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What US healthcare means for the world

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Stephanie Flanders | 18:03 UK time, Wednesday, 9 September 2009

I write this from New York, where commentators can talk of little else but President Obama's "make-or-break" speech on healthcare.

For the past month, the US airwaves have been filled with pictures of townhall meetings and demonstrations on health care reform across the country, with angry citizens begging the president not to embrace "socialised medicine", and turn America into Russia. As if.

President ObamaThe good news for the White House is that all that sturm und drang seems to have changed very little. According to the New York Times opinions on healthcare reform are pretty much what they were before the summer.

A CBS poll taken at the end of August found that 60% of Americans still support the idea of a government-backed alternative to private health insurance, compared with 66% in July. And 50% said they preferred Obama's ideas on health care to the Republicans' - down from 55%.

So much for the good news. The bad news is that the financial markets aren't the only part of the economy that can be led astray by human psychology. It can mess up the best laid plans for healthcare reform as well.

One of the big findings of behavioural economists is that people suffer from "status quo bias". They fear change and hold on to what have, even if what they have is pretty flawed.

We saw a taste of it in the UK this summer. No-one has a good word to say about the NHS - until it is threatened from outside, and we all suddenly decide it's the best health system in the world.

As James Surowiecki pointed out recently in The New Yorker
, status quo bias is killing Obama's healthcare reform plans.

In the middle of the presidential campaign a year ago, a poll found that only 29% of likely voters rated the US health-care system good or excellent. But asked the same question last month 48% put it in the good or excellent category.

The only thing that's changed about US healthcare in that time is that voters have listened to months of debate over reform.

Should anyone outside the US really care about what happens? Here are two obvious reasons why we should - and one slightly less so.

The first is that healthcare reform is the most important policy goal of the president of the world's most important country. Win or lose, this battle is going to affect his ability to get other things done as well, some of them (like climate change) extremely important to the rest of the world.

Second, the US healthcare industry is roughly the size of the UK economy. It matters if an industry that size is going to be fundamentally reformed. And, given the rate of growth in healthcare spending right now - it may matter even more if it isn't reformed.

The third, less obvious, reason to care about the US healthcare system is that it has actually played an astonishing role in making the US the world's largest consumer in the past 20-30 years.

Between 1950 and 1980, personal consumption in the US was around 62% of GDP. But in the next 30 years it grew to nearly 70%, about 8 percentage points more than the OECD average.

We tend to think that rise was all due to a debt-fuelled spending spree on foreign-made cars and TV sets.

But the share of spending devoted to those kinds of physical goods actually fell sharply during that period, from 45% in 1980 to about 33%.

That was partly thanks to those things getting cheaper. But the main reason was the onward march of healthcare costs.

According to the US Bureau of Economic Analysis, healthcare costs now account for 16% of total private consumption, roughly double the share in 1975. And of course, government healthcare spending has risen hugely since the 1970s as well.

The bottom line is that America's very high level of consumption relative to other countries is a relatively new story, and it is almost entirely accounted for by rising healthcare costs.

Unlike other consumption, health care spending has even continued to rise since the US went into recession at the end of 2007.

Of course, health care costs have been rising elsewhere - in some cases even faster than in the US. But per capita health spending is still double the OECD average, and US healthcare spending is more than 17% of GDP - streets ahead of anyone else.

Critics say - with some justification - that Obama's plan will do very little to curb the growth in health care spending in the US. It may even make things worse.

You might also say it's up to Americans to decide what they spend their money on. We already know that the rest of the world cannot afford to rely on US consumers in future as heavily as they have in the past.

All of that's true. But if we want American consumers to have the money to buy much of anything at all, we probably want somebody - either President Obama or someone else - to change the status quo in American health.


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  • Comment number 1.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 2.

    US Healthcare is all, and only about, a cartel doing its best to protect itself against competition. It is very little about the health of the nation - that is a side show. It is about insurance premiums. Follow the money!

    Their very justified fear is the any competitor that has a safer risk profile will be able to offer lower premiums for a better level of treatment and so hurt the bottom line of the existing providers but forcing the price down for everyone. It would be a strange situation if the existing health insurance businesses were not tending towards being fat cash cows (for decades). They are scared. As I said earlier it is all about the money.

  • Comment number 3.

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  • Comment number 4.

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  • Comment number 5.

    The problem with a large healthcare system is that it is also a large employer, often of lowly paid workers. Cuts in healthcare means a lot of unemployment and less money being spent by consumers. This is as true in our nationalised NHS or Free Market American way. Cuts may be easy to make but the consequences to the wider economy are much more complex.

    I supose we could retrain hospital managers or porters to make cheap clothing for Primark or even M&S, bringing production back to the UK.

  • Comment number 6.

    Another way the world should look at it is this.
    The rediculous levels of spending in the US means that, effectively, here in England health research is heavily subsidised by Americans. They shovel tons of money into new and innovative medicines (paid for by the high costss and encouraged driven by the possibilities of huge profits) and methods. The English (and rest of the world) can take the pick of the best at a fraction of the cost.
    If this disappears, the rest of the world will either have to start taking a bigger share of the R&D costs or accept that medical development will slow down.
    Healthcare reform may be good for the US, but the rest of the world may regret it!

  • Comment number 7.

    I don't think you need to invoke behavioral economics arguments to explain the reluctance for reform, it is just another instance of self interest as selfishness (a lot of the people have a narrow view of what they are maximising and all of the things they are maximising are about them). Eighty percent of Americans get good or excellent care, a high proportion of them have their care subsidised by their employer or, in the case of the elderly, by Medicare. A lot of these people judge that nothing Obama is doing will improve their care (and may make it worse if they have to share with more people), but what he will do is add to their taxes. I do not believe post-Thatcher (the era of self) that the UK could ever institute a major new , largely altruistic,redistributive, social programme (just as we could no longer fight a war of almost universal sharing of sacrifice). For me the strongest argument for radical US Health reform is that existing arrangements involving company health schemes (which Obama will leave largely untouched)are cripplingly expensive for so many US companies and seriously affects competitiveness- it is therefore around an argument about whether you want the status quo in health or continue to have a job that the case for reform should be made. It is worth noting that, as the UK is now a big spender on health, health care is eroding UK economic performance, if only marginally -the productivity performance of the NHS on any measure is below, on some measures severely below, the productivity performance of the sectors from which the resources are being taken to fund health.

  • Comment number 8.


    Yes, I totally agree, and in this Country it's called the NHS !

    There are actually some real issues here but not the one's commonly touted by the Harridans on both sides. It is about personal dignity and the acceptance of some simple long established rules:

    Do no harm...

    Nurse the sick...

    Comfort the dying...

    The fact that technology can extend life, must be tempered by a judgement based upon the quality of that life and whether those resources might be better spent upon a more viable case and whatever the "Health System"... Think about it because and regardless of personal ability to "pay", the real issue is purely medical in terms of both private and State paid health care.

    The real question concerns ethics rather than cost, at exactly what point and under what circumstances does a Doctor move from trying to "cure" to providing purely "palliative medicine". How can we as fellow "privately insured" or "tax payers", ensure that our "cash contributions" are being used properly in this context ?

    Regardless of cost, we first need to get the "context" right. Did George Best deserve a liver transplant that he rather quickly abused ? It makes little to no difference whether Health Care is funded privately or publicly, what really matters is a holistic appraisal of the potential outcomes driven by both medical possibilities and best value to the whole community whether fellow insurance holders or taxpayers.

  • Comment number 9.

    Providing healthcare entirely by insurance as in the U.S is the most expensive way of doing it because of the multitude of profit centres involved. If you add to that inflated housing costs you get a brake on the economy and high unit labour costs. Somehow Obama has to find a way to provide cover for the 40 odd million who do not have it and at the same time drive down premiums elsewhere through state competition. This is a very difficult concept for Americans to grasp.

  • Comment number 10.

    Comment 5 : Boilerbill

    I agree that there are many consequences to the wider economy from reforming public services so as to produce more efficiency, but I'd seriously suggest that looking at high NHS employment levels as some sort of a boost for the economy is ridiculous. Yes, of course NHS pay has an effect on the rest of the economy, but then so would paying people to build pyramids, or make bombs. It's absurd to maintain employment levels just because there are transitional difficulties in cutting out the chaff. Why should we even begin to think that perpetuating socially useless activity throughout the economy is in the interests of anyone? And, equally to the point, why should those pursuing socially useless activity think it morally correct for them to continue to be paid for it?

  • Comment number 11.

    The US government's attempt to create a government-run healthcare monopoly has been to propose a law that would eventually drive the private health insurance industry out of existence. Additional taxes and mandated costs are to be imposed on health insurance companies, while a government-run "health insurance" bureaucracy will be created, ostensibly to "compete" with the private companies. The hoped-for end result is one big government monopoly which, like all government monopolies, will operate with all the efficiency of the UK NHS.

    Of course, it is difficult to compete with a rival who has all of his capital and operating costs paid out of tax revenue. Whenever government "competes" with the private sector, it makes sure that the competition is grossly unfair, piling costly regulation after regulation, and tax after tax on the private companies while exempting itself from all of them.

    Change is coming? You betcha!

  • Comment number 12.

    No 6 "The rediculous levels of spending in the US means that, effectively, here in England health research is heavily subsidised by Americans. They shovel tons of money into new and innovative medicines (paid for by the high costss and encouraged driven by the possibilities of huge profits) and methods. The English (and rest of the world) can take the pick of the best at a fraction of the cost."

    Since when ?? The pharmaceutical companies, the world over, are not charities. Then are there to squeeze the last penny they can out of every drug they produce. Therefore, they charge the same price for the same drug to Americans AND any others !! This was what the big row about anti-malarial and anti-AIDS drugs for Africa was about. They were sold way above the cost of production although the R&D cost had already been recovered and more.

    However, the major cost differential between US healthcare and elsewhere is in the fact that Americans are the most litigious people in the world. They will sue at the drop of a hat. Therefore, healthcare workers from the lowest to the highest, have to have expensive professional indemnity insurance or its equivalents !! All this has to be factored into the costs of healthcare.

    American doctors are not all that much better paid than British doctors. It's all the rest of the costs that make US healthcare that much more expensive than elsewhere; not forgetting that *MOST* of US healthcare are actually businesses in it to make a profit !!

  • Comment number 13.

    Sadly, I don't think Obama has a cat in hell's chance of getting half his healthcare reforms onto the statute books. There are too many powerful business interests in the US which are working to ensure this does not happen. Look at the number of lobbyists employed by the healthcare industry in Washington who are against this bill and you get a pretty good idea about why this is doomed.
    I agree with you Stephanie that this is important to the world. Largely, because of where it will lead the US natianal debt over the next twenty years if it is not sorted out. Economists and forecasters in the US talk about the coming national debt cruch in about 20 -30 years, when if things are not sorted - Medicaid, Medicare, Social Services and of course interest payments for the trillions of dollars currently growing the national debt will take up most of the National Debt at that time in the future. Other public expenditure on education, defence, homeland security, transportation infrastructure will have to be paid out of further borrowing. However, I guess the dollar will no longer be the reserve currency by that stage and our world's resources will be so depleted by our return to unsustainable growth, it will probably not matter! Mind you at least the climate will be warmer!

  • Comment number 14.

    Who cares about the USA health care situation! Rather worry about the disintegration of British society.

  • Comment number 15.

    Who really cares if the Yanks sort out their health care provision apart from the Yanks? It's up to them how they organise their healthcare!

    However, if looking after your sick and needy is one of the signs of a civilised society then you can look at the the growing precentage of Yanks who have no healthcare cover and wonder. Along with that consider the number of homeless people there are in the US and the latest guestimate (apparently endorsed by the White House) that approaching 8% of children in the USA go to bed hungry! And all this in suspposedly the richest nation in the world.

    This is not a question of economic choices. It is really a question of civilised values.

    Whilst we are at it, let's not attack the vested interests in the US system defending their position when we give free range to vested groups both within and without the NHS to shape public policy eg the latest rant on alcohol advertising.

  • Comment number 16.

    Part of the reason private health insurance has become so expensive in the US is the litigious nature of American Society. Their attitude is if anything goes wrong, or doesn't go quite to their satisfaction, obviously they have to sue someone. For this reason, American doctors have to pay ever increasing premiums for their public lability insurance, so the whole things spirals upwards with costs out of control.

    The NHS is far from perfect, but it is certainly not all bad either.

    In a civilised society, we do not believe that medical care is only for those who can afford to pay. The current American system lacks compassion and is a stain on their society.

  • Comment number 17.

    "One of the big findings of behavioural economists is that people suffer from "status quo bias". They fear change and hold on to what have, even if what they have is pretty flawed."

    Stephanie - Please spare us from this ridiculous notion that behaviour economists are somehow breaking ground with such findings. Yes, they may come up with some fancy new buzz word or phrase "status quo bias", but actually this is nothing more than saying that people resist change. Surprise, surprise. This is a fact well known to mainstream psychology and management consultants for many decades. Unfortunately, the relatively new field of behavioural economics seems intent on trying to con everyone, including many economists who are less well versed in psychology than in mathematics or accounts that these are breakthrough findings. Most of the time its simply plaguriarism from another discipline.
    Generally, social psychology and managerial/organisational psychology shows that people will often proclaim their love of change (e.g. the Obama brigade, now followed so originally by Cameron). However, when asked to make changes in their own lives, many will then reconsider their position. Indeed, the organisational behaviour literature is full of examples of cases within companies where resistance to change is a problem, whether in its passive or more so in its active mode.
    So one should hardly be surprised that when the majority of Americans within their healthcare system are asked to make changes, which will probably involve their either losing some benefits or paying more for existing benefits to help those outside the system, then the mood shifts towards a more reactionary stance.
    In many respects, this is simply human nature. The world is littered through history and inhabited by such examples at present. For example, many people may support a grand idea or principle such as "combat climate change". However, when asked to make the necessary sacrifices, the numbers tend to decline. This is because when individuals are asked to make the changes, they suddenly realise that the sacrifices are more than they want to make. Sure, they can still see the benefits, especially if everyone participates. However, the notion of relative contribution comes into play. So in this example, some people might say I support change in policy to protect the climate, but I cannot make major sacrifices such as changing the SUV, foregoing holidays overseas on long-haul flights, etc., especially if there are one billion Chinese who are increasing their relative levels of pollution. Unfortunately, these kinds of sentiment are also fuelled by a lot of misinformation (sometimes provided by courtesy of the government or business interests), so the person in the street is quite frankly not really aware of the true facts. Indeed, today's world seems to increasingly revolve about soundbites based upon faulty science, bad reasoning, distorted statistics and political spin. People will therefore end up desparately wanting change, but then getting hopelessly confused when presented with the options and alternatives; hence reverting to the status quo as a "better the devil you know alternative."

  • Comment number 18.

    How easy it is to feel smug about this one, when we all know that the NHS does not deliver standards of health care that bear international comparison. Hats off to Obama for putting his head above the parapet. Sooner or later it's an issue UK government will have to address, I suspect with just as many sacred cows and vested interests to confront.

  • Comment number 19.

    #17 Strighalk,

    Totally agree!

    When discussing this issue with Americans they invariably link health care change to socialism. When you question them further they don't actually know what socialism but they know they don't like it!!

    I get the feeling that, they feel that, if they adopt Obama's proposals then it will signal the end of The American Dream. Unfortunately it may well be that The American Dream is over irrespective of health care changes.

  • Comment number 20.

    "One of the big findings of behavioural economists is that people suffer from "status quo bias". They fear change and hold on to what have, even if what they have is pretty flawed.

    We saw a taste of it in the UK this summer."

    Ummmm so, you do read the blog! ;-)

  • Comment number 21.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 22.


    If the Obama administration manages to push through their healthcare reforms in the US congress, then it will result in some big winners and also some big losers. Let's have a look at who the winners and losers will be:


    1. The large US medical insurance providers such as Blue Cross or Blue Shield. Why will these large companies become winners? Essentially, these large companies will lobby the administration to introduce regulation which will price the smaller competitors out of business. How does that work? Large companies are able to absorb regulatory and other costs better than smaller ones. Less competition, of course, means higher costs for consumers. The field then will be left clear for these large corporations to operate a government sanctioned monopoly but, at the same time, give the appearance that healthcare is still provided by the private sector when, in fact, the reality is that it has become more socialised.

    2. The "Disease Groups", such as the breast cancer, heart disease and lung cancer lobbies. These organisations will lobby state capitals and the US Congress by arguing that it will be a great idea to force every healthcare insurance plan to cover their particular disease. If these lobbies are successful, then US citizens will be compelled to pay the extra costs for cover whether they want that cover on not.

    3. The US government itself, of course. More regulation equals more taxpayer funded government bureaucracy and more government non-jobs.


    1. The US pharmaceutical industry. How come? Presently, the US is the only country that allows its pharmaceutical companies to charge market prices for their products. This enables those companies to invest more in carrying out R&D into new, innovative and potentially life saving drugs. In other countries in the rest of the world, governments have slapped price controls (fixing the price below market prices) on their pharmaceutical industries and therefore less money is available to invest in R&D. Once the US government controls the healthcare industry they will force US drug companies into the same position as their overseas competitors. In effect, the US pharmaceutical industry will become a mere utility for providing yesterday's drugs for today's patients.

    2. The US citizen who already has employer provided health cover. His or her cover will be taxed more to fund the "Grand Plan".

    3. Any US citizen who doesn't have health insurance plan. They will be forced to pay for one after the reforms are passed by the US Congress.

    4. The small healthcare insurance companies. See WINNERS para. 1.

  • Comment number 23.

    No 11 "The hoped-for end result is one big government monopoly which, like all government monopolies, will operate with all the efficiency of the UK NHS."

    Look further !!

    *Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt. Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized catastrophic health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries."*

    The NHS is *NOT* the only government operated healthcare system in the world. Most developed countries have a government operated healthcare system. Our neighbours across the ditch have an excellent, albeit expansive, one !! I have friends working as doctors and nurses in their (French) hospitals so I do know something about it !!

  • Comment number 24.

    No 17 "...but actually this is nothing more than saying that people resist change"

    Well, the great unwashed rioted bloodily in early October 1582 when the calendar was switched from the old Julian one to the new Gregorian one. They shouted, "Give us back our 11 days !!", totally ignoring that those days didn't actually exist.

    Will the people in the US riot to protect their virtual or non-existent "right" to pay for their expensive healthcare ?? We'll have to wait and see !!

    Meanwhile, the sun still rises in the East and the birds will sing.....and then poo all over your car !! :-)

  • Comment number 25.

    "Americans are the most litigious people in the world. They will sue at the drop of a hat."

    I believe this is perhaps not due to the nature of Americans, but their system of punitive damages. As far as I understand, this means that any financial penalty levvied on an offending corporation or individual is paid directly to the person suing (but then at the same time set at a size that hurts). So if you successfully sue a sufficiently large fast food chain, you get paid tons of cash even if the issue only affected you in a small way, because it also affected millions of others in a small way. Who wouldn't? Perhaps Obama should start here...

  • Comment number 26.

    How to sell a sub-prime mortgage the US way !! Brave lady, she stood up to the pressure !! Now for the next sales bonanza - healthcare insurance !!

  • Comment number 27.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 28.

    In the end history remebers key points, not the detail. The key point is that for whatever reason 40 million Americans cannot afford healthcare. If America wants to have any moral authority in the modern world it has to deal with this.

  • Comment number 29.


    ishkandar (#23) "The NHS is *NOT* the only government operated healthcare system in the world."

    Yes, see Cuba......;-)

    This current fuss about the 'Russification' of the USA should bring home to some how and why Britain made itself just a little unpopular wih the American business elite back in 1945 and beyond....

  • Comment number 30.

    #15. foredeckdave wrote:

    "Who really cares if the Yanks sort out their health care provision apart from the Yanks?"

    The problem with insurance based private sector schemes is that they are part of the same international insurance panoply as all other insurance companies, including ... banks... etc... This 'may' make the outcome of the insurance v.s. state healthcare argument important to the UK as we have this great 'advantage' of being the World's major financial service centre!!!!

    "This [healthcare] is not a question of economic choices. It is really a question of civilised values."

    Quite right, a nation's civilisation is measured by how it treats its poor, sick and underprivileged (not an original thought of my own - try the US Declaration of Independence or Constitution or some such source! or even the Bible!)

  • Comment number 31.

    #30 John_from_Hendon


    The concentration of wealth (economic power may be a better term) is a very worrying question that must be addressed if this global economic mess is to be sorted.

    It may be a 'hobby-horse' of mine but I really feel that wealth, both corporate and privtae, has undergone a major change. Firstly it divorced itself both physically and psychologically from nation states. Now it appears to have divorced itself from the tangibles upon which it is supposed to be based. If we ever had to meet the old promise on the banknote then I think that we would uncover a string of valueless 00000s!

  • Comment number 32.

    Agree that America funds leading edge research and that we benefit as a consequence. That leading edge stuff though can seam meaningless to someone who can't afford the basics. Surely the duty of society is everyone gets basic healthcare at least- that American levels of infant mortality should be up there with the best. Not just superb care for rich middle aged men with prostate cancer.

  • Comment number 33.

    tayldn123 (#32) "Surely the duty of society is everyone gets basic healthcare at least"

    You beg the question like so many others.

    Duty to others is a socialist notion, but it's anathema to staunch anarchists/individualists i.e free-marketeers, where the rights of individuals take precedence over the power of the state. That translates into everyone paying for care as a service. Anarchists object to expanding social-welfare as this means their taxes go to supporting others, especially the underclass. To the anarchists, that 'disincentivizes' the latter. Ironically, in the land of the free, the poor (low cognitive ability) generally have to fend for themselves. The fear is that anything else encourages them to breed and sponge off the harder-working (more able). The latter want consumers but they don't want to subsidize them more than they have to to keep them consuming. The alternative is to limit the size of families amongst those unable to support them, which is not quite the same as not having a welfare state. The fact that the USA (and ever more so, EU states) is liberal-democratic (whichever party is in power), means that little gets in the way of progressive regulation and privatization... Obama makes grand promises, but his odds on delivery given the nation's debt (see our planned cuts in public services too) are low...

    The fact that this rights-duties issue is so grey in Liberal-Demoracies is why arguing the point is so futile. Duties were central to the Soviet and PRC constitutions. They were also central to Old Labour, and National Socialist in general. The Liberal-Democracies underrmine this. Watch the UK and USA privatize more.. it's relentless. That, along with low TFRs overally (especially in the brighter half of the population) is pretty much all that matters as dependent variables I suggest. :-(

  • Comment number 34.

    Great article Stephanie. We (I'm writing from USA) will have to reform our health care system sooner or later. The costs are too much of a burden on our economy. It's health care costs that crushed General Motors (not to mention not making any high quality small cars, ahem).

  • Comment number 35.

    #28 sonbinor39. The only type of authority that US oligarchs are interested in is the type that is delivered from 30,000 feet, and backed by 12 fully operational Carrier battlegroups.

  • Comment number 36.

    My husband was ill a couple of years ago.

    The bill for two days in an american hospital with every known test was $66,000. We know because we were receiving the statements from the insurance company. Our copays were about $250.

    The drugs he how takes to prevent a recurrence that could require nursing care for life cost about $500 per month. Our copays are $30 per month.

    Workers where we live preferred increases in their benefit packages paid to their union who provide pay to cover long term sick, pensions and health care to extra pay in their back pocket. This has been the case for 4 years and based on the numbers above its not difficult to see why.

    These are the people for whom health care is a crippling expense but who earn to much to get Medicaid.

    My older neighbors get their healthcare (for the most part) via Medicare.

    It would be very interesting to know how much of the 17% of GDP is spent on these patient groups and how much on the insured 18-65 year olds. This matters. Its government spending. It partly causes the US deficit. This does matter to the rest of the world.

    Given that the money spent on healthcare stays in the US, for the most part, its not the same as borrowing to purchase overseas. This matters to the rest of the world

    When 70% of US bankruptcies are caused by health care costs, it really does matter to Americans.

    And pharmaceuticals actually help keep people out of hospital reducing costs overall. That should matter too

  • Comment number 37.

    The issue here must surely be far more basic than is currently being portrayed in the US. This is not evil socialism taking over the world at the expense of the American dream- that is simply modern marketing confusing and muddying the water, previously it was known as propaganda.

    The fundamental issues remain;

    1. Poor people should have access to basic health care in a prosperous country,

    2. Access to that health care should be universal and not assessed by means,

    3. Health care should not be dependent upon terms of a contract where there is a disproportionate and grossly imbalanced bargaining position between the parties, e.g. consumer vs. insurer.

    4. Having been in a car accident someone should not be presented with a £15,000 bill having been in hospital for 14 days (not me but a friend).

    In the U.S your healthcare provision, and ultimately, often, survival, rests on the terms of your individual policy or contract. This is fundamentally flawed and leaves the poorest people in society, most vulnerable.

    This is not a left wing/right wing debate, it is a moral duty. In previous times companies accepted by convention a degree of corporate social responsibility but what is not apparently widely acknowledged or discussed (partly due to lobbying), is that this is no longer the case. If an insurer/loss adjustor and/or underwriter can mitigate their loss, they will. The personal impact of such decisions can be shocking.

    People die in America because their insurer says they have reached the maximum benefit under their policy. People are not treated as they cannot afford the excess on their policy. Their are flaws in any system, but to have no safety net, to be turned away at the door to the hospital, of the wealthiest country in the world? This is a sad indictment on a nation which holds itself out as something entirely different and as modern and inclusive.

    However- why is this all so difficult? Because they have left it too late. Their insurance industry is grotesque, a lobbying beast like no other. A huge employer, a massive chunk of the economy and on a scale that cannot simply be swept aside overnight. Change is desperately unpopular but Americans need to wake up and smell the coffee.

    Particularly when their unemployment rates are so high, and rising.

  • Comment number 38.

    pawns_or_players (#37)

    The fundamental issues remain;

    1. Poor people should have access to basic health care in a prosperous country,
    2. Access to that health care should be universal and not assessed by means,"

    Say poor means lower genetic ability to cope. Say it means more prone to diseases too. Say those diseases include risk of heart disease, obesity, Type II diabetes, substance abuse, violence, 'mental' illness etc. What is basic care? If this means life-time drugs and care/supervision/nursing/custody in the community at what cost, and to whom? Factor in the much higher birth rate in those least able to cope and you start to see the picture, especially if the birth rate amongst the more able (who not only earn more, but provide essential services) is shrinking - which it is...

    See the problem? It's economic. Those who make out that peole are basically all the same and hat it's just access to money which differentiates people miss the point that what makes people different is their genes and if those who carry the most at risk genes have the most children, a public system will not be able to cope as it a) won't have enough people and b) enough money. See the doctor-patient ratios in sub-Saharan Africa and S. Asia. Check out mean IQs where the ratios are very high..

    Those who gloss over all these facts are eiher being conveniently negligent or are cognitively-challenged.

  • Comment number 39.

    How everyone remains naive astonishes me. Reflect back on the banking and financial services. Supposedly government regulated and supervised. When all the abuses were recognized and it collapsed the government stepped in with taxpayer monies and wrote them a big check and bought all their bad investments. Same thing with US healthcare. Most reports clearly show that the public option could be funded by the elimination of fraad in the system. The Republicans are the defenders of fraud as many of their supporters make a lot of money in healthcare and fraud helps finance campaigns. Big business run governments...all over the world. This isn't about healthcare, it is about government sponsored graft and corruption. Governments no longer represent people, they are always proud to say they represent "interests." People tend to vote for their own disadvantage.

  • Comment number 40.

    Private medical care businesses have many mouths to feed from their health cash plans,budget and fully comprehensive indemnity plans and modular medical benefits. Actuaries work out claims reserves , do they, and hospitals are staffed and built and surpluses invested. Shareholders take their cut.I dont know how the OECD work out their per capita healthcare costs - are they comparing private premiums payable with public service provision costs in universal care systems netted back to everyone?

  • Comment number 41.


    Actually healthcare is a misapplication of your ideas here. The greatest strain financially on healthcare is support of the aged (that's not a fact - I am just guessing).

    Obviously if people are genetically superior and prone to long life, that is a greater cost to healthcare than higher reproductive rates.

  • Comment number 42.

    No 41 Frank - Read that book - Make room. Make room. by Harry Harrison. It was made into a film called - Soylent Green. In that book, Harrison postulated "Temples of Euthanasia" as a solution for the aged.

  • Comment number 43.


    And another point is gene therapy. I would imagine that blanket DNA alterations in a human body would result in this genetic information being passed on to descendants. If healthcare would mature to direct genetic manipulation, then the world would be very different and some of the points JJ raises might become obsolete.

  • Comment number 44.

    ...or rather, disguised. Is being able to modify your own DNA eugenics and would it be a neat answer to these problems?

  • Comment number 45.

    No 44 Frank - eugenics is when questions like "who chooses what to be altered" are answered.

    In his series - War Worlds - Jerry Pournelle postulated a race called the Saurons that deliberately selected for superhuman physical characteristics. They then set out on a galactic domination only to be hammered because they were strategically hopeless. They forgot to select for mental characteristics as well. :-)

  • Comment number 46.

    #42 ishkandar,

    Ah! those famous words, "Solent Green is people" but perhaps not quite as epic as "May the Schwartz be with you" :)

    For me, euthanasia can only be a voluntry decision.

  • Comment number 47.

    ishkandar (#45) Eugenics is to be contrasted with dysgenics. Dysgenics means deterioration of the gene pool. One ends up with less able people to provide medical care and other services to lots of people who need it. Hostility to eugenics aids nobody, and harms everyone in the end. Eugencis means good family planning/breeding. Don't believe the black propaganda 'science' ficton, much of it is subversive. Argue with the facts as much as you like, but so long as we don't do anything one can look to nations with dysgenesis to predict what will be coming. Is that what anyone wants? Is that wha those who migrate here want? I don't think so. They just don't think. Do able people from S Asia and Africa who come here for a better life care about the people they leave behind or are they just interested in themselves? So much for duty to others...

  • Comment number 48.


    Eugenic / dysgenic according to what criteria?

  • Comment number 49.

    FrankSz (#48) "Eugenic / dysgenic according to what criteria?"

    I've spent an awful lot of time and effort explaining this!

  • Comment number 50.

    Addendum (#49) What part of this (Feb 2007) has still not sunk in?

  • Comment number 51.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 52.

    No 47 "Do able people from S Asia and Africa who come here for a better life care about the people they leave behind or are they just interested in themselves? So much for duty to others..."

    There is an entire city in Bangladesh that is "almost" British. It was and still is built up with money earned by the Bangladeshis who have migrated here and have sent their honest and hard earned money home to help build up a city and provide much needed jobs. Look it up if you will.

    "Dysgenics means deterioration of the gene pool."

    The Nazi/Hitlerian dream was certainly one of dysgenics by *your definition* since they advocated the in-breeding of a small gene pool and tried to wipe out any one not from that small gene pool.

    It is a well established scientific fact that small gene pools are non-viable and that they will soon die off if mutations or cross-breeding does not occur !! Of course, this is totally contrary to political/racist dreams but, then again, such people will allow ideology to over-ride inconvenient scientific facts !!

  • Comment number 53.

    If Obama succeeds, we'll be able to go to the USA for free health care. It would make a change from them coming here for free care from the NHS.

  • Comment number 54.


    ishkandar (#52) "then again, such people will allow ideology to over-ride inconvenient scientific facts !!"

    You are writing irrelevant nonsense and ignoring he facts. Please learn a little science to replace your love of argumentative rhetoric. I've given you the demographic facts and all you do is repeat black propaganda which I've been saying has been instrumental in bringing about the decadence via Liberal-Democracy. Your horror stores are just that, tools for promoting Liberal-Democracy, which is the real horrow baed on its TFRs.

    Look into the changing demographic of London, especially East. Look at the dysgenic fertility in Pakistan and Bangladesh (population has tripped to 150m (3x Britain's) in the same period Britain has risen by 10m. Muslims and Jews suffer genetically via inbreeding (the former by consanguineous marriages). For the British community this shows up in the SEN figures), in Jews it shows up in a number of well documented genetic disorders. The German program was about raising the birth rate after WWI. Singapore tried this, but failed (so called celver humans are not really all that smart, especially the arts trained ones). Russia is trying it by bribe its people to have kids with fridges etc! Look up TFR 1.1-1.3 across Europe. What do you notice? See what happens to the population with a TFR of 1.1-1.3.

    Now look up the ratios of doctors to patients in S Asia (mean IQ= ~81) and Sub Saharan Africa (mean IQ= ~70). Look up the rank ordering of these groups in OECD PISA tests (they present some sub-group data) and especially our own national Key Stage SATs (and USA SATs). What do you notice?

    You are not paying attention to what matters. This will destroy (is destroying) Europe and the USA demographically/economically. Reducing these European gene pools to the same status of the above S Asian countries and Sub Saharan African countries (see the different TFRs of Eureope and the above countries) in the name of 'equality' is not smart, it's dumb, and it's subversive/economic suicide. Look at the economies of those S. Asian countries and Africa.

    This is why the USA health care system is in a mess (se Hispanic immigration and TFR - by 2050 the European Amercan population will be about half the population, and then start falling further). In the UK, the NHS is under severe threat along with other public services like education, for the same reasons.

    I suggest that this is how immigration is actively used to destroy socialism in the liberal-democracies and encourage free market anarchism/consumerism.

  • Comment number 55.

    Glenis Devereux

    So I've been playing with your XLS simulator on the site.

    First some feedback
    a) Your comments and text are practically unreadable. If your aim is to convey a message, why don't you do it properly?
    b) The XLS sheet is pretty nice. You've put some effort into it. The choice of XLS is good in that it allows other people to play with it. I would have written programs in C#
    c) The XLS sheet doesn't work when you first download it. The buttons fail without error. The way to fix it is to change Macro security on the client to Low, close the workbook and re-open it. This won't be obvious to your intended audience, and the one comment on your site about the XLS is that it does not work.

    Now to the storylines/scenarios themselves:
    a) Banks must have some percentage of issued loans held as reserves. It is a small percentage, but it is missing from the model. Simply issuing a loan without capital reserves is illegal. Not to say it doesn't happen, but when banks do this, they usually go running off to the central bank for loans.
    b) Central bank missing from the model
    c) Interest burden missing from the model
    d) Asset speculation missing from the model

    However, your simulations do serve to illustrate something that I hadn't actually got clear in my mind until now:
    - Someone, some group, actually has to CHOOSE how/when/where to inject capital into the system properly, in order to keep the economy ticking. It's all smoke and mirrors, the leadership is just a bit more sophisticated.

  • Comment number 56.

    See anything familiar here?

    Incidentally, those really interested in 'Behavioural Economics' should skip 'Prospect Theory' and go back and look where all this work really started (cf. Chung and Herrnstein in the 1960s on quantitative analysis of parameters of reinforcement (e.g. delay......) before it was translated/appropriated by the cognitivists. Chung got out of it quite early, went into medical research. Herrnstein allegedly thought there was a 'liberal conspiracy' at the end (see his work published in 'IQ in the meritocracy' and 'The Bell Curve'. I've spelled some of this out for those interested.

    Unwitting group competition for resources?

  • Comment number 57.

    No 55 "I would have written programs in C#"

    C sharp ?? Eeek !! Unclean !! Unclean !! Do it in Assembler !! :-)

  • Comment number 58.

    #57 Teehee. I used to do it for a living when I wrote games back in the early 90s. 6502,68000,80x86 etc. Quite fun.

    Now its UML, Object Orientation, Aspect Orientation, Functional Programming, parallelism and anonymous close to philosophy that there's no difference.

    Can one subclass Loan from Interest Based Fund? Can class Money permit a negative amount, or should the Account be associated with a positive only Money class, but expose DR/CR properties? ;-)

  • Comment number 59.

    Frank Sz (#58) "I used to do it for a living when I wrote games back in the early 90s."

    Lots of people can program FrankS... The point to grasp is that as with maths and logic in general, it is 'analytic', and as such, has nothing to do with reality per se. It is just a useful way of automating how we 'effectively' manage physical reality. Alas, in recent times it has become and end in itself (i.e. for the excitement it can bring via 'surprise' in virtual reality). Without good data it's a waste of time. It has become a sink hole for the self-obsessed.

    Take note.

  • Comment number 60.

    No 58 And then there is the all important variable size. It had been discovered the hard way that currency should be expressed in its smallest unit in order to have accurate results in currency conversions. Most reliable exchange rates these days are expressed to 6 decimal places. Then after conversion, there's the rounding up to do to make them more "human legible".

    That's why, programming for derivatives are "so much fun" !! Throw in the fancy stuff like "butterflies" and "condors" and you'll find a lot of bald designers and programmers !! :-)

    Never done any games myself so I haven't any idea what it feels like but designing for all that financial stuff is enough to drive a man to drink. Speaking of which....

  • Comment number 61.


    And then there's the hysteresis of repeated operations on a fixed-precision quantity, and tracking the accumulated error margin as part of the quantity. eg: "Balance: 50.0001USD +/-0.01% error" .

    We should have stuck with analogue computers so we could keep numbers in capacitors.

  • Comment number 62.


    Addendum (#59) Can everyone spot the begged questions now?

    Can everyone spot the irrational psychology which is intensional?

    Central Planning..... as we once had it before it was subverted. Is Obama a Central Planner? See his campaign team.

  • Comment number 63.

    If Obama's team was truly into Central Planning/welfare etc, we would have seen the beginnings of a reversal in much that's been happening in Europe over the past 50 years, beginning with the way that Financial Services are regulated and a reversal of privatization. We'd see the death of political correctness (which is right wing anarchistic not left wing) and we would have seen troops pulled out of Iraq and Afghanistan in conjunction with a massive change in policy towards the Middle East. To me, the indignant noises from Israel seem feigned. China and Russia would be helping the USA and the animosity to Iran would have stopped, and Miliband would not have been able to have behaved as he did during the Iranian elections. New Labour would be in massive retreat, with Old Labour riding high and the Conservatives running for cover with the Lib-Dems. Obama's PR team has trie dto stage manage some of the above, but the behaviour of the UK is the give-away I suggest. :-(

    Sadly, what we appear to be seeing is just more theatrics after another makeover just as we had when New Labour took over in 1997.

    It would be nice to be proven wrong in he future.

  • Comment number 64.

    JadedJean's obsession with Hayek: What does it mean? Maybe, a suppressed admiration for him? Is JadedJean, deep down, an anarchist struggling to get out of a statist mindset?

  • Comment number 65.

    On The Status of Untruths, Deceptions and Misunderstandings in #54

    ishkandar has every right in his post #52 to make the statement "then again, such people will allow ideology to over-ride inconvenient scientific facts !!" as the claim that small gene-pools are non-viable is supported by the evidence so far reported.

    "Look into the changing demographic of London, especially East." Let's put the demography of East London into context before making claims about its implications. Since the Middle Ages the Eastern part of London has always been an area of high concentrations of immigrants - English peasants, Irish and Scottish peasants, Huguenots, Jews, Eastern Europeans, West Indians, Bangladeshi and Bengalis. The commomality is that all have been poor and needy upon arrival and have dispersed with the general community over time. Therefore the changing demographic of East London is no kind of new or dysgenic problem but one that both the capital and the nation as a whole has coped with over centuries.

    If you wanted to draw attention to a long lasting population change then you may have had more success by looking at Southall - but I nearly forgot the attainmnet levels of the 2nd/3rd generations here are significantly higher than the 'standard' population so therefore doesn't support your falicy!

    "The German program was about raising the birth rate after WWI." What have become known as The Nuremberg Laws addressed themselves to racial prurity and did not codeify any requirement to increase procreation amongst the Volksgemeinschaft. If you wish to refer to the German civil honours and pensions granted to mothers then I would also refer you to the French system that was also in place at the time (without the 'purity' requirement).

    "Now look up the ratios of doctors to patients in S Asia (mean IQ= ~81) and Sub Saharan Africa (mean IQ= ~70)." What is this statement supposed to mean? That S Asia and Sub Saharan Africa are/have been deprived areas is unquestioned. The number of doctors per patient is merely a reflection of their economic development. Whilst the figures are not available and therefore the comparison cannot be accurately made, it is likely that the ratio would be very similar to Western European countries at similar stages in their eonomic development.

    "our own national Key Stage SATs (and USA SATs)" Now you brought in the concept of IQ. Our Key Stage tests do not measure IQ. The scores are manipulated to give an approximation of what the IQ score might be. Amongst Educationalists in the UK (and elsewhere) there is common agreement that IQ is a very poor indicator of individual value and potential and that SATS themselves are next to useless - except for bureaucrats and politicians!

    "Reducing these European gene pools to the same status of the above S Asian countries and Sub Saharan African countries" There is NO indication that the gene pool of Europe has been reduced.

    "This is why the USA health care system is in a mess" The USA health care system has been in a mess for many many years. The fault lines have been exposed by a rapidly increasing jobless total and the ever increasing cost of health provision. it has little or nothing to do with Hispanic imigration.

    Similarly you assertions regarding the NHS and education are totally unfounded.

    "I suggest that this is how immigration is actively used to destroy socialism in the liberal-democracies and encourage free market anarchism/consumerism." If immigration is being actively used "to destroy socialism" then you will be able to tell us all who developed this policy and who is 'actively' using it?

  • Comment number 66.

    foredeckdave (#65) Please try to learn something.

    Apologies if you have a learning difficulty. See pictures in this link if you do. This is reliable data. Repeated every year at Key Stages. Also in USA and elsewhere. It's very probably genetic.

  • Comment number 67.

    No 65 "Since the Middle Ages the Eastern part of London has always been an area of high concentrations of immigrants - English peasants, Irish and Scottish peasants, Huguenots, Jews, Eastern Europeans, West Indians, Bangladeshi and Bengalis."

    And then there were the church immigrants, The Dominicans, the Franciscans and the Carmelites also know as the Blackfriars, the Greyfriars and the Whitefriars. Their names still live on in London's street and area names !! And previous to that, there were the Danes and the Saxons who set up two markets in London knows as "cheaps", one in the East and one in the West !! Eastcheap now exist as a road and Westcheap has become Cheapside !!

    Then there's the worst illegal immigrants of them all - THE POTATO !! These damn things are all invasive !! Why, you can find them in any supermarket or food shop !! Send them home, I say !! NO MORE Potatoes !! :-)

  • Comment number 68.

  • Comment number 69.


    If you had the ability then you could answer the charges in #65. As you are either unable or unwilling to do so then they stand to convict you of Untruths, Deceptions and Misunderstandings.

    In your case DSM IV-TR criteria are confirmed as applying.

  • Comment number 70.

    #67 ishkandar

    But what will we do with all the Chippies?

  • Comment number 71.

    foredeckdave (#69) "If you had the ability then you could answer the charges in #65....."

    Because of the generally obnoxious way that you post, I only respond to what I consider to be rational in your contributions. As most of them are hopelessly ill-informed and aggressively defensive/offensive I gloss over much of what you post. You should be far more appreciative given the things I tell you about - especially given that you still have a lot to learn about yourself, and yet I take it you're not young? ;-)

  • Comment number 72.


    Thank you for your reply. I am very grateful to you for presenting me with the opportunity to expose your untruths and deceptions.

  • Comment number 73.

    foredeckdave (#69) "I am very grateful to you for presenting me with the opportunity to expose your untruths and deceptions."

    You don't appear to have grasped that you aren't in a position to expose truths and deceptions, just what you don't know/understand/believe.

  • Comment number 74.


    Then prove it. Put quite simply put up or shut up. If you can't defend your statements and prove mine to be factually wrong then all of your posts will be tainted with the charge of being untruths and deceptions.

    The time for avoidance is long passed!

  • Comment number 75.

    No 70 "But what will we do with all the Chippies?"

    Deep fried turnips ?? :-)

  • Comment number 76.

    foredeckdave (#74) "Then prove it. Put quite simply put up or shut up."

    Proofs are things one does in mathematics. You need to go and do some research. Empirical research. It would help if you had a science degree first. It would enable you to grasp what's been provided in the posts and links. As it is, it's painfully clear you don't know the first thing about research and how it's done.

  • Comment number 77.


    Stop dissembling. You do not have either the moral or intelectual high ground even though you have convinced yourself that you do.

    If you actually engage in any form of research then you will know that, when presenting conclusions and implications one is very circumspect regarding the limits that can be supported by that research. You are not doing that. Therefore your 'defence' also falls.

    You have cobbled together pieces of research, removed them from their terms of reference and created a new reality to fit your own tainted views. Your empiricist credo lies in tatters.

    Now everybody has the right to believe whatever they want. Contrary to your statement, everybody has the right to be wrong. What you do not have the right to do is to propogandise those views as facts. What you do not have the right to do is insult either other bloggers or the basis of their arguments. As you continue to do both ten you can expect to continue to be challenged and corrected.

  • Comment number 78.

    foredeckdave (#77) Look at the Standards Site data on ethnic minorities achievement and bear this in mind when looking at the ETS material (linked to many times). Look elsewhere for borough breakdown by ethnicity. South East London boroughs are mainly black when it comes to ethnic minorities, these are high risk for crime, low attainment, exclusion etc, but have normal TFRs so do not contribute to massive growth except via immigration, they are mainly English speaking as a first language too. The boroughs North of the river and East are primarily S. Asian and have high TFRs. Growth is in these areas, atteinment is slightly higher than South of the river, but growth is much higher as it's above replacement (Tower Hamlets is about 24% White British as Key Stage 1). The rank ordering of attainment in KS results is in the pdf at the Standards Site (this is just a summary of much more extensive data). This ordering has been the case for approximately a decade (as long as the etnicity data has been recorded). The group achievement gap has not been closed anywhere in the world. Look at the USA for the orderings. This has been a major research area since at least the 60s.

    Neither I, nor anyone else in these blogs is obligated to justify what's said here apart from providing some links for those interested. I have referenced material here and eslewhere many times. It is all well known amongst professionals. It is up to you to find out more if you wish to.

  • Comment number 79.

    Addendum (#78) Just to be clear, this has nothing to do with skin colour or racism per se. The group at the top of Key Stage results every year at KS1 - KS4 is the British Chinese, followed by British Indians (British Jews are not included in the British 16+1 scheme, but other drawing on Faith School data suggests that they would be up there along with the other top groups).

    The point being made is subtle. It is epidemiological. It is about groups, prevalence rates of behaviours (and their functional relationships with other key socio-economic variables), reproduction rates and projected demands on resources.

  • Comment number 80.

    ...and so the BBC invites consideration of US health care policies and expenditures, and BBC contributors examine their navels, their intelligence and the supposed, imagined or postulated intelligence of others.

    Is there no understanding anywhere. The US has no money therefore its domestic health care fantasies are irrelevant.

    JP Morgan has a balance sheet showing some $87 trillion of derivatives. The Chinese government has announced that Chinese state owned companies are free to default on obligations arising under derivatives contracts with foreign entities.

    Hong Kong has required that its gold, currently stored in London, be returned to Hong Kong. The Chinese government has advised its citizens that they should consider acquiring gold and silver for its investment potential.

    This should tell you two things; (i) The Chinese do not want anything to do with the toxic US$, and; (ii) The Chinese recognise that the US government has been captured by financial oligarchs (how could it be otherwise when one bank is allowed to develop a balance sheet about 5 times larger than the GDP of the sovereign state in which is is headquartered), and have essentially declared a kind of financial war on those that control the government. Maybe this is the fabled "third way" in action.

    The financial oligarchs have already threatened to bring down entire economies unless governments authorise a further massive transfer of wealth to them (currently about $13 trillion and counting). Do you really think they are about to simply hand over power to China? Do you really that China will succumb to overt intimidation?

    The future is bleak, someone needs to start telling the truth. Absent a willingness to tell the truth then people need to demand that they be given access to the truth. That perhaps would be a measure of intelligence!!

  • Comment number 81.

    armagediontimes (#80) An interesting post. Please re-post with links to your sources for each assertion.

  • Comment number 82.

    No 80 "The Chinese government has advised its citizens that they should consider acquiring gold and silver for its investment potential."

    I've been advocating the acquisition of gold and/or silver and/or platinum since I first started posting in Peston's blog and, subsequently, here. Others have seen this as a good investment plan too. Considering that the Chinese government is not exactly stupid or blind, they know a good thing when they see one.

    "The Chinese do not want anything to do with the toxic US$"

    The Chinese have been moaning about the US$ for a long while now. When they were challenged about their stockpile of US$, they showed willing by trying to invest in that US oil company, they were blocked by the US Senate !! US hypocrisy at its best !! So the Chinese have ganged up with the other BRIC countries and are trying to switch to SDRs as a reserve currency. Failing which, gold, silver and platinum are just as good !!

    Meanwhile, the US$ will start going down the pan, especially with their $1.6 trillion budget deficit !! With all that in mind, how will they find more money to change their healthcare system(s) ?? As had been said many times earlier, the entire crux of their healthcare problems is the high costs of it !!

    Micromanaging it will only end up costing them more, as had been discovered here when NuLabour tried to micromanage the NHS !!

  • Comment number 83.

    Slightly off topic -

    Yet another NuLabour/Lord Mandy success !! Alchemy would have kept part of the company going but NuLabour and the unions wanted the Phoenix Four to take over and even gave them sweeteners to do so. So now the company is dead, the employees are out of work and the NuLabour cronies, that "took" £42 million out of an ailing company, are happy !! A great success all round !!

    Franksz, you know the end is nigh when NuLabour starts pandering to dead men. I have always greatly respected Alan Turing for his work in computing but this posthumous pardon and honours is simply dredging up dirt for more sound bytes !! He was a great man and he was and still is honoured for what he contributed to our knowledge. Now they should leave him to rest in peace !!

  • Comment number 84.

    #81 Jadedjean. You seem to be confusing me with a journalist. Facts are much more informative than assertions.

    For JP Morgans balance sheet see here [Unsuitable/Broken URL removed by Moderator]

    This is for Q1 2009 and shows $81 trillion - it has since risen by about another $6 trillion.

    For the size of the US economy see here

    For the repatriation of Hong Kong gold see here

    For the Chinese governments recommendation that its citizens buy gold and silver see here

    For the Chinese view that its state owned firms can repudiate derivatives contracts entered into with foreign entities see here

    For the aggregate US costs of bailing out its financial system see here

  • Comment number 85.


    what was the subject of your doctoral thesis and was it rejected ?

  • Comment number 86.

    IMHO one of the main points raised by Stephanie is the following ... "One of the big findings of behavioural economists is that people suffer from "status quo bias". They fear change and hold on to what have, even if what they have is pretty flawed" ...

    ... as this not only applies to US healthcare (which is arguably irrelevant as a 'soon to be' bankrupt economy will not be able to afford anything) but to 'leaders'/economies in general. Most current 'leaders' are ignoring the the solutions we need (eg. completely different style of economics/leadership and the separation of commercial/investment banking*), and will only acknowledge/respond to the problem at the last minute, to try to avoid a catastrophic loss ... the sad thing for the nations they govern is that by then it will be far too late to do anything ... and the next stage of crisis is already looming.

    * take a look at for instance.

  • Comment number 87.

    Well assuming that the US economy is not about to tank then I fail to understand how Barack Obamah cannot sell his healthcare plan to the public, perhaps it is not ambitious enough.

    That healthcare in the US is currently hugely profitable and 47 million potential customers are not buying into seems to me to be a failure of marketing.

    With a simple flick of legislation, a quick bit nationalisation (with a zed) and all American consumers will benefit from reduced healthcare costs and a bigger customer base (even if those at the bottom are only paying premiums of 10USD/y)

    It is the American Dream.

    Have these people not heard of spin ?

  • Comment number 88.

    BobRocket (#87) "It is the American Dream.

  • Comment number 89.

    #81 Jadedjean. Censorship appears to prevent me from complying with your request, but you can work it out for yourself if you are really interested.

    Reuters carries stories about Hong Kong gold and Chinese exhortations to its citizens to buy gold and silver.

    The CIA World factbook confirms the $GDP of the US. The US Comptroller of the currency confirms the $trillions in derivatives exposure held by JP Morgan.

    The BBC probably confirms the aggregate US government support for its financial industry, although I used Money and Markets which breaks down the commitment into its component parts.

    The New York Times carries a story related to Chinese repudiation of derivatives obligations.

  • Comment number 90.

    BobRocket # 87

    "Well assuming that the US economy is not about to tank..."

    That is the mother of all assumptions, which is dependant on how the US's largest creditors continue to view the Obama administration's reckless fiscal and monetary policies.

    "...then I fail to understand how Barack Obamah cannot sell his healthcare plan to the public, perhaps it is not ambitious enough."

    It's not a question of "selling it" but more about can the American people afford it?

    If we just look at the existing federally funded Medicare program, which has doubled every year since its inception, we can see that spending on this program has grown steadily as a percentage of the total federal budget ($440 bn as at FY 2007 or 16% of all US government spending). It is the third largest category of spending behind Social Security and the military.

    The value, including unfunded liabilities, of the program in FY 2007 over a projected 75 year period was $34 trn. That means that sum would have had to have been set aside in 2007 in order for the principle and interest to cover the shortfall over those 75 years.

    No one doubts that the US healthcare system needs reform. However, total socialisation - and HR 3200 is the next step towards that - is definitely not the way to go.

  • Comment number 91.


    Armagediontimes (#89)

    An additional perspective, perhaps, on derivatives issue.

    It often comes down to the way a message is worded does it not? 'British police attack protesters', 'British courts lock up Muslims'...', 'Nazis gas Jewish ...(clothes?)', Khmer Rouge round up intellectuals and ...', N Korea's secretive state..', 'Iran hangs children...'. Those 'Stalinists' and 'Islamo-Fascists'..., what are they like eh?..

    Sadly, the material which I've posted here (and elsewhere over recent years) covering changing demographics on both sides of the Atlantic, the relationships between the genetics of mean ability/personality, the selection of, and reinforcement of, self-centredness (narcissism/celebritism), the effects on GDP (see the economics and population growth of Bangladesh, Pakistan, Sub-Saharan Africa etc, the role of TFRs on politics and social-order, prevalence rates of diseases/disorders etc, is all depressingly true. :-(

  • Comment number 92.

    LibertarianKurt (#90) "..we can see that spending on this program has grown steadily as a percentage of the total federal budget ($440 bn as at FY 2007 or 16% of all US government spending). It is the third largest category of spending behind Social Security and the military."

    It's a matter of supply and demand (see #91) Our ERs aren't a bit like the programs 'ER' or 'Casualty' are they?

    Do you really think that free-market (libertarian policies) i.e. market-forces can serves as brakes on dysgenic fertility or does the empirical evidence suggest, on the contrary, that they actually drive this?

    A bone for you.....;-).

  • Comment number 93.

    JadedJean # 92

    A free-market does not have a "policy"; it is just a dynamic process of countless voluntary exchanges between producers and consumers. No-one or nothing directs it: If that was the case, then it can hardly be described as free.

    As you are so obviously just another blinkered statist, it's not surprising that you are unable to comprehend the meaning of the word free as in "free-market" or, indeed, in any other sense.

    BTW, if you think that some kind of free-market for healthcare currently exists in the US, then think again!

  • Comment number 94.

    #91 Jadedjean. I´m not sure I understand your post.

    Of course there is ambiguity in the Chinese pronouncements on derivatives - how, at this stage, would it serve their interests to be more explicit? They have fired the proverbial warning shot across the bows but retain flexibility as to future actions.

    The core message is clear they are not about to be dragooned into supporting western financial oligarchs.

    Their message regarding gold is much clearer. Why could this be? They want to buy gold, and yet their pronouncements are designed to increase the price of gold. Hmmm could this be because they understand that the gold price is rigged and all efforts are made to suppress the price of gold. Who gets hurt if gold breaks sharply upwards? Why western financial oligarchs who have habitually shorted gold, but lack the physical gold to make good on their obligations.

    Everything the Chinese do is calculated to ramp up the pressure on the oligarchs, always allowing an opportunity for their demands to be met. How do the oligarchs respond? They instruct their captured legislators to pass laws limiting the imports of Chinese tires.

    The Chinese understand the nature of the western system to a far greater extent than most people living under the system. That is why their measures are aimed at the oligarchs - the true rulers of the world, and not the notional governments.

    How can anyone believe that this is not the case? If power resided with government then how is it possible for one bank to have a derivatives portfolio that is 5 times the size of the US economy, and how is it possible that this is of no interest to the mass media.

    As you can see the BBC are keen to censor this information even though it comes from the US Comptroller of the Currency which is itself an arm of the US administration.

    The Chinese do not intend to back down, and the oligarchs will never voluntarily release their hands from the throat of humanity, and that explains why the US has 12 operational carrier battlegroups. The problem, in the end the only problem, is that these carrier battlegroups do not intimidate the Chinese.

  • Comment number 95.

  • Comment number 96.

    It means that social issues have overtaken vested economic interests in the richest and most powerful democracy.

  • Comment number 97.

    armagediontimes (#94) "the BBC are keen to censor this information"

    Whilst I don't take much issue with what you have said in your post about China's overall interests (it is a socialist state after all, with some NEP experimental policies as I see it) as to the above, I suggest you consider whether some of your links may just have breached House Rules, as moderation isn't done by the BBC itself, but by an outsourced company. I'm not always sure why some posts are referred or pulled, but that's because I'm not a moderator - but I am prepared to accept that they may know some things that I don't. For what it's worth, from my own experience, I think the moderators try to be fair. At times some of them will inevitably get it wrong, but from what I've seen, they generally do a fair job. I try to avoid contentious website link posts, although don't mind saying something, or someone else saying it, if there is data somewhere to back it up. There are usually sites which provide the data in a fair and balanced way.

    I reckon you are right to be concerned about the way things are going, I just thought that some of the data and sources I provided might have helped you make your case more substantively.

  • Comment number 98.

    #97 Jadedjean. "There are none so firmly enslaved as those who falsely believe themselves to be free" - Goethe

    #96 Nautonier. Good to see that you consider "social interests to have overtaken vested economic interests in the richest and most powerful democracy"

    This would explain why 1 in 50 US children are homeless, and why 10% of US citizens qualify for food stamps.

    On the bright size some 500 US citizens have acquired aggregate wealth of $5 trillion, which luckily means that none of the 500 are either homeless or in need of food stamps.

    Open your eyes, look around and read some Goethe!!

  • Comment number 99.

    JJ various

    You are back on your genetic arguments - The argument is specious as I (to use your own silly and inappropriate language) 'as I have explained before'.

    Economics (and that included healthcare availability) arguments based on functions of genetics are not only irrelevant in the extreme they are most seriously morally and ethically pernicious, 'evil' and repugnant to civilised society and have been for millennia.

    If you are incapable of understanding this there is something seriously defective in your World view! If you really need me to explain this this to you in words of one syllable please ask.

  • Comment number 100.


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