9, 2009 [1 favorite]


Well, the hunger quiz doesn't inspire much confidence in the rest of that site. It starts off with the old (by now) 1-in-8-Americans-hungry canard. That in turn is derived from USDA Economic Research Report #68, Household Food Security in the United States, 2007. (Link to the full USDA report on this page. Direct link to the .pdf files here.)

Drilling down into the report, we find that the 1 in 8 figure comes from table 1A, under the heading "All individuals (by food security of household)", which lists

food-insecure: 12.2%

12.2% is 1 in 8. That's the source of the figure. Note that it's not tallying hungry people, it's tallying people who lived in a food-insecure household at some point in 2007.

So what's "food-insecure"? It's defined, sure enough:

About 89 percent of U.S. households were food secure throughout the
entire year 2007 (fi g. 1, table 1A). “Food secure” means that all household
members had access at all times to enough food for an active, healthy life.
The remaining 13 million U.S. households (11.1 percent of all households)
were food insecure at some time during the year. That is, they were, at times,
uncertain of having, or unable to acquire, enough food for all household
members because they had insufficient money and other resources for food.


To unpack that a bit further: if the members of a given household were not certain they would have enough food for even one day during 2007, then all members of that household were counted, for purposes of this survey, as facing food insecurity for that year. In short, we're not talking about hungry people yet.

About two-thirds of food-insecure households avoided substantial reductions
or disruptions in food intake, in many cases by relying on a few basic foods
and reducing variety in their diets.


And even there, we're still tallying as "food insecure" everybody who lived in the same household as somebody who went hungry or had to change his diet or was worried about going hungry or having to change his diet--at any point in 2007.

I first saw this report mentioned in Anderson Cooper's CNN weblog in November of 2008. Mr. Cooper's take was that An estimated 36.2 million people struggled with some form of hunger (or, to use the government term, “food insecurity.”) That's about like reporting a statistic that you call "struggling with bird flu" and including everybody who actually got bird flu and everybody who lived in the same household as somebody who got bird flu and everybody who lived in the same household as somebody who was not certain he would not get bird flu. At some point during the measured year.

Since then the "1 in 8 Americans Hungry" webmeme has become almost as common as lolcats. I don't think does any service to people who are actually, chronically, hungry to inflate the commonly understood meaning of "hunger" in this fashion just to generate everybody-panic-about-MY-issue headlines.
posted by jfuller at 7:14 AM on June 9, 2009 [6 favorites]


More specifically: what have YOU done to help someone, anyone in the past few weeks?

Anyone looking to help others might consider joining the Metafilter Kiva team that celebrates our 10th.
posted by Houstonian at 7:14 AM on June 9, 2009 [1 favorite]


But, by the same token I certainly don't need someone (whose country just openly elected fascists to represent them mind you) to tell me once again that my country is the one with the shameful history on equality and wealth distribution, conveniently ignoring the entire history of human kind (especially that particularly bloody, tribal, barbaric, colonial, nationalistic, feudalistic, racist, sexist... Western "Civilization" part).

yes, but that's the point. It doesn't stop the US of A from lecturing the Rest of the World on all of the above and more
posted by infini at 7:14 AM on June 9, 2009


All these arguments about socialization and nationalization, etc boil down to one argument:

Do you think centralized planning allocates resources more efficiently than decentralized suppliers competing with each other? It doesn't matter if the central planner is the US government or Monsanto.

What markets are defective? Health insurance, finance? Are those markets really decentralized?
posted by Pastabagel at 7:39 AM on June 9, 2009 [2 favorites]


so the rest, this majority you speak of are just too stupid to realise they are being screwed over and vote the selfish capitalists out are they?

No, but a whole lot of people are apparently willing to kiss the pavement in the hope that, someday, they or their children will get to wear the boot of capital and stomp all over somebody else's face.

That's The American Dream™.
posted by Kadin2048 at 7:51 AM on June 9, 2009


America suffers from a plague of abundance. Our great wealth has fostered great greed, where people who have a home, a car, and plenty to eat and drink want more: a 2nd home, a bigger, nicer car, restaurant meals, etc. It's causing a plague of obesity, the spread of McMansions with lots of enormous rooms which must then be heated, cooled and filled with stuff, cars so big they don't fit in parking spaces, guzzling lots of gas.

It's natural to want more, but in America, it's exacerbated by advertizing. If you love your kids, you'll buy the expensive fish sticks because minced fish means you don't care enough. You may think you're immune to ads, but there's a reason companies spend gobs on advertizing. It works. And not just to sell you a brand of shoes, but to influence your vote and your attitudes. To get back to the topic of food, the article repeatedly says that healthy food is too expensive for poor people. Not true. Lean beef, organic food, and fresh vegetables are expensive. Canned vegetables are still nutritious, and frozen veg can be more nutritious than fresh. But people have become convinced that they need the southbeach diet, or huge amounts of protein. People are so accustomed to pre-prepared foods that many people have no idea how to cook. You can eat well and cheaply, but you do have to be taught.

In corporate America, profit is the only consideration. Shareholders take no responsibility for what the company does, they care only about profit. I've listened as someone complains about the morally bankrupt behavior of a company like Enron, and a sentence or 2 later, comments on how well their portfolio is doing (yeah, not recently).

That greed, combined with a lack of responsibility, has landed the US economy where it is. Even so, most of us are still incredibly well off in comparison to the rest of the world. Bizarrely, the one area where most Americans are lacking security is health care. Most of us are a layoff away from not having access to health care. I feel lucky to have basic financial security, but if I were laid off, I couldn't afford the cost of my health insurance, but couldn't afford to be without it.

I like Americans. As individuals, I find Americans to be generous, but as voters, for the last 8 years, the idea of feeding poor people has not been a priority.
posted by theora55 at 8:00 AM on June 9, 2009 [4 favorites]


Our great wealth has fostered great greed, where people who have a home, a car, and plenty to eat and drink want more: a 2nd home, a bigger, nicer car, restaurant meals, etc. It's causing a plague of obesity, the spread of McMansions with lots of enormous rooms which must then be heated, cooled and filled with stuff, cars so big they don't fit in parking spaces, guzzling lots of gas

I agree with all of your points except for obesity. Anecdotally, rich people eat much healthier than poor people do, and the statistics seem to back up that obesity increases more in low-income groups.

To get back to the topic of food, the article repeatedly says that healthy food is too expensive for poor people. Not true. Lean beef, organic food, and fresh vegetables are expensive. Canned vegetables are still nutritious, and frozen veg can be more nutritious than fresh.

There are many interconnected problems that lead to low-income people having unhealthy diets. If you are a single mother who lives in a low-income urban neighborhood and works two jobs to be able to pay the rent, you don't have a lot of time, money, resources, and energy to make sure that you and your family are eating healthy foods. On a per-calorie basis, it's cheaper and easier to pick up junk food at a fast food restaurant or at a bodega than it is to buy and/or cook a healthy meal.
posted by burnmp3s at 8:20 AM on June 9, 2009 [1 favorite]


I'm all for some more socialism, personally. Like Spock said, "The needs of the many outweigh the needs of the one..."

Most households are socialist. Do the adults in the household share their earnings to collectively pay bills and take care of needs? Of course they do, if they're wise. For about five years, me and my significant other resisted that, and kept basically everything separate. We argued over money, who contributed most in this way or that way, just not very happy times at all. That threatened to destroy our relationship, so we decided that was just stupid, and we began operating as a cohesive team, maximizing our individual strengths and minimizing our individual weaknesses. Since then, everything has been oh so smooth. Our finances improved, our needs are met, we don't argue any more, and we're happier with each year that passes. Funny how sometimes you don't appreciate socialism, or even notice it, even as it is the underpinning of virtually all traditional households.
posted by jamstigator at 8:25 AM on June 9, 2009


No, but a whole lot of people are apparently willing to kiss the pavement in the hope that, someday, they or their children will get to wear the boot of capital and stomp all over somebody else's face.

That's The American Dream™.
posted by Kadin2048 at 10:51 AM on June 9


Really? "The boot of capital"? Somebody call Dr. Who, I need to get out of 1900's Russia.

We should have socialism? Why, because it works so well in the Netherlands and Sweden? Let me explain to you how small Sweden is. Sweden has roughly half the population of the Netherlands. And both have fewer people than Los Angeles.

But why Sweden? Why not copy the Greek healthcare system, or Spains? Oh, right, because those two national healthcare systems are terrible, and everyone knows it. In fact, why not just cherry pick US states? I bet the hospitals in Montana and Wyoming are wonderful.

The problem with socializing most things, with centralizing most things, is that they don't scale well. In fact, they scale horribly. How many additional levels of middle management will you need to add to the Dutch healthcare system for it to function here?

The Veterans Health Administration has almost 280,000 employees. They treated 5.5 million people. The population of the US is 300 million. With the VA's current organizational structure, you would need 16,800,000 employees to care for the US population, assuming no additional layers of management or additional organizational structures to manage the size.

If a national health service was run like the VA, it would be the single largest organizational entity in the history of the world. It would employ almost as many people as the entire US government employs now, including the military and post office.

Let's compare the US to other countries of its size, instead of subjectively picking northern European countries that you happen to like to visit on holiday. Here are all the countries with fewer than a billion people and more than 150 million. These countries all have nationalized health care systems (except the US):

United States 306,625,000
Indonesia 230,330,000
Brazil 191,258,884
Pakistan 166,596,500
Bangladesh 162,221,000
Nigeria 154,729,000

So there's your comparison. Not Holland. I assume you are all clamoring to get an MRI in a Indonesian hospital.

So I'm curious to hear how all the Metafilter management gurus are going to organize and manage a US national healthcare system in such a way that it doesn't result in the greatest managerial and public health catastrophe in the history of the world.
posted by Pastabagel at 8:31 AM on June 9, 2009 [4 favorites]


if you're poor, it's your fault.

This is a very popular conceit and, believe me, not just among Americans; and also, very interestingly, not just among the well-off to filthy rich.

I remember a friend telling me about an American survey (I wish I remembered the details better) that was taken, I believe, just after the Bush Jr re-election. It concluded that the majority of Americans, no matter what the state of their current finances, believed that, if they worked hard, denied themselves etc, would someday be rich. In other words, they believed in the American dream (or certainly, a mercenary and boiled-down version of it).

I wonder what the results would be today.
posted by philip-random at 8:53 AM on June 9, 2009


Pasabagel,; please don't criticise that which you know little about.
Spain's social healthcare is very good. Every small town has a doctor and district nurse.
Healthcare is...wait for it....FREE for every man, woman, and child in the land regardless of income or lack of. You keep ramping on about how vast the US is; I therefore ask you to consider economy of scale. Please consider Cuba - a country that is broke and yet has one of the highest per capita rates of doctor. It is a matter of commitment. Maybe if the US reined in its vast overspending on Military hardware, all of its people might eat and have healthcare. In a democracy the individual gives power to the state therefore the state should care for the individual. But I digress.
posted by adamvasco at 8:55 AM on June 9, 2009 [1 favorite]


Pastabagel, this comment makes no sense. If you picked two countries of similar size, with similar per capita income who had nationalized versus private healthcare and compared their spending versus the resulting level of care that would be fine, but you haven't actually made any substantive argument that our size makes the European model impossible for the US.

If there was really such a thing as a truly free market with totally open competition, and if everyone truly acted in their best economic interest, and if everyone truly had equal opportunity, everyone in the world would be making the exact same amount of money.
posted by snofoam at 9:01 AM on June 9, 2009


The Veterans Health Administration has almost 280,000 employees. They treated 5.5 million people. The population of the US is 300 million. With the VA's current organizational structure, you would need 16,800,000 employees to care for the US population, assuming no additional layers of management or additional organizational structures to manage the size.

If a national health service was run like the VA, it would be the single largest organizational entity in the history of the world. It would employ almost as many people as the entire US government employs now, including the military and post office.


Pastabagel, as always, you present a strong argument, lucidly presented and backed up by relevant information (ie: facts).

Yet part of me has to say, "so what!" to your figures. Or more to the point, why NOT have 17 million people employed in the deadly serious business of comforting the day to day concerns and afflictions of some 300 + million? Though, as soon as I say that, I know it's batshit-insane. A bureaucracy half the size of the current Canadian population!?!? You should try dealing with the Vancouver Island Health Authority.

Is there not some way we can blame all this on Obama?
posted by philip-random at 9:08 AM on June 9, 2009


yes, but that's the point. It doesn't stop the US of A from lecturing the Rest of the World on all of the above and more

So the answer is to lecture back?
posted by Pollomacho at 9:09 AM on June 9, 2009


The issues raised in the Abramsky article don't seem to me to be matters of socialism versus capitalism, or the American Way versus the rest of the world. Rather, they seem to require adjustments and re-organisation of some of the USA's existing systems so that they can cope with the welfare demands that are being made on them. Nothing straightforward or easy, but equally nothing requiring a basic ideological shift on anyone's part. The current economic climate is going to cause problems for the UK and other EC systems too.

Can I say that, whether you approve of it or not, I don't think state help for the poor or sick is socialism - not unless it's accompanied by state control of industry and the general economy.
posted by Phanx at 9:16 AM on June 9, 2009 [1 favorite]


We should have socialism? Why, because it works so well in the Netherlands and Sweden? Let me explain to you how small Sweden is. Sweden has roughly half the population of the Netherlands. And both have fewer people than Los Angeles.

Not to detract from your point regarding potential diseconomies of scale, but the Dutch healthcare system is almost entirely private. Basic health insurance is mandatory and insurance companies receive payments from a risk pooling system to compensate them for taking on patients with pre-existing conditions (whom they have to take on at least for their basic package).
People with good jobs generally get premium insurance which is less regulated and for which insurers can reject people and bill them what they want.
I think that a government re-insurance program is more likely to scale to a country the size of the United States than a Canadian or British single payer system.
posted by atrazine at 9:20 AM on June 9, 2009


Pastabagel: Universal health care in the US would not be done by making all doctors, nurses, etc government employees. It would be done by having a single, government-regulated insurance system for everyone in the country. All of the private hospitals, clinics, and other practices would stay private, it's just that the payments would come from the government instead of a hodge-podge of government, insurers, out of pocket payers, and non-payers.

This would actually represent a tremendous streamlining over the current system, which employs tens of thousands of middle men whose job is, ultimately, to deny coverage in order to make a profit. Basically, nationalized health care in the US would be less like the VHA and more like Medicare/Medicaid, except that the health care providers would be paid reasonable rates for their services.

Now, whether that or the current plan of moving to mandatory private insurance with a public insurance option is best is another question. But I don't think anyone is, at this point, seriously suggesting making millions of health care workers government employees.
posted by jedicus at 9:25 AM on June 9, 2009


The Veterans Health Administration has almost 280,000 employees. They treated 5.5 million people. The population of the US is 300 million. With the VA's current organizational structure, you would need 16,800,000 employees to care for the US population, assuming no additional layers of management or additional organizational structures to manage the size.

Also, this is surely a little disingenuous. According to this, there are a number of priority bands which determine how much care a veteran is eligible for and the highest few bands are for those with chronic service connected injuries. Of the non-combat injured that qualify, many are retired.
You can't extrapolate from a sample of multiple amputees and old people to the entire population.
posted by atrazine at 9:42 AM on June 9, 2009


"whose country just openly elected fascists to represent them mind you"

This can't be emphasized enough. Were this article run before the elections, it might have some traction. Not that there aren't valid points here, there's no excuse for people starving in one of the most bountiful countries on Earth because of political idiocy. I don't think there's any question there's far too much wealth and power concentrated in the hands of too few people and corporations.
That said, yeah, given the right shift across the board there in Europe - mote/beam, all that.
Apparently EU voters are not so much into the socialism. Looks like an existential crisis.
Whether it is or not or whatever is going on - this just seems like finger pointing "Oh, bu-bu-but - America!" Yeah, well, your people just said 'No' to socialism as well.

"Has America developed good social safety nets for its poor? No.
Why not? Because they just don't want to. It's just the way Americans are."

Yeah, well, you've got what - Geert Wilders who's looking to fight a religious war and Nick Griffin who's a holocaust denier. (The only real upside was in Sweden with the Pirate party looking to foster greater internet privacy.)
So - has Europe stopped its fascination with fascism, and xenophobic authoritarianism? No.
Why not? Because they don't want to. It's just the way the Europeans are.
posted by Smedleyman at 10:17 AM on June 9, 2009


The Veterans Health Administration has almost 280,000 employees. They treated 5.5 million people. The population of the US is 300 million. With the VA's current organizational structure, you would need 16,800,000 employees to care for the US population, assuming no additional layers of management or additional organizational structures to manage the size.

According to what I was able to figure out from the web, in 2006 approximately 14 million people were employed in health care in the US and, as someone else pointed out here the VA looks after a lot of high maintenance patients. I'll concede your figure and raise you a "so what?"
posted by lordrunningclam at 10:26 AM on June 9, 2009


"whose country just openly elected fascists to represent them mind you"

Right, and that sucks and all. However: it makes absolutely no sense to compare the results from a proportional representation election with those from a first-past-the-post election.

Apparently EU voters are not so much into the socialism. Looks like an existential crisis.

Take into account that the political alignments aren't necessarily the same as those in the US though, many of these parties are economically socialist and populist while being regressive lunatics on social issues. They want unemployment benefits and healthcare for everyone - but their definition of everyone is the product of racist thinking.
posted by atrazine at 10:34 AM on June 9, 2009 [1 favorite]


Also, this

(1) If America can't get it together to look after their sick and ill people ( no NHS )
then what makes anyone think they give a damn about their poor?
(2) Has America a good track record on equality issues? No.
(3) Has America shown economic benefit of its vast wealth to all ? No.
(4) Has America developed good social safety nets for its poor? No.
Why not? Because they just don't want to. It's just the way Americans are.

[numbering added by me]

Fair cop on #1, but the UK's record on the other three isn't really much better. The UK is by far the most unequal country in Western Europe.
posted by atrazine at 10:38 AM on June 9, 2009


So the answer is to lecture back?

You have a better suggestion, sahib?
posted by infini at 11:01 AM on June 9, 2009


It would be done by having a single, government-regulated insurance system for everyone in the country.

So we are back to the original point. Is one insurance company better than many? The problem in the health insurance industry is that it is not at all competitive. People by and large don't buy their own health insurance. Their employer picks it, the worker pays for it, and if you switch jobs, they have to get new health insurance. The people who pay for the service aren't the ones choosing the supplier. There is not pressure to reduce insurance costs because the people pay for the insurance aren't negotiating the purchase. The system is completely bizarre. I don't get car, home, or life insurance from my employer. Furthermore, those insurance rates are tailored to my habits. My driving record affects my rates. But with health insurance, my co-workers health problems determine my rates.

I'd suggest before doing something radical that we do something simple. Decouple health insurance from employment, and make insurers compete in the market for customers they way auto insurers and life insurers do it. If you do this, you would see two things:

1. Rates for healthy people (i.e. most people) would tumble.
2. Rates for unhealthy people would rise, and they would know specifically why they are rising. Obese? Pay this much more. Smoke? Pay that much more. These people would know that losing a certain amount of weight, for example, would translate to saving money on insurance. People would have to internalize the health insurance cost of their lifestyle. This in turn would cause people at the margin to live a healthier lifestyle.

There'd be other benefits too. Without employers paying some of the insurance cost, costs per worker would drop, which means it because easier to hire more people.

If you picked two countries of similar size, with similar per capita income who had nationalized versus private healthcare and compared their spending versus the resulting level of care that would be fine, but you haven't actually made any substantive argument that our size makes the European model impossible for the US.

There is no "European model". Healthcare is not standardized across Europe. Is the health system in Greece the same as in the Netherlands? Why not? Aren't they both in Europe?

The reason I gave you the list of countries I did is to make a point - there is no country comparable to the US in both size and per capita income. The system we have in the US has enabled the country to achieve what it has, namely an extremely large and extremely affluent ethnically diverse and literate population, spread out across a large geographic area, with a high life expectancy and a high standard of living.

Here is something else to consider. No matter what system you create, there will always be poor people. There will always be the starving and the ill.

If there was really such a thing as a truly free market with totally open competition, and if everyone truly acted in their best economic interest, and if everyone truly had equal opportunity, everyone in the world would be making the exact same amount of money.
posted by snofoam at 12:01 PM on June 9


Wrong. You may value leisure more than someone else, so you are likely to work less than they do. All things being equal, they will have more money than you, even though you both acted in your economic best interests (economic best interest does not equal financial best interest). (There are other reasons too, e.g. comparative advantage).

Furthermore, the function of government is not to equalize the outcome. It is to equalize the rules and the enforcement of those rules.
posted by Pastabagel at 11:03 AM on June 9, 2009


many of these parties are economically socialist and populist while being regressive lunatics on social issues.

So would you say that they merge nationalist tendencies with socialism?
posted by Pollomacho at 11:09 AM on June 9, 2009


According to what I was able to figure out from the web, in 2006 approximately 14 million people were employed in health care in the US and, as someone else pointed out here the VA looks after a lot of high maintenance patients. I'll concede your figure and raise you a "so what?"
posted by lordrunningclam at 1:26 PM on June 9


Because my example only discussed the size assuming no changes to the organization, which is purely hypothetical and impossible in practice. Futhermore, large organizations do not scale well, and in fact an organization can become so large that it's costs to offer additional goods and services actually increase See diseconomies of scale.

If the Obama administration ushered in an era where people believe the fundamental principles of economics have been repealed, either they are in for a big surprise or we are all going to have to relearn some very very painful lessons.
posted by Pastabagel at 11:12 AM on June 9, 2009 [1 favorite]


I thought this was the sorted of thing the US was designed to do well? What is the state system other than a way of mitigating diseconomies of scale?

By which I mean, can't one state establish an "SHS" and see how it goes? I'd guess that some very rich people would leave due to the increased tax (or other tax-like payments), probably making a large amount of noise as they went. I'd also guess it would become hugely more popular with young professional couples looking to start a family. And we'd see fewer posts from that state on AskMe saying "should I see a doctor about this" when they pretty obviously should, but the financial repercussions are too scary. As a non-American those posts are pretty WTF for me.

Maybe it would be good and other states would take it on. Maybe it would be a horrible failure and be abandoned in 5 years. Or something in between - I can't pretend to be knowledgeable either way. I guess the NHS could have turned out to be a disaster rather than an imperfect but adequate system. But it didn't.
posted by Wrinkled Stumpskin at 11:46 AM on June 9, 2009


Wrinkled Stumpskin (heh) the problem with that idea is that the people who need the services most wouldn't be able to move to that location while the people that need it least (the rich, larger companies) would move to another state to avoid paying for it.

States compete amongst each other to give tax breaks and discounts on services to "create jobs" which looks great in a campaign advert but doesn't look so hot when you crunch numbers and realize it's just a race to the bottom.

so the rest, this majority you speak of are just too stupid to realise they are being screwed over and vote the selfish capitalists out are they?

I don't know that it's a majority, but it's a damn lot. What was the percentage that voted for McCain again?
posted by anti social order at 12:33 PM on June 9, 2009


Wrinkled Stumpskin (heh) the problem with that idea is that the people who need the services most wouldn't be able to move to that location while the people that need it least (the rich, larger companies) would move to another state to avoid paying for it.

I continue to await the exodus from Massachusetts. Anyway, larger companies want this because it lets them reduce their own spending on health insurance.
posted by atrazine at 12:40 PM on June 9, 2009


6 January 2009

The Indian government will bear the treatment costs of the poor under a new health insurance scheme. Using a smart card embedded with 11 types of software, patients can now afford the services of private or government hospitals through cashless and paperless transactions.

posted by infini at 12:46 PM on June 9, 2009


So would you say that they merge nationalist tendencies with socialism?

Somebody else did that, didn't they? Who was it again? It's right on the tip of my tongue.
posted by infinitywaltz at 1:14 PM on June 9, 2009


Rates for unhealthy people would rise, and they would know specifically why they are rising. Obese? Pay this much more. Smoke? Pay that much more. These people would know that losing a certain amount of weight, for example, would translate to saving money on insurance. People would have to internalize the health insurance cost of their lifestyle. This in turn would cause people at the margin to live a healthier lifestyle.

This is great in theory, but wouldn't it fuck over anybody that had health problems not of their own making? Not all people with diabetes got that way from over-eating, and plenty of people get cancer without having smoked.
posted by infinitywaltz at 1:16 PM on June 9, 2009


Wouldn't dealing with the insurance costs and rates of say, GM workers, be vastly more expensive for all concerned (except GM) on a per-person basis? I had the impression that dealing with 100,000 people individually would result in substantially higher fixed costs for the insurer (way more staff needed), which would in turn be passed on to the insured.

And, while I agree that revealing to the insured how much more their insurance is costing them because of their waistline might bring about change in some cases, that does nothing for the large numbers of people who drew shitty hands at the genetics game. Even in otherwise healthy pepole that creates an ethical dilemma: "Mr & Mrs Smith, you both carry trait X in your genes, which is fine for you, but your family rate will go up by an order of magnitude should you reproduce." Capitalistic selection, almost.
posted by Decimask at 1:30 PM on June 9, 2009


infinitywaltz beat me to it. I can't believe how long it took me to type that.
posted by Decimask at 1:31 PM on June 9, 2009


I'm not defending capitalism or The American Way or anything like that here. What I'm saying is that specifically on the issue of getting food to low-income families, Americans are in nearly universal agreement that it's a good idea and very large numbers of people support these kinds of initiatives. For all of the backwards right-wing political blustering that goes on in the US, I still dare any pundit to go on TV at Thanksgiving or Christmas and say that people should cancel their food drives or shut down the food banks. That rhetoric would go over like a lead balloon for Americans of nearly all social and economic classes because everyone knows that giving food to people who need it is a good idea.

There's a difference though between people voluntarily donating food to a local food bank through can drives and the such versus a program like food stamps that people are forced to support via taxes. I don't think conservatives or libertarians have a problem with people helping their fellow man, it's that they hold that private charity can do better than forced government charity.

Likewise, with the exception of pundits like Rush or Coutler, they aren't into seeing people go without medical care. Their issue is that private health care (and not necessarily the mess we're in now) is far better than a universal health care plan.
posted by champthom at 1:33 PM on June 9, 2009


So... if they work tolerably well in individual European countries, why could you not have 50 different healthcare systems organised within US states?

And hearing people using the fact that some fascist-types were elected in the UK and around Europe for some absurd point-scoring is remarkable. I'm sure there are no racists in the US. Never mind the rather small number of them elected across the whole of Europe, or the fact that even most of the 'right' wing parties in Europe support universal health care and government provided social safety nets.

Europe has problems. The US has problems. Someone can write a post about the problems of the EU, go ahead, hopefully it won't descend into the classic pissing match that criticism of the US always seems to.
posted by knapah at 1:37 PM on June 9, 2009


> for some absurd point-scoring is remarkable.

How long you been out here on the intertubes, sonny?
posted by jfuller at 2:50 PM on June 9, 2009


Quite a while, but I always hold out hope. Especially here.
posted by knapah at 3:02 PM on June 9, 2009


The United States already spends twice as much as Canada per person for health care - despite the fact that Canada is a) more ethnically diverse (much high proportion of population are immigrants), and b) substantially less densely populated. When it comes to health care, it's not how many people you have, it's how far apart they are that really drives up the price. And we have better heath statistics.

We acheive this because our single payer system is more efficient. We pay less in overhead and adminstration costs.
posted by jb at 6:50 PM on June 9, 2009


jb, according to this McKinsey report on healthcare costs (which I linked to before), only 15% of the US additional costs are caused by administration and insurance. That is, if we reduced those expenditures to be exactly in-line with the rest of the world, we would reduce our current costs by only 4%, and still pay 39% more than our peers for healthcare. Page 5 on the interactive graph sums it up nicely.
posted by FuManchu at 3:23 AM on June 10, 2009


FuManchu - good point. You are all paying too much for OTHER THINGS, as well as admin. This recent article by Atul Gawande sums up some of the problems well. Basically, when health care is about profits, profits are maximised regardless of cost to consumer or actual health care.
posted by jb at 9:03 AM on June 10, 2009 [1 favorite]


Hang on! I just noticed the FPP is about hunger, not health insurance
posted by infini at 10:55 AM on June 10, 2009


Good point, infini - but the health care debate comes up and up again because it is one of the major problems for poor families.

Speaking back to a comment earlier in the thread - I agree that saying that 1 in 8 Americans are "hungry" (something historically associated with starvation) may be somewhat misleading, but the concept of food insecurity is a very important one to understanding the realities of poverty within the developed world. In the developed world, we have reduced the price of food to the point where it is a much smaller fraction of our family budgets than it is in the developing world or ever was in the past. But that doesn't mean all is golden - as the FPP points out, there are large numbers of people who aren't starving, but who also are not secure -- food insecurity is a major source of stress (itself problematic), affects children adversely in their development and in their education, and generally sucks. Food insecurity can also disrupt families in their efforts to try to plan their finances well - when you have been hungry, and you get a bit of money, you are all the more tempted to spend it on treats and things you have been denied, even if that's not the absolutely more rational purchasing choice. My mother called this the cycle of "two-week feast, two-week famine", because she watched families on welfare go through this -- they were so limited on their diet by the end of the month that when their check came, they would go a little crazy and buy all the nice food and treats they hadn't been able to have, only to (of course) find themselves short at the end of the month. This isn't a personal attack - just that hungry people (and that can be protein or nutrient hungry, as well as empty stomached) don't think rationally. And breaking this cycle is very hard, and takes a great deal of will power that not all of us have.

The reason that people get het up about food insecurity in America (or any developed nation) is not because it is worse than the straight-forward starvation in the developing world -- it patently is not. People get upset about it because we are not talking about a country like Haiti where there are massive problems - we're talking about a country which is throwing large amounts of food in the garbage, where there is such richness, and it's shocking that anyone would go the least bit peckish, let alone hungry, because they could not afford food. It's shocking because many people in the developed world don't realise that we do have such poverty -- they haven't lived it, and it is invisible to them. That's what articles and websites like this are about - not trying to claim that Americans et al are starving in large numbers, but that there is a different but still bad thing happening, even here, in our backyard.

I especially liked their point that hunger is as common (or more common?) in rural areas - rural poverty is a different creature to urban (and I think usually worse, based on my observation of both), but often lost next to the immediate visibility of urban poverty.
posted by jb at 11:22 AM on June 10, 2009


agree on the waste, that hurts, that the systems are designed to consume/waste

took me ages to get over the amount of food one *has* to "throw" away

no cows to eat it in the garbage, no poor people to give it too

and the media overplays the 'richest economy/consumer society/market/country' in the world bit so much that for the billions with media access of some sort who have never been to the US its unimaginable just how much poverty there is

there's a serious disconnect in the systems meant to serve it imho partially due to this "denial" of the problem, or at least its not as obvious as it can be in other countries, while at the same time, hte "free hand" of the market (or whatever) means that profit is the primary motive for most systems as mentioned above in the health insurance discussion
posted by infini at 11:39 AM on June 10, 2009


and thank you

I've appreciated the debate on health insurance as well
posted by infini at 11:41 AM on June 10, 2009


Stopping the Death Spiral
US healthcare reform can help the world

posted by infini at 6:42 AM on June 11, 2009


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