Wednesday, October 26, 2005

The Old Brain Pan responds

I've received a clarification e-mail from Nick Reavill, the author of The Old Brain Pan post which I mentioned the other day. You may recall that it was about my parody of the BBC's article regarding the UN's attempted takeover of the internet. Nick, a Brit currently residing in the States, seems perfectly reasonable (except for his continued admiration for the NHS), and has given me permission to reproduce his e-mail here, lest there be any more confusion.

Dear Scott,

I am the 'Sloshings' you speak of. My name's Nick, actually, and 'Sloshings' was the category of the post, but I'm new to this blogging game. I didn't miss your point. I thought your parody was quite funny, and intentionally ridiculous. I linked to your site merely to point out that it wasn't my idea that the Iranians might run their own World Service. I kind of agree with you about the BBCs bias, especially the point you make about the reporting of Iraq's constitutional vote. I also agree that the British media is very biased about the USA, the BBC included, and I had to move here to find that out. My main point was that the BBC is so much more than it's news reporting and that all news outlets are equally, if not more biased. The way you feel about a news outlet’s veracity depends on your own bias, I think.

I’m not budging on the NHS though, and as wonderful as your country is, when it comes to healthcare, the US is seriously lacking. The banks are rubbish too, but generally I’m having a great time.

Regards,
Nick

32 Comments:

Anonymous Anonymous said...

"all news outlets are equally, if not more biased.

But the BBC has the distinction of being funded by a compulsory levy, non-payment of which can result in imprisonment.

That makes bias a little hard to stomach.

1:15 AM  
Anonymous David H said...

'I’m not budging on the NHS though'

I wonder what sort of personal experience Nick has of the NHS and the American Health Service. Many people are fully in favour of the NHS right up until the time that they, or a close relative, have serious need of its services. Then they realise just how awful it is. I have many years' experience of NHS treatment for a fairly serious disease and I can report that the level of incompetence and apathy that I've encountered on a regular basis are nothing less than scandalous. This is nothing to do with under-funding or any easy leftist get-out - this is as a result of the way in which the NHS is organized - the patients have no choice and thus no power.

12:13 PM  
Anonymous Nick Reavill said...

Hello,

I have responded to these comments here

3:31 PM  
Anonymous avaroo said...

If the NHS is so great, why do Brits who can afford it, buy private health insurance? What I cannot understand is the patience of Brits with the NHS. I have a friend in Stafford whose mother was diagnosed with cancer and she couldn't get chemo and radiation for months after her diagnosis. In the US, she would have had it right away. Due to the delay in her treatment, her prognosis is terrible. Why is a system that delivers awful service ok as long as everyone gets the same awful service?

3:30 PM  
Anonymous avaroo said...

One more thing on the healthcare issue. Like many Brits, Nick seems to confuse health CARE with health INSURANCE. They are not the same. Americans without health insurance receive healthcare every day in the US but Brits with health insurance often cannot get healthcare. Which would you rather have, health insurance or healthcare? My friend's mother had health insurance but no healthcare. It's the same in Canada, another nation with nationalized healthcare yet in some provinces, people cannot find a doctor. No thanks.

3:41 PM  
Anonymous Peter S said...

Thank you, avaroo. There is a common misconception (in the U.S. and abroad) that Americans without health insurance get no health care at all. Nothing could be further from the truth. Much care is provided by state and federal care hospitals and agencies; additional resources are mobilized by private and local agencies and comunities. You can hardly walk into any municipality in the U.S. without finding some local group providing care for the uninsured.

Another thing to ponder: Recent studies indicate that U.S. doctors provide an average of 15-20% of their care for free, every year, mostly to uninsured Americans. Private hospitals give away free care, too, every day. Nick's main selling point seems to be that medical care in the UK is free, the same faint praise I've heard from Canadians about their healthcare system. But rare are the phrases "high quality" or "prompt and efficient" used to describe the care. Never mind "patient choice"...

4:29 PM  
Anonymous Nick Reavill said...

Hello,

Peter S said 'nothing could be further from the truth'. That is stretching it more han a little. There is some healthcare available for the uninsured, of course, and you can bet that it is substantially less accessible and of a worse quality than the NHS. How many people get a phisiotherapist for free in the US system? There are also a large amount of people in the US who are insured but are struggling under a large medical debt - again not something you get under the NHS (see here for stats).

Patient choice is a luxury that the poor can't afford. I would rather see an awful service as long as everyone had access to it (again, the uninsured may have access to some healthcare in the US but it is much worse than the NHS, and if you think otherwise you are fooling yourself). The NHS does fail on a number of counts and that is why those lucky enough to be able to afford it go private. What I would most like to see is everyone have access to "high quality", "prompt and efficient service", not just the those who are rich enough. Or should poor people not be allowed that choice?

6:36 PM  
Anonymous Peter S said...

Mediocrity (or worse) for all, excellence for none? Egad, Nick, set your sights higher! Again, you laude the NHS simply because it's free. FYI, in the last two days I have provided my professional services to six patients (out of about 35 total patients) who were uninsured. Two were Hispanic immigrants who were pregnant and needed Cesarean sections. Two were deaf citizens of our county, supported in part by a local charity though the largest portion of their services billable will go uncollected. One of the others had recently lost her job and insurance and had a broken ankle fixed anyway. The remainder of the 35 were insured. And my colleagues and I (in our private practices at our private hospital) gave them all the same, high-quality care we give to ALL of our patients (and no, I am not simply tooting my own horn and am most definitely not "fooling myself"). It is shameful of you to suggest that we gave a "worse quality" of care to the six. And this is roughly the ratio of insured:uninsured patients that practitioners, on average, see every day.

How can you promote a system that "fails on a number of counts"? And how good can a system be when the only ones in a position to make a choice (i.e., the "lucky") so often choose not to be in it?

3:23 AM  
Anonymous avaroo said...

Nick, you say..."I would rather see an awful service as long as everyone had access to it"

Here is the crux of the difference between our views. While some people in the US no doubt do get mediocre healthcare, most Americans get the best healthcare available anywhere in the world. I would not rather see everyone get the same awful service even if some others get better service that I do.

And the NHS isn't free. Doctors get paid in Britain, they are not volunteers. What is the difference between paying at point of service or paying through taxes? You're still paying.

You also say...."There is some healthcare available for the uninsured, of course, and you can bet that it is substantially less accessible and of a worse quality than the NHS."

There is quite a lot of healthcare available to the uninsured in the US. And none of it would come anywhere near the substandard care the NHS doles out to an incredibly patient British public. Could any American imagine waiting 4 or 5 months for chemo after being diagnosed with cancer?

You continue...."There are also a large amount of people in the US who are insured but are struggling under a large medical debt"

Is that worse than dying because you waited for "free" care from the NHS? I'll ask again, if the NHS is so great or if it's even barely acceptable, why does anyone in Britain who can afford it buy private insurance?

"What I would most like to see is everyone have access to "high quality", "prompt and efficient service", not just the those who are rich enough."

And failing everyone having such access, you prefer than no one has such access. As you said..."I would rather see an awful service as long as everyone had access to it".

4:39 AM  
Anonymous avaroo said...

One more thing Nick,

US healthcare costs way more than healthcare anywhere else in the world. But we also have access to more and better healthcare than anyone else. Perhaps we value healthcare more highly than others do. We're certainly more willing to spend more for it.

At the end of the day, do you really believe that the NHS is better because every expense is spared in providing care to anyone who cannot afford to go private? What you have in Britain is a system where anyone who can afford to go private has access to better, more prompt and efficient care. The rest of you have to accept what you get with the NHS. Not terribly equitable, is it?

4:55 AM  
Blogger Scott Callahan said...

Pete,

Thanks for posting your professional experiences with the uninsured. I was hoping you would do that.

I suspect that Nick is a victim of the liberal media spin that generally exists on the whole healthcare issue, both here and in the States.

SC

8:42 AM  
Anonymous Nick Reavill said...

OK, so:

1/ I don't think that no-one should have access to private health care. You all seem to be inferring communistic tendencies where I have none (a conservative media bias perhaps). I think it's a shame that it has to exist because the NHS is not good enough.

2/Peter S - I applaud your work with the uninsured and I am certain there are many more splendid people healthcare professionals out there like you. Are you legally obliged to give this care? I doubt it, which means that every uninsured person undoubtedly does not have access to it, only people who are lucky enough to live near a doctor like you. People should not have to rely on charity.

3/ Avaroo - no it's not very equitable, but it's more equitable than the American system. Are you all seriously asking me to believe that you get that same level of care whether you are insured or not in the US? Or that the level of care for the uninsured in the US is better than for NHS patients. What happens to an uninsured person who has cancer, or any other protracted illness? How good is outpatient care in the US for the uninsured. It is easy (or even likely to happen) that an uninsured person will get physiotherapy or regular visits from a carer after a serious accident, as will certainly happen in the NHS?

4/ A person with a broken ankle in the UK will get that ankle fixed immediately and will get physiotherapy if they need it.

5/ Avaroo - what's the difference between paying at point of service or paying through taxes? The difference is that if it's paid for with taxes those how can afford it pay for those who can't (I don't believe that question was really serious, because if it is, it cuts both ways and socialists and capitalists can down tools and go for a picnic).

Look, there are two points at stake here. Firstly, is the NHS any good? On this issue I will freely admit that it could be much, much better, and that it lets a lot of people down. Is it better than healthcare for the privately insured in the US (or the UK for that matter)? No, of course not, and to those lucky enough afford it in the UK I say good for you - use it whenever you can (I appreciate my talk of mediocrity for all could easily have been misinterpreted, and for that I apologise). Is it better than healthcare for the uninsured in the US? Please refer back to the story of my mother's tribulations and tell me if an uninsured person would get that in the US.

Peter S - I cast no aspersions on you and your colleagues fine work, but I say again - if the care for the uninsured is no different than for the insured, why get insurance in the first place?

Secondly, if the NHS is in a parlous state, what's to be done about it? Give up and let everyone go private, if they can. I say no! I say make the NHS better, whether that means raising taxes or making better use of the money already provided. I was asked if it was worse to be in debt than to die of cancer. No, definitely not. However, is it worse to be in debt after suffering a serious but non-fatal accident, and not be able to afford to send your children to college, or not. Make the NHS so that no-one has to wait for chemo and that argument disappears.

There is a political divide between me and the rest of you, and that's fine. There is much talk of a liberal bias in the media and a lot of that is true, but I don't think moderate right-wingers are evil (extremists of any stripe leave me cold). I've heard myself described by sections of the media as a bleeding-heart, naive liberal (not me personally, of course), but you shouldn't believe everything you read that suits your politics. I don't think capitalism is all bad, and I don't want to make all property public by any means, but next you'll be telling me that it's great to be poor in the US and that the standard-of-living gap, including healthcare, between rich and poor isn't widening all the time - that sounds naive to me.

7:05 PM  
Anonymous Peter S said...

I am not legally obliged to give care to the uninsured OR to the insured; I (and the vast majority of practitioners in the US) simply choose to do both.

1:02 AM  
Anonymous avaroo said...

"Avaroo - no it's not very equitable, but it's more equitable than the American system."

How so? If you have private insurance in Britain, you get better, faster service. How is that more equitable than the US healthcare system?

"Are you all seriously asking me to believe that you get that same level of care whether you are insured or not in the US?"

let's use your broken ankle scenario. In the US, you would be treated in an emergency room whether you can pay or not. Have you never wondered why you don't see hundreds or thousands of Americans walking around with crippled or distorted limbs because they weren't set after being broken?

"Or that the level of care for the uninsured in the US is better than for NHS patients."

I know it is. If the NHS deems something too expensive, you just don't get it. No American would wait 4 months for chemotherapy.

"The difference is that if it's paid for with taxes those how can afford it pay for those who can't "

pretty much the same as what happens in the US then. Those who have insurance subsidize the care of those who do not.

"if the care for the uninsured is no different than for the insured, why get insurance in the first place?"

If the NHS is adequate, why do people feel they have to buy private insurance?

"However, is it worse to be in debt after suffering a serious but non-fatal accident, and not be able to afford to send your children to college, or not."

this is a red herring and I suspect you know it. If you don't know that it's a red herring, then you know as little about how people pay for college in the US as you do about US healthcare.

"Make the NHS so that no-one has to wait for chemo and that argument disappears."

Gee, what a concept. Wonder why no one else has thought of it.

"next you'll be telling me that it's great to be poor in the US"

Poor Americans have a higher standard of living than middle class Europeans. You seem to think that healthcare must be financed the way the NHS is, no matter how bad the quality it produces. But nationalized healthcare has failed everywhere. That's why Canadians and Brits buy private insurance if they can. That alone, indicates the systems have failed.

8:15 PM  
Anonymous Anonymous said...

"Poor Americans have a higher standard of living than middle class Europeans".
Do they really? Could you expand on this?

3:38 PM  
Anonymous avaroo said...

Yes, they really do. For example, most poor Americans live in much larger houses than even middle class Europeans, they are more likely to own two cars and have more of the amenities of life. There has been some research in this area, one study showed that black Americans have a higher standard of living than Swedes.

8:57 PM  
Anonymous avaroo said...

Try this report, anonymous. See page 15, although the whole report is quite interesting.

http://www.timbro.com/euvsusa/pdf/EU_vs_USA_English.pdf

9:11 PM  
Anonymous avaroo said...

Here's the report that discusses Sweden vs black Americans.

http://www.mises.org/story/955

Relative to household in the United States, Swedish family income is considerably less. In fact, the study concludes, average income in Sweden is less than average income for black Americans, which comprise the lowest-income socioeconomic group in this country.

The research came from the Swedish Institute of Trade, which, according to Reuters, "compared official U.S. and Swedish statistics on household income as well as gross domestic product, private consumption and retail spending per capita between 1980 and 1999."

The study used "fixed prices and purchasing power parity adjusted data," and found that "the median household income in Sweden at the end of the 1990s was the equivalent of $26,800, compared with a median of $39,400 for U.S. households."

9:18 PM  
Anonymous avaroo said...

Shocking story on the substandard care the elderly receive through the NHS.

http://www.spectator.co.uk/article.php?id=6841&page=1

10:28 PM  
Anonymous Anonymous said...

Averoo, Nothing you have responed with is any kind of evidence that "Poor Americans have a higher standard of living than middle class Europeans". I really would like you to deliver some kind of knock out blow.
Sweden? Sweden is one one country in Europe. Tell me about Europe, and European middle classes, or lets just leave your point alone shall we?
"one study showed that black Americans have a higher standard of living than Swedes" tell me about this. Where and why are you making correlations between black Americans and Swedes?
Josh.

1:32 AM  
Anonymous avaroo said...

anonymous,

If you do not understand that having larger homes, owning more transportation, having more purchasing power and more of the amenities of life amounts to a higher standard of living, I can't help you.

Sweden is one country in Europe, one that has a lower standard of living than American blacks as a group have. Did you know that?

I think you probably didn't read the timbro report I linked. You can read all about European middle classes in it. That's why I linked it.

1:53 PM  
Anonymous Nick Reavill said...

avaroo,

Your definition of a higher standard of living is revealing. Personally, I would include literacy rates (higher in Sweden than in the US), infant mortality rates (lower in Sweden than in the US) and the share of wealth (more evenly distributed in Sweden - all these facts come from the CIA World book). Averages are tricky things - if you have an small but significant number of extremely wealthy people they can push the average up considerably.

I read those reports and they make a great deal about how many TVs Americans own, but there was a very revealing sentence in the Mises Institute report:

...I would think that even the poorest sections of Stockholm and other Swedish cities are more liveable and attractive than what one finds in many U.S. cities. Even with the high taxes, I think I would rather live in downtown Stockholm than in downtown Detroit or Newark.

That is a frank admission that the standard of living is better for poor Swedes than poor Americans, even if they do have less cars. I used to live in the roughest council estate in the East End of London (the poorest part), in an ex-council property, and that was at least double the size of the average flat in New York, where I now live. I had a nice life there. How would you feel about living in the projects in East New York?

2:52 PM  
Anonymous Anonymous said...

Averoo,

First of all, I'm not asking you to help me.
I don't think I read any evidence to prove your original assertion. You might want to read a little bit more widely (and not just statistics that prove your case) before you start bandying about sweeping statements that have their basis in personal bias. I would be inclined to think a little harder about what you have to say if you went to the effort of finding more nuetral sources.
"Sweden is one country in Europe, one that has a lower standard of living than American blacks as a group have. Did you know that?" - I still don't know this.
Is it because we all instinctively understand that American Blacks are at the bottom of the heap in the USA and the Swedes are at the top in Europe - I assume that was what you were saying. My God, being Swedish is worse than being black! Fine by me.
Personally I class living without the risk of being shot as "one of the amenities of life", Would it be wrong to make the assumtion that gun crime in America is most prominant in black areas?
Youre right I didn't read the entire Timbro report, but I gathered the notion that America is collectively richer than Europe, I will concede that America is a rich country but I won't accept that the distribution of wealth in America is anything up to the high standard of Sweden.

I went to Sweden recently as a matter of fact. Lovely place. Very expensive...

Josh / Anonymous

3:56 PM  
Anonymous avaroo said...

Well, you actually did ask me a question. That's asking for my help. I provided the relevant information. You'll have to read it if you'd like an answer to your question. You are, of course, free not to read it, but then you have only yourself to blame for not getting an answer to your question.

To answer your question about standard of living, which is an economic issue, statistics will have to be used, even if you don't care for them.

I find your statement "being Swedish is worse than being black" somewhat of a non sequitur and more than a tad racist. Perhaps you meant to say that being Swedish means one is worse off economically than being a black American. If so, you are correct. I'll give you the benefit of the doubt and assume that you simply misspoke.

I said nothing about distribution of wealth in the US or in Sweden.

I'm sure Sweden is lovely.

1:49 AM  
Anonymous Anonymous said...

I'm sorry you thought I was being racist - I actually thought the same of you. I thought the non sequitur was yours.
Seriously though back to your original statement - "Poor Americans have a higher standard of living than middle class Europeans". The UN Human Development Index doesnt seem to agree with you or your statistics,
It measures the three basic factors for human development. I would equate this with standard of living, you however may chose not to.
The three are - Life expectancy at birth, Knowledge (as measured by the adult literacy rate) and the combined primary, secondary and tertiary gross enrollment ratio. A decent standard of living, as measured by GDP per capita at purchasing power parity (PPP) in Us dollars.

So according to their calculations Sweden is in there at number 6 (one below Canada) and the USA is at number ten.
I find it hard to believe that a social group in the USA that you have labelled as "poor" is richer than the middle classes of the 7 European countries above the US in the Human Development index. Surely theres a non sequitur if ever there was one.

Have a look at these.

The report -
http://hdr.undp.org/reports/global/2005/pdf/HDR05_HDI.pdf

http://hdr.undp.org/

http://www.economist.com/displaystory.cfm?story_id=4405531

I have read your reports and I was happy with the methodology.

"Nearly all officially poor U.S. households, moreover, are equipped with basic modern plumbing, including running hot and cold water, indoor flush toilets and indoor baths. While 30 percent of all Americans were without indoor toilets" Something maybe wrong with the way your statistics are gathered...

"But many of today's poor, while having a material standard of living above average Americans in an earlier period, are in another more important sense, very poor. They are trapped in "behavioral poverty": a vicious cycle of illegitimacy, destroyed families, absent work ethic, crime, drug addiction, and welfare dependency. Senator Daniel Moynihan, the New York Democrat, has stated that "in many if not most of our major cities we are facing something like social regression."49 The welfare state, while transferring enormous financial resources to these lower income Americans, adds to this "behavioral poverty," rather than relieving it. And the Census poverty reports, by exaggerating poverty in the U.S. and thereby stimulating even greater welfare spending, in a real sense has added to the misery of these households.
." Doesn't sound like middle class Europe to me.

http://www.heritage.org/Research/PoliticalPhilosophy/BG791.cfm

You have to take into account the distribution of wealth, the wealthiest ten percent of Americans are 15 times richer than the bottom ten percent. In Japan, for instance, the ratio is only 4.2:1.

Josh

11:35 AM  
Anonymous Anonymous said...

Sorry Averoo,
I meant to say "I have read your reports and I wasn't happy with the methodology"...
Josh

11:38 AM  
Anonymous avaroo said...

I would have had to have made a racist comment in order to be considered racist. I didn't. You did.

Human development is not the same thing as standard of living.

I did not label any social group in the US poor or anything else.

If you'd like an answer to your original question, you can see the timbro report. My comment and the information I provided had nothing to do with human development or distribution of wealth. My comment was strictly related to standard of living, a purely and very specific economic term.

6:34 PM  
Anonymous avaroo said...

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

The UN Human Development Index (HDI) is a comparative measure of poverty, literacy, education, life expectancy, and other factors for countries worldwide. It is a standard means of measuring well-being, especially child welfare.

The HDI measures the average achievements in a country in three basic dimensions of human development:

A long and healthy life, as measured by life expectancy at birth.
Knowledge, as measured by the adult literacy rate (with two-thirds weight) and the combined primary, secondary and tertiary gross enrollment ratio (with one-third weight).
A decent standard of living, as measured by gross domestic product (GDP) per capita at purchasing power parity (PPP) in USD.

My original comment and your question concerned standard of living.

6:45 PM  
Anonymous Anonymous said...

Not racist - ironic.

So, "Poor Americans have a higher standard of living than middle class Europeans".
If I am to accept this, which I don't and won't, is this to say that middle class Europeans are poor by American standards? Or could I infer from your original statement that there isn't poverty in America? The "poor' just arent really poor? Thats either great news for the US or the statistics relating to poverty in the USA are gathered in exotic and misleading ways.

I truly don't believe that the american poor have a higher standard of living than the European middle classes. firstly because even if we do take you at your purely financial word you still are wrong.

What I'll say is the US is clearly richer than some European countries but it is also not as well off as others.

To quote wikipedia as you have previously -
http://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28nominal%29_per_capita

Secondly why would you compare the USA with the whole of Europe, a collection of countries so diverse (economically amongst other things) that a straight comparison is both useless and meaningless?

"Sweden is one country in Europe, one that has a lower standard of living than American blacks as a group have. Did you know that?"

Back to the race issue that you raised (you clearly implied that Blacks in America are poor) an equally perverse statement one could make looking at these figures is that Black people from Luxembourg, Norway, Switzerland, Ireland, Denmark and Iceland all have better standards of living than American whites. Did you know that?
Josh

9:46 PM  
Anonymous avaroo said...

"My God, being Swedish is worse than being black!"

This is what you said. Not ironic, racist.

"So, "Poor Americans have a higher standard of living than middle class Europeans".

Yes.

"If I am to accept this"

There are no statistics which you must accept. You asked for them and I provided them.

"which I don't and won't"

Yes, I am aware that you are simply unwilling to accept the statistics. The question then is, why ask for something which you already know you are unwilling to accept?

"is this to say that middle class Europeans are poor by American standards?"

It is to say that poor Americans have a higher standard of living than middle class Europeans. That is what I said.

"Or could I infer from your original statement that there isn't poverty in America?"

If you can find where I've said this, please provide a quote to support your inference. Otherwise it is just bizarre. Is it not possible for you to remain on topic? Or even anywhere close to it?

"The "poor' just arent really poor?"

Poor is a relative term. It depends upon where you are talking about.

"I truly don't believe that the american poor have a higher standard of living than the European middle classes."

And no amount of statistical proof would ever be sufficient for you. You are politically incapable of accepting the statistics.

"firstly because even if we do take you at your purely financial word you still are wrong."

Let's see the statistical proof. And that would have to be statistical proof that poor Americans do not have a higher standard of living than middle class Europeans.

"What I'll say is the US is clearly richer than some European countries but it is also not as well off as others."

Off topic. The topic is "Poor Americans have a higher standard of living than middle class Europeans".

"Secondly why would you compare the USA with the whole of Europe, a collection of countries so diverse (economically amongst other things) that a straight comparison is both useless and meaningless?"

They can be statistically compared.

"Back to the race issue that you raised"

I raised no race issue.

"(you clearly implied that Blacks in America are poor)"

Where?

"an equally perverse statement one could make looking at these figures is that Black people from Luxembourg, Norway, Switzerland, Ireland, Denmark and Iceland all have better standards of living than American whites."

You can make any statement you like. If you intend to prove it, you'll need to provide the statistics on black people in Luxembourg, Norway, Switzerland, etc. that indicate this to be the case.

1:56 PM  
Anonymous Anonymous said...

Not racist. On topic. Read the statistics. Think harder. Good bye.

8:16 PM  
Anonymous avaroo said...

Yes, racist.

I provided the statistics. You read them.

Don't ask questions you don't want an answer to.

Think period

buh bye

8:47 PM  

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