My take on the US healthcare debate

I’m an American living in the UK for the past few years so I have a unique perspective on the US healthcare issue that I wish to share. I’ve experienced both the US private insurance based system and the UK state-run healthcare system and I do feel that people in the US are missing the point and that the arguments for and against miss some very important facts.

I’m an IT contractor, I do network engineering, security work, plus some coding and perl scripting thrown in. I’m the director of a limited company which hires me out to difference companies on short-mid term contracts. In the past I have had a several permanent jobs both in the US and UK. In the US one of the primary concerns anyone has is healthcare for themselves and their family. When chosing a job one of the big questions is the provider and policy the employer offers. Insurance is a huge concern for those who are self-employed and in many cases the costs involved for private coverage are exhorbitant enough to prevent people from starting their own business. And if you lose your job you have the unenviable choice of either paying way over the odds to keep your old policy or taking a huge gamble and going without. I know American Ex-pats who can’t move back to the states because they have pre-existing medical conditions and would be denied health coverage. Can you imagine being barred from your own company because you have diabetes or MS? What does that say about America?

In the UK it’s completely different. If I lose my job I don’t have to worry about being covered until I get a new one. When looking for a job I don’t have to think about insurance, I can chose the best job for me. I can start a business, quit work for 6 months and write a book or iPhone apps all without a second thought. I pay into the system so I’m entitled to the benefits.

Some people are saying that state-provided healthcare makes one less free, but that couldn’t be farther than the truth. For me it’s given me freedom from worry and the freedom to pursue my own career goals.

Some of the arguments against state-run healthcare make me crack up because they actually support the case more than they damage it if you look past the emotionality:
– “There will be a department of doctors who decide what care people get. They’ll decide who lives and who dies!” OK, so how does this differ from private healthcare companies? They have whole departments which have the whole purpose of deciding how they can give you the least care possible. They also have whole departments tasked with denying people care they are entitled to so they can save money. Which would you rather have, a system which is trying to save its stockholders money or a system which is trying to save your money?
– “There will be huge lines to see the doctor!” Why? Are people going to go for the sheer novelty of it? I spend as little time as possible at the docs and I suspect others would be similar. In the UK I don’t wait any longer to see a GP than I would in the states, why would I? What’s the basis of this statement?
– “I’ll have to pay for other people’s coverage!” I hate to tell you but you already do. You want to know what people without coverage do in the US? They go to the emergency room where they can’t be turned away. They get treated because it’s illegal and unethical for the hospital not to. And guess who pays for it? You do either through taxes or in your insurance premiums. So you pay either way.
– “yeah, but it will cost me more because they’ll all use it more!” Better people see the doctor for a minor condition than go to the ER with a major condition, it will cost less. I know a guy with no health insurance and no money who had chest pains and had a quadruple bypass. He didn’t pay a thing because he had nothing to give them. That cost the hospital, and therefore society more than $300,000. He hadn’t seen a doctor in years because he didn’t have insurance and couldn’t pay. If he had he would have been diagnosed with heart problems years before he needed surgery and received preventative care which would have cost a fraction of emergency care. All these people going into the ER with acute conditions cost the system about the same as if they could go to the doctor before things get that desperate.

It seems that some people think that if we adopt socialized medicine in the US that the 4 horsemen of the apocalypse will appear, the sky will fall, and time itself will end. Get a grip! In the US we have a state-funded education system that goes from nursery through grad school, we have state funded roads, parks, water supplies, waste removal, and social security amongst many other state-funded systems. We are better off for all these things, so why not healthcare? What’s the big deal?

why we should like the CIA

I like Obama and the majority of what he’s done so far, but I’m disappointed by his failure to support the CIA. The CIA takes their orders from the President of the United States, after 911 Bush said to go after the terrorists and they did. He approved rendition and the use of intense interrogation and even torture despite his supposedly higher moral christian values. He set the tone for what was to come, and what was to come is a dark time in the history of the US yet the focus is on the actions of the CIA and not those who set their policies.

After the cold war the Clinton administration gutted the CIA even though then more than ever it was needed because of the massive changes the power vaccum would bring. It also changed the rules so that the CIA had a much harder time gathering intelligence, for instance it became forbidden to recruit as an operative anyone who was or had been part of a terrorist group, which was madness! Terrorist cells are incredibly hard to penetrate and one of the very few ways they can do this is to recruit terrorists as agents. How can an intelligence organization function without co-opting the very people they need information on? The result was that through cuts and frustrated people leaving the CIA became under-resourced and undermanned at the very time it was most needed. If the CIA had been better supported they may very well have prevented 911 and history would have been very different.

It takes years of investment and effort to build up an intelligence network to watch terrorists, you can’t snap your fingers and make it appear. However, you can, if you are president, snap your fingers and make someone dissapear into the dungeons of a friendly foreign power for some “intense interrogation”, and when you’re as desperate for intelligence as the administration was at the time that would probably appeal. Now, 8 years later our heads are clearer, we’ve forgotten how we all felt after the attacks which sparked these policies and we don’t like what was done. We can’t go after our own former president and his staff can we? I mean, that’s way too hardcore isn’t it, so let’s instead go after a nebulous government agency that everyone likes to hate. What’s the worst that could happen? Try another 911 or worse.

Intelligence is not about satellites or spyplanes, it’s about people. People interpret the pictures, people listen to communications intercepts, and people piece together the disparate information from 100 sources into a cohesive picture that officials need to make decisions. The best people at the CIA are there because they want to be there, because they believe in it and they want to serve the people of the US. OK, it’s a government agency so there’s paper-pushers and bureaucrats galore, but at the core there’s some people who really know what they are doing and boy do we need them! These people gather and process the information that the government uses to make decisions from economic to to military posture, and they are the ones who are best places to protect the US against further terrorist attacks. These tasks are vital to the long-term welfare of the USA, so these people are vital as well. Most of them are well-educated and intelligent and could do very well in the private sector, the only thing keeping them in their moderately-paid government jobs is the motivation they get from doing the job itself. If we destroy the morale of the organization they’ll leave, the CIA loses skills and knowledge that are irreplacable. Intelligence networks will be lost, and it will take years to rebuild them even if it can be done. It takes years to make an intelligence officer, you can’t just hire them ready to go.

What the CIA needs is continuity, not chaos every time a new administration comes in. Good long-term intelligence requires clear goals set out years in advance and then be followed up, not a top-down disruption every time there’s a new president. In the era where nuclear terrorism is certainly possible more than ever weneed the CIA whether we like it or not. A global power must have a global intelligence service to function effectively. Yes, the CIA makes mistakes, and yes they sometimes do things we would consider objectionable but sometimes that’s the way it has to be in a nasty, brutal world. Yes, the interrogations went way too far, but Guantanamo Bay was also way too far, the invasion of Iraq on a pretext was way too far and it all came from the very top. Let’s remember that before we start a witch-hunt that will destroy the morale of the organization that is far and away our best defense against international extremism. I’m not saying the CIA should be above the law, instead let’s make that law apply to EVERYONE evenly, if we aren’t willing to prosecute those who gave the orders then we can’t go after those that followed them.

North Korea’s hostage release

I’m really glad for the families of the reporters that were kidnapped from China and falsely imprisoned in North Korea for trespassing (and the reporters too of course) and have now been released. Some would say that it’s a triumph of diplomacy, however I can’t help but feel that we’ve played a big card here when we should have been tougher. Washington says that we didn’t make any concessions to BK and their nuclear program was never discussed but we DID make a concession, a big one named Bill Clinton. It was more than a photo op for North Korea, and it was more than a short stay by a former president in a hostile nation, it’s us giving them what they want.. I feel we took the easy way out. I know that in any diplomatic exchange there is a give and take and I’m happy with that, but this wasn’t a give and take, they took and then they took again. We gain nothing except the freedom of two citizens that were essentially kidnapped to give NK bargaining power, and we lose a point for doing so. That’s no diplomacy, it’s a form of surrender and it sits bad in my stomach.

The worst part is now that it’s worked once they’re going to try it again and the administration is going to have to make the same choice again. Who are they going to send next time? I know if it was my daughter I’d feel differently but I hate to say it would have been better to gain their freedom in a way that didn’t play into NK’s hands and make the US look ….. weak. No wonder Mr. Clinton wasn’t smiling.