Preparing for state of the union

As you prepare to watch the state of the union address tonight (or to avoid it altogether if you can’t stand to watch), keep in mind these pieces: SusanG’s piece on why the NSA surveillance is not only illegal, but highly problematic (it could help convince your friends who say they have nothing to hide, so why protest it). And Malcolm Gladwell’s excellent piece from last August in the New Yorker about health savings accounts, and the reasons why they reinforce a moral hazard notion of health insurance, rather than a social insurance notion. Here’s just one excerpt from the piece, which I highly recommend:

"One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during th Clinton years—efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the Unite States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two an half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to th hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American lif expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in th nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MR machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billio dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-fiv million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy— country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuc with a health-care system that leaves its citizenry pulling out their teeth with pliers."

The punchline? Because we would do almost anything to avoid thinking about the common good.