THE MOST astonishing revelations in Michael Moore’s “Sicko” have nothing to do with healthcare. They’re about vacation time. French vacation time, to be precise.
Sitting at a restaurant table with a bunch of American ex-pats in Paris, Moore is treated to a jaw-dropping recitation of the perks of social democracy: 30 days of vacation time, unlimited sick days, full child care, social workers who come to help new parents adjust to the strains and challenges of child-rearing. Walking out of the theater, I heard more envious mutterings about this scene than any other.
“Why can’t we have that?” my fellow moviegoers asked.
The first possibility is that we already do. Maybe that perfidious Michael Moore is just lying in service of his French paymasters. But sadly, no. A recent report by Rebecca Ray and John Schmitt of the Center for Economic and Policy Research suggests that Moore is, if anything, understating his case. “The United States,” they write, “is the only advanced economy in the world that does not guarantee its workers paid vacation.” Take notice of that word “only.” Every other advanced economy offers a government guarantee of paid vacation to its workforce. Britain assures its workforce of 20 days of guaranteed, compensated leave. Germany gives 24. And France gives, yes, 30.
We guarantee zero. Absolutely none. That’s why one out of 10 full-time American employees, and more than six out of 10 part-time employees, get no vacation.
Of course, if you have more (paid) holidays you may (as a society) end up earning slightly less. Most of the Europeans I know are OK with that, but I wonder if Americans would be…
As the article points out, the average American worker gets 13 vacation days a year. When he says “We guarantee zero. Absolutely none” of course what he actually means is that the GOVERNMENT does not mandate vacations for corporations.
Most of my friends get large chunks of vacation time — which they do not take. It piles up every year — but they have things they want to accomplish at work, rather than take the vacation.
He then goes on to point out that our lack of vacation time is actually due to our desire for productivity. And he proposes this solution:
[blockquote] “Here in the sweltering D.C. summer, there’s nothing worse than wearing a necktie when the thermometer reads 95 and the humidity is so thick you could swim laps. But on your own, there’s not much you can do about this state of affairs. If you’re the only one who shows up dressed down, you’ll look bad for it. But if your office, or meeting, were to collectively decide to ease the dress code, all would be better off.
This is what the European Union just did, imposing new regulations on its bureaucrats barring ties in the summer. Cutting down on air-conditioning costs was the rationale, but centralized action was the only way to end the practice. Otherwise, every individual would still have had the incentive to show his commitment by dressing in a tie. Only the collective could remove that spur.
So too with vacations. Very few individual workers in the United States can ask for four weeks of vacation. It is not only outside the benefits of their job but far outside the culture of our workplace. The incentives for most every individual, particularly if they want to keep their position and amass a reputation as a good employee, is to abide by those norms.”[/blockquote]
Great — that’s just what we need. A large government entity telling us all how we can dress, and how little we should produce — in order for those who don’t wish to wear ties and who wish to take more vacation to feel better.
Sarah,
Yesterday on NPR (!) I heard a great joke about the EU neckties. Something about giving them EU regulators more energy to argue over the labeling on tuna fish cans.
Americans take less vacation because they take home more of what they earn and the government takes less. They have an incentive to work more. This theoretical argument jives with the empirical findings of economists. If workers in the US desired vacation more than pay it would be in the interest of firms to grant more vacation.
A mandate to take more vacation would be equivalent to the government saying we don’t know what’s good for us.
Michael Moore should take a look at the square footage of European housing compared to US. Should France mandate that the French live in bigger apartments? Of course not.
Did Moore mention unemployment rates in France? Or their connection to violence there? Or that mandates not fire cause firms not to hire? Of course not. It doesn’t fit his agenda.
I look forward to another movie, “Imbecile!”
The US economy is one of the best in the world. While we don’t have the government guarantee of 30 days vacation and excessive unemployment pay, our unemployment rate is roughly half that of France. Our GDP per capita is 130% of France’s.
So, if you don’t mind being unemployeed or making 77% of your current pay and having a 37.38% income tax (based on per capita GDP) and a 19.6%VAT tax (not even retail sales tax, but a tax at each transaction) verses a 28% federal income tax and not federal sales tax, then go ahead and move to France.
Me, I like it in the USA.
Statistices are from here for France
http://country.alibaba.com/profiles/FR/France/taxes_accounting.htm
and here for the USA
http://country.alibaba.com/profiles/US/United_States/taxes_accounting.htm
YBIC,
Phil Snyder
I ‘earn’ vacation and sick time at my job. However, we have a small staff and anyone taking vacation/sick time means more work for those still on the job. If/when we schedule vacation time, we are asked to carefully check the calendar to make sure it does not conflict with someone else’s request. Guess what DOES NOT happen? Right now we have one person out on extended sick leave due to an operation on her foot. Two other staff decided to take vacation leave shortly thereafter, and just took it (they earn it, they have a right to take it), leaving us three staff short. That left three full time day employees on the job, plus several assorted night/weekend part timers. Frankly, at the end of that first week, I was ready to resign.
Today, I was informed that a fellow full-timer was planning on taking Friday off for family time. I reminded her that I had requested Friday off for a crown fitting at the dentist, which would take most of the morning, and with the intensive procedure I was planning on NOT coming back in that day. “But it’s not on the calendar” she said. I took her over and there it was in big letters ‘JIM OFF — DENTIST’. “Oh, I didn’t see that!”
So earning time is not the problem. Getting everyone to agree on TIMING is the problem.
Frankly, I haven’t had a real vacation in five years. Most of my time off is spent around the house working on the “honey do” list.
Peace
Jim Elliott <><
Any study that considers France an “advanced economy” is automatically suspect.
We have unemployment at levels that were considered impossible thirty years ago, and which Europeans would consider impossible right now.
“American collectivism”–the very phrase sends shivers down my spine.
The author did not discuss the fact that in normal times, the French unemployment rate is about twice that of the US. Nor did the author raise the point of how difficult it is for young workers to get into “real”, career-track jobs in France….people continue endless graduate studies, “internships”, and other types of “hidden unemployment” until they are about thirty. The system works all right if you are employed, assuming you don’t mind confiscatory taxes, but getting into the labor force is a killer. Of course, employers desperately try to avoid hiring anyone, since it is virtually impossible to get rid of an unsatisfactory employee.
If the current system is working so well, why did the French elect a President on the basis of a pledge (among others) to roll back the 35 hour work week?
I am self-employed in a business where I am the revenue and profit center. If I do not work, I make no money, and I have no guaranteed anything…but I would not change a thing, and certainly not embrace the privilege of living in a society where the government tells me HOW TO DRESS!!! As General MacArthur said (more or less…), “In this world, there is no security, only endless opportunity.”
I would like to keep it that way.
The study did not also include that Americans are 46% more likely to survive any major disease or traumatic injury in OUR health care facilities than those in countries with ‘socialized’ health care. Which explains why you see so many Canadians, British, French, Chinese, etc. coming to America for treatment, and so few Americans going to Canada, England, France, China, etc. for treatment.
You all keep using a strange word in your posts. What is “vacation”?
RE: “”American collectivism”–the very phrase sends shivers down my spine.”
I hear that brother!
The French economy, like the German, is utterly stagnant, and has been for years. This has to do with more than just mandated vacation time, but the latter is symptomatic of a system that is over-regulated and has all but destroyed incentives to work. One result, ironically enough considering the general left-wing bias of such a system, is that the poor are hurt disproportionately, because the economy doesn’t create jobs that will allow the poor to pull themselves out of the borderline poverty that the government keeps them in. All of which makes you wonder whether people like Michael Moore really are as blind to reality as they seem, or is there some more insidious motive that would lie behind their wanting to fasten such a system on the necks of Americans.
Geez Looeez. The usual straw men. Government regulation = appalling tyranny. Would anyone care to go back to the days when the Cuyahoga River regularly caught fire? I thought not.
Of course, nowadays the regulation doesn’t have to be as heavy there; people have figured out that they can have a pretty clean environment without too much sacrifice, and companies that keep their acts pretty clean tend to do better because a significant fraction of potential customers are willing to pay a premium for low pollution. But before everybody figured that out, our noses needed to be rubbed in it by regulation.
Here’s a straw man from the other side, the classic worker’s comment on an “open shop”. This bears nicely on the claim that people could “choose” individually to take plenty of vacation time (libraryjim’s situation, a job presumably in the public sector, doesn’t apply).
[blockquote]“What is th’ open shop? Sure, ‘tis where they kape the doors open to accomadate th’ constant stream av’ min comin’ in t’ take the jobs cheaper than th’ min what has th’ jobs.
“Tis like this, Hinnissey: Suppose wan av these freeborn citizens is workin’ in an open shop f’r th’ princely wages av wan large iron dollar a day av tin hour. Along comes anither son av a gun and he sez t’ th’ boss, ‘Oi think Oi could handle th’ job nicely f’r ninety cints.’ ‘Sure,’ sez th’ boss, an th’ wan dollar man gets out into the crool wuruld t’ exercise his inalienable roights as a freeborn American citizen an’ scab on some ither poor devil.
“It’s all principle wid the boss. He hates t’ see men robbed av their indipindence.â€[/blockquote]
According to the article, associates at law firms “overwhelmingly” would take a cut in pay for some time off. But, just like getting rid of neckties, if only one person did it she’d find herself on the street.
So long as it didn’t create a situation where people had to worry about whether they could put food on the table for the entire pay period — or lose their jobs to workaholics — I think that an exchange of more time off for a pay cut would be pretty popular across the board.
The dirty little secret is that high American productivity is built on the unpaid overtime of salaried workers, and — at the other end of the pay scale — people who are deliberately given just few enough hours to keep them from qualifying for benefits.
If that’s not true at your shop, congratulations. And you’d better hope it doesn’t get bought out by a “better” money manager.
RE: “So long as it didn’t create a situation where people had to worry about whether they could put food on the table for the entire pay period—or lose their jobs to workaholics—I think that an exchange of more time off for a pay cut would be pretty popular across the board.”
Maybe so — and if that is the case, individuals need to negotiate for that in their own jobs, rather than the government MANDATE it for folks who don’t wish it at all.
I know plenty of people who negotiate various perks in exchange for decreased other perks. The place where that is most difficult is, ironically, in large bureacratic corporations where they are the most heavily regulated by the government.
[blockquote]individuals need to negotiate for that in their own jobs, rather than the government MANDATE it for folks who don’t wish it at all.[/blockquote]
The problem is (and see the classic “open shop” analysis from about 1900) that if individuals try to negotiate that sort of thing, most of ’em can be replaced. Very, very few of us are irreplaceable. That cold, hard fact is the reason for unions.
And government regulation.
NW (#15)
Government regulation is like an axe – it is pretty good about chopping down trees, but it’s useless at sharpening pencils. Use regulation to fine tune the economy is as useless as sharpening a pencil with a blunt axe.
Remember, though, power shifts cause problems too. Look at the US automobile industry and its difficulty adapting to foreign competition because the unions had so much power. This caused a large decline in US auto sales and cause even more layoffs for union employees as well as further costs (because of the union contracts for continued financial support for laid off workers) to the US industry.
Some regulation is necessary as is some power at the worker level. Too much concentration of power in either management, labor, or government will give us a bad system. The trick is where do we find the balance that will give us the least unjust economic system.
YBIC,
Phil Snyder
In my persoanl experiance in a unionized shop, the reason for unions was so the lazy and incompetent could sit around, while younger workers hoping to be noticed and promoted did all the work. One woman, for example, was fired after being no show/no call for all but 4 days in three months. The union later had her reinstated with back pay. See, actually showing up and not even pretending to work is itself not necceasary, just get yourself on the books and go home. Shortly thereafter I left for a vehmently open shop firm. If you couldn’t do the job they’d try to find one you could do, or send you packing. Work hard and get extra pay or extra paid leave. Did the same volume of work with 1/3 of the staff. We got paid more, firm spent less on the department as a whole. Everyone wins, except the parasites.
From this thread, it looks like it’s true that most Episcoplians are in the upper income brackets, so maybe many of you don’t know how it really is for most of us wage slaves. I work for a small newspaper, staff of 7. I get one week of vacation a year and I make up for it by working 12 hour days the week before *and* the week after. Can I negotiate perks? No. I am totally expendable despite winning awards and taking up the slack when my boss was sick, when the associate editor abruptly quit, etc., etc. Do I want to work 56 hours a week? No. It’s what I have to do to keep my job in a poor, rural area where jobs are hard to find. A close relative works in child protection – he is on call all the time, even on vacation. He accumulates “time off” that he can’t take because there already aren’t enough hours in the day to do all the paperwork and visitations he has to do (he has children in placement all over the state – and this is a big state – so he often has to be on the road checking on those kids). He can’t get paid for the overtime either because the state breathes down the boss’ neck if anybody gets overtime. He has, very rarely, received something they call, jokingly, “Chinese overtime,” meaning that he gets paid his regular rate, not an overtime rate, and only for some of his overtime hours, not all. The stress of his job is unbelievable. Oh, and he does get the occasional perk, like the family that threatened to kill him, his boss and the state’s lawyer in court. He and his colleagues do the work of many times their number because the state says they have to – never mind that there is a crying need for more case workers. Yes, Americans are overworked and overtired, and yes, some things, many things in life, are more important than “production.”
At the same time, Unions don’t seem to be the answer. When the auto plant here unionized, the union became another monkey on the workers’ backs and, with its demands, ultimately forced the plant to close.
The money quote is, “In this country, we have left it to the individual…” Bingo! That’s as it should be. Let those who want to live in a socialist nanny state go elsewhere. It’s not that Americans are tired and overworked, rather Western Europeans are lazy and underworked.
#13 NW Ohio–I wouldn’t use law firm associates as a bell weather for anything. Working for a big law firm comes with certain expectations. No one is making them do it. I was a partner of a large and prominent law firm for 20 years and wore a tie eveyday for two reasons. First, clients, even clients who dress casually themselves, expect their lawyers to dress the part. Second, you have to wear a tie to court. That’s just the way it is. I am personally sick and tired of first year associates, who have no experience of any kind, but expect to be paid $90 to $150K to start, whineing about long hours and having to dress professionally.
#16 Phillip–Regualtors are OK, but they are limited in their world view. When the only tool you have is a hammer, eveything begins to look like a nail!
#18 Sherri–Unfortunately, working extra hours to take a vacation is true about the “boss” too.
#18 Sherri–Unfortunately, working extra hours to take a vacation is true about the “boss†too.
I’m sure that’s true of some bosses, David. It’s not true of mine, and I doubt he’s all by himself. 😉
#21 Sherri–I guess I was only speaking from my personal experience. I have never worked in the Dilbert world. But I suppose there ARE a lot of pointy-haired bosses out there, who have reached their highest level of incompentence.
As yet, only two or three people have addressed what I see as the main point of the article: people don’t have the power to make workplaces more humane without help — typically collective bargaining (which takes a union, with all of their flaws) or government regulation (not perfect either).
According to the article, both the pointy-haired expectations of higher-ups and the lemming-like expectations of co-workers feed into this problem.
Unfortunately, I’m an unmarried marriage counselor: I’ve got tenure, though it doesn’t mean as much as it used to (I’m having a “performance review” this year).
I’ve found the comments here instructive. But since I married into an old-style Labor family… my perspective is more like #18 Sherri.
[blockquote]Most of my friends get large chunks of vacation time—which they do not take.[/blockquote]
It usually depends on whether your position is categorized as exempt/non-exempt. I have been at both ends of the scale. I worked for ten years at Harvard University, where I was non-exempt (and got a measly two weeks vacation) for two years, and then became exempt for eight years (when I never used my four weeks of vacation a year).
Since then my vacation time has varied, depending on my classification. In my last two positions, I was considered non-exempt because I worked hourly (although programming would usually be considered professional level work). I was back to two weeks a year–and it stunk.
During the years my wife worked at Harvard, she also got four weeks vacation. When we moved to CT, she returned to school, and worked only part-time, Although her work is highly skilled, and requires a degree, there were no benefits, no vacation, and she did not get paid holidays.
Again, lousy deal. At a time when we could least afford it (because we were paying tuition and my wife was working part-time in addition to being a full-time student), and most needed time off, we had the least spare time, and were barely making ends meet.
I do not blame employers for this. The problem lies with a system in which Americans have the most expensive health care per capita in the world, and yet the private sector (either employers or individuals) is required to carry the full burden. (Yes, that statement does reflect my left of center politics.)
Sherri,
I worked for a boss like that. I was originally hired to work at FSU Libraries with an 8-5 job, occasionally filling in for the opening shift (7:30 – 4:30) and rotating weekends. Well, the director retired and the new director had this wild idea that everyone should work rotating shifts each day!
So, a sample week might look like:
Monday opening shift 7 – 4.
Tuesday closing shift 6 PM – 2 AM
Wednesday day shift 8-5
Thursday afternoon shift 1-10
Friday late day shift 10-6
Later we all went to Saturday – Wednesday or Sunday through Thursday shifts as well.
The next semester everyone would have their schedules tweaked so they would have the same type of schedule, but work them on different days. And yes it was possible to work a closing shift and come in the next day to open.
We went to the Union, but they said “Hey, she’s the director, she has the right to allocate her staff as she sees fit.”
70% of the staff, including department heads, left that first semester. The only ones who didn’t were the ones with too much time build up to lose.
Fortunately, her five year contract was not renewed.
I was glad to leave, myself!
How do you suggest that we make the economic system in America more just instead of more unjust? I submit that taking over 50% of a person’s pay (between income and VAT taxes) in taxes is unjust. I also sumbit that universal regulation concerning things like vacation or benefits is also unjust.
YBIC,
Phil Snyder
It’s a complex matter, and the reality of what kind of vacation time American workers get “on the ground” varies a lot. Plenty of commenters have said that they get, in effect, no vacation time at all — either because they’re in a position without benefits, or because they simply can’t ever take the vacation time they theoretically accrue.
Here’s another factor, which we’ve also seen examples of in this thread: the Puritan work ethic, pervasive in this country, makes work a positive virtue and means that non-work — for any reason, even vacation time or sick time — is always seen as at least faintly sinful. The guy who takes two weeks off per year is sneered at by the guy who only takes one week; and both of them are scorned by the guy who takes no vacation at all and works 60-hour weeks to boot. Meanwhile, his children are looking at his picture and saying, “Daddy who?”
Demanding those brutal hours from employees — or even allowing them — is often a bad idea for the employer in the long run. People burn out and quit, or worse, burn out and stay. Business is a marathon, not a sprint, and you have to pace yourself. Unfortunately, many companies don’t realize that.
Me, I work hard — sometimes. When the deadlines are coming up, then I’ll put in the long hours. The rest of the time, I work normal hours and don’t give work a second thought on evenings and weekends. I make a point to take all the vacation time they give me, because I enjoy vacation time and I’m not interested in winning the “Who took the least time off?” competition. But then, I’m lucky enough to have a job where I can do that; I know that plenty of people don’t.
#24, the private sector will [i][b]always[/i][/b] carry the entire burden of health care, either through direct payment, or through taxation, or through inflation due to government creating money out of thin air. Government consumes, private sector produces.
RE: “The problem is (and see the classic “open shop†analysis from about 1900) that if individuals try to negotiate that sort of thing, most of ‘em can be replaced.”
Then why is it that so much negotiation takes place? It’s a common occurrence. Truth is that, though someone is always ultimately replaceable, it’s inconvenient for bosses and corporations to go through the employee-search, the hiring, and the training.
RE: “The problem lies with a system in which Americans have the most expensive health care per capita in the world, and yet the private sector (either employers or individuals) is required to carry the full burden.”
Well . . . actually only a *part* of the private sector is required to carry the entire burden — which is what makes it such a burden on folks like me. When I go to the hospital, either I or my insurance will pay not only for my hospital stay, but for a portion of the thousands of folks who walk through those doors getting TOTALLY FREE medical care.
“(Yes, that statement does reflect my [right] of center politics.)”
; > )
[blockquote]the private sector will always carry the entire burden of health care, either through direct payment, or through taxation, or through inflation due to government creating money out of thin air. Government consumes, private sector produces.[/blockquote]
I suppose this is true in a kind of redefining of what is usually meant by “private sector” sort of way. In which case it all depends on how the private sector carries the burden. For example, if there were no such thing as health insurance whatsoever, and we all just paid individual expenses straight out of pocket as need ariose, also would mean that the private sector funded health care.
The current American way–in which millions are uninsured, and small companies and family businesses risk going under because they have to pay a disproportionately higher share of the burden, and large corporations like Walmart deliberately restrict the number of full-time employees so as not to pay benefits, and companies like Starbucks that do offer health care pay more for health care than they do for coffee beans, and the self-employed constantly risk bankruptcy, and people cannot afford to work less hours because part-time employment does not offer benefits, and people fear layoffs more because of losing health care insurance than loss of income, and catastrophic illnesses or accidents means having to sell everything one owns before one can do on Medicare–does not seem to be working very well.
[blockquote]Well . . . actually only a *part* of the private sector is required to carry the entire burden—which is what makes it such a burden on folks like me. When I go to the hospital, either I or my insurance will pay not only for my hospital stay, but for a portion of the thousands of folks who walk through those doors getting TOTALLY FREE medical care.[/blockquote]
Sarah,
I’m assuming you mean these people get TOTALLY FREE medical care because they do not have health care insurance. In a country in which health care insurance is directly connected to the quality of one’s employment, why would you think that millions of people do not have it?
In a country in which health care insurance is directly connected to the quality of one’s employment, why would you think that millions of people do not have it?
Thank you for asking that one, Dr. Witt.
“Sitting at a restaurant table with a bunch of American ex-pats in Paris, Moore is treated to a jaw-dropping recitation of the perks of social democracy: 30 days of vacation time, unlimited sick days, [and] full child care. … ‘Why can’t we have that?’ my fellow moviegoers asked.”
We can. The question is at what price. Take the case of “unlimited sick days.” Experience indicates that the longer and more generous you make unemployment benefits, the longer people tend to remain unemployed. Similarly, if you provide unlimited sick days, more than a few people will abuse the system by calling in sick when they are not really sick. But the money to pay these abusers for not working must come from somewhere: e.g., lower wages or higher prices. The system would, moreover, reward dishonesty with additional vacations time. Most Americans would not want that. It’s a stinky tradeoff.
Americans do want paid vacations but not necessarily 6 weeks of it. A government-mandated 30 day minimum essentially represents a decision that long vacations are better than higher pay—and worth some increase in unemployment. BTW, I don’t believe 6-week vacations prevent workaholism; the real issue there how much of ordinary work weeks you spend working and worrying.
RE: “In a country in which health care insurance is directly connected to the quality of one’s employment, why would you think that millions of people do not have it?”
Because they are not buying health insurance.
And we’ve decided that people who work have to pay for people who do not.
I await the day that the government decides that we must pay for “transportation care” — because of course all people have the right to be transported without paying for it. So that means FREE cars, FREE airline tickets, FREE car mechanic checkups, FREE gasoline.
Because . . . we all need transportation!
We’ll simply add a small surcharge to all those lucky folks who have car insurance, and it’ll all be taken care of.
Continuing #33:
What we most need is basic health insurance coverage for the working poor and other workers who currently do not have it and cannot afford it. Giving employers tax credits for providing such coverage would make sense, perhaps in combination with some mandates for larger employers to provides such coverage.
This would be a much sounder form of government intervention than requiring 6-week vacations (on top of national holidays) and an abuse-prone system of unlimited sick days.
Dr. Witt said: RE: “In a country in which health care insurance is directly connected to the quality of one’s employment, why would you think that millions of people do not have it?â€
And Sara replied: Because they are not buying health insurance.
To which I add – do you think the quality of employment might have something to do with that?
Sarah [#34]: Just curious . . . Do you support or oppose government FINANCING of primary and secondary education: i.e., using tax money to pay for educating children from kindergarden through high school? (My question deals with only who pays for education and thus leaves open the possibility of letting parents use vouchers to pay the schools of their choice.)
Mr. Witt,
The statistics I have read suggest that American health care outcomes are not that much better than they are in socialized countries. However, our costs are incredibly high compared to them.
What people don’t realize is that other countries ration their healthcare in ways that Americans would hate. For instance, people don’t get knee replacements or dialysis beyond certain ages, becuase it isn’t in the budget.
The problem with the American system, is that everyone gets everything, eventually, regardless of payment source. We work out the payment plan on the fly, later. Don’t believe me? Just go to the emergency department and say you have chest pain.
As a physician, I would say that at least half of all the health care that we give does not need to be given. Most of that happens because of patient demands, alot happens due to fear of lawsuits, and a small but significant portion occurs because physicians are overly impressed by the latest whiz-bang me-too 10X as expensive drug and ignorant of older cheap and excellent alternatives. Since in almost all cases, someone else is paying the bill, there is no pushback on patient expectations.
My proposal, not ideal, but the best we can do, is this. Take the current Medicare/Medicaid plans and combine them into one system that provides a floor of sorts for health care. The focus would be on chronic disease management like HTN, DM, etc, infants/children/vaccines, and OB. There would be strict rationing of prescriptions, a strict and minimal formulary for medications, no futile care at the end of life (comfort care/hospice only), etc. If you wanted something special or unusual you would have to pay privately for it, like the English do it. Every year, there would be a healthcare tax levied on Americans. That would be like the public schools. In some communities, they are OK. In many more, you have to pay for private school or home school to avoid your kid getting in trouble. As dissatisfaction with the value of the medical service/cost rose, eventually people would figure out some sort of voucher plan to reprivatize they system and reintroduce competition and lower cost.
Overall, people would hate it. Every year we would argue about how much of the budget would go toward healthcare, and the left would say it wasn’t enough, etc. But at least we could have an honest conversation about how much all this is really costing the country.
The bottom line is that if someone else is paying, you don’t get to decide what you want to order. That’s why our system is in trouble, but still a great system in terms of what it is capable of providing. Of course, we could take the Hillary plan and outlaw private medicine, like Canada has. That way liberals would be happy because people wouldn’t know what they were missing.
Meanwhile, I’ll be setting up my clinic just over the border in Mexico!
Bill, what American health care is more Wal-Mart and less Uncle Sam. The biggest problem in American health care is that high regulations and medical malpractice regulation (yes, it is a quality control regulation enacted by a jury) prevents efficient health care from reaching the market. Combine that with the difficulty of bringing generics to market and you have a system where everyone expects to drive a Lexus even if they don’t produce enough personally to pay for a Lexus, but government regulation prevents bringing the Toyota Tercel to market.
Getting government involved in health care will wreak less efficiency, stifled innovation, and the corrosive effect of requiring the highly productive and diligent in this country to pay for the less productive, made all the worse because everyone feels entitled to drive a Lexus.
Socialism is also a primarhy contributor to the decline of the Church in Europe. Where people depend on the government and in the misguided idea that we can change the rules of economics, they depend on the Church and its message of personal responsibility less.
Oh, and by the way, if you were getting healthcare though my idealized governement system, you are not allowed to sue if you don’t like the service. We would have boards of review to go over any suspected cases of malpractice. Doctors who screwed up would eventually loose their licenses. No damage payments to families, though. Hey, you get what you pay for!! Of course, we could put a line item in the budget to cover payments to injured people, but of course, that would cost more wouldn’t it?? So, I guess a few less people would get knee replacements. We could get lower the age from say 62 yo to 61. Or we could raise taxes again. Either way, an honest conversation at last.
Reason,
Good analogy with the car. I like to point out that if the government decided tomorrow that they were very excited about helping people out with their transportation problems, it would start out with some sort of subsidy. After 10-20 years our nation would have the best cars in the world, but they would be unnaffordable.
Sherri,
The patients I see who are working too hard are often working in rural areas that are economically depressed. Many of them stay in these areas because of family connections. Sometimes it is very expensive to stay close to family, if that family lives in a poor area of the country, in the sense that high paying jobs are not available.
Companies are not going to hire new employees at full time, because the benefit costs are too high. They will work the ones they have overtime or hire part time workers.
I advise leaving town. Seriously. I know that is tough, but some communities can’t support the people who attempt to live there.
I appreciate the good intentions of your advice, Cap’n Jack, but I am less sanguine than you about the opportunities available in cities – it seems that there is much urban poverty, too.
Urban poverty? After 60 years of Democrat Anti-Poverty programs? Surely not! After all FDR, JFK, LBJ and 40 years of a Democratic Party controlled congress all declared war on poverty did they not? And set up commissions and commitees and buracracies and agencies to eliminate poverty. So surely there cannot be ANY urban poverty, can there?
;-P
William asked:
[i]In a country in which health care insurance is directly connected to the quality of one’s employment, why would you think that millions of people do not have it? [/i]
[b]I[/b] have it because my empolyer (Gadsden County, a governmental agency) provides it for me as part of my employment package. However, my family does NOT have it because the cost for “spouse + family” is too high for me to afford having taken out of my paycheck (Almost $300 bi-weekly — is that the word for “twice a month”?).
What about catastrophic care, you ask? Please do. I’ll wait.
ok, last year my wife fell and broke her arm. The emergency room, doctor visits and physical therapy was still came out LESS than the cost of what it would be to have been paying the insurance + the deductable for one year.
Imagine that.
Oh, by the way, my daughter has a health care plan through her university, my son does have health insurance through his school. My wife is really the only one who is ‘not covered’.
[blockquote]However, my family does NOT have it because the cost for “spouse + family†is too high for me to afford having taken out of my paycheck (Almost $300 bi-weekly—is that the word for “twice a month�).[/blockquote]
Yes, indeed. I mentioned above that we moved to CT so that my wife could pursue further education. I also mentioned that her part-time job did not provide health care benefits. What I did not mention is why she ultimately ended up dropping out of her program. I was laid off from my job working in a homeless shelter because our Governor (recently released from prison for corruption) refused to release any state funding to non-profit agencies until the legislature agreed to his budget demands. I collected unemployment for the first time in my life and about half of that went to pay COBRA until I could find another job. Fortunately, I was only unemployed for six weeks, but when I did find another job, it provided health insurance only for me, not for my spouse. She ended up dropping out of school and going to work full-time so we could both have health insurance.
I also did not mention why I left that job. A little over a year ago now, my father had a severe stroke. My parents had a good pension, and the standard health care package that came with it. What they didn’t know was that three months after my father entered a nursing home, the insurance coverage ran out. My mother had two choices. She could sell everything she owned in order to qualify for Medicare and keep my father in the facility, or she could bring him home. She brought him home, and I left my job to move to Arizona for six months to help care for him during the transition. Fortunately I was able to do this because my wife’s company did provide family health care insurance.
After six months without work, I returned to CT, now in debt. I took the first IT job I could find, but one that has not paid well enough to make ends meet if I accepted their health insurance package–which again, would cover only me. I opted not to take the insurance package, because otherwise we could not pay the debts we incurred while I was unemployed in Arizona. For this last year I have been covered by my wife’s insurance. If she had lost her job during that time, we would again have been without insurance.
Fortunately, I am starting new work soon–and it includes health insurance for both of us so my wife will not have to work fulltime. Unfortunately, this kind of roller coaster ride is what too many Americans are experiencing these days–again, because health care insurance is directly connected to quality of employment. Most Americans are just a paycheck away from having no health care insurance.
Jim,
You point out something that many people miss. Although going completely bare on health insurance is risky, in case you end up needing a heart transplant or get leukemia, overall the monthly costs of low deductable or copay coverage become staggaring in just a few short months. Often times you really are better off just paying for unexpected health care costs out of pocket, rather than angling for someone else to do it for you. I liken the low deductable/copay policies to paying the mob for protection money. They really are not offering you anything other than the chance to take your money each month.
Another analogy is that of your car insurance. Most people would not purchase a car repair/new tires/oil change copay coverage. Why? Because it would cost too much. Most of us come out better to just pay for these expected costs as they arise. We purchase liability and collision coverage for our cars to protect us from the unexpected and devastating costs of an accident or killing someone, not the regular and predictable events. I’m sure someone out there offers such repair coverage, and I’ll bet that whoever offers it is making a nice profit. In other words, the problem in health care is not that of being uninsured. It is that we have too much insurance, and the wrong kind. The availability of insurance has done more to raise the cost of healthcare than any other item, and it has inflated the market expectations in terms of unneeded care, overly expensive drugs, etc. It is the same reason why auto body work is SOOO expensive. The companies figure insurance will pay, and now even the cars are built with the understanding that insurance will pay to repair them after wrecks.
This is why I recommend the HSA (Health saving account) plan. You get a high deductable major medical plan, for those unexpected leukemias, and pair it with a tax free savings account. Your unused balance in the savings accunt rolls over each year and is there for you to use toward your deductable. At around 59, I think, you can take out the money for any purpose tax free. The HSA makes sense for everyone, EXCEPT those who have heavily subsidised coverage at work, such as government employees. For instance, in my family which has one or two fairly minor chronic medical issues, coverage through my own HSA with Blue Cross/Blue Shield is $150/mo. Were I to buy family coverage through my work it would cost me >$1000/mo. I try to bank some of the difference each month.
The biggest problem with HSA coverage is for patients who are not making enough to save anything and/or are already chronicly ill. The reason why the left hates HSA’s so much is the same reason that they hate private schools and vouchers. It gives people a choice, and liberals are against choice (except for abortion that is). HSA’s make it clear to everyone that the productive or at least healthier people are paying for those who either don’t/won’t work, or some who truly can’t.
I support community health centers for the indigent or chronicly ill, where the community covers these costs. I think it would be less expensive than the free coverage that they get at the ER and in the hospital. I also volunteer with the free clinic in my town, for the working poor. We mostly treat what I call Diobesotension (diabetes, obesity and hypertension) and it’s related problems of heart disease, kidney disease, etc. Years ago, communities ran charity hospitals where patients could get such care on a sharply discounted basis, but without marble floors and new furniture in the waiting room. With the advent of Medicare and Medicaid, attempts were made to mainstream these efforts at charity and supposedly remove the shame attached to getting help. Well, those efforts have failed. I think the older model was better.
[blockquote] I await the day that the government decides that we must pay for “transportation careâ€â€”because of course all people have the right to be transported without paying for it. So that means FREE cars, FREE airline tickets, FREE car mechanic checkups, FREE gasoline.[/blockquote]
Sarah,
What this comment misses is that society does indeed provide “transportation care” in many ways for people who cannot afford it. Agencies that work with the homeless and working poor routinely distribute bus tokens and even sometimes provide used automobiles so their clients can find work or look for work or do the kinds of basic things we have to do, but cannot do without transportation. (I donated my last clunker to a homeless shelter.)
And, of course, transportation itself is one of those things government provides for all of us. The highway system, traffic lights, highway patrol officers, are all provided FREE. My ability to drive the public roads does not depend on my employer providing transportation insurance or my purchasing private transportation coverage.
Similarly, government provides police and military services that I do not have to purchase from the private sector or depend on my employer to cover. Can you imagine having to purchase police or fire or military protection from the private market? (BTW, my understanding is that fire protection was purchased by private individuals in ancient Rome. If you didn’t have the money, your house burned down.)
But health care is different from transportation. If I can’t afford a Lexus, I can always drive an old Ford. I can borrow a car or beg a ride. I can take the bus, and, if worse comes to worse, I can walk.
Unfortunately, if I need open heart surgery or I’m involved in an incapacitating automobile accident, I can’t perform the surgery on myself. I can’t buy it “used,” and I can’t borrow it from family or friends. If I just “do without” the consequences are a bit more severe than my not being able to afford a new Lexus.
Mr. Witt,
I’m sorry about your bad situation with your dad. Unfortunately the government and insurance companies prefer to work with institutions like nursing homes and are afraid that if they help you care for your dad at home there might be fraud. So, they spend obscene amounts on nursing home care, when for most patients all they need to cover is 24 hour sitting and lifting/bathing help at home. Most elderly or debilitated patients do NOT need to be institutionalized or have 24 hour medical supervision. They should be cared for at home and non-medical sitters do just fine.
It’s unfortunate that your dad did not have Long Term Health Care coverage, which should be purchased around the age of 50. It pays for at home care if possible, and nursing home care if required. Most families would prefer to keep a loved one at home, but can’t afford to pay for 24 hour sitters. Pity the government doesn’t respect this feeling and that society does not let people know of their options BEFORE events like this take place.
[blockquote]Unfortunately the government and insurance companies prefer to work with institutions like nursing homes and are afraid that if they help you care for your dad at home there might be fraud. So, they spend obscene amounts on nursing home care, when for most patients all they need to cover is 24 hour sitting and lifting/bathing help at home. Most elderly or debilitated patients do NOT need to be institutionalized or have 24 hour medical supervision. They should be cared for at home and non-medical sitters do just fine.[/blockquote]
Yes, you’re absolutely correct. My father’s condition improved considerably after he returned home. The most difficult part of my six months in Arizona was NOT helping my mother learn to be a caregiver. That was a challenge, but doable. And there were marvelous social service agencies that helped with day to day things like bathing, sitting, etc. (My mother ended up paying for these out of pocket since they weren’t covered by insurance.)
The most difficult part of my time in Arizona was struggling with an unscrupulous nursing home billing department that for three months tried to manipulate my mother into committing my father permanently to an institution when he didn’t need it, and didn’t want it, and tried repeatedly to bill my mother for things covered by insurance. (My one satisfaction was that by writing numerous letters and making telephone calls, and forcing meetings in which I presented pages and pages of spreadsheet documentation, I eventually forced an investigation, and the woman took “voluntary” early retirement.)
We also spent hours, days, weeks, dealing with clueless insurance company employees. After my father’s stroke, his personal physician refused to care for him. When my mother tried to get his primary care physician changed, the insurance representative on the other end of the line kept insisting to “talk to Mr. Witt.” When my mother explained that my father was no longer capable of speaking and so could not come to the telephone, the employee nonetheless kept insisting that she needed to “talk to Mr. Witt.” Numerous times we received either bills for things that were actually covered under the policy, and even several telephone calls in which the company claimed that they had no record that my father even had a policy.
We eventually dealt with all of these problems, but dealing with them was actually more stressful than dealing with consequences of a massive stroke. I have become quite jaded not about health care–most of my father’s physicians and caretakers were marvelous compassionate people–but about the way we pay for health care in this country.
Cap’n Jack – there is a lot that “long term care” doesn’t provide, but infers that it does. My dad ran into that with is wife when she was getting too much for him to handle on his own. Thank God for hospice care as Barbara was terminal and needed constant care, but would not improve.
What we need is a new way to pay for health care and a new way to ration the care that is given. With modern medicine being able to keep people alive much longer than previously possible, we have more and more people in long term care situations where they are alive, but not able to function much in society so we put them away so we don’t have to deal with them on a daily basis.
Health insurance was created to pay for unforseen costs in health care, not for annual checkups, flu shots, normal innoculations or well child care. What we have done is create a system where the majority of the consumers of the product/service are divorced from paying for it. Can you imagine what would happen if we had “lunch” insurance where a person was responsible for only 10% of the lunch tab after an annual deductible of $50? I hope you all could see the rise in cost and the decline in quality that would happen over time. This is what has happened with our health care financing. As we have had more and more of the financing of health care taken out of the hands of individuals, we’ve seen the cost rise and the overall quality rise much slower. Patients have no interest in saying “no” to different tests or drugs or procedures.
Government financing of health care would not make the situation any better for most people. It would make it better for some people (those without health insurance) and the upper classes with lots of money would be relatively unaffected because they can afford to pay what they want for the care they get (unless you outlaw paying more for more care). The ones hurt the most will be the middle class who largely have health insurance and, thus, ready access to relatively competent care.
What ideas (other than complete laize faire free market health care – which doesn’t or or complete government paid health care – which doesn’t work eather) can we as a group come up with?
YBIC,
Phil Snyder
Cap’n Jack,
We have HSA coverage. Between dental and eye care for us and two kids, routine medical examinations, and asthma and cholesterol medication, every single penny of our HSA contributions is spent. It’s just another way of taking medical expenses out of my paycheck pre-tax (I did that before the HSA plan came online), but has eliminated the free preventive medical care (vaccinations and medical exams) and discounted prescriptions that we enjoyed before.
The HSA plan [b]did[/b] save my employer a good bit of money, which probably meant the difference between offering health insurance to all employees (ensuring that it is a non-taxable benefit) and not doing so.
As for setting money aside according to the difference in premiums, there isn’t that much difference — less than $100 per month (we really only had catastrophic-care insurance before, with a few extra bennies like preventive care and discount prescriptions). And we [i]always[/i] set considerable money aside every month; it’s been a habit for all of our marriage.