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It is clear that a large number of US citizens believe that healthcare ought not be a universal right, but most also find it unpalatable to simply allow people to die of preventable diseases.

That's the dilemma of a certain category of moralists in the United States: people shouldn't have anything they can't pay for, so they deserve to suffer and die, but it's immoral not to help them and unseemly to leave them helpless and suffering. Torn between the desire to enforce justice on others (let the bums die!), fulfill their own moral obligations (do unto others!), and maintain appearances (we're ranked with Mexico, for God's sake?), they muddle through in contradictions.

In reply to dantheman's sibling comment, there may be some people who reason that way, but the popular argument is based on no clear conception of anything. It's just contradictory impulses that aren't logically reconciled at all. That's how it can be so popular to decry "socialism" while simultaneously defining socialism so broadly that almost all Americans support some instances of it.

I'm in the UK - I'm more than happy that some of my taxes go to giving everyone a pretty decent level of healthcare, does that make me a socialist?

Pretty much. Between the NHS and the dole Britain is a fairly socialist country, as is most of western Europe. I'm not sure when socialism became a dirty word.

I don't think tithing a small percentage of your income to help society's poor is a socialist concept. Traditionally you gave the church 10% and they spent much of that on the poor.

> I'm not sure when socialism became a dirty word.

I think certain interests in US have put a considerable effort into their propaganda to make it so. It stems from the "Red Scare" and what used to be the fear-du-jour for us before it was replaced by "terrorism". But the previous fear hasn't been completely replaced. It was planted there and periodically, when appropriate, politicians and other interests are able to tap into it to further their purposes.

Think of these fears as backdoors into into a system. The typical access to a system is through a rational, objective argument. The faster and more effective is to bypass that use the "fear" backdoor.

These fears take a while to cultivate. Once they are there, they are ready to be used and abused.

I'm not sure when socialism became a dirty word.

It's a bait-and-switch. Socialism defined in one way (collective ownership and management of the means of production) is anathema to almost all Americans and probably (I'm guessing) to most Europeans. Americans believe it's an inherently inefficient system leading to relative poverty compared to private ownership and competition, not to mention much less freedom. That kind of socialism is unpopular and indeed scary.

Collective ownership and management of some fraction of economic output -- i.e., taxation and public spending -- is universally practiced throughout the world and nearly universally accepted (though in many cases the collective nature of management is just theoretical, with the majority of citizens having no say.)

The genius of right-wing American scare pundits is to erase the difference between these things in the American mind, making "common sense" exceptions for some kinds of spending. Spending on the wrong things is "socialism." It's a flexible and pragmatic smear. Right-wing pundits and politicians have a lot of reasons for disagreeing with different kinds of government spending (some very sensible): it's inefficient, it takes from the deserving to give to the undeserving, it hurts poor people by making them lazy, it gives too much power to unelected officials, and so on. Whatever the reason for attacking spending, any bad spending is "socialism" and, being logically indistinguishable from full-scale authoritarian Socialism, might lead to it. (The focus on logical equivalences and consequences, and the fear that runaway logic can blow up a society the way a runaway reaction can blow up a nuclear plant, is reminiscent of arguments between parents and children. It makes more sense to be afraid of runaway sentiment, but they're not going to say anything bad about unfounded, immoderate emotion because unfounded, immoderate emotion is their business.)

Thus, they can take any minor disagreement about the scope of government involvement between citizens in a stable, relatively politically homogeneous country (especially considering our remarkable diversity in other ways) into a clash of ideas between sensible conservative people (who closely resemble the average American) and card-carrying, bomb-throwing, society-subverting leftists, or their stooges who are too naive to realize the importance of the logical equivalence between taxation and collective ownership.

It's not a policy that people shouldn't receive things they can't pay for. Very few in the US believe that the receipt of goods should be predicated solely on one's ability to counter with money for goods received.

The policy is that the government shouldn't be involved in private affairs and that while public encroachment in these spaces may make things cheaper in the short-term, everyone, except perhaps a very small portion, will be worse off as the intervention matures.

I don't necessarily agree that government should stay totally out of the matter at this point either, and I of course concede that it is a little off-kelter to have the same group screaming bloody murder when they think that they may go to a government-sponsored doctor but happy to submit to electronic strip-searches and groping at the airport, but I didn't want such a gross mischaracterization to slip by without challenge. There are many generous people in the United States and many who'll help you if you need it. The opposition is not hostility to the poor, merely a different conception of the proper place of government.

> Consequently, cheap early intervention to preserve health is often shunned in favour of expensive, late intervention to prevent death. To my mind the most egregious example of this is drug abuse and alcoholism - huge amounts are spent on ER care for disastrously ill addicts, but little is spent on basic social work and rehabilitation.

One example of this that is frustrating and heartbreaking at the same time is a piece by Gladwell called "Million Dollar Murray"

http://www.gladwell.com/2006/2006_02_13_a_murray.html

The mindset that is against government healthcare is one based on a clear conception of natural rights theory. It recognizes the validity of negative rights and the complete contradiction that is positive rights. Though most aren't against providing healthcare through non-coercive means such as private charity.

So, you'd classify a right to the belongings of others as a positive right?

Yes, positive rights are claims that someone can make against another -- I have a right to food, you must provide it for me, etc. In this case, I have a right to healthcare, you must provide it for me.

From wikipedia:

Under the theory of positive and negative rights, a negative right is a right not to be subjected to an action of another person or group—a government, for example—usually in the form of abuse or coercion. A positive right is a right to be subjected to an action of another person or group. In theory, a negative right forbids others from acting against the right holder, while a positive right obligates others to act with respect to the right holder.

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

So all people have the right to have all people provide their material needs. Seems unworkable to me. Maybe it just works for parasites.

"I am a citizen, you must hold (if you are the government) or fund (if you are a taxpayer) an election for me to vote in."

What's your feeling on that positive right? I've encountered people who argue against democracy, and I've encountered people who will re-word the right as stated above and then call it a negative right. I disagree with the former, and the latter only succeed in demonstrating that the difference between positive and negative rights is one of phrasing, and not of the right itself. Do you have a different take on the matter?

Very few people in the U.S. fully oppose a positive right to health-care though. They're against a positive right to see a doctor and get regular treatment, but are in favor of a positive right to receive emergency-room care if necessary. Hence, ERs are required to treat heart-attack and stroke patients who show up on their doorstep, even if the victim is uninsured and has no ability to pay; turning them away is illegal.

So the question isn't over whether there's a positive right to health care--- almost everyone agrees there is to some extent. The disagreement is over which kinds of care are included in the right.

The deeper problem here may be though that treating an emergency patient that is dying thus requiring immediate care they can't afford could run higher costs that the appropriate preventative treatment they were unable to afford.

Morally we are obligated to save the emergency patients life but also morally we shouldn't have let their condition slip to the point it is in.

> most aren't against providing healthcare through non-coercive means such as private charity

I've never been able to give that a more benign reading than "as long as it doesn't cost anyone enough to seriously affect the problem". I'd rather be required to pay to keep society at least minimally humane, than voluntarily pay for gates and guards to protect me from the poor, desperate, and angry.

What's perplexing to me is how big soda and junk food suppliers get away using so much sodium in their products to increase sales.

They "get away with it" because hundreds of millions of people continually buy their products.

For what it's worth, the NYC Department of Health and Mental Hygiene is running a "education campaign" addressing exactly that: http://www.nyc.gov/html/doh/html/pr2009/pr057-09.shtml

We also have one of the highest taxes on nicotine sales in the country, for similar reasons.

I say that government can experiment in social engineering, but only as long as they're completely transparent about what they're doing.

I say we have rights that supercede your say so.

In most other developed countries, it is politically straightforward to spend $20,000 a year on coaxing and cajoling a patient into managing their diabetes better in order to prevent them from becoming a $70,000 a year dialysis patient. Needless to say that the benefits to this approach are greater than just a cost saving.

I agree with your basic points. But as someone who both is American and has a serious life threatening medical condition, I think there must be some deeper reason for this American quirk.

I know that a lot of "standard wisdom" concerning nutrition and the like not only doesn't work for me but is actively harmful to me. I have managed to get off 8 or 9 prescription drugs and now manage my health issues via diet and lifestyle (and herbs and supplements when necessary). But I have gotten there by following a pig-headed, asinine, "don't tread on me" sort of path. It has been really important to actively reject outside intervention in favor of home-grown solutions for my issue. I suspect something similar may be true for most Americans. America was founded by social outcasts who left their countries of origins to go elsewhere under really harsh, deadly conditions -- conditions which were, nonetheless, more tolerable than the social expectations they were fleeing.

Most people cannot fathom my choice to live without furniture and without a car. I sleep on the floor and most of the time I own only two or three outfits. I get lots of comments from people who are often just trying to make conversation but nonetheless are basically butting in to things that they know nothing about and which are none of their business. For example, I do not own a jacket. Jackets are too hard to keep adequately clean and most are not designed to be washed regularly (ie every single I wear it). I find that undershirts work better for me than jackets. I have also been known to walk to work in flip flops in 40 degree weather. People inevitably feel compelled to tell me to get a jacket or comment that my feet must be cold or something. It is usually under circumstances where I do not have the time (even if I had the inclination) to explain to them that whatever annoyance I suffer from the cold is laughable compared to the suffering it has allowed me to walk away from. It is also usually from people at work, this in spite of a company policy that no one other than my immediate boss is to offer "constructive feedback" on my appearance, and then only if I am in violation of dress code. It annoys me to no end yet I realize that if I made a big stink about it, I would most likely be the one deemed to be 'a problem' (and it would unnecessarily call attention to my medical condition, which I do not wish to do). Most of these people are well-meaning and genuinely concerned for my welfare and/or just trying to make conversation. So I try to handle things diplomatically and lightly and good-naturedly, without referencing the serious medical situation that drives my unconventional literally "remarkable" (ie worthy of remarking upon by these people) choices.

So I think it is possible that most Americans have some deep-seated reason(s) for balking at the idea of someone interceding in their diet and lifestyle choices at an earlier stage in the process. I know outside interference is one of the things that I feel most threatened by. Since I don't have a doctor's note for doing what I do, I can't really justify or defend it on some kind of "legal" grounds or some such. I'm just some lone nut-case who occasionally makes fantastical claims that most folks find unbelievable -- an issue I work very hard to keep out of my place of employment.

It is unfortunate that the results are so expensive. But I am not entirely convinced that the cajoling and convincing that works in other cultures would necessarily be such a good thing for a society of outcasts who could not conform and chose to face so much hardship in order to start over elsewhere. For me, conforming -- even in seemingly small matters like wearing a jacket -- leads to enormous suffering and would eventually kill me. So I just am unable to "go along to get along", in spite of internal wiring that makes me want very much to do that. But I just can't. Maybe a lot of Americans also just can't, yet are willing to accept intervention at a later stage of more serious crisis because at that point there is nothing to lose and a great deal to gain.

What I find interesting is how well you indirectly answer the question.

Americans are irrational. We are superstitious and confuse things like the availability of early treatment with being forced to use it. We are also selfish and unwilling to live with the results of our poor decision making process.

PS: It's not hard to demonstrate that universal heath care would cost less and be more useful than are current system. However, most people already decided to do something else so people are not going to change their mind over something as silly as a rational argument.

I have no idea what you mean. I've done a lot of research to come up with solutions which work for me. I don't see how that is irrational or superstitious (though perhaps you aren't suggesting I am, it sounds to me kind of like that is what you are implying). All I am saying is that if Americans are fundamentally different in their physiology/basic wiring, then the things that work for some other group may not work for them. Even if people cannot explain that very well, they can have some awareness that the expectations other people try to impose on them routinely cause more harm than good. I have also worked extremely hard to resolve my problems in spite of most of the world actively telling me it cannot be done. I don't see how that indicates I am making bad decisions but want other people to fix it.

Anyway, I really have no idea what your point is. So probably no point in going on.

EDIT: In regards to the PS you added after I replied, since diet and lifestyle changes have been my primary means of getting well and I have not seen a doctor in several years, I don't much care what the US does about the "healthcare system".

if Americans are fundamentally different in their physiology/basic wiring, then the things that work for some other group may not work for them.

On the surface that may seem like a perfectly rational standpoint. The reason why it's part of a superstitious belief is how that idea links up with other ideas. You are not arguing based on social data, but rather the abstract idea of what America is and for better or worse that's an superstitious argument.

Anyway, Western Medicine as understood by the specialists in their respective areas is vary different from that practices by doctors in the field. It's all well and good to prescribe proper nutrition and exercise, but there is no reason not to do it. If your goal is peak physical condition then there is a lot of research in that area, but doctors work around the lifestyles of their customers and most practical research is designed for that setting.

PS: The heath care system protects you in ways that you are probably unaware. Sanitation, food safety, vaccination area all obvious, but healthy populations reduce the spread of disease. The influenza outbreak of 1918, a global plague that killed between 20 and 40 million people, resulted in large part from a local breakdown in heath care on the front lines. http://virus.stanford.edu/uda/

Edit: The evidence of the breakdown starts with: However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US http://virus.stanford.edu/uda/ and it's well worth the read.

On the surface that may seem like a perfectly rational standpoint. The reason why it's part of a superstitious belief is how that idea links up with other ideas. You are not arguing based on social data, but rather the abstract idea of what America is and for better or worse that's an superstitious argument.

In addition to resolving my own health issues, I have also raised two "twice exceptional" kids (gifted and learning disabled). The more gifted of the two was never identified by the public school system as gifted. He was always in special ed. My sons and I have walked away from a conventional lifestyle much as early immigrants walked away from the lifestyle of their native lands to come here. Europeans generally don't understand quite a few things about American culture, including the gun culture here. But Europe killed off most of its deadly animals a long time ago. We still have bears and wolves and poisonous snakes. We also have a lower population density, which means that if you get into trouble, you are more likely to have to deal with it yourself. There may be no one to call upon, much less police to intercede.

Additionally, studies show that Americans generally view more space around them as "theirs". One study found that some criminals in jail claimed such a large space around them as "theirs" that you basically couldn't be in the same room without them feeling you were in their space. This likely was a factor in their generally aggressive/violent reactions to things that wouldn't provoke others. The fact that Americans tend to claim so much more body space than Europeans or Middle Easterners may be part of why we are viewed as "the ugly Americans" -- it likely causes us to start conversations with people whom we think are "in our space" but who view us as butting in inappropriately. This view of or need for more space may well be due to physiological wiring, not just culture. It may well be part of why Americans prefer to spread out and create suburban sprawl rather than live in denser urban settings.

That is just a few examples. I don't think my assessment that Americans on the whole are likely wired differently from other people is simply superstitious. There is substantial evidence that we are misfits and loners and overly aggressive by the standards of more "civilized" cultures. We are mavericks and discoverers and explorers. This may be part of why we were the first to make it to the moon. Those traits are not simply pathological, with no good in them. But they do cause enormous problems in some settings. And there is substantial evidence that traits like that are rooted in physiology -- that "mental" differences are rooted in physiological differences (such as brain wiring).

FWIW: My medical diagnosis is "atypical cystic fibrosis". The typical prognosis for CF is that you get gradually sicker and sicker until infection has eaten away your lungs and you qualify for a lung transplant or die. I am not using diet and lifestyle to seek some kind of peak performance from a place of basic wellness. I have used them to stop being bedridden, close the hole in my left lung, get off 8 or 9 prescription drugs, get well enough to work a full time paid job for the first time in my life, and get well enough to live without a car and get around mostly on foot.

Peace.

> Since I don't have a doctor's note for doing what I do, I can't really justify or defend it on some kind of "legal" grounds or some such. I'm just some lone nut-case who occasionally makes fantastical claims that most folks find unbelievable -- an issue I work very hard to keep out of my place of employment.

There is a difference though. You are probably in the top 1 percentile when it comes to intelligence and being able to rationally research and figure out what it better for you.

But what about the other 99% ? They choose to lead a lifestyle that might in chronic and expensive (yet initially completely preventable) diseases. Then they rely on emergency room treatment and in the end they end up costing everyone more time, money and energy.

U.S. already spends more on healthcare than West European countries that provide a public option and yet delivers worse care for the average of citizen. I don't know that what we have is because we don't provide a public option or because we _do_ provide any govt. sponsored health care. I strongly suspect it is the former, not the later.

Note, that if we didn't have a "free" emergency room treatment option + Medicare and Medicaid, the argument for a completely govt. "hands-off" approach would be stronger. Let everyone who could not achieve a certain financial prosperity just die off. They are unfit anyway. Eventually only the healthy and/or wealthy will remain. I think that would be very disturbing but I think there are segments of the population who would strongly support this.

However, now it turns out that the same people that are severely against govt. doctors telling them what to eat will run the the same govt. run hospital when they have a heart attack. And eventually everyone ends up worse off. The doctor's time is wasted, the patient is in critical condition and dying, everyone's money is wasted.

Perhaps in the end it comes down to education. I think the younger generation is brainwashed into believing certain things about independence, self-reliance, freedom, and so on. But they are not educated to the level where they can function in such a self-reliant manner. I am not. I do not have the tools or the ability, for instance, to test every single piece of meat or produce that I buy in the store. Maybe I am being slowly poisoned. The same thing with medicine. I don't know enough to choose the best medication for me. If I had a serious condition, I doubt I would have the knowledge to pick between prescription mediation A or B.

The point is that our cultural attitudes might actually be harming us as a nation. They are predicated on certain conditions that are just not true anymore. What used to be an advantage has become a disadvantage. And I think we either make the conditions true again (educate the hell out of everyone) or we should try to slowly change our attitudes.

A) I wasn't arguing for or against any particular solution. I was only thinking out loud about what may be at the root of these persistent American patterns.

B) Having very successfully raised and homeschooled two special needs kids and largely resolved my supposedly unresolvable health issues, I have found that wondering why people do the seemingly "stupid" things they do is more valuable and productive than just condemning them for their stupidity and insisting they do...whatever my personal bias suggests is "the right thing" when I don't even know what is really causing the problem.

C) Our cultural attitudes may well be harming us as a nation and as individuals. That doesn't necessarily mean that what works for other nations will be our salvation.

If you want my opinion on some possible viable solutions: What I am finding is that a lot of people, regardless of intelligence level, are using the internet to do their own research and find solutions that work better than what doctors are generally telling them. I also toy with the idea of creating a simulation (aka "game") to teach other people who may not be as capable as I am of figuring it out from scratch how to achieve similar results anyway. There are substantial obstacles to me getting that done. I don't know if I can overcome them in addition to my daily battle to overcome my genetic disorder. I suppose time will tell.

> I also toy with the idea of creating a simulation (aka "game") to teach other people who may not be as capable as I am of figuring it out from scratch how to achieve similar results anyway.

That is interesting. I know the military is trying this. They have a limited amount of time to teach a larger and larger amount of things to new recruits. They are experimenting with VR environments.

But I can see how that could be applied to other things. Perhaps a sim environment that lets someone see how molecules interact.

My ex was career military, so I am familiar with the fact that they do this sort of thing. It is one reason I take it seriously as a potential educational medium: The military has some very solid practices, in part because lives are stake. Similarly, lives are stake with health issues.

I am not really thinking in terms of how molecules interact. I am thinking in terms of how to convey the means to avoid exposure to germs/toxins/etc and also how to convey the subtle cumulative impacts of dietary choices. I think many people prefer pills to dietary changes because the difference a pill makes is readily recognizable whereas dietary impacts are far subtler and easily overlooked, thus not really taken seriously by many people. I've made substantial changes in my body chemistry, in part by micromanaging my diet. This has (apparently -- by observation) made changes in things most people think can't be changed. They need a more explicit mental model and I need a more information dense means to convey my ideas and experiences. The written word on my website is just not adequate to the job.