Healthcare reform's impact on Nashville

[Guest 5th & Main Urbanite]

The fact we as a society let people die because they have inadequate or no health insurance at all is nothing short of immoral. The fact that people have to pay to save their own lives is immoral. Not everyone has the ability to make a high salary. As Jesus alluded to, the poor will always be with us. As Robert K. Merton said every strata of society has a purpose in the economic system whether rich or poor and one strata cannot survive without the other.

 

What kind of civilization are we that even one dies because they cannot afford health insurance and healthcare?

To my friend Fiieldmarshaldj: Your knowledge of political history is impressive, now impress us with actual solutions to the healthcare crisis. 39 recall votes to the Affordable Care Act? How about 39 solutions that work.

[fieldmarshaldj]

The complaints tend to ring hollow when those who defend coercive federal government tactics to nationalize healthcare see nothing wrong with the crises of tens of millions of abortions or the epidemic of Black-on-Black murders (dismissing the former as "choice" or focusing on that farce of a trial in Florida to distract the public from the facts of the latter). In the UK with its nationalized NHS, there are horror stories daily of people needlessly dying as a result of that dysfunctional monstrosity. That we would seek to emulate such a system increases the likelihood of the sick meeting with a terrible end before their time (with others even refusing to seek out treatment for justifiable fears of worse harm coming to them).

 

We need to be aggressive with untangling the federal government from so many aspects of our lives where they simply do not belong. Allow those that know about and work in these various careers and industries to be the ones to deal with, not armies of overpaid and ignorant DC-centered bureaucrats. Want to help the sick and injured, want the industry to improve, to become more competitive, drive costs down ? Get DC the hell out of it. That's my solution to this manufactured crisis.

[producer2]

There in lies the rub and the reason for my original cartoon. You have your beliefs which are totally opposite of mine. Both of us have many more who believe like we do. Currently you are trying to overturn laws that exist and I am trying to keep them intact. Good luck 

[fieldmarshaldj]

^Except the cartoon was an absurdist exercise in cognitive dissonance. If it were the reality, Detroit would be a paradise (or at least better off than it was in 1960 when it was one of the most productive and richest cities in the nation, still run mostly by competent Republicans up to that point). Of course, Detroit and places like it are where utopian "Progressive" philosophy run into the wall of reality, and now it looks like a half-century war has been raging there (well, it has).

 

You state your views* are opposite to mine, proudly proclaim as much, but continually fail to explain your own positions and how they can and have worked (and what their appeal is). It's not logical. But that's always been the problem with that ideology... it's never been logical, and its end result always the same, which is disaster. It's one reason why I left that ideology behind as a youngster, and why I'm similarly astonished anyone above that age can "believe" in it with a straight face. The quote misattributed to Churchill comes to mind...

 

(*Just as an aside, even worse is that you think this is a democracy... but it does point to the left-wing mindset of what they think this nation is about -- Obama's colossally arrogant, "I won." Democracy is two wolves and a lamb deciding on what to eat for lunch. This is a republic, sir, and as was said long ago, I "aims" to help keep it.)

[producer2]

This is exactly why "your side" continues to lose people like myself to the "other side". If you can't see the gap widening then I guess you are doomed to fight an uphill battle for a long time to come.

[ruraljuror]

"Except the cartoon was an absurdist exercise in cognitive dissonance. If it were the reality, Detroit would be a paradise (or at least better off than it was in 1960 when it was one of the most productive and richest cities in the nation, still run mostly by competent Republicans up to that point). Of course, Detroit and places like it are where utopian "Progressive" philosophy run into the wall of reality, and now it looks like a half-century war has been raging there (well, it has)."

 

I don't think it's fair to blame what's happening in Detroit exclusively on progressive policy.  Do you really think it's fair or are you just trying to make a point?  You mention that Detroit was run mostly by competent Republicans up to 1960, but as we've already noted at length, the Republicans of that era do not very closely resemble the Republicans of today.  More importantly, there's been a major shift of our entire economy away from the manufacturing/production sectors over the last 40 years.   Compared to a lot of the other assembly-line industries, Detroit did very well for a very long time--but the world was changing in ways that worked against them.  Failure to properly adapt to a changing world can have devastating results.

 

"You state your views* are opposite to mine, proudly proclaim as much, but continually fail to explain your own positions and how they can and have worked (and what their appeal is). It's not logical. But that's always been the problem with that ideology... it's never been logical, and its end result always the same, which is disaster. It's one reason why I left that ideology behind as a youngster, and why I'm similarly astonished anyone above that age can "believe" in it with a straight face. The quote misattributed to Churchill comes to mind..."

 

 

The United States is currently 37th in the World Health Organization's Ranking of the World's Health Systems.

 

Countries ahead of the U.S. on that list that have Universal healthcare systems: France, Italy, San Marino, Andorra, Malta, Singapore, Spain, Oman, Austria, Japan, Norway, Portugal, Monaco, Greece, Iceland, Luxembourg, Netherlands, United Kingdom, Ireland, Switzerland, Belgium, Colombia, Sweden, Cyprus, Germany, Israel, Morocco, Canada, Finland, Australia, Chile, Denmark, Costa Rica.

 

Countries ranked ahead of the U.S. that don't have Universal healthcare systems: Dominica (ranked 35th).

 

 

So there's a few examples of where universal healthcare seems to be working better than our own healthcare system.  The appeal of such systems is better access to better healthcare for more people, if that's not clear.  As I've said before, I'd prefer a single-payer system, but the ACA is a step in the right direction.  We can do better than 37th.

 

Now it's your turn to 'to explain your own positions and how they can and have worked (and what their appeal is).'  So far, you've said that the federal government should stay out of healthcare entirely, but I haven't heard many reasons why (other than broad claims that the government makes everything worse), or much about what the alternative looks like and/or what evidence you have that our health care system will improve if the government is removed from the equation. 

[samsonh]

Samsonh did his homework. Thanks for moving this to the coffeehouse and numbering the points.  I only have a few minutes, but I can address most. 

 

BTW: The spigot reference is to the revenues that will certainly diminish under Obamacare, as its own stated goal is to control costs (how do you think that will happen? One, or both, of two ways, reducing services or reducing ). And don't be fooled into thinking that the payers and delivery systems aren't on the same page with respect to fees.  Both "sides" know fully and completely that they better get their rate increases right now while the "getting is good". In fact, as has been practice for decades, these fees are negotiated. 

 

Okay...

 

1.  Re: Gracy comments (see above).

2.  Re: GAAP accounting vis-a-vis Capex: Your reference to GAAP notwithstanding, you did not explain your counter to the spigot. GAAP refers to accounting, as opposed to strategic management, and I am speaking almost exclusively with respect to strategy, as that's where virtually all macro-economic government policies have their direct impact. 

3.  Re: Short term (OpEx) vs. Long term (CapEx)... you dispute yourself here to your point 2.  Let me see if I can make this as simple as possible.  Taking the previous 2-3 years of CapEx does not (at all) prove future trends.  As most large orgs do their planning for such expenditures well in advance. As we've already seen wrt Short term expenses (just ask Vanderbilt), the long term cuts are coming!!  Just by their nature (LONG TERM), they take longer to adjust to market conditions.  Even with that point made, I remind: SCOTUS didn't even give their ruling on Obamacare and the new taxes associated with it until June 2012. Now that it is the law of the land (Obama's executive orders notwithstanding), trust me (oh, trust me!!)  those capital projects are being reevaluated... and many will be cut completely. 

4.  I never said the "industry was dying"... it's dealing with uncertainty.  Don't change the subject!  You cannot dispute that it is dealing with increased uncertainty due in great measure to Obamacare.  That's a fact that no one in the industry disputes. Despite your assertion, go back to my original comments and you will see exactly what is happening in the industry (like consolidation on steroids).  The ultimate effect of this could possibly help Nashville's healthcare industry (Long term), but it is also at risk of being reduced to irrelevancy if the progression continues toward single-payer (then Washington DC will be the nation's healthcare hub). Personally, I doubt the consolidation will do any good to the entrepreneurial environment that has been fostered by the existence of healthcare talent in Nashville.  We have seen it in energy and manufacturing, and the new federal regs will lead to a one-size-fits-all approach to healthcare and restrict innovation (and by extension choke new businesses).  No doubt, there will be continued consolidation as larger entities acquire orgs in new markets or 

5.  Re: "Delay of implementation"... Once again, this is a direct result of the uncertainty injected by Obamacare. But putting that aside for a moment, you keep using short term facts/evidence to support your counter to my firm belief that Obamacare will damage the industry, and very likely the status that Nashville enjoys as a premier center in the industry.  That recognition has come from private healthcare, and the whole idea behind Obamacare is to put the industry on the public's dime (sts). Strategic planning is virtually impossible when the regs are shifting from day to day.  That's what Obama and the Democrats don't seem to know (or care about).  And by the way, when government runs the show, the people in government have no incentive to care about the consequences of their bad laws... until the s**t hits the fan. And that is what Obama has been trying to avert with his latest executive order. 

6.  Re: Stock prices of private health companies:  Um, short term vs. long term again (not convinced you understand the difference).  As my good friends used to like to say during the Bush administration: "The stock market is not a good gauge of the economy".  Well, the stock market (short term) is not a good gauge of the future of healthcare under Obama.  Look, common sense alone will tell you that efficiencies and cost-control don't come from increased government involvement.  There is no example of that happening... ever!  And if you look closely enough, you will already see the effects of Obamacare on the private sector.  

7.  Re: SCRI and Parallon:  Dmills has made the best argument to my original points.  However, these organizations are in large measure funded by HCA (hence, subsidiaries).  Time will tell how these entities will fare under Obamacare.  Then again, this is the crux of my speculation (it's purely speculative).  I made it based on my experience and I truly think there are things behind the scenes that are causing this delay... other than what Nevin wrote last week being financial.  We will see.

 

You are absolutely correct that I do not think Obamacare will lead to improved care and/or increased coverage (its stated goals).  Even the latest push by Obama and Hollywood celebs is an attempt to "drive" more people currently paying out of pocket for their healthcare to higher premiums under Obamacare, and it's a tacit admission of an early failure. And yes, the immediate impact of the law will (appear to) help the large Nashville companies, and some startups as a result of opportunities they may see from the forced changes of government regulation.  Let's at least agree that healthcare will not be made more efficient under Obamacare... unless you think the DMV and all the other bureaucracies from the DC to Nashville are more efficient. And let's not even go to the bad faith the bureaucrats and politicians have already shown with very sensitive personal information.  

 

All in all Samsonh, you have not addressed the points made about short-term vs. long-term view of healthcare management and the chasm that results from uncertainty (both structural and systemic).  You reference something about GAAP, but ignore completely the whole impact on strategic management made in the first place.  Remember folks... it's all about uncertainty.  And Obamacare has injected an enormous amount of uncertainty into the industry.  

 

I understand your unconditional love for Obama, but your emotional stakes here cannot change the effects of the ACA.  It will (already has) have a negative effect on the industry. That is what you are disputing (not anything about the WES), and I simply think you haven't made your point that Obamacare will be good for Nashville.  I think it will be bad.. and I have my own experience and common sense to base that on. Not emotions!

 

 

1. You believe rates will go up but revenues will go down? If more people and procedures are covered, wouldn't revenue for hospital companies go up? Every Wall Street analyst I have read thinks health care reform is a great thing for the HCA's and CYH's of the world.

http://www.reuters.com/article/2013/06/19/us-hospitals-stocks-analysis-idUSBRE95I05L20130619

 

PS. These are not short term investors. These investors are doing DCF analysis and deciding these companies are good bargains.

 

And I quote "They expect company earnings to strengthen as more Americans gain insurance coverage and hospitals lose less money treating the uninsured"

 

2. You misunderstand accounting and cash flow. The only way HCA could "get it while the spigot is on" is to stop investing in projects. HCA cannot force consumers to come get surgeries, they cannot force people to get sick. Their business is relatively fixed. That is why your comment makes zero sense. You have yet to explain what you mean by this.

 

3. Again you misunderstand accounting. Capex is by definition money spent on long term projects. It is then depreciated. http://www.marketwatch.com/Story/story/print?guid=BEA4CC00-F2F8-11E2-9F9D-002128040CF6 Without risk there is no reward. Inudstries go through periods of consolidation and then they go through periods of disintegration. Porter's five forces are always strong at work.

 

5.  Strategic planning is always possible, even if regulations change. In fact, that is kind of the point of having a strong strategic(long) term plan. I mean you mentioned as much earlier in your post. Details of the implementation of ACA will obviously change as time moves on, but that should never alter a strong strategic plan.

 

6. Stock prices reflect investor views of the long term prospects of companies. They are based on valuation techniques I am very familiar with.. Investors currently view the earnings potential of these companies to be fantastic. If you disagree you should be able to make a mint by shorting them.

 

7. Those companies are almost free standing companies. They may have initially been funded by HCA, but they are independent to a large degree. In fact, I would venture to guess that Parallon may be spun off in the next few years.

 

 

 

As to whether health care will be more efficient, I do not know. I know that Medicare is more efficient that private insurance. I know Medicare scores higher satisfaction than private insurance. I know health care is a good/service unlike most others, due to the information asymmetries involved.

 

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

http://www.commonwealthfund.org/News/News-Releases/2012/Jul/Medicare-v-Employer-Insurance.aspx

 

 

ML, I have not been emotional. I have linked articles and showed stats. I have not told stories about how uncertainty is killing the goose for our city. You have done that. This legislation definitely has it's pros and cons. But it is an improvement over the system we had before where costs were rising dramatically year after year.

Your experience is great, but reality seems incompatible to your feelings of what will happen in the future. If you truly believe what you say, you should have no trouble making a fortune betting on that in the stock market, as market participants seem to wholeheartedly disagree with you. And after all, isn't the free market usually right??

[bigeasy]

Seems impossible to try and make a point on here without making personal attacks. Such a shame.

[fieldmarshaldj]

This is exactly why "your side" continues to lose people like myself to the "other side". If you can't see the gap widening then I guess you are doomed to fight an uphill battle for a long time to come.

 

And again, you make these generalized "anti-" comments, but still cannot elucidate your own views. This has been the sum total of your side of the debate here:

 

You: "I oppose you ! (and here's a cute cartoon !)"

Me: "Why ?"

You: "I oppose you !"

Me: "Why ?"

You: "Because I oppose you."

Me: "Why ?"

You: "Because your side is wrong."

Me: "Why ?"

You: "It's wrong and you're losing people."

Me: "Why ?"

You: "I oppose you ! You're wrong."

 

What an enlightening debate, Producer.

[dmillsphoto]

Seems impossible to try and make a point on here without making personal attacks. Such a shame.

 

Unfortunately, those who make personal attacks end up doing so when they start to question their own stance or can't provide evidence to backup their claims. Classic fight or flight. I must say, thank you all for keeping it mostly civil.

 

EDIT: Huh. I spoke too soon. FMDJ - no need for that last post. You're seeking an argument, I understand, but it's purely political. I've kept this thread open as it relates to the ACA and the future of businesses that could be affected by it's implementation in Nashville. Let's back off the wider ranging attacks on political ideology and keep it focused. That goes for everybody, not just FMDJ.

 

I will talk with Neo about creating a "I gotta get this out of my system" thread.

[fieldmarshaldj]

ruraljuror, on 26 Jul 2013 - 11:22 AM, said:

"I don't think it's fair to blame what's happening in Detroit exclusively on progressive policy.  Do you really think it's fair or are you just trying to make a point?" 

[producer2]

And again, you make these generalized "anti-" comments, but still cannot elucidate your own views. This has been the sum total of your side of the debate here:

 

You: "I oppose you ! (and here's a cute cartoon !)"

Me: "Why ?"

You: "I oppose you !"

Me: "Why ?"

You: "Because I oppose you."

Me: "Why ?"

You: "Because your side is wrong."

Me: "Why ?"

You: "It's wrong and you're losing people."

Me: "Why ?"

You: "I oppose you ! You're wrong."

 

What an enlightening debate, Producer.

never once said or posted you were wrong. Just said we have different viewpoints and pointed out the widening gap between the political parties, that's all. ruraljuror has already said it much better than I could so I leave it at that. 

[ruraljuror]

ruraljuror, on 26 Jul 2013 - 11:22 AM, said:

1. "I don't think it's fair to blame what's happening in Detroit exclusively on progressive policy.  Do you really think it's fair or are you just trying to make a point?" 

 

That's another problem with the "progressive" left. They refuse to take responsibility for the damage their ideology has created. Always someone else's fault. If Detroit had been managed by Conservative Republicans for that same period and ended up that same way, do you believe for a moment that the left would not point a finger and blame them ? Look at the imbecilic rageaholic Ed Schultz. He is in such denial about the political dynamics of the city, post-Eisenhower, that he blamed the GOP for Detroit. He follows the 2 basic rules of the left: Rule #1, Blame Conservatives/GOP. Rule #2, If the Progressives/Democrats are at fault, see rule #1. Then you get to the other problems, that when a Conservative tells the truth, they're called a bully, racist, mean spirited, "it's not fair !", et al. It's yet another reason why those espousing leftist politics are like dealing with small children.

 

 

 

 

You're right. They were more Conservative in 1960. For that matter, Democrats hadn't yet to go over the horizon on the ultra-radical social issues we have today. But there were so many true-believers in "big government can solve everything." Had Detroit Progressive Democrat Mayor Jerry Cavanagh not been one of those, along with so many others on the left running our cities, we'd not have seen such deterioration.

 

 

 

 

Detroit could've been saved with the right leadership. Instead, it was cursed with epic-level civic leadership incompetence, greedy unions, the productive classes voting with their feet, leaving behind an underclass of people that were destroyed by big government taking the place of daddy.

 

 

 

 

The problem here is the absurdity of comparing all of those countries to the United States. San Marino ? Andorra ? These aren't even countries, these are tiny, wealthy, homogenous enclaves. It was one of the things I mentioned early on to Producer, citing these types of places as an example of ones that allegedly work as an example to impose on a nation as populous and diverse as the U.S. is absurd and really a non-sequitur. There is no country on earth that can really compare to us in that regard.

 

 

 

 

It isn't just healthcare that the federal government should stay out of, it's virtually the whole gamut of industries it has felt the need to interfere in in order to control and "improve." I believe in rolling back most everything implemented post-1933 from Washington, DC. Our federal government is resembling the leadership of Detroit at the point all proverbial hell broke loose. Going back even further, even elimination of the IRS, which has become the de facto gestapo arm of the current regime without so much as any accountability. This government has become so lawless, that seeing the nationalization of the healthcare industry is just another means to control the population. This should terrify every law-abiding citizen in this country.

 

In a nation of over 300 million, there should be very little beyond what is explicitly specified in the Constitution that DC should have any mandate or control over. The military, and that's about it. Let the states and locales be the laboratories (if they must) for government policies (though those too should be minimal at best). Return to the people control of their lives and destinies, away from politicians seeking to control and exploit them for personal gain.

 

Because there is demand, let the private sector be the catalyst for improving our various industries (healthcare, et al). Without the heavy-hand of government interference in all walks of life, we can free the people to rise to the challenges of the future, innovate, and leave our children with a nation in better shape than it was when we were young. We can never be as great as we could as long as we remain on the wrong course we're on right now. The costs are already too great, in monetary regards (fast approaching $20 trillion in debt) and in human costs.

[fieldmarshaldj]

To tell you the truth, I don't know why Detroit failed.  I will also concede that progressive policy and union constraints probably had a part to play in it.  That said, without a better reason to believe otherwise, I continue to think that a variety of other factors most likely contributed to the result, as well.  As I said, decline in the manufacturing sector across the board is a pretty clear indicator that Detroit wasn't independently responsible for the mess.  Additionally, Detroit is/was a big city, but it was only a city, and was subject to the policy implications of both State and Federal government, as well.  More than a few Republicans were at the helm of the nation when the manufacturing outsourcing movement took place.  More than a couple Democrats, too.  But, to reiterate, I don't know why Detroit failed, I imagine there were a lot of contributing causes, but blaming any one factor at the exclusion of all others seems myopic, in my opinion.

 

If Conservatives were running Detroit, politically, socially/culturally, et al, for the past 50+ years, it would be quite clear who would be to blame. The left needs to take responsibility for the disasters it has made of Detroit and many other urban locales.

 

 

Also, you're right that there were times in our history when Republicans were more conservative than the current GOP establishment.  However, there were also times that Republicans were less Conservative than the current establishment, not to mention the Tea Party (e.g. National Parks, Interstate System, Environmental Protection Agency, etc.).

 

In the case of the EPA, that was Nixon's fault. But Nixon was never a Conservative. He was a liberal Republican who believed in big government. As for the National Parks, I'm not necessarily opposed to that, but I don't believe the feds do a good job with management. Keeping them in title, but privatizing their management would be a better solution for them. As for Interstate System, that speaks for itself.

 

I also agree that it's absurd to compare the U.S. to San Marino and Andorra.  What drew your attention to those two countries in particular?  I didn't mean for them to be the focal point of the list, rather, I included every country on the list with a better ranking than the U.S., and San Marino and Andorra happened to be two of the 35 universal health care countries with a better health care system than ours.  I will note that first you asked why no one had given any examples of where universal health care has worked, then when provided with a list of countries with successful universal healthcare programs, you dismissed the entire proposition by claiming 'There is no country on earth that can really compare to us in that regard.'  If that's the case, then why ask for examples in the first place?  Also, what's the threshold for population size and how homogenous does a population have to be in order for universal healthcare to work?

 

Because proponents of government healthcare have a habit of citing countries that aren't of any comparison to the United States and concluding because it works in a given place (if it works, since we have no posters here from Andorra or San Marino to explain how it is they are doing so well) that it can and will work here. If you start looking at the larger places, such as the UK, that gives you a better idea of how the bigger the country is (and diverse, both ethnically and economically), the worse it gets. The NHS there is a nightmare, and I read articles almost daily on the human costs.

 

Finally, in my last post I appropriated a question you'd asked producer--""Now it's your turn to 'to explain your own positions and how they can and have worked (and what their appeal is)."  I then reiterated that you'd "said that the federal government should stay out of healthcare entirely, but I [hadn't] heard many reasons why (other than broad claims that the government makes everything worse), or much about what the alternative looks like and/or what evidence you have that our health care system will improve if the government is removed from the equation."

 

To that, you responded with:

 

"It isn't just healthcare that the federal government should stay out of, it's virtually the whole gamut of industries it has felt the need to interfere in in order to control and "improve." I believe in rolling back most everything implemented post-1933 from Washington, DC. Our federal government is resembling the leadership of Detroit at the point all proverbial hell broke loose. Going back even further, even elimination of the IRS, which has become the de facto gestapo arm of the current regime without so much as any accountability. This government has become so lawless, that seeing the nationalization of the healthcare industry is just another means to control the population. This should terrify every law-abiding citizen in this country.

 

In a nation of over 300 million, there should be very little beyond what is explicitly specified in the Constitution that DC should have any mandate or control over. The military, and that's about it. Let the states and locales be the laboratories (if they must) for government policies (though those too should be minimal at best). Return to the people control of their lives and destinies, away from politicians seeking to control and exploit them for personal gain.

 

Because there is demand, let the private sector be the catalyst for improving our various industries (healthcare, et al). Without the heavy-hand of government interference in all walks of life, we can free the people to rise to the challenges of the future, innovate, and leave our children with a nation in better shape than it was when we were young. We can never be as great as we could as long as we remain on the wrong course we're on right now. The costs are already too great, in monetary regards (fast approaching $20 trillion in debt) and in human costs"

 

--To me, your response didn't really address the questions I was trying to ask, but that may just be a result of our different perspectives, and you may believe that you answered the questions thoroughly.  Again, to me, however, It seems like you're saying 'we should do this' or 'government shouldn't do that' but you didn't give any support for those assertions or any examples that I could pick up on.  If you're willing/interested in clarifying--I understand that you think government should stay out of pretty much everything, but why should the federal government not be involved in healthcare specifically, what does our healthcare system look like and how does it work absent any involvement on the part of the federal government, and can you give any examples of how our health care system will work better (or has worked better in other times or places) with less government involvement?

 

Because the federal government is a bureaucracy. It doesn't create (except unaccountable spending with money it doesn't have), it doesn't innovate. It is inherently statist and inefficient. Healthcare is a field that requires innovation and creativity to meet the needs of the nation. Federal heavy-handed control that stifles innovation, creativity and competition is disaster and antithetical to our nation's ideals. Unfortunately, this isn't just the case with healthcare, but business and education as well.

[ruraljuror]

--FMJD, I think this discussion has been interesting and mostly positive, but we need to clear some things up here if it's going to continue.  It's starting to feel like you're not actually reading what I'm writing, in which case there's not much point in taking the time to respond.  Let's go through this:

 

You wrote, "If Conservatives were running Detroit, politically, socially/culturally, et al, for the past 50+ years, it would be quite clear who would be to blame. The left needs to take responsibility for the disasters it has made of Detroit and many other urban locales."

 

If you reread the paragraph to which you're responding, you'll see that the only points I was trying to make were that I don't know why Detroit failed but that I assume a variety of factors contributed and I will continue to believe that without a reason to think otherwise. 

 

Your response is simply an assertion that 'if conservatives were in charge then everything would've been better and that the progressives are responsible for all problems cities are facing.'  This is a fair claim to make, but it doesn't mean much if you don't support your assertion with evidence or an explanation of how you arrived at those conclusions.  Can you give an example of a city run by conservatives over the course of the last 50 years that managed to retain their manufacturing industries?  How about a city, or a state, or a different country with conservative leadership that is thriving as a result?  How can you dismiss the role of state, national, and international governments and economies?  How can you dismiss the emerging auto-industry competitors who arose in Germany and Japan as they rebuilt post WWII?  How do you reconcile your position with the fact that many cities with historically progressive leadership are doing well?

 

You don't need to answer any of those questions unless you feel compelled.  In fact, as I thought I indicated in my last post, I'm happy to wrap up talking about Detroit altogether.  Again, I don't know why Detroit failed, but I think singling out any one cause at the exclusion of all others is myopic and I will continue to believe so without a more compelling reason to think otherwise.  Blanket assertions without explanation or supporting evidence won't change my mind.

 

 

You wrote, "Because proponents of government healthcare have a habit of citing countries that aren't of any comparison to the United States and concluding because it works in a given place (if it works, since we have no posters here from Andorra or San Marino to explain how it is they are doing so well) that it can and will work here. If you start looking at the larger places, such as the UK, that gives you a better idea of how the bigger the country is (and diverse, both ethnically and economically), the worse it gets. The NHS there is a nightmare, and I read articles almost daily on the human costs."

 

First you claim 'proponents of government healthcare' cherry pick their examples to make a point (that universal healthcare works in other countries), then you immediately proceed to admit to cherry picking your own examples to make a point (that some countries with successful universal healthcare systems aren't very comparable to the U.S. and are therefore weak examples).  You'll notice that I provided the entire list of countries with better healthcare systems than ours, it just so happened that 35 out of 36 of them happen to have universal healthcare systems and some of them are small and very different from the U.S.

 

More importantly, it continues to seem like you didn't read my last post.  You bring up the problems in the U.K. without acknowledging that the U.K. is among the countries I listed with a better healthcare system ranking than ours.  In fact, they're ranked 20 spots ahead of us.  I wouldn't deny that you regularly read articles about problems with the U.K. system, but you could read articles daily about about problems with our system, as well.  Despite our respective issues, they're still ranked among the top 20 healthcare systems in the world while the U.S. barely made the top 40. 

 

 

You wrote, "In the case of the EPA, that was Nixon's fault. But Nixon was never a Conservative. He was a liberal Republican who believed in big government. As for the National Parks, I'm not necessarily opposed to that, but I don't believe the feds do a good job with management. Keeping them in title, but privatizing their management would be a better solution for them. As for Interstate System, that speaks for itself."

 

Here again, it doesn't seem like you read the post to which you're responding.  You wrote, "In the case of the EPA, that was Nixon's fault. But Nixon was never a Conservative."  Yes.  I figured you'd say as much and I don't entirely disagree.  That was, in fact, exactly my point.  I never said Nixon was a conservative.  I said he was a Republican--in order to make the point that Republicans of yesteryears had sometimes been less conservative than their contemporary counterparts.  The fact that you don't consider Nixon a conservative is exactly what I was trying to say.  Also, when you wrote 'the interstate system speaks for itself' I honestly have no idea what you mean.  I think the Interstate system has been a pretty good infrastructure investment, but we apparently don't see eye to on an a number of issues, so who knows?

 

 

You wrote, "Because the federal government is a bureaucracy. It doesn't create (except unaccountable spending with money it doesn't have), it doesn't innovate. It is inherently statist and inefficient. Healthcare is a field that requires innovation and creativity to meet the needs of the nation. Federal heavy-handed control that stifles innovation, creativity and competition is disaster and antithetical to our nation's ideals. Unfortunately, this isn't just the case with healthcare, but business and education as well."

 

First, I appreciate your taking another crack at answering my questions about the healthcare issue.  That said, from my perspective it still doesn't seem like your response really addresses the questions I was trying to get at.  Specifically, "what does our healthcare system look like and how does it work absent any involvement on the part of the federal government, and can you give any examples of how our health care system will work better (or has worked better in other times or places) with less government involvement?" 

 

The response you provided is just another series of assertions without any evidence or support for your conclusions. We can break it down sentence by sentence--

 

"Because the federal government is a bureaucracy":  I don't disagree, though I think it's an over simplification.  Certainly the only ways by which most citizens ever interact with government is through bureaucratic channels, so the federal government can definitely appear as nothing more than a giant bureaucracy.  In any case, fine, the federal government is a bureaucracy.

 

"It doesn't create (except unaccountable spending with money it doesn't have), it doesn't innovate.": I love this sentence.  You say that the government doesn't create and it doesn't innovate, but in the middle of the sentence you parenthetically acknowledge that the government does create and innovate, albeit only through 'unaccountable spending'. 

 

Essentially we're in agreement then that the government does actually create and innovate, we just disagree about the funding used to spur those creations and innovations.  To that, I will point out that the National Bureau of Economic Research and the Federal Reserve Bank of San Francisco estimate the return on investment for publicly funded scientific research and development over the last 60 years is somewhere between 30 percent and 100 percent.  That's a pretty good ROI in my book.

 

 

"It is inherently statist and inefficient":  Well, yeah, I suppose the federal government is inherently statist, as are all federal governments to some degree or another.  But it is not entirely statist, which is why the degree is an important distinction, I think.  Also, yes, federal government is inefficient.  Once upon a time, that very inefficiency was lauded by some conservatives who were not necessarily opposed to some progressive changes, but thought those changes should happen slowly.  Regardless, I agree--it's inefficient and could be better.

 

 

"Healthcare is a field that requires innovation and creativity to meet the needs of the nation":  We agree again!

 

 

"Federal heavy-handed control that stifles innovation, creativity and competition is disaster and antithetical to our nation's ideals":  I've already pointed out the ROI we've gotten from scientific research investment and you've already admitted that the federal government does create and innovate, indirectly if not directly.  As for your 'heavy-handed' description, the usual argument from Republicans (other than promoting cuts to funding) is that there isn't enough oversight into how money is being spent on research projects (e.g. 'Why are taxpayers funding research into the mating habits of banana slugs and who approves this nonsense?').  I know that Republican is not the same thing as conservative, but my point is simply that 'heavy-handedness' when it comes to our R&D is not an issue that usually comes up.  In fact, privately financed research grant recipients often have less freedom because their work is constrained by the agenda of their financiers. Our government spends a lot of money on a lot of projects and all they have is an inefficient bureaucracy to keep track of it all!  As you can probably imagine, once the grants have been issued, public researchers often have a lot of freedom, which lines up pretty well with our nation's ideals as I understand them and has given our country a technological advantage over the rest of the world for the majority of the last century. 

 

"Unfortunately, this isn't just the case with healthcare, but business and education as well.":  You have made it abundantly clear that you believe the federal government has no business in healthcare, business, education, and pretty much anything else other than national defense.  If your goal has been to drill that point home, you have succeeded masterfully. 

 

 

--Since we're supposed to be primarily talking about healthcare anyway, I'll try one more time:

 

If not the ACA then what?  Should we go back to the status quo pre-ACA despite the flaws in the system?  How do you envision our healthcare system working absent the involvement of the federal government, and can you give any examples or evidence to support your claims?

[Guest 5th & Main Urbanite]

Don't expect to hear back from Fieldmarshaldj. I think you made your point more eloquent. I have known Davy a long time, and he is a good guy, but his disdain for Europe, liberals, progressives, the Left,  Democrats etc is epic. The funny thing is he used to be one not so long ago.

 

Regarding UK Healthcare. It's excellent and my nephew, who lives in the UK,  has never had  a difficulty using the NHS.

[fieldmarshaldj]

Don't expect to hear back from Fieldmarshaldj. I think you made your point more eloquent. I have known Davy a long time, and he is a good guy, but his disdain for Europe, liberals, progressives, the Left,  Democrats etc is epic. The funny thing is he used to be one not so long ago.

 

Regarding UK Healthcare. It's excellent and my nephew, who lives in the UK,  has never had  a difficulty using the NHS.

 

Actually, I was taking a break from the thread, which delayed my response. I don't have a disdain for Europe, but I do harbor disgust for its leaders allowing those great nations to fall into the abyss between the tag-team effort of failed leftism and the invasion of Mohammadans (although my opinion of Poland and Russia, as of late, has considerably improved). I also harbor disgust towards those in BOTH parties allowing our own nation to go down the toilet, between those espousing similarly failed leftism and gargantuan federal government, cultural rot (including this bizarre fetish and obsession with sexuality), open borders and the like, transforming us into a nightmare state akin to Orwell's '1984.' As for when I was a leftist, it was when I was a child, so that is now almost 30 years ago. It was largely because of indoctrination and not being able to discern or understand its mission. I fortunately was soon able to figure it out and rejected it.

 

I will comment on the UK system's NHS, which is anything but excellent.

[fieldmarshaldj]

Sorry, I had to remove the quote blocks since there's a limit on them (I'll boldface my comments, hopefully that will work)

 

--FMJD, I think this discussion has been interesting and mostly positive, but we need to clear some things up here if it's going to continue.  It's starting to feel like you're not actually reading what I'm writing, in which case there's not much point in taking the time to respond.  Let's go through this:

 

The problem here may be you just don't agree with the points I'm making. But I am reading what you're saying, otherwise I wouldn't be able to reply point by point.

 

"You wrote, "If Conservatives were running Detroit, politically, socially/culturally, et al, for the past 50+ years, it would be quite clear who would be to blame. The left needs to take responsibility for the disasters it has made of Detroit and many other urban locales."

If you reread the paragraph to which you're responding, you'll see that the only points I was trying to make were that I don't know why Detroit failed but that I assume a variety of factors contributed and I will continue to believe that without a reason to think otherwise."

 

 

Again, what I find so galling is that intellectual-wise and common-sense-wise, the reasons are entirely clear. If you concede that, it would serve as an indictment that the left-wing model that Detroit has served as for a half-century is a colossal failure. Leftists have a knee-jerk denial mode that their policies ever fail or ever make things worse. The entire 20th century is a monument to their failures. It's why I find it similarly bizarre, if not repugnant, that any logical person could continue to espouse such policies and offer up rationalizations and dissembling or plead ignorance as to the source of said failures.

 

"Your response is simply an assertion that 'if conservatives were in charge then everything would've been better and that the progressives are responsible for all problems cities are facing.'  This is a fair claim to make, but it doesn't mean much if you don't support your assertion with evidence or an explanation of how you arrived at those conclusions. Can you give an example of a city run by conservatives over the course of the last 50 years that managed to retain their manufacturing industries?"

 

That query would be difficult to answer to an extent, as the central problem is that virtually no large cities were run by Conservatives. Conservative approaches to governance of urban locales, with little exception, was tossed out with the advent of FDR. Despite warnings of the damage it would create, heavy-handed, top-down policies of welfare and dependence were bred. Once in place, much like a drug addict well into his habit, impossible to break.

 

"How about a city, or a state, or a different country with conservative leadership that is thriving as a result?"

 

 

Because there is no definitive locale that has an across-the-board example of such governance. Part of it has to do with state or federal laws that would prohibit such governance. I can only cite "bits and pieces" examples, such as the law-and-order examples of Giuliani in NYC (1994-2001), Steve Goldsmith in Indianapolis (1992-2000) with privatization of certain services, Bret Schundler's (1992-2001) turnaround of Jersey City. Just in electing anti-statist civic leaders can revitalize depressed/decayed areas.

"How can you dismiss the role of state, national, and international governments and economies?  How can you dismiss the emerging auto-industry competitors who arose in Germany and Japan as they rebuilt post WWII?  How do you reconcile your position with the fact that many cities with historically progressive leadership are doing well?"
 

I don't dismiss their roles, but ultimately, a city can rise or fall based upon its own local leadership. How well a state or nation is managed around it cannot overcome urban/civic incompetence as Detroit has demonstrated. As for cities "doing well" by your reckoning (with leftist leadership), you'd have to cite examples of that.

 

"You don't need to answer any of those questions unless you feel compelled.  In fact, as I thought I indicated in my last post, I'm happy to wrap up talking about Detroit altogether.  Again, I don't know why Detroit failed, but I think singling out any one cause at the exclusion of all others is myopic and I will continue to believe so without a more compelling reason to think otherwise.  Blanket assertions without explanation or supporting evidence won't change my mind."
 

As I've already stated, Detroit is such a glaring example of leftist mismanagement that it comes off as disingenuous when you (or any other committed left-winger) state you don't know why it failed. It's time for some honest, self-assessment and reflection here.

"First you claim 'proponents of government healthcare' cherry pick their examples to make a point (that universal healthcare works in other countries), then you immediately proceed to admit to cherry picking your own examples to make a point (that some countries with successful universal healthcare systems aren't very comparable to the U.S. and are therefore weak examples).  You'll notice that I provided the entire list of countries with better healthcare systems than ours, it just so happened that 35 out of 36 of them happen to have universal healthcare systems and some of them are small and very different from the U.S."
 

 

I'd ask what are the criteria for claiming they are "better" than the U.S. ? How and why do we rank so far down the list ? What does it mean to be on such a list ? I state unequivocally that placing a list of nations (some having little more than the population of a section of Nashville) in league with or comparing them to the United States is absurd. I'm sure if we took an upscale and racially homogenous locale in the U.S. (with low crime) and compared it to said foreign nations, it would be at the top of the list. But you can't do that. Taking a nation of over 300 million as diverse as ours and trying to impose a specific federal government policy for socialized healthcare upon it is ludicrous (and ultimately tyrannical).

 

 

"More importantly, it continues to seem like you didn't read my last post.  You bring up the problems in the U.K. without acknowledging that the U.K. is among the countries I listed with a better healthcare system ranking than ours.  In fact, they're ranked 20 spots ahead of us.  I wouldn't deny that you regularly read articles about problems with the U.K. system, but you could read articles daily about about problems with our system, as well.  Despite our respective issues, they're still ranked among the top 20 healthcare systems in the world while the U.S. barely made the top 40."

 

Because that list is highly questionable, as I stated, with unequal comparisons. If the UK's system is so great, why aren't millions of Americans with its "third rate" healthcare (as said list implies) not flooding in to take advantage of it ? I mean, the UK sounds like heaven (according to the list).

 

"Here again, it doesn't seem like you read the post to which you're responding.  You wrote, "In the case of the EPA, that was Nixon's fault. But Nixon was never a Conservative."  Yes.  I figured you'd say as much and I don't entirely disagree.  That was, in fact, exactly my point.  I never said Nixon was a conservative.  I said he was a Republican--in order to make the point that Republicans of yesteryears had sometimes been less conservative than their contemporary counterparts.  The fact that you don't consider Nixon a conservative is exactly what I was trying to say.  Also, when you wrote 'the interstate system speaks for itself' I honestly have no idea what you mean.  I think the Interstate system has been a pretty good infrastructure investment, but we apparently don't see eye to on an a number of issues, so who knows?"
 

 

 

You misunderstood me, I wasn't saying at all that interstate building was a bad thing (although there has been examples of terrible waste, such as Boston's infamous "Big Dig").

 

 

"First, I appreciate your taking another crack at answering my questions about the healthcare issue.  That said, from my perspective it still doesn't seem like your response really addresses the questions I was trying to get at.  Specifically, "what does our healthcare system look like and how does it work absent any involvement on the part of the federal government, and can you give any examples of how our health care system will work better (or has worked better in other times or places) with less government involvement?"

 

 

Our healthcare evolved just fine without overarching government involvement and control from the founding of the country. I stated before that I believe our Founding Fathers would be appalled that the government would involve itself in the industry of healthcare in an attempt to control it. Such a concept is repugnant and monstrous. I pose the question, why do they need to be involved ? How does government control make it better ? How does adding layers of bureaucracy, arduous rules and regulations improve our system ? Industry, any industry, fares better when it has the least amount of strict government control. This is common sense.

 

As for giving you an example here of less government involvement in healthcare, that's going to be hard to do since there's been decades now of deepening involvement rather than "letting go." If a given state or locale attempted to do so, they'd likely be stopped by a federal judge saying, "you can't do that !" It's bad enough now that states are trying to hold off the onslaught of "ObamaCare" which means even MORE control above where we're at now. Insane.

 

"The response you provided is just another series of assertions without any evidence or support for your conclusions. We can break it down sentence by sentence--

"Because the federal government is a bureaucracy":  I don't disagree, though I think it's an over simplification.  Certainly the only ways by which most citizens ever interact with government is through bureaucratic channels, so the federal government can definitely appear as nothing more than a giant bureaucracy.  In any case, fine, the federal government is a bureaucracy."

 

 

Yes, I'm glad you concede the point. So why does that bureaucracy need to control the lives of over 300 million people and dictate to them the how and why and where of their healthcare ? Is that logical ? Is it even remotely efficient ? I also, despite the dubious judgment of a single Supreme Court justice, do not consider it Constitutional.

 

"It doesn't create (except unaccountable spending with money it doesn't have), it doesn't innovate.": I love this sentence.  You say that the government doesn't create and it doesn't innovate, but in the middle of the sentence you parenthetically acknowledge that the government does create and innovate, albeit only through 'unaccountable spending'."
 

 

This was a highly sarcastic comment of mine. Said "creation" is the drastic expansion of the bureaucracy. You'll note Washington, D.C. has experienced virtually none of the recession ("Depression") that most of the rest of the country has for a half-decade. Their cottage industry is government and more government. This is not creation in the positive sense of the word, and certainly not innovation. It's no wonder Northern Virginia and Maryland, along with DC itself, vote heavily for the Democrats, because they're voting for their own jobs and livelihood based on that bureaucracy which is unsustainable. Of course, the establishment Republicans don't seem particularly bothered by this.

 

"Essentially we're in agreement then that the government does actually create and innovate, we just disagree about the funding used to spur those creations and innovations.  To that, I will point out that the National Bureau of Economic Research and the Federal Reserve Bank of San Francisco estimate the return on investment for publicly funded scientific research and development over the last 60 years is somewhere between 30 percent and 100 percent.  That's a pretty good ROI in my book."
 

 

How are we doing facing down $20 trillion in debt (nevermind the far-beyond-that-total level of unfunded mandates) ? When we hit that wall, it ain't gonna be pretty. We'll be lucky not to have inflation to rival Zimbabwe.

 

 

"It is inherently statist and inefficient":  Well, yeah, I suppose the federal government is inherently statist, as are all federal governments to some degree or another.  But it is not entirely statist, which is why the degree is an important distinction, I think.  Also, yes, federal government is inefficient.  Once upon a time, that very inefficiency was lauded by some conservatives who were not necessarily opposed to some progressive changes, but thought those changes should happen slowly.  Regardless, I agree--it's inefficient and could be better."
 

 

You're not going to make an efficient system with a government controlling the lives of over 300 million people. When I speak of improved efficiency, I speak of separating the government from the people, returning control of their own lives and destinies to them. Returning the government to its small and Constitutional state of being.

 

"Healthcare is a field that requires innovation and creativity to meet the needs of the nation":  We agree again!
 

And what better way to halt said innovation and creativity by full-scale federal government control.

 

"Federal heavy-handed control that stifles innovation, creativity and competition is disaster and antithetical to our nation's ideals":  I've already pointed out the ROI we've gotten from scientific research investment and you've already admitted that the federal government does create and innovate, indirectly if not directly."
 

 

And I clarified my points that almost none of it contributes to that in a positive way. It only benefits those bureaucrats and elected officials suckling the tits of the system. Antithetical to the Founders and frankly grounds for a revolution by the people. It's a helluva lot worse than the tyranny of King George.

 

 

"As for your 'heavy-handed' description, the usual argument from Republicans (other than promoting cuts to funding) is that there isn't enough oversight into how money is being spent on research projects (e.g. 'Why are taxpayers funding research into the mating habits of banana slugs and who approves this nonsense?').  I know that Republican is not the same thing as conservative, but my point is simply that 'heavy-handedness' when it comes to our R&D is not an issue that usually comes up.  In fact, privately financed research grant recipients often have less freedom because their work is constrained by the agenda of their financiers. Our government spends a lot of money on a lot of projects and all they have is an inefficient bureaucracy to keep track of it all!  As you can probably imagine, once the grants have been issued, public researchers often have a lot of freedom, which lines up pretty well with our nation's ideals as I understand them and has given our country a technological advantage over the rest of the world for the majority of the last century."

 

I don't have a problem with studying the mating habits of banana slugs. I have a problem with the federal government using taxpayer money on it. Virtually all of this should be privatized. Smaller government means taxes can be lessened, so private entities can have more money to freely spend on such research. Without those layers of bureaucracy placed between, just imagine how much more we'll be able to learn about banana slugs (and in a more timely manner) !

 

 

"Unfortunately, this isn't just the case with healthcare, but business and education as well.":  You have made it abundantly clear that you believe the federal government has no business in healthcare, business, education, and pretty much anything else other than national defense.  If your goal has been to drill that point home, you have succeeded masterfully."

Have I ?

 

"--Since we're supposed to be primarily talking about healthcare anyway, I'll try one more time:

If not the ACA then what?  Should we go back to the status quo pre-ACA despite the flaws in the system?"
 

 

Yes, yes, yes ! Because implementing the corpulent madness known as ObamaCare is the medical equivalent of treating a cut above one's eye by chopping off one's head above the shoulders. I'll take a flawed system of LESS federal involvement any day of the week. The feds need to keep their damn hands off my healthcare !

 

"How do you envision our healthcare system working absent the involvement of the federal government, and can you give any examples or evidence to support your claims?"

 

Because the federal government does not PROVIDE healthcare. It provides bureaucracy. Doctors provide healthcare. It's time to allow doctors to do their jobs and keep DC the hell out of their and our business and allowing people to decide what is best for them. Enough is enough.

[dmillsphoto]

I am trying so hard to stay neutral.

[producer2]

Healthcare reform affects Nashville in a positive way if allowed to proceed. Hospitals and hospital companies will be able to collect more in terms of treating patients that actually have insurance instead of the cost of indigent care that they currently are forced to endure. There, back on topic...

[UTgrad09]

I'm honestly not sure how Detroit fits into this argument...but in any case, I don't think Detroit's failure can be attributed to any one political system or ideology. It's more in line with a debate on the perils of cronyism and corruption. Any political party can be guilty of that. Now if Detroit had built its debt by creating a universal heathcare system and its debt was a cause of that, I could see how it would be appropriate. Its demise has nothing to do with healthcare or even providing any sort of service to its citizens. Its demise has to do with politicians, unions, and yes, free-market businessmen fleecing the city for everything it once had.

[Guest 5th & Main Urbanite]

I'm honestly not sure how Detroit fits into this argument...but in any case, I don't think Detroit's failure can be attributed to any one political system or ideology. It's more in line with a debate on the perils of cronyism and corruption. Any political party can be guilty of that. Now if Detroit had built its debt by creating a universal heathcare system and its debt was a cause of that, I could see how it would be appropriate. Its demise has nothing to do with healthcare or even providing any sort of service to its citizens. Its demise has to do with politicians, unions, and yes, free-market businessmen fleecing the city for everything it once had.

Detroits main problem is it banked it's entire economy, and future in the auto industry, and the industries that support the auto industry. The model was unsustainable, and the problems go back to the 1940's. In his book Middlesex, Jeffrey Euginides alluded to Detroit's problems when he was growing up there in the 1970's. Detroit should have had a more diverse economy, and it did not.

 

Regardless of politics, ideology, and philosophy on economics and government, the auto industry was doomed to failure. Less people in major cities are buying cars. Many young people no longer get their drivers licenses at 16 anymore, and many like myself only own a car because it is a necessity in Nashville. If I ever worked downtown again, we would go down to one car and sell the other.

 

For years Detroit produced junk while Japan, South Korea, and Europe made better cars. The reason for that is very complex, but cities as well as businesses go out of business when they do not produce and sell what the market wants. For years Detroit made what accountants and stockholders wanted, not what drivers wanted.

 

Healthcare reform will indeed be market driven no matter which political party is in power and whether Obamacare will be repealed or not. Whether it's the government or the private sector, they both need to fix something quick. 40 million Americans have no healthcare at all, and many millions more cannot afford what is available. Out of 311,000,000 Americans, over half have no healthcare or cannot afford it.

 

The point is, it is not working, and the populace have spoken. Obama would not have been elected for a second term if people were not in favor of some type of National Health System. I know my friend FMDJ does not want to hear this, but when I was in the UK I read stories in the papers daily of UK residents who were choosing UK and Western Europe healthcare over coming to America. I did not see UK residents begging the Prime Minister, nor the Labor Party, The Conservative Party, or the Democratic Party to start American style healthcare in the UK.

 

America is no longer the golden beacon for the world anymore. The reason for that is we have let our Capitalist greed overshadow our taking care of citizens. America is more interested in tax breaks for the rich, and high profit margins rather than insuring all 311,000,000 people, and that is shameful. 

 

"Proud To Be An American"  is a slogan now rested in Nationalism and the Arian Movements of extremists in Russia and Far Northern Europe. Violent Tea Party Type protests are common in those movements where only one ideology is represented. One race is tolerated, and the rest are seen as the enemy, much like the Anti-Islam Extremists that are trying to stop a Mosque in Rutherford County, Tennessee. That slogan is all about a false sense of security. Proud of what? Decaying cities? Fighting two wars? Uneducated children? Starving families? Destruction of good labor jobs and shipping them overseas? 1/5 of the country having no insurance? Right wingers wanting to get rid of the minimum wage? Right wingers wanting to abolish the Postal Service, Unions, EPA, and Department of Education?

 

To wax nostalgic of Ronald Reagan, the greatest tax and spend Republican of all time, all of this does "Trickle" down to Nashville and our healthcare industry. We need customers to support our healthcare industry. It needs to be affordable for everyone.

 

The last point I'll make is this. When people became customers of the healthcare system rather than patients is when all American Pride was lost.

[UTgrad09]

Detroits main problem is it banked it's entire economy, and future in the auto industry, and the industries that support the auto industry. The model was unsustainable, and the problems go back to the 1940's. In his book Middlesex, Jeffrey Euginides alluded to Detroit's problems when he was growing up there in the 1970's. Detroit should have had a more diverse economy, and it did not.

 

Regardless of politics, ideology, and philosophy on economics and government, the auto industry was doomed to failure. Less people in major cities are buying cars. Many young people no longer get their drivers licenses at 16 anymore, and many like myself only own a car because it is a necessity in Nashville. If I ever worked downtown again, we would go down to one car and sell the other.

 

For years Detroit produced junk while Japan, South Korea, and Europe made better cars. The reason for that is very complex, but cities as well as businesses go out of business when they do not produce and sell what the market wants. For years Detroit made what accountants and stockholders wanted, not what drivers wanted.

First off, the auto industry wasn't 'doomed from the start'...there are some very specific reasons they got to where they are -- and I won't address all of them. I do think you are absolutely correct in saying that Detroit should have diversified their economy. But the fact that there are more cars on the road than ever before sort of shatters the idea that the industry is doomed. Detroit's problems started well before most major cities were recovering...the auto boom was in full force while Detroit was failing -- but the boom wasn't happening in Detroit. The automakers were moving manufacturing out of the city. Also, whether or not people in major cities are buying as many cars is irrelevant considering that the central cities make up a smaller percentage of the population in comparison to suburbs. It's not like the market is or has been drying up. Owning a car is a necessity in most places, not only Nashville. Most of the American population relies on cars, even in the largest metro areas.

 

Second of all, your point about Asians and Europeans making a superior product IS one of the primary reasons Detroit's companies are in the shape they are in. Detroit did put out a good product, but they got lazy...rested on their laurels. They figured they had a captive market, so they worried more about making money than improving their products. And they were slow....VERY slow to react to competition gobbling up their market share. Really, it is quite arrogant what they did...and it is still biting them decades later.

 

Thirdly, and I don't want to start a debate here on the merits of unions, but the UAW is also in part responsible for what happened to Detroit. Constant threats of strikes and demands for huge pension programs really weren't what was needed while foreign auto makers were gaining ground on them. Detroit's auto industry was so wrapped up in themselves, they allowed foreign makes to set up factories, many of them in non-union states, to produce cars that were more American made than what Detroit was producing. Of course, you can throw in other factors such as the decline of American manufacturing as a whole, and the replacement of factory workers with robots as contributors to Detroit's problems. What used to require a massive workforce was being replaced by robots, or being outsourced to other countries or states to save money. 

 

But to say the auto industry as a whole is the problem is plain wrong...otherwise Volkswagen wouldn't be pouring billions into their plant in Chattanooga...likewise Nissan in Smyrna, Mercedes in Alabama, BMW in South Carolina, Subaru in Indiana, Hyundai in Georgia, etc, etc. Detroit simply did not adapt to the changing world of auto manufacturing...and unfortunately, it burned the city a lot worse than it burned the companies themselves.

I have absolutely no idea how to address the rest of your post...other than to say that is an exceptional tangent.

[samsonh]

To MLBrumby,

 

http://nashvillepost.com/news/2013/8/1/coming_off_q2_surprise_hca_brass_still_focused_on_costs_cap_ex_projects

 

Read through this article. You will see HCA is still investing in it's future through CapEx.You will see expenses rose, which contradicts your theory that they are somehow making lots of money at the expense of the future. I mean, every point in this article backs up what I am saying!

[fieldmarshaldj]

Healthcare reform affects Nashville in a positive way if allowed to proceed. Hospitals and hospital companies will be able to collect more in terms of treating patients that actually have insurance instead of the cost of indigent care that they currently are forced to endure. There, back on topic...

 

"If only those right-wingers will stop opposing the great and perfect ObamaCare, our health care will be the bestest in the whole world. Those meanies !"

 

Pray tell, P2, where's that money coming from ?