The purpose of a writing class is to develop a meaningful thesis, direct or implied, that will generate a compelling essay. Most importantly, a meaningful thesis will have a strong emotional connection between you and the material. In fact, if you don’t have a “fire in your belly” to write the paper, your essay will be nothing more than a limp document, a perfunctory exercise in futility. A successful thesis will also be intellectually challenging and afford a complexity worthy of college-level writing. Thirdly, the successful thesis will be demonstrable, which means it can be supported by examples and illustrations in a recognizable organizational design.
Other Website: http://herculodge.typepad.com/
1. Vulnerable Americans: They are not the abject poor or homeless; they are working class people who can't afford health insurance (211).
2. "You're too sick, so goodbye." This mentality informs a lot of US health insurance companies who deny coverage to "high risk" customers and just dump them. This should be unacceptable.
3. The Great Medicine Question (214): Is medicine a guaranteed human right or a commodity to be bought and sold in the free market?
4. Brainwashed into Us Vs. Them Mentality: Some Americans, the "Us," say they don't want to pay for the "Them" when it comes to health insurance. This mentality is loaded with fallacies, moral and logical.
5. Distributional Ethics: Medicine is a commodity, the best available to the wealthy. The hell with the rest (215). "I got mine; get yours."
6. America's 85%: They want universal health care; however, they don't know how severe the problem is; they don't know that people can be turned away from a hospital, even an ER, especially in the face of nonpaid bills. This is legal (220); Americans are not engaged in the health care debate or pressed with the "first question": What are our basic values? And this leads to this: Should health insurance be a right? Class warfare is another problem, the us vs. them problem.
How does T.R. Reid outline his major points in Chapter 13?
He gives the major myths and repudiates them, a highly effective argumentation format that you will be asked to do in your college essays.
Myth 1: European style socialized medicine can’t work in capitalistic America.
Refutation: Many of these European countries use “private-sector mechanisms” (230)
The Bismarck model is private and even the Beveridge model has some private components.
Myth 2: National health care will result in rationed care, waiting lists, and limited choice.
The evidence in Japan, France, and Germany, among other countries, contradicts this assertion (231).
Myth 3: National health care will lead to waste and an inefficient, “bloated” bureaucracy.
In fact, ALL other systems are cheaper than ours. We waste the most money evidenced by spending the most per person while getting the worst service (232).
Myth 4: “Health Insurance Companies Have to be Cruel.”
Americans assume this because of their experience with health insurance companies in America; however, in other countries all people are given treatment and are not denied treatment the way they are in America (233).
Myth 5: “Those Systems Are Too Foreign to Work in the USA.”
In fact, America has cobbled together pieces from all the other countries. The American problem is that America has no cohesive, logical system; rather, it has a “crazy quilt” of different systems that result in overwork and waste (235).
Obamacare Explained
Goals
To outlaw denial of coverage
To impose billions of new taxes
To enforce calorie counts for all fast-food restaurants and beyond
To slow the growth of medical costs
To expand the definition of povery and add about 16 million to those who are covered
To generate "guaranteed issue" so that no one is denied coverage because they are "too risky." However, this law is compromised because of vague individual mandate.
DALE Metric for "healthy life expectancy" 254
Top countries:
1. Japan
2. Australia
3. France
4. Sweden
5. Spain
6. Italy
7. Greece
8. Switzerland
9. Monaco
10. Andorra
America ranks 24th on the Dale Index even though America is the wealthiest country.
There are dozens of ranking systems, we read, and over and over America ranks at the bottom (266).
What the new law won't do
Won't simplify crazy quilt of conflicting and overlapping payment systems
Won't give us universal coverage
Using the Toulmin Model of Argumentation for Your Essay
1. Paradox: We're a first-rate economy with first-rate medical research and equipment but a fourth-rate health care provider.
2. America's quilt payment system: a crazy, overlapping pay system resulting in chaos, wasted money, and conflicting systems with no one willing to take accountability (29). Tens of millions of Americans are uncovered. See waste in the US healthcare system.
3. Moral bankruptcy argument: We allow children to go to bed with an earache, toothache, or asthma attack because we don't provide a basic human need in the world's wealthiest country (30).
4. Prevention argument: Prevention would save us billions of dollars a year. One source, American Public Health Association, says we will save 16.5 billion a year with prevention.
5. Avoidable mortality (32): How well does a country treat curable diseases? America is last in the world. We're also last for quality of life at 60, a benchmark for general health. We also the worst developed country for infant mortality (33).
6. American Health Care Money: American health care costs are number one and the providers make more profit than any providers in any other country. But we have the worst health care of all developed nations. American doctors make two or three times as much money as other doctors from other countries (35). But the biggest reasons for our bloated health costs are the way we manage health care and the complexity of our health system (36).
7. America's shame: America is the only developed country that relies on profit-making health insurance companies for essential health care (36). We refuse to embrace the non-profit model even though countries that use it have superior health care.
8. American System of Not Helping: Health care companies don't want to spend money on helping people: The less they spend on health care, the safer their CEOs and the higher their stocks (37). Don't help people; spend money on administrative costs. America's administrative costs are the highest in the world. Unlike other countries, American health care companies are motivated to deny claims.
9. Guaranteed issue: Countries, except the US, guarantee service to all people while the US health companies cherry-pick their customers based on a risk assessment (38). Other countries also have individual mandate, which means all citizens feed the pool of money for health insurance (39).
10. The Lose Your Job Lose Your Health Insurance Model: This horrible model is unique to America. No other wealthy country uses it because it is immoral (40). This is shocking for me to read about because all my life I've heard this mantra: "America is the greatest country in the world!"
11. Administrative Monstrosity Model: Complicated, confusing health care model that makes maximum money for health care providers and minimizes quality health care: It's unique to America (44).
Moral Reasons for Supporting Some Form of Universal Healthcare
1. Letting people die from illnessness that could have been treated is unacceptable in a developed country, especially when the US is the only country that allows this. We're not a member of the Zero Club.
2. For-Profit model doesn't work.
3. All other developed countries have a successful model of universal healthcare.
4. We spend more money per person but are in dead last.
Review Questions
What is the paradox of the American health care system?
See pages 28 and 29.
We are a system of the haves and the have-nots like Nikki White.
America has the best facilities and doctors but is the highest in “avoidable mortality” (32).
America also ranks low in survival rate from diseases.
More young people die in America than in other rich countries (33).
America is at bottom for health at age 60.
America is dead last in keeping newborn babies alive (33).
See infant mortality rates on page 34.
While ranking worst in all the above categories, America has the highest cost of health care, another paradox (34). One reason is that doctors, nurses and other health care providers and staff make more money than their counterparts in other countries.
This extra income is necessary for inflated college costs and malpractice insurance (34).
But these salaries are a tiny factor. The two huge factors are the way we manage our health system and the unnecessary complexity of our health care system (35).
Profit motive is so important in America, that United States is only country in the world that denies coverage for fear of individuals being at special risk for getting sick (38).
Other countries have one health care system; America has or “crazy quilt” or jigsaw puzzle of different pieces that don’t fit together (41).
Billing is so complicated in America that it’s the only country who has to hire “compilers,” middlemen who “compile the bills that doctors submit and then shuttle them through the payment system” (43).
How should French health care allay the anxieties people have about adopting the Bismarck system?
No waits, no denial of services; full access to best services; affordable care through employer and government paying private hospitals (like Kaiser). The French Ministry dictates what hospitals can charge for services to keep costs down.
The World Health Organization ranks France number one in the world.
Part II Common Arguments For and Against Universal and Socialized Health Care
Part III. American Exceptionalism, Hubris, and Our Health Care Crisis
Americans resist learning from other countires who have better health care in part because of American Exceptionalism, the belief that America is the light in the darkness, the salt of the earth and as such is entitled to influence the world, not the other way around (difficult to reconcile the idea of American Exceptionalism with a country that was founded on a slavery economy).
1. My mother told me to help the other children, seeing I was the oldest, I thought it was a great idea.
2. I did bad and and got spanked, my little brothers did the same and got spanked as well.
3. My learned helplessness came in childhood, I was told I was like my younger brothers.
4. It was never their intention to have an affair, Eileen just wanted a tutor.
5. Love has no name, love has a final destination.
6. Tian is not only concerned with losing his job, he also has to manage his mother.
7. Tian sees no way out, he can't ask his mother to leave.
8. Meifen has time on her side, she's an old sly fox who's played this game before.
9. Dave had only a few girlfriends and both of them left him; leaving him to feel rejected and hurt.
10. The characters from Ja Jin's stories suffer from learned helplessness caused by self-reinforcement and solipsism.
11. Conjuration happens as people speak. (Harry Potter language)
12. He doesn't care about his wife's thoughts because of his solipsism coming from low self-esteem.
13. The Third Eye gives a person a feeling of enlightenment and allows them to find freedom from the shackles that imprisoned them in their learned helplessness and personal issues.
How to Set Up a Counterargument in Your Rebuttal Section (The Templates)
Some of my critics will dismiss my claim that . . . but they are in error when we look closely at . . .
Some readers will 0bject to my argument that . . . However, their disagreement is misguided when we consider that . . .
Some opponents will be hostile to my claim that . . . However, their hostility is unfounded when we examine . . .
TR Reid at the Peterson Institute
Many of these questions can be used in the rebuttal section of your essay.
One. Is Obamacare universal care?
No, because under Obamacare 6-8% still won’t be covered. That’s 20 million who will be without health insurance. This will result in “cost shifts,” which will raise costs and defeat the purpose of health reform. Additionally, Obamacare is not a unified system; it’s still a hodgepodge or patchwork and this too will keep costs higher than they should be.
Two. Can the French government manage anything efficiently?
Yes and far better than the US. In France medical administrative costs are 4.8%; in contrast, the US has 18-22% administrative costs.
Three. Yes, US citizens pay more for drugs (three times as much as in Europe and Japan), but these higher prices fund our superior medical research. How do you respond to that?
Reid answers that in fact other countries are doing just as rigorous research and making innovations that help the world: Britain invented Viagra; France invented state-of-the-art hip and joint replacements.
Four. But, relating to the question above, European and Japanese research is subsidized by the US citizens’ paying higher prices for their drugs. Is this true?
Reid says yes it’s true and the US should pay lower prices and make European and other countries pay more for their research.
Five. Which universal model is best for America?
The Bismarck model, especially as it’s used in Japan, because they keep costs down. In Japan, average hospital visits a year are 15; in America it’s 4.8.
Six. But in Japan those low consumer prices generate excess demand.
TR Reid concedes this point. Japan should charge more. GDP health costs in Japan should go up from 8 to 9% and he adds, “America would love to have a health cost GDP of 9%.” Why? Because we’re saddled with an 18% GDP for health costs, the highest in the world.
Seven. But the Japanese system is not sustainable when we consider hospitals can’t pay their bills or pay doctors enough or hire enough nurses. Also price controls lead to shortages and blackmarkets.
TR Reid concedes all of these problems but says Japan simply needs to go from 8 to 9% GDP to fix this problem.
Eight. Reid points out that the US is the only country that pays insurance underwriters to deny coverage and deny applicants and then he quotes Paul Krugman: “It would be cheaper for insurance companies to eliminate these underwriter positions and simply allow all claims and applicants.” In other words, it’s cheaper to be nice.
Nine. “If you’re really sick, you want to be in America.” That proves that America has the best healthcare in the world.
Reid’s response: Yes, it’s the best healthcare for the rich and those who can afford their insurance (which can be taken away at any time). US healthcare doesn’t serve everyone evidencing an immoral paradox that needs to be changed.
Ten. “We’ll lose high-end medical care if we go universal.”
No other country that’s gone universal has suffered a decline.
Eleven. “All of your analysis is based on rich countries. Does it apply to the poor countries, which are 80% of the world?”
“I was looking for models to fix the US system. I never claimed to be trying to do anything else.”
“Pay or die” model in those 150 poor countries is not a model for us.”
1. Egalitarianism: equality for all people, no outliers, no extremes. We see this mentality in Canada and this mentality informs their health care system.
2. Canada is not a utopia: long waits and doctor shortages undermine the system but the Canadians still love their health care system more than any government program.
3. America's Myth of Rugged Self-Reliance Vs. Protect Humans from a Free Fall of Cruelty: This myth feeds the Out of Pocket system.
4. Straw Man Fallacy 1: To claim that Reid is painting utopian pictures of overseas health care systems. He is not. He is pointing out their flaws. However flawed, these other countries are morally superior to the US in that they don't like to leave people behind. For a variety of reasons, America doesn't care.
5. Straw Man Fallacy 2: To claim Reid is arguing that we can make an easy transition to a universal health care system (164). Reform is tough but can be done as we have seen in Taiwan and Switzerland.
6. Learned helplessness (164): Americans have seen so many failures to reform our health care, including Clinton and a currently struggling Obama, that we've given up, thrown in the towel, come to the conclusion that "nothing can be done."
7. Resigning to the status quo: giving up and saying "things must stay the same because nothing ever changes."
8. Hope in a Chinese saying (169): "To find your way in the fog, follow the tracks of the oxcart ahead of you." Reid's thesis is that we must do this, following overseas countries' health plans. Taiwan did this, following the Canadian model. Soon Taiwan enjoyed higher life expectancy and higher quality of life (174).
9. Ethical Obligation Principle (183): Health care is a fundamental right for everyone. Clinton made economic arguments (183), showing that America wasn't in the mood for moral appeals. Obama started with economic appeals but in 2010 he changed to ethical and moral ones.
10. Micro and Macro approach: We can look at the effects of universal health care, or not, on the individual, micro, also called Medical Model; or we can approach on a larger society level, macro, also called the Public Health Model (186). The latter deals with prevention and helps stop the spreading of disease. Smoking and obesity are discouraged, for example, in huge public campaigns.
11. America's sin of not providing pre- and post-natal care (202).
Review Questions
What liability results from “free” health care?
People tend to use a lot of care. Long lines are the dreaded result (115).
American opponents of universal health care use the above even though Britain outscores America in every health category.
How is China moving in the opposite of most rich countries in the realm of health care?
See pages 152 and 153
China, like America, is a rich nation that places burden of medical care on the consumer and like America has horrible health care ratings.
As China has gotten richer, its health care has gotten worse for average citizens. Rich citizens get good health care; the rest do not.
What is the most compelling reason for changing the American health care system?
It’s a moral imperative.
Also, the current system is a threat to our economy.
Why do Americans and politicians show a lack of will toward changing the system?
See pages 164 and 165.
We lose moral focus. We see our failed attempts. We see Democrats and Republicans fighting rather than trying to come up with solutions. We feel helpless in spite of every other developed country doing it. We’re full of excuses.
Perhaps Americans don’t see health care as a right as in other nations (215).
Perhaps Americans see health care as “an entitlement for the lazy” that the rich pay for. This is brainwashing according to Reid.
But in fact 85% of Americans when polled believe universal coverage is a right (220).
Too many Americans have been brainwashed into believing that anyone can be treated in America. As GW Bush said, “You just go to the emergency room.” But this is wrong. Many are turned away or wait so long they die (220).
We’re shortsighted. We don’t pay for prevention. We have no pre- or post-natal care like other industrial countries (203).
We refuse to follow the Chinese saying, “To find your way in the fog, follow the tracks of the oxcart ahead of you” (169).
We so far have given in to commercial interests and have not made a priority, as other nations have, to make the moral and ethical imperatives for universal health care the leading force (183).
1. Ignorance of calling Bismarck system "socialized medicine": We see that the system in Germany is mostly private in spite of efforts to demonize all universal health care as socialism, a buzz word that stops the debate and ceases intelligent conversation.
2. No waiting and abundant choice in Germany, France and Japan: These examples refute the fears of the anti-universal health coverage camp.
3. individual mandate: all citizens, as in Japan, must sign up for a health plan. A lot of Americans are hostile to this idea.
4. Japanese doctor income level is too low: Those who provide medical care in Japan are underpaid. Today, as we read in the Japan Times, there is a doctor shortage.
5. Pay the Piper Principle: No UK medical bills but a sales tax of 17.5%
6. Facing the Financial Abyss: Emergency medical procedure for author's daughter in Britain frightened him. What would the bill be? It was nothing. Now he knows why Brits put up with high taxes (119).
Review Questions
One. How successful, or not, is the Bismarck system in Germany and Japan?
Remember Bismarck is private, non-profit insurance plan paying a private provider.
See 90 and 91 for comparison of Japan and Germany.
Japan pays doctors and nurses the lowest (91).
On page 96, we see that many Japanese doctors are underpaid for their services.
But Japanese doctors graduate typically with no student debt and tuition fees of $1,500 a year (97).
Two. What is the purpose of British health care?
That nobody should ever have to pay a bill. This works because in Britain the sales tax in 17.5 percent.
Final Essay 4, Worth 400 Points: The Healing of America by T.R. Reid
In a 6-page research paper, not including your Works Cited page, address the following proposition with an argumentative thesis:
One camp of readers would praise T.R. Reid’s book as a heavy dose of sanity counteracting a sick American public health care policy shackled by greedy politicians and insurance functionaries, polarized pundits, fear tactics, close-mindedness, and other pathologies. Another camp of readers would repudiate Reid’s book as an ideologically fueled polemic sodden with biases, fantasies, and socialistic excesses. Which camp are you in? Support your position in a thesis with mapping components that defend your assertion. Be sure to address your opponents to show why they’re misguided in at least a page of your essay.
Your guidelines are as follows:
This research paper should present a thesis that is specific, manageable, provable, and contestable—in other words, the thesis should offer a clear position, stand, or opinion that will be proven with research.
You should analyze and prove your thesis using examples and quotes from a variety of sources.
You need to research and cite from at least five sources.
You must use at least 3 different types of sources.
At least one source must be from an ECC library database.
At least one source must be a book, anthology or textbook.
At least one source must be from a credible website, appropriate for academic use.
The paper should not over-rely on one main source for most of the information. Rather, it should use multiple sources and synthesize the information found in them.
This paper will be approximately 5-7 pages in length, not including the Works Cited page, which is also required. This means at least 5 full pages of text. The Works Cited page does NOT count towards length requirement.
You must use MLA format for the document, in-text citations, and Works Cited page.
You must integrate quotations and paraphrases using signal phrases and analysis or commentary.
You must sustain your argument, use transitions effectively, and use correct grammar, spelling, and punctuation.
Your paper must be logically organized and focused.
Introduction, MLA Format and Common Grammar Mistakes on Research Paper
Task 1: The four parts of an introduction A simple introduction to an argumentative assignment has four parts. Read the following description of the parts. Then circle the sentences in the introduction above which cover each part and write the number for each part in the margin next to it, e.g. for the first part draw a circle around the sentence(s) that introduce(s) the topic and write "1" in the margin next to it.
1.
Introduces the topic
2.
States why the topic is important
3.
States that there is a difference of opinion about this topic
4.
Describes how the assignment will be structured and clearly states the writer's main premise
Do’s and Don’ts of Writing an Introduction
Don’t
Use a trite quotation like “We have nothing to fear but fear itself.”
Don’t use any cliché like “All talk and no action” or any other over-familiar phrase that has no freshness.
Begin your introduction by writing, “In this essay it is my objective to . . .”
Don’t use a common dictionary definition of a term you want to define.
Don’t begin with “In today’s society” or “In society today” or “In today’s modern world” or “The modern world in which we live in” because all are lame.
Don’t be trite or boring.
Do’s
Do establish relevance. Why is your topic compelling, a topic your reader needs to reckon with?
Do begin with a compelling cultural reference.
Do begin with an extended definition that helps your reader understanding a term that is central to your essay.
Do begin with a refutation of a commonly held opinion: “Most United States prison sentences don’t make us safer; they increase crime and feed business interests, not human interests.”
Do begin with a series of rhetorical questions: “Have you ever wondered by so many Americans are apathetic to the very issues that determine the core of their morality and quality of life?”
Do begin with a “delicious quote” or paraphrase that captures your reader’s attention: “Economist Paul Krugman said it would be cheaper for insurance companies to fire their underwriters who are paid to deny medical claims and simply not deny medical claims.”
Your thesis is more than a general statement about your main idea. It needs to establish a clear position you will support with balanced proofs (logos, pathos, ethos). Use the checklist below to help you create a thesis.
This section is adapted from Writing with a Thesis: A Rhetoric Reader by David Skwire and Sarah Skwire:
Make sure you avoid the following when creating your thesis:
A thesis is not a title: Homes and schools (title) vs. Parents ought to participate more in the education of their children (good thesis).
A thesis is not an announcement of the subject: My subject is the incompetence of the Supreme Court vs. The Supreme Court made a mistake when it ruled in favor of George W. Bush in the 2000 election.
A thesis is not a statement of absolute fact: Jane Austen is the author of Pride and Prejudice.
A thesis is not the whole essay: A thesis is your main idea/claim/refutation/problem-solution expressed in a single sentence or a combination of sentences.
Please note that according to the MLA Handbook for Writers of Research Papers, Seventh Edition, "A thesis statement is a single sentence that formulates both your topic and your point of view" (Gibaldi 42). However, if your paper is more complex and requires a thesis statement, your thesis may require a combination of sentences.
Make sure you follow these guidelines when creating your thesis:
A good thesis is unified:
NOT: Detective stories are not a high form of literature, but people have always been fascinated by them, and many fine writers have experimented with them
(floppy). vs.
BETTER: Detective stories appeal to the basic human desire for thrills (concise).
A good thesis is specific:
NOT: James Joyce’s Ulysses is very good. vs.
BETTER: James Joyce’s Ulysses helped create a new way for writers to deal with the unconscious.
Try to be as specific as possible (without providing too much detail) when creating your thesis:
NOT: James Joyce’s Ulysses helped create a new way for writers to deal with the unconscious. vs.
BETTER: James Joyce’s Ulysses helped create a new way for writers to deal with the unconscious by utilizing the findings of Freudian psychology and introducing the techniques of literary stream-of-consciousness.
Quick Checklist:
_____ The thesis/claim follows the guidelines outlined above
_____ The thesis/claim matches the requirements and goals of the assignment
_____ The thesis/claim is clear and easily recognizable
_____ The thesis/claim seems supportable by good reasoning/data, emotional appeal
Class Exercise:
Write a one-paragraph introduction and thesis for your final essay.
In a 6-page research paper, not including your Works Cited page, address the following proposition with an argumentative thesis:
One camp of readers would praise T.R. Reid’s book as a heavy dose of sanity counteracting a sick American public health care policy shackled by greedy politicians and insurance functionaries, polarized pundits, fear tactics, close-mindedness, and other pathologies. Another camp of readers would repudiate Reid’s book as an ideologically fueled polemic sodden with biases, fantasies, and socialistic excesses. Which camp are you in? Support your position in a thesis with mapping components that defend your assertion. Be sure to address your opponents to show why they’re misguided in at least a page of your essay.
Your guidelines are as follows:
This research paper should present a thesis that is specific, manageable, provable, and contestable—in other words, the thesis should offer a clear position, stand, or opinion that will be proven with research. You should analyze and prove your thesis using examples and quotes from a variety of sources.
You need to research and cite from at least five sources. You must use at least 3 different types of sources.
At least one source must be from an ECC library database.
At least one source must be a book, anthology or textbook.
At least one source must be from a credible website, appropriate for academic use.
The paper should not over-rely on one main source for most of the information. Rather, it should use multiple sources and synthesize the information found in them.
This paper will be approximately 5-7 pages in length, not including the Works Cited page, which is also required. This means at least 5 full pages of text. The Works Cited page does NOT count towards length requirement.
You must use MLA format for the document, in-text citations, and Works Cited page.
You must integrate quotations and paraphrases using signal phrases and analysis or commentary.
You must sustain your argument, use transitions effectively, and use correct grammar, spelling, and punctuation. Your paper must be logically organized and focused.
Body Paragraphs: Point by point refutation of their reasons for having their position.
Conclusion: Restatement of thesis in dramatic form.
Either way, you'll have to address your opponents' views.
Ten Reasons for Being Against National or Universal Healthcare:
1. inefficient in the hands of clunky government
2. will raise taxes
3. free market, not socialism, increases service and products
4. decreased patient choice
5. patients will abuse free service and overburden the system
6. uninsured Americans can already receive healthcare through non-profit, charities, and emergency rooms
7. healthy people will pay for unhealthy people (obese and smokers)
8. government will restrict behavior and become intrusive
9. lower profits will disuade the best and brightest from pursuing medical careers
10. healthcare isn't a right
Ten Reasons for Supporting National or Universal Health Care
One. The U.S. Constitution guarantees to promote public welfare and to insure domestic tranquility.
Two. Other countries have universal coverage and serve their people better without being “destroyed by communism.”
Three. Universal healthcare is a moral imperative. Who are we as a people if we don’t value guaranteed healthcare for everyone?
Four. Universal healthcare is good for small and big business (except for the healthcare insurance companies).
Five. It doesn’t discriminate based on medical condition.
Six. It eradicates for-profit insurance companies who value their money over our health.
Seven. It makes a less complicated payment system saving billions of dollars over the current system, which has at least 25% waste.
Eight. Government-fueled universal healthcare is the only force big enough to take down the evils of for-profit insurance companies.
Nine. It will provide preventative medical care saving billions of dollars and saving tens of thousands of lives.
Ten. Healthcare will be affordable for all.
Lexicon
1. Pathos, Ethos, and Logos (emotion, credibility, logic) when it comes to the moral question of health care in the Prologue: Nikki White died without good cause. Wealthiest country couldn't give her standard country when less wealthy countries could. The situation is neither ethical or logical.
2. American patient's dilemma: Too rich for paid health care, welfare, and too poor for high quality health care: 20,000 Americans die every year without good reason because of our failed health care system. This does not happen in any other developed country. We aren't talking about this, but we are eating at buffets. We are blind to our detriment.
3. "Our fundamental moral decision": As Americans, we have decided not to provide health care for everyone. We don't guarantee medical care for the sick unlike every other developed country. We are morally bankrupt. Politicians in bed with health care lobby have persuaded us that universal health care is "un-American" and "communist." Are we so malleable and gullible?
4. Moral denial and numbing: Either we are in denial of our moral failing to provide health care or we are numbed to our awareness of our moral failures. T.R. Reid wants to wake us up.
5. Either/Or Fallacy (presented to us by many politicians): For many Americans, we must either keep our current health care system, as flawed as it is, or submit to the evils of socialized medicine and violate our true American nature. In fact, this is a myth: Most developed countries who provide universal health care are not socialist (3) but anti-universal health care politicians continue to push this logical fallacy. And sadly too many Americans believe them.
6. Primary motive for changing health care: We can look at economics, politics, and health reasons for changing it but the primary motive should be a moral one.
7. American Health Paradox: We spend the most money per person for medical care and we receive the worst medical care. We spend $7,400 per person while Japan, ranking high in quality medical care, spends $3,400.
8. The book's thesis: On page 8 we read we can find cost-effective ways to cover every American by borrowing methods from other countries.
9. American pride and hubris: "We're number one!" and "We'll never bow down to socialists!" are inaccurate, ignorant, and irrational and yet this mentality impedes us from positive change. This mentality is the knee-jerk (not using the brain) reaction to the proposition that we need universal health care.
10. We have a history of benefiting from borrowing from other countries in popular culture (TV shows) and even our highway system (from Germany). Why is there such a stigma with national health care?
11. Pragmatic: reasonable and practical and problem-solving as opposed to being stubborn, hard-headed, irrational. We need a pragmatic approach, not an ideological one.
12. Egalitarian: No one stands out. We're all in the middle, no extremes above or below. Canada embodies this mentality and they have universal health care with long lines for some procedures.
13. Absolutists: British will not pay a penny for any medical procedure. This is their absolute position, so they don't mind paying with health care with higher taxes.
14. Bismarck Model of Health Care: Payers get their benefits through payroll deductions, but everyone is covered with a job or not. The health care systems work non-profit. We see this system in Japan, Germany, Belgium, Switzerland, and Latin America (17).
15. Beveridge Model of Health Care: Government pays for all health care through taxes. We see this system in Britain, Italy, Spain, and Hong Kong. This system is also used in the United States Veterans Affairs or the VA.
16. National Health Insurance Model: This is a hybrid of Bismarck and Beveridge: The providers are private but the payer is a government-run insurance program. This single-payer system keeps costs down (19). We see this system in Canada, Australia, Taiwan, and South Korea.
17. Out-of-Pocket Model: Have money or die. We see this model in poor countries.
Review Questions up to Chapter 2
One. How is the death of Nikki White on page 1 a moral condemnation of America?
She died unnecessarily and without protest in a country indifferent to the moral bankruptcy of a country that doesn’t protect its people.
The moral condemnation can be further based on the fact that our health care system “has become excessively expensive, ineffective, and unjust” (8, 9). America is ranked 37th in the world for health care service based on quality and fairness (9). Yet we spend the highest percentage of our GDP on health care (9).
Japan ranks higher in health care in America but spends less per person at $3,400 vs. $7,400 per person in America (so health insurance companies getting all that money?)
Two. What dilemma was Nikki in that is like so many Americans? See page 1
She made too much money for health care under welfare but not enough money to pay for drugs needed to save her life.
Three. Why does Reid compare the cost of fighting terrorism with the cost of health care on page 2?
We spend hundreds of billions to fight terrorism based on 9/11, which killed 3,000 people, yet every year twenty thousand Americans die because of a lack of health care. This doesn’t happen in any other developed country in the world.
Four. What “moral decision” has our country made on page 2?
Whatever entitlements we enjoy, we have decided to not cover health care for our people so that at least 23 million are uninsured. We've got an "I've got mine; get yours" mentality.
Five. What is Reid’s thesis?
See page 11: “The thesis of this book is that we can find cost-effective ways to cover every American by borrowing ideas from foreign models of health care.”
Are we too arrogant to learn from other countries? Too proud? Too inclined to demonize other countries as being “socialist”?
Indeed, American exceptionalism, the belief that the American way is the best way, impedes us from looking at foreign countries and their superior methods. See page 12. Fantasies of American superiority in the face of our hideous health care ranking need to come to an end.
Indeed, politicians and others respond to health care by shouting, “But it’s socialized medicine!” It’s as if that ended the argument. This is the major political weapon.
Six. What are the flaws of the “socialized health care is against free market and low taxes” argument?
Most national health care systems are not socialized. Also, Americans already have socialized car such as the Veterans Administration.
It’s a fallacy therefore to accuse someone promoting universal health care as being socialist or un-American.
Seven. What is comparative policy analysis and why is it so important?
Find out what works in other countries, like the Super Highway, and implement it in your own country.
Eight. What are the 4 basic health care models?
On page 17 we read about
(1) The Bismarck Model, a nonprofit private plan that amounts to charity.
(2) The Beveridge Model
The government provides health care through taxes like in England. It operates like the Fire Department or a utility.
This system is what Americans think of when they think of “socialized medicine” even though they conflate the Beveridge Model with all the others.
The Beveridge Model is most purely implemented in Cuba and US Veterans Affairs, which is ironic.
(3) The National Health Insurance Model
This is a combination of the Bismarck and the Beveridge in which the government is the payer to private health care companies.
This is nonprofit and needs no marketing so the cost is cheaper than private insurance.
(4) The Out of Pocket Model
If you’re poor, you get no medical care because you live in a country that has no health care system. Only the rich can get medical care.
America has all four systems in its crazy health care amalgam. We rely on separate systems for separate classes of people (21).
Nine. If everyone agrees the American health care system is dysfunctional, then why is there resistance to change?
Knee-jerk (reacting without thinking) reflexive hostility: “Socialism is un-American!”
Hospital chains, pharmaceutical companies, insurance companies, their lobbyists all pay big money to disseminate propaganda and pay-off the politicians.
Opponents argue that bureaucrats decide who gets what kind of treatment, called “access to treatment decisions” and these decisions result in “limited choice” (24).
Americans apparently lack the moral fortitude to embrace the moral principle that informs all other developed countries: Health care should be for ALL people; however, whites get better health care than people of color while no such racial disparities exist in other developing countries (23).
You should focus on this moral argument and its strength, or not, in your essay.
Ten. All developing countries do better in the “basic measures of health care performance.” What are these measures?