Sunday, September 23, 2012

Mountain Rescue in Yilan: Our Scary Hiking Story and why Taiwan's National Health Insurance Rules (and America Sucks)

Near that waterfall is the water hole that Brendan fell into - this is us swimming before it happened
So, last Sunday (just about one week ago), my husband, a friend and I took a hike/river tracing excursion to Yuemeikeng waterfall: we wanted to show our friend the falls and I was eager to return with a better camera and take more photos. Plus, I wanted to try the hike in something better than sports sandals, and bought river tracing shoes for this trip as well as future ones.

We set off alright, following the directions I remembered, and made it a good ways up the river. Then we came to a deep swimming hole carved out by a powerful waterfall of moderate height. We took a swim, and then tried to figure out how to get over it. We weren't going to make ti by climbing, that was for sure. I remembered their being a side trail over this fall from our last hike, and started up it - but the ropes that had been there were gone and the ground was steep and slippery. This was almost certainly a result of the typhoon that had blown through recently. I was almost certain to fall into the gorge below - and not necessarily in deep water - if I continued. Other river tracers made it over the waterfall or had their own climbing equipment for that section of trail.

We searched for alternate trails and found none on the same side - I found what I thought was an alternate, in an area I vaguely remember walking around in on the last trip, and started up it, with the understanding that if this didn't work out, we'd either turn back or take the high trail, which might give us a view of the waterfall but probably no safe way down.

The trail seemed overgrown and in places not really a trail - but I saw some footprints, which made me believe that it was a good route up and over the falls, and we continued far past where we really should have.

Our friend said she was starting to believe this path wasn't safe - I wanted to look ahead to confirm that but was also within a few minutes of agreeing to turn back. We were maybe 20 meters above the gorge at this point.

Before that could happen, Brendan - who was hiking between us, shouted as a large section of ground gave out beneath him. I had just climbed the same bit of ground, but clearly two people clamoring over it was more stress than it could take. We heard his interminable fall down, grunting and yelping as he was hitting trees and underbrush on the way down in a manner not dissimilar from this (after Homer starts falling).

Twenty meters of that - later on we learned that he'd lost his glasses and his wedding ring in the fall - and twenty meters of us gasping in terror has he took the worst fall of his life, as well as the worst fall any of us have ever personally seen anyone take.

Then, silence. It was about ten meters after that straight down into the water, with nothing but a slick rock face in between.

And then, a loud splash.

We heard shouts, and then nothing. I was terrified and started shrieking - but I was also stuck. I had just climbed over the ground that had given out under Brendan. How would I get around that safely and back down? Could I get up to the trail at the top safely? Probably not and almost certainly not.

I told our friend, who was behind me, to go see about Brendan first while I figured myself out - I figured I could stay up there almost indefinitely (provided the ground didn't give beneath me too) whereas Brendan almost certainly needed immediate aid.  I still didn't know what had happened - I didn't know where in the river he'd fallen. I didn't know if he had a lot of cuts, some broken bones, a concussion, or worse. He might have been dead. The thought of that final possibility terrified me - imagine not knowing if your best friend, your beloved spouse, a person who is so good that they're like gold to their core, a person who, if they leave this world while young, then the world is not fair and any god that may exist is uncaring, and knowing it was your idea to take the trail up - and not knowing how you are going to get down to find out. Feeling like you, for deciding to check a little further ahead, should have been the one to go down with that chunk of dirt. For feeling like there might be a hole that just got ripped out of your heart and soul, and a person you are pretty much of the other half of, gone - and you don't even know yet if that's true.

Like that. I couldn't even cry, but I couldn't stop crying - it was that much of a shock. Obviously, it was a bigger shock from him, but I can only write knowingly about my perspective.

So as Brendan lay below - possibly OK, possibly not - and Emily tried to get to him, I spent the next few minutes figuring out how to get back down, or back up, or decide to wait for help, or somewhere or something. After several minutes of what seemed like careful deliberation but was really my adrenalin-fueled lizard brain making decisions for me, I swung carefully over the crumbled ground, hanging on by roots and prayers to a god I don't believe in to make it down to my husband at the bottom of the gorge.

Two-thirds of the way down, Emily came back and said two words: "He's alive". She also said "his leg's pretty bad and he's bleeding from the head, but he's talking and conscious and he's alive".

All I really heard was "he's alive" - I didn't remember the rest until later. I took Bigfoot steps through the bit of shallow river to where he was - some river tracers had seen him fall and gotten him out of the deep water.

Fortunately, he'd fallen in that one section of river carved out by the waterfall that was so deep that we, when diving down, couldn't reach the bottom. Ten meters straight down, and all I can say is that he was extremely lucky that that's where he landed. Ten meters into any other portion of that river and it could have been much worse. He was sitting on a rock, blood running down the back of his head (he patted it to show me that there was no brain coming out), back cut up pretty bad, huge gash in his knee.

We had no cell reception - nobody, not those with Da Ge Da, Fareastone or China Telecom, had any signal. Emily knows First Aid, so she watched for signs of shock, broken bones, trauma etc. as she used her teeth to cut apart the cheap towels we'd brought and tie them to his bleeding. We got him food and water, and I took off with just some money, my phone and sandals down the river to get to an area with reception and call for help.

Truth be told, I wanted to be there with my husband in his time of need, but this made sense: I speak Chinese and know the trails and river better, having hiked a few times in this area before. Emily knows First Aid. It was smarter to send me for help and leave her with Brendan. A group of river tracers helped us to the best of their abilities, but went back to their activity when they saw he was basically OK, and probably going to be OK. Emily tore apart towels with her teeth (her teeth!) and tied them to his head and leg with shoelaces to staunch the bleeding, and looked for signs of shock, broken bones, head trauma, hypothermia and other injuries.

I got to a juncture where I still had no reception but had to take off my river tracing shoes and put on sandals. As I was doing so, a Taiwanese couple came by and I asked them if they had reception - I didn't, but they had China Telecom and did. They helped me call 119 - I thanked them and said I wouldn't mind if they went on their way, but they stayed with me. I had forgotten to bring food and water, and was starving and thirsty - they asked me if I was hungry and thirsty and gave me a sarsparilla soda and raisin bread, which I wolfed down like a thieving Labrador who'd just stolen it.

Sitting, wet and covered in mud and silt, by the bridge, waiting for the EMTs to arrive, while still racing on panic, guilt, worry and adrenalin felt like someone had trapped me in aspic - I couldn't leave, I had to wait for the EMTs - but I couldn't sit still. Brendan was probably fine, but I still had a curdling stomach (which didn't stop me from shoving an entire loaf of bread down my gullet, mind you) and a sense of urgency. No....URGENCY.

Five guys showed up - a local lookin' dude in blue and white plastic shoes and faded clothes, a guy in a black EMT shirt with some ropes and a walky-talky, and two men in burgundy shirts with something wilderness-y embroidered on the pockets.  One had a pallet and huge Emergency First Aid bag. One wore dress shoes. At first I was really worried - this was mountain rescue in Taiwan? A dude in sandals and another in dress shoes?

I led them to the river, put on my tracing shoes and was all "OK, LETS GO NOW" but they stood around for what felt like the same amount of time it took for the Roman Empire to fall, discussing amongst themselves in Taiwanese.

I tried to implore them to just go through the damn river already, my husband is hurt and you need to go NOW. I was perhaps a little more hysterical sounding than I should have been. The younger of the two burgundy shirts said he understood my worry, but Sandal Guy was an experienced mountain guide in these parts, and carrying my husband back through the river was more dangerous than a trail. If a trail could be cut, they'd try that instead.

"But there are no trails! We were just there! He fell because I thought it was a trail but it wasn't a trail and WE NEED TO GO NOW!!11!!1".

One of them said (in Chinese) "I know, this is your husband and you are really worried, but trust us, we know what we are doing and we'll get him out." That calmed me down, because even I could see that he was right.

I should have shut my mouth, or shoveled in some more raisin bread - the EMTs clearly knew what they were doing and the mountain guide got them down through a trail they cut themselves. I waited at the top - I'd be more trouble than I was worth at this point, and I finally realized this and stayed out of the way - while they descended to the river below with ropes, pullies, the pallet and the aid kid. Ages later, they carried, dragged and prodded my husband up the "trail" from where he was sitting in the river.

At first I was horrified that they'd make him walk in that condition - we called 119 in the first place because he couldn't walk and was feeling faint - but also contrite, so I waited to ask Emily why they'd decided to pull him up - at times making him walk by basically forcing him along and shouting at him in Taiwanese - rather than put him on a stretcher.

Apparently they'd examined him, bandaged him, and saw injuries that would require stitches but no head trauma and likely no broken bones, and decided it would be smarter to get him up partly on his own two feet (well, his own one foot) and put him on a stretcher on the trail rather than have men haul him up on something not designed to be hauled in that way. Brendan had been sitting in the river - cold, flowing water - for almost an hour by then and was shivering. The cold water certainly helped keep swelling down, but there was a risk of infection that the emergency room doctor later warned us about. His shirt was ruined, and his spare soaked, so Emily put him in my spare t-shirt, which obviously looked ridiculous on him, but you gotta do what you gotta do.

A strange omen of things to come?

A few things amazed me about this part of the ordeal.

First, what a strong person Brendan is. I mean, I knew that, but Emily remarked later how amazed she was that Brendan sat there bleeding profusely for almost an hour and didn't complain or freak out. That, while in obvious pain, he made it up the mountain with those guys shouting at him in Taiwanese. He didn't understand them, but when it was clear he needed to move, pain or no pain, he moved. He stayed in good humor even as they got him to the main trail and put him on a stretcher.

Second, that mountain rescue came quickly and was free of charge - we paid the emergency room fees later on, but the actual rescue and ambulance didn't incur extra expense. It was as good as I'd imagine mountain rescue to be in any Western country. I would absolutely, if I were caught in an emergency in the mountains, trust these guys with my life. Dress shoes or no. I don't really know how it works - whether they're on call and in uniform at certain times or just always on call, but they got there in 20 minutes - on a trail that's not that well-known yet (many people in Jiaoxi have never heard of it).

Third, the disparity between the locals who helped me so much, and the group of river tracers later on (the group that was there when Brendan fell did their best to help us out). As they were trying to figure out how to get to Brendan, a group of them was returning down the trail with all sorts of equipment. The mountain rescue guys asked if they'd stick around and help if necessary, and they said no. They were within their rights to do that, but I was surprised. I guess I would have stuck around. I have noticed when enjoying Taiwan's great outdoors (and how great it is!) that other individuals and small groups or families totally have your back. They'll chat with you, help you out, share snacks with you (and I do share with them), even give you a ride. The large, organized groups, however, never do. They'll make sure you don't die but that's about it. Again, within their rights, but being within your rights is not always synonymous with being kind. I remember a story told by a friend who climbed Jade Mountain and hiked from the bus stop to the first cabin (back when that was a 14km hike with no public transport). It was dark and raining and they were being followed by dogs, but nobody with a vehicle would give them a ride - all organized hiking groups. Contrast that to when a friend and I got stuck at the Laomei waterfall trailhead - a 2km, no streetlight walk back to any main road through farms where dogs lived. We quite easily scored a ride to the nearest bus stop from another leisurely day hiking couple. In this situation, the most helpful non-professionals were the couple who lent me their phone and fed me their soda and raisin bread, and stuck with us until Brendan was in the ambulance. I never learned their name (but I did thank them), and they'll have my eternal gratitude for taking care of me when I needed someone to help me help Brendan.

Fourth, I have not yet figured out how our band of three, plus the couple that helped me and the rescuers (fewer than ten) turned into a parade of approximately 30 people as we got to the end of the trail. I honestly have no idea where most of these people came from - two guys on scooters, a guy with blue hair, a few other day hikers, and about twenty other completely random people. My best guess is that word got out among people at wherever mountain rescue hangs out and the base of the trail that "some dumb foreigners had an accident in the mountains, why don't we go see what's up?" "OK, I've got nothin' else going on, let's check it out".

At the end, I thanked everyone including the Taiwanese couple and the EMTs got Brendan into an ambulance and sent us to National Yangming University Hospital in Yilan (I told them "the best nearby hospital" and that's the one they chose). It was my first and hopefully only ambulance ride not only in Taiwan, but ever. And yes, I Facebooked the whole way there, once it was clear that Brendan would be fine (obviously I would not have done that had he not been OK). It's not often that you get to be tagged in a photo like this:

Don't worry, Brendan's the sort of person who sees humor in such photos, assuming the person is not in any danger.

At the emergency room, he got a CAT scan and an X-ray, care for his less serious wounds, stitches and a dry hospital gown.

The X-rays and CAT scan confirmed that he managed to slide 20 meters and fall straight down for another 10 or so without breaking any bones or suffering any head trauma. Not even a mild concussion.

Which means that the fifth thing to amaze is that I am apparently married to Clark Kent. I think he may fly around saving lives and stopping criminals while I sleep. If a fall like that doesn't break a bone, I am not sure anything will (knock on wood).

Then they gave him an IV to make sure he didn't dehydrate, gave him some painkillers and observed  him for a few hours to make sure he didn't have some trauma they'd missed (nobody wants this), and a chance to rest. The care he received was as good as any you'd get in an American emergency room - no, better. He didn't have to wait. The ER was a little busy, but not understaffed. He got the attention he needed immediately - something you may not get in an ER in the West. I remember cutting my knee badly enough that I needed stitches one year at summer camp, and waiting two hours in the ER before a doctor was free to see me.

Emily and I went to a nearby hotel that has a deal with the hospital to provide discounts to patients and their family - we got a room for three hours (NT$500) and took showers and a rest. I frequently walked back to the hospital to check on Brendan, and 7-11 to buy him some sort of shirt. He had no clean, dry, non-ripped and non-bloody shirts to wear. He ended up with undershirts, but they'd do. He felt faint, but probably from exhaustion and shock more than anything, and I helped him hobble very slowly to our hotel room. Once there, he said he didn't think he'd make it back to Taipei that night, so we sent Emily home, paid a bit more for a full night, put a towel down on the pillow and slept in Yilan. We both canceled work the next day. Him because he was in no condition to teach, me because I needed to get him back to Taipei and then help him at home.

Some things I learned from the whole ordeal:

- I do realize just how lucky Brendan is. I do attribute it to luck: if anything, the fact that some people are not so lucky at all, and people do die hiking, mountain climbing and river tracing just because they didn't manage to fall into deep water, has made me feel that no, this is not the result of a higher power watching out for us. If it were, people just as deserving of a happy ending as Brendan would get it. So this hasn't caused any sort of religious epiphany.

- I will never, ever, EVER again make fun of people who take what seem like too many safety precautions when hiking or river tracing. I do understand the need for climbing gear, a wetsuit and a helmet for serious, challenging river tracing, but I felt that the Yuemeikeng trail was so easy - I mean, even I have done it, and I'm hardly Olga Outdoors - that a helmet was really not necessary. Well, no. Brendan was fine, but he might not have been, and had he fallen a few meters to the left, a helmet might have saved his life. In this case, a helmet would have meant no stitches in his head. So kids, listen to Auntie Jenna: wear a helmet when river tracing.

- Just because something has footprints and looks like a trail does not mean it is a trail you should be taking, or a real trail at all. I don't care how those footprints got there, if you feel like it's not a good trail, don't take it. Just don't. Even if you have to turn back. I have learned my lesson.

- I am really not interested in hiking or river tracing right now. I will surely hike again in the future, but for the forseeable future I am going to stick to safe trails. I had the jeebus scared out of me and I'm not interested in it happening again.

- I do realize how lucky we are that this happened in Taiwan and not, say, Nicaragua, Sri Lanka, or Indonesia...or even China. Yilan County had the facilities to come to our aid quickly. I don't want to think about how much longer Brendan might have sat in that cold water, bleeding had this happened in a less developed country, or one in which we didn't have a cell phone (we generally don't travel with one), or I didn't speak the language, or had subpar hospitals. I am not too interested in seeing how good Nicaragua Mountain Rescue is, or how good their hospitals are. Lesson: don't do risky hikes in places where you don't have access to emergency services. Get a guide or don't go. It sounds obvious, but you'd be surprised.

- Take a First Aid course. I will. Again, it seems obvious, but it hadn't really occurred to me. Emily did a lot to keep Brendan safe while I went to find help, and I'd like to have the knowledge to be able to do something similar should I ever need to.

This was our final destination - I'd been there before. We never did make it. I'm not sure I'll go back. Too many bad memories now.

Finally, for all of you out there who still think America's craptacular private health insurance "system" is superior to a nationalized system like Taiwan's, I can assure you that National Health Insurance saved our butts. I am a big fan of Taiwan's nationalized insurance, which covers everyone but allows private hospitals and clinics to open alongside government-run hospitals. It means everyone is covered, but you don't have to wait for care because the private clinics help ensure that everyone gets quick attention. It's expensive, but not any more expensive than what you lose in productivity when you have a population that can't afford to seek medical treatment before it becomes dangerous/unavoidable. It's not perfect - people complain of perfunctory visits and ridiculous regulations on what can be prescribed when, and what is and isn't covered - but it's a hell of a lot better than America's horror.

Here's a breakdown for you:

Mountain rescue
Taiwan: free
USA: Usually free, but not always (It's hard to say if we'd have been found "negligent" and possibly charged for the cost on the USA: in retrospect we shouldn't have been on that "trail", but at the time, seeing those footprints, it seemed like, if not a great idea, that at least it wouldn't end as it did). Had we been hiking in Maine, Brendan's home state, the government would have been legally allowed to bill us for the cost of the rescue.

I'd say the level of training and competence evident in Yilan is comparable to what I'd expect in the rest of the developed world.

EMTs and Ambulance
Taiwan: free
USA: It depends - but usually not free
It may be ree if it is publicly funded, but it's not always. Private or fee-based ambulance services can be quite expensive (I know, Yahoo! Answers is not a good source, but in this case I believe it is accurate). Private insurers may or may not cover it: if they deem it wasn't medically necessary (Brendan technically could have been transported by car, but we didn't know that at the time), or are out-of-network, or take you to a hospital that the insurer won't improve. The ambulance may be covered but take you to an out-of-network hospital. Or your insurance may only cover you in your region. Let's say $500 as many sources agree this is the typical fee, and with all the weird rules and ways to reject a claim, there's a fair chance we'd have been stuck with that fee. However, let's assume everything goes according to plan and you pay a $50 co-pay for the ambulance ride.

Emergency Room
Taiwan: NT$500 (US $20 or so)
My old insurance plan paid for ER visits with a $50 deductible, some charge up to $250. I think the mean is about $100 so let's say $100 (this coverage plan confirms that). Without insurance or if insurance deemed that his visit was not medically necessary (it was, but private insurers seem to work on a plane of logic devised from their own sense of whimsy coupled with sadism) it could have been several thousand. Brendan needed more care than the child in this article's first anecdote, but like the child, got stitches for a deep wound. Let's say without insurance it would have been a similar amount - about $5500. I'll be generous and assume that includes X-rays.

CAT scan
Taiwan: Free with ER visit
USA: $300-$1500 (confirmed here - could even be more)
I'll go with $1500 here as he had CAT scans with contrast dye of his head, pelvis, leg, foot and possibly other parts - he may have gotten a shoulder and abdominal ones as well. I'm really not sure. It could have been much more than that, up to $3000 or even higher. Insurance usually asks for a 20% deductible for such tests, which would be $300 for a $1500 scan, or $600 for a $3000 scan.

Taiwan: free with ER visit, very cheap (like maybe $10 USD) otherwise
USA: $200-$500 (check the comments)
Let's be generous, though, and assume in our range that the huge ER bill included the X-rays, stitches, doctor check and pain medication - I'll include this cost in a range, but it may not be a separate charge.

Follow-Up Visits
With stitches in wounds as deep as Brendan's, he'd need at least one follow-up to remove them, or more than one to make sure everything was healing alright. He'll probably have to see an orthopedist soon to check for soft tissue damage.

Taiwan: NT$200 (US$6), typically, no waiting - we paid more for one visit but it wasn't strictly necessary to go back to the hospital in Yilan before returning to Taipei
USA: US$50 with insurance, typically (it varies), or $200 or so (again, it varies) without insurance - that'd be for a doctor to check/remove the stitches and again to see the orthopedist (a specialist - plans in the USA vary).

Total: 4 visits so far in Taiwan (NT$800 or about $25 USD), we'd probably go to the doctor less were we in the USA. 2 visits at $50 copays is US $100, or without insurance $400 USD.

Walking Cane
Taiwan: free - the ER gave us one, but if we'd had to pay, maybe NT$300 (US $9)
USA: let's say US $20, although that is a generously low estimate

Taiwan: Free
USA: assuming ER medication was free but medication given later on prescription had to be paid for: my estimate (I have no way of verifying this accurately, but I can make a good guess) would be $20 with insurance, up to $60 or more without. Let's be charitable and stick with $60 for some basic Neosporin-type stuff and some antibiotic cream.

I won't even get into the cost of acquiring a hotel room ($30 US in Taiwan, probably $100 US in the USA), food while in a different city (negligible in Taiwan, probably $50 or so in the USA with three people eating a few meals, even if we ate cheaply), transport back to Taipei (we would have paid that anyway), and taxi to the bus station and then apartment (total $300NT or $9 US, would have been more like $40 in the USA), and getting Brendan shirts (about US $5 here, probably would have cost me more in the USA).

Total cost in Taiwan:

Mountain Rescue - Free
Ambulance - Free
$20 ER
CAT scan - Free
X-rays - Free
$25 follow-up visits
Cane - free
Medication - free

$45 USD for the entire thing

Total cost in the USA if you are lucky and have insurance

Mountain rescue - free
Ambulance - $50 co-pay
Emergency room - $100 with insurance
CAT Scan - $300-$600 with insurance
X-rays - charitably, let's assume this is covered by the emergency room fee. If not, maybe $100
Follow-up visits: $50 for two follow-ups and $50 to see an orthopedist = $150
Walking Cane $20
Medication $20

$640 - my minimum estimate with insurance, $1040 as a maximum total cost even if you are lucky and insured!

Total cost in the USA if you are one unlucky bastard

Mountain rescue - free (you're not that unlucky)
Ambulance - $500
Emergency room - $5500
CAT scan - $1500-$3000
X-rays - let's say this isn't covered by the ER bill and estimate it at $200 (which is being generous!)
Follow-up visits - $600 for two follow-ups and one orthopedist appointment (note that in Taiwan you'd have had four visits)
Walking cane - $20
Medication - $60


= may as well file for bankruptcy now

Or, $8,380 if you are only a little unlucky
and $9,880 if your CAT scan was on the more expensive end of things

Just in case you're not furious yet, here's the cost in Taiwan even if you don't have insurance:

Mountain rescue: free
Ambulance: not sure, but the EMT told me it was actually free no matter what (will double-check or someone can correct me in the comments if I'm wrong)
Emergency room: from my sister's visit, NT$800 or about $25
CAT scan - no idea - can anyone help? I'll ask some doctor friends soon
X-rays - NT$300 (from my own experience) or $9 USD
Follow-up visits - NT$400 each for 4 visits = NT$1600 or about $48 USD
Orthopedist without insurance - NT$1000 (estimated from what it's cost me to see a chiropractor and an OB/GYN that didn't take national health insurance) or US $30
Walking cane - NT$300 maybe (US $9)
Medication - let's estimate a total of NT $500 (US $20), which is overstating it


= USD $141 (not including CAT scan)


Poor Americans shouldn't go hiking. If you're poor, and American, or even not poor but lack insurance, don't just stop hiking - stop EVERYTHING. Just go live in a bubble. If you're in an accident, and live, your life is still over. If you can afford the bubble. Which you probably can't. You're fucked, because a bunch of "meh meh meh let's spend all our money on wars we don't need to be fighting and tax cuts for people who don't need them and then balance the budget on the backs of the poor and elderly and tell those poor and elderly that they're the moochers who won't take personal responsibility"folks.

And, also, clearly nationalized health insurance works, and clearly even setting the insurance issue aside, medical care costs too much in the USA and I have to ask why. Costs in Taiwan are about 1/2 to 2/3 that of the USA, so why is the difference more like several orders of magnitude just in the case of medical care? When medical care in Taiwan is comparable to that in the USA (in the case of emergency rooms, it's better)?

Note that the expenses listed in Taiwan are generally one line each - because it's all very simple. There's about a paragraph per expense under the US section, because it's complicated, and easy to get screwed (out of network, ambulance brings you to the wrong place, insurance says something was not necessary even though doctor said it was etc.). That right there says a lot about how screwed up the American system is. It shouldn't be that way. It should cost $X, at all times, for everyone, under every insurance plan.

And also, note that I put "in Taiwan with no insurance" at the end - because while it's possible to go through this in Taiwan with no insurance, almost everyone is insured. Youd've been insured, almost certainly. The exceptions are few and far between. In the USA, it is absolutely not a guarantee that you'd be insured.


Brendan said...

A couple of points:

"I mean, I knew that, but Emily remarked later how amazed she was that Brendan sat there bleeding profusely for almost an hour and didn't complain or freak out."

Well, a big part of that was the physical shock of what happened. Although I was certainly uncomfortable, I wasn't in any actual physical pain. That head wound of mine freaked everybody out, but it never hurt, even as the doctor was sewing it up later. And while my leg hut PLENTY later on, it didn't cause me any pain as I was sitting there on that rock waiting for help. Plus, I tend to accept bad situations stoically as long as I don't actually have to do anything I'm uncomfortable with as a result.

"He stayed in good humor even as they got him to the main trail and put him on a stretcher."

That was an ILLUSION. Getting me back up the hill was one of the most unpleasant experiences I ever had, far more so than the wait to be rescued. I was in a pretty poor mood by the time they laid me on the stretcher. But the thing was, there was no one (except myself) who I could get upset at. It wasn't the rescuers' fault that I got hurt in such an inconvenient place.

cj said...

O my good heavens, thank everything that you are all safe and relatively unscathed! That is a super scary experience. Am glad things weren't any worse. Do take care!!!

yt said...

好可怕!Thank goodness you are all ok. I hope you are all recovering well.

I was once told to multiply the direct conversion of the Taiwanese dollar to the US dollar by 3 to get a better sense of the price. The thought was that the Taiwanese income is about one third of the US income, so it would be a better sense of the relative worth. I'm not sure if it is accurate, but it did make sense.

The conversion would still make what you paid in Taiwan lower than what it would ever be in the US. But the payment with insurance would feel more like $135 in the US rather than $45.

Jenna Cody said...

YT - I see the value in doing that to get a sense of the price vis-a-vis purchasing power. I didn't do it, however, for a few reasons. The first is that our salaries are quite high compared to most Taiwanese - we make closer to a salary you'd expect in the USA for what we do.

But for an average Taiwanese person, if you account for the fact that they save a lot more than the average American, and would likely have that amount in savings regardless of the fact that they make less, that impacts how high the cost "feels" in Taiwan. Also account for the fact that everything else is cheaper - a Taiwanese person may make on average much less than an American or a Japanese person, but PPP In Taiwan is actually higher than in Japan.

However, I do see the point that many Taiwanese forking over $45 US would impact them as $135 might in the USA if their income is lower (most of my students wouldn't have this problem as they're businesspeople who generally command quite high salaries).

Still, $135 in the USA would be getting off lightly!

Readin said...

"He got the attention he needed immediately - something you may not get in an ER in the West. I remember cutting my knee badly enough that I needed stitches one year at summer camp, and waiting two hours in the ER before a doctor was free to see me."

I've been to emergency rooms in America a few times. It doesn's surprise me that you had to wait a long time to get your stitches. I've had to wait even longer for minor things. But the one time I went in for something that seemed serious the receptionist sent us straight in, no sitting in the waiting room at all. They prioritize.

Readin said...

Mountain rescue
Taiwan: free

EMTs and Ambulance
Taiwan: free

CAT scan
Taiwan: Free with ER visit

Taiwan: free with ER visit,

Walking Cane
Taiwan: free - the ER gave us one,

Taiwan: Free

None of those things are free. You didn't pay for them, but someone did. You didn't pay for the EMT, but the EMT gets paid. Where do you think the money comes from? You didn't pay for the ambulance, but van manufacturer was paid as was amulance driver and the people who provided the gasoline. Where do you think that money came from?

Of course you know it came from the people around you. All those hard-working Taiwanese who pay taxes even if they don't have the time or money to spend on fun river-tracing trips. They gave you a free ride and paid for what you admit were some dumb mistakes on your part.

Having a system where we force people to pay into the community pot to pay the mistakes and recreation of people has its advantages, but it isn't free.

I'm glad you and your husband made it back safely, but please don't dishonor your benefactors by claiming all this was free. They paid for it.

Mike Fagan said...

"It really amazes me how much your post showed of how little you understand about basic economics, or basic human kindness."

What a nasty and unnecessary comment; Readin put his (correct) points to you politely and didn't deserve that.

If the organized river tracer groups were, as you said, "within their rights" to leave, then by the same logic other people would be "within their rights" were they not forced to pay for the risks other people want to take.

There is an ethical difference between freely choosing to help other people and being compelled to do so irrespective of one's own wishes.

Jenna Cody said...

Or rather, let me amend that: with no entitlement programs, you have a people whose lack of caring about their fellow man means that nobody who needs a leg up gets it: as such, those who need assistance in a bad situation are stuck there forever, or are forced into unacceptable circumstances.

WIth it, you can educate people to realize that the public good truly is a public good, and is worthwhile. This can help them realize that, whether or not you know someone who benefits from something like national health insurance, it helps everyone if everyone contributes and everyone has access when they need it.

WIthout it, you educate people to be cruel and selfish.

Plus, no, sorry, look at countries that are doing fairly well: Sweden, Germany...countries with strong safety nets and strong ideas about what constitutes everyone contributing for the public good. When executed well, it is a boon, not a burden, on the economy. If you don't understand that, then you truly do not understand economics.

Plus, Readin is wrong in her assessment that national health insurance is unfair: most Taiwanese want it. They may criticize specific elements of it, but generally it is a popular program.

She's also wrong in that we "took advantage" of it: we use it no more than anyone else in a similar situation might, and we contribute just as much (if not more, as our salaries are higher than average) as they do.

Jenna Cody said...

Let me amend again -

If anything, we use National Health Insurance *less* than the average Taiwanese person. In this circumstance we used it, but generally we don't go to the doctor for colds or the flu, as many locals do. We don't stay in the hospital for unnecessary overnight visits and many do (especially the elderly). We pay for our own annual checkups, I see private clinics for some things (such as chiropractic) that don't use National Health Insurance, and we go to the doctor only when needed.

One issue in Taiwan is the elderly visiting doctors too often - sure, that's one downside, but I'd rather see them visiting doctors too often than what happens in the USA, which is elderly without means visiting them too infrequently. We visit doctors rarely, so if anything, we are a net profit to the system, not a loss, this one situation excepted.

Again, you and Readin are just plain wrong.

Mike Fagan said...

"I'm sorry, but Readin is absolutely wrong, and absolutely heartless."

Excuse me, but Readin explicitly said that he (she?) was "glad you and your husband made it back safely".

Jenna Cody said...

Think of it, rather than you paying for someone else to see the doctor, as a massive nationwide risk pool that, while not profitable, is at least acceptable (seeing as this kind of thing will never be profitable).

So you pay into it, but you get a benefit out. So does the other guy. It doesn't really matter who is richer or who is poorer, who is healthier and who is not, because with a risk pool of 25 million, it all evens out.

Mike Fagan said...

"She also implied that social welfare in any form should not exist..."

No she did not.

Her comments were largely factual corrections of your erroneous claims concerning "free" costs.

Her only expression of opinion, aside from being glad that you and your husband made it back safely, was that socialized healthcare "has its advantages".

Jenna Cody said...

Ah, I think I see the problem.

Readin has posted on my blog before, and has made plenty of comments along those lines (she's also anti-abortion and anti pre-marital sex, and anti-contraception coverage, and pro-stereotype, as per those comments - but I chose not to get back into that here). She's quite the conservative. We've been down that road.

But while she's right on one account - that the stuff isn't "free", she assumes it was a free ride: it wasn't. She's wrong - we also contribute, and generally speaking we use the system far less than many locals. She assumes that the locals who pay can't afford river-tracing or hiking - again, generally, wrong. River tracing in that particular river costs $400 for the shoes, a bike helmet you probably already own (we didn't wear them - our mistake) and bus fare. She assumes that we got care on the part of "benefactors" - well, yes, only if you assume that we don't contribute. We're just as much benefactors of others as they are of us.

But, you know, you have one very good point: I'm coming at Readin's comments with the knowledge of what she's said before. You are not.

Neither is anyone else who doesn't read my blog regularly, so in that spirit, I'm going to delete some of my former comments.

Mike Fagan said...

If you will apologize to Readin, then I will treat your arguments as worth the respect of an answer, but not until then.

Jenna Cody said...

Readin - you do realize that I pay taxes in Taiwan just like every hardworking Taiwanese person, right? In fact, I earn a surprisingly high salary, and as such, I often pay more than a local might pay in taxes. We have national health insurance because we work here and are entitled to it - we contribute, we don't mooch.

So really, I paid for our dumb mistake just as much as any other Taiwanese person, and I would happily pay for a Taiwanese person's dumb mistake with my tax dollars, as well.

Because, you know, I AM my brother's keeper, and he is mine.

Anyway, what the system pays for more than makes up for what it costs - I realize that National Health Insurance runs at a deficit, but having it there so the population can get back to work and be healthy and productive saves money in a broader sense. A lot more than you'd save by cutting funding for those services. This is how we waste money in the USA: we don't cover that sort of thing for everyone, and even if you do have coverage, you pay a lot out of pocket for often inferior service. People avoid getting medical attention for this reason, and so they end up sicker, out of work longer, less productive and costing the economy money.

Because my husband was able to get quick treatment and wasn't afraid of the costs (so didn't try to do anything dumb like walk out of there when he couldn't), he was back to work in two days. Contrast that to the USA, where someone who avoids seeing a doctor because they can't afford it might be out of work for weeks. He's more than contributed back to the economy what the country paid for his health care.

Edited from: September 24, 2012 11:14 PM

Jenna Cody said...

I disagree entirely.

Some degree of social welfare must be compulsory. The problem with Communism is that the degree is too high. The problem with Libertarianism/modern American fiscal conservatism is that the degree is far too low - it descends into selfishness and heartlessness.

With too much social welfare, you lose a sense of social ambition, incentive and self-sufficiency, and it makes it easier for corruption to take root.

But with too little, you have a nation of people who don't care about their fellow man.

(Edited from a previous comment)

Jenna Cody said...

I do apologize for my immediate, and wrong, reaction to the comments on this post (although I do disagree somewhat with what she said - what we got was only "not free to the Taiwanese" if you assume we didn't contribute enough to deserve the service - if anything, what we've paid in health insurance premiums for the past six years has been a boon rather than a burden to the system).

Honestly, though, considering the bad blood her comments on past posts have engendered (and a lot of the heartlessness in those comments from days past) I really can't say I care for her.

I don't think we really need to get into a discussion on insurance - you're not going to change my views and chances are, I'm not going to change yours.

Mike Fagan said...

"I don't think we really need to get into a discussion on insurance..."

Then perhaps "we" shouldn't be posing ex-cathedra on matters "we" are not prepared to defend in debate.

Brendan said...

Readin has commented on LaoRenCha before, as well as Michael Turton's blog. Readin's views on politics are not the issue so much as the fact that Readin has a history of stating (often insulting) speculation about the people in the post (s)he's commenting on as fact, speculation which is based on nothing in the original post, or indeed anywhere outside of Readin's own skull.

Maybe Jenna should have been more charitable, but if she jumped to conclusions it's due to Readin's own past behavior.

Jenna Cody said...

Michael - I have posted my views, and I can defend them. I've had this debate with people before.

Besides, it's my blog. I can post what I like. I have the power to allow you to comment, or not. So you don't really get to tell me what I should or should not post.

You're free to post a rebuttal if you like. I'll probably even publish it. I may or may not reply - this whole thing is giving me a migraine.

Jenna Cody said...

Thank you Brendan. This has been an issue in the past. It is absolutely true that I should not just flip my lid because I see a name I don't like in the comments, but also absolutely true that there is a history there.

Which is often the case when someone flips their lid without seeming immediate cause.

Mike Fagan said...

"You're free to post a rebuttal if you like. I'll probably even publish it."

OK. To that end I have just one question:

If you have a "right" to force other people to pay for the costs of your health insurance, then how come you don't have a right to force us to pick cotton for you?

Jenna Cody said...

Because it's a public good, like roads, bridges, schools, libraries, scholarships. Society is better because we all pay taxes that pay for these things - health care should be like schooling. Paid for by all of us, free to children. All children need schooling of some sort, and all people need health coverage.

Plus, it's not "forcing others to pay for you". It's a giant risk pool. You pay in as part of the public good just as you do all your other taxes - which is why we have nifty things like roads and schools, unless you'd like to only travel on your own privately-built roads - and you get a benefit. You get health coverage that the system can support in a way that a for-profit system can never support. You use it when you need it (and everyone needs it at some point). Others pay for you, and you pay for others.

It's not the same thing at all as slavery.

You could argue that it need not exist, but a basic survey of good economic and social policy will show you that it does. Or you could go be a hermit somewhere and hide all your money under your mattress, helping nobody, and nobody will help you when you need it (which you will).

Jenna Cody said...

And if the risk pool is large enough - like an entire nation - costs go down. You end up saving money. Everyone does. It's not profitable, but it doesn't need to be, and can never be. It doesn't even need to pay entirely for itself - all it needs to do is cost less than what we lose in lost productivity and wages earned and spent from sick people who can't work or are less productive due to illness, and can't afford to seek treatment.

Care, on the other hand, absolutely should include private options. That is what makes it so good in Taiwan - you don't have to wait to get medical treatment because there are so many options, both public and private.

Mike Fagan said...

"... it's not "forcing others to pay for you..."

Yes it is: refusal to pay NHI is typically punishable under statutory law.

"Because it's a public good, like roads, bridges, schools, libraries, scholarships."

What is the common denominator among those "public goods" which disqualifies cotton? After all, all of us need clothes do we not?

Jenna Cody said...

Private care works when there are public hospitals and clinics to supplement them: with public "competition", if private facilities don't give you good service for a reasonable price, people will go to public ones, or better private ones. This works because private care services can be run at a profit. You pay money, you get a service.

Health insurance, on the other hand, can't. It's not like other kinds of insurance, which you get hoping nothing will ever happen to you. EVERYONE needs to use their health insruance. Everyone gets sick, even if it doesn't happen until they're older. Those who don't get sick may still need maternity/natal services as well as various check-ups or tests.

As such, it just plain isn't profitable: the benefit of having universal health insurance is that the profit is felt in other sectors of the economy - healthy people contribute more to the economy than sick ones, and the best way to ensure public health is to make it affordable for all. It doesn't work in the same way that other private industries might, even other insurance programs. It's more like schooling: education itself isn't profitable (when it is, tuition tends to be so high it's a joke, or at least very exclusionary, for little benefit beyond networking with other rich people). Education of the public, however, contributes to the economy in other ways.

No private company would take that on, because they don't get the benefit. So when only private schemes are available, with public coverage only for the old or very poor, they're designed to screw the purchaser and profit the company. In other industries, the consumer profits too because it's in the company's best interests to profit by providing a good service - but with health insurance, since everyone will need it at some point and risk pools, as they are in the USA, are generally just too small, the only way to profit is to refuse coverage for those who need it most, charge sky-high rates, deny services, and institute regulations aimed at paying out as little and as rarely as possible.

In short - it doesn't work.

I could argue something similar about public transportation, but that's a different debate.

Some industries are inherently profitable and should be left to the free market, with reasonable regulation. Some are just not, but need to exist for the public good.

Jenna Cody said...

It's a tax - so if you want to go down that road, you could say that it's not fair that the government forces you to pay any taxes at all beyond what you want to pay. But then have fun without roads, schools, bridges or anything else. It's no different with health insurance in Taiwan. You can argue that it's a tax you don't want to pay, but I'd say you don't want to pay it because a.) you're heartless (yes, even if I took it back about Readin's comments on this post, it still applies to you) and b.) you don't understand good economic and public policy. Adults pay taxes - that's part of the deal.

It's a risk pool, and I don't see anything wrong with a law that states that all must participate and a corresponding tax.

The difference between those things and clothing is that clothing retail is inherently profitable. It is best to leave that up to the free market, because it works. Health insurance, major roadworks and education are not. You can't allow the free market to control things that just plain are not profitable directly: things that profit society indirectly aren't things private enterprise is interested in. That doesn't mean we don't need them.

And also, please don't pretend that your "cotton picking" comment wasn't a reference to slavery in a ham-handed way.

Besides, I could say "what is so different about your view compared to allowing the wealthy to retain their wealth and benefits, while the poor and middle class get screwed and receive inferior treatment and services through systemic socioeconomic repression"?

Also, it's heartless.

Jenna Cody said...

Either way, for Taiwan, your argument is invalid because Taiwan's NHI is popular. It is criticized in specific ways but few Taiwanese, if any, want to do away with it...because it WORKS (fortunately people in Taiwan are generally not heartless).

If society as a whole wants something - and I've heard almost universal praise in Taiwan for NHI (and the criticism has all been in favor of reform, not scrapping the system) - then clearly the populace is not being forced. If one person feels "forced", well, that's their problem. George W. "forced" me to help pay for a war in Iraq that I don't think we should have fought, but I paid my taxes anyway.

There is far more dissent in the USA regarding our abysmal "system" than there is in Taiwan. There are also more uninsured people who don't get treatment that they need and our economy bleeds a lot more from lost productivity. That right there says something.

Mike Fagan said...

"It's a tax - so..."

So it is "forcing others to pay for you" then, no? This is after you had said it wasn't.

"You can't allow the free market to control things that just plain are not profitable directly: things that profit society indirectly aren't things private enterprise is interested in."

I see. So neither healthcare nor education were produced prior to State involvement in the 1870s?

Readin said...

Just to clarify something - I'm not arguing that socialized health care is completely bad. Of all the forms of government welfare, health care is clearly the most beneficial. As Jenna has alluded to, you can't work if you're sick. The alternative of telling someone who is infirm to "get a job" isn't terribly useful.

But if we're going to discuss socialized health care and design a system that works, we need to be honest about it. Calling the services "free" obscures the truth. The services are paid for by taxpayers.

As for the criticisms of America, I have two main objections. First, you didn't limit the criticism to American health care. You didn't say "American health care sucks", you said "America Sucks". Just as you say you react negatively to me, I react very negatively to people who insult my whole country - including my American family members, the American sailors who prevented Taiwan from being ruled by Beijing, the hundreds of thousands of American soldiers who died so you can have the freedom to say things like "America sucks" or whichever country you don't like (be it Japan or China).

It looks like some posts got re-ordered and two that I submitted were lost. I'm not sure what's going on.

Readin said...

BTW, one of the big problems with American health care is that it already has so much government interference. For example, you mentioned prospect of losing your job and your health insurance at the same time. The reason this happens is that the government provides big tax incentives for insurance to be provided by employers. Another example is the huge impact of medicaid and medicare.

Readin said...

"anti-contraception coverage"

I'm not against insurance companies choosing to cover contraception - in fact I'm very much in favor of it.

I'm opposed to the government telling companies they have to cover contraception.

Just as I'm opposed to the government telling you you can't use contraception (gotta get that birthrate up).

I'm in favor of freedom.

Jenna Cody said...

Michael -

I never said it wasn't a tax. I said it wasn't forcibly making you pay for others. I don't feel that's what taxes do. If you view "public good" as "me paying for others", you don't understand public policy. If you view them as "something we need for the common good which also benefits me", you do.

As for whether those things existed before the 1870s, they did (well, health care, yes, but not health insurance so much - insurance as an idea has existed for centuries, but health insurance in the USA didn't become a popular thing until the late 19th century)...

...but only for those at the top of society. Illiteracy rates were high, kids didn't get schooling or get all the schooling they could have (or, arguably, should have) and people died younger not only because medicine was less advanced, but because they didn't have access to or couldn't afford what medicine was available.

So the wealthy and middle class (such as it was) got the best care and education, and everyone else got very little education, didn't go to college (yes, I do believe college should be affordable to all, even if not all attend), and often died of health problems that were treatable even then. A poor man who got TB back then was basically a dead man. A wealthy one probably wouldn't have gotten TB, but if he did, he'd hang on much longer.

What leaving these things to the free market did (and would do) would not be to make them more available and efficient: it makes them available only to those who can pay. So children born of parents who can pay get better educations and are healthier, and so they become the next generation's wealthy. The children of those who can't pay don't get access, and they remain the next generation's poor.

Rather than creating a society of opportunity, you create one of systematic repression. That's why every other developed country (including Taiwan) has socialized these important institutions. Only the USA continues to deny access to health care to those who can't afford it. (You can say that everyone who needs it will get treated, but that only works for the ER: for long-term illnesses that require treatment but not trips to the ER, they don't).

In short, it's a misconception that less government involvement = more access. If you want only one small segment of society to be able to afford these things, by all means put them on the free market. If you don't want the middle class and poor to suffer, you make them accessible in a way that privatizing them can't.

Readin - I STILL disagree with you, but hey, at least you're being polite in this post.

Jenna Cody said...

Besides, I never said that health CARE should be socialized. It shouldn't.

Only health INSURANCE. Which really didn't exist, according to Wikipedia, in the USA before the 1870s.

Mike Fagan said...

"And also, please don't pretend that your "cotton picking" comment wasn't a reference to slavery in a ham-handed way."

It was quite deliberate. The principle of slavery - compelling people to do things against their will - is what makes the State health insurance system possible and it is this same principle that you are defending.

"Either way, for Taiwan, your argument is invalid because Taiwan's NHI is popular."

I see, so the mere statistical "might" of a majority is what makes any given policy "right". By that logic then, a majority support for some other system of healthcare (such as mutualist associations competing on a free market), would render your opinion - ipso facto - invalid.

"If society as a whole wants something... then clearly the populace is not being forced. If one person feels "forced", well, that's their problem."

How very Orwellian.

Mike Fagan said...

"I never said it wasn't a tax. I said it wasn't forcibly making you pay for others. I don't feel that's what taxes do."

You don't "feel" that taxation is based on force. I see.

"As for whether those things existed before the 1870s, they did ...but only for those at the top of society."

I understand that is a common belief, but it's not true - neither in education, nor in healthcare. Access to both education and healthcare was nearly universal prior to State involvement.

The importance of that point is that it is a direct refutation of what you had claimed earlier: that education and healthcare cannot be produced by anyone other than the State because they are "inherently unprofitable".

Nor are education and healthcare public goods in themselves; they are private goods. The distinction between public and private goods is not one of "indirect benefits", but of whether the producer of those goods has control over who may receive them. So roads - in the absence of toll booths - are public goods since anyone can drive on them, as are radio broadcasts since anyone with a radio-receiver can listen to them, but services like healthcare must always involve the administering of limited resources to specific individuals and are therefore private goods, whatever positive externalities they might also confer elsewhere. You might as well say that because a factory confers indirect benefits on "society as a whole" (i.e. via employment, wages and perhaps reduced crime incentives) that therefore fatories are "public goods".

"...people died younger not only because medicine was less advanced..."

The advancement of medicine has been a consequence of science and has nothing to do with the State socialization of either health care or health insurance.

Besides, it remains the case today that richer people can afford to consume more healthcare resources than poor people. That will always be true even under a socialized system, unless either (a) some form of rationing is introduced, or (b) the rich people somehow disappear.

"So children born of parents who can pay get better educations and are healthier, and so they become the next generation's wealthy. The children of those who can't pay don't get access, and they remain the next generation's poor."

Access to healthcare does not determine wealth, but I presume the point you were trying to make there was that inherited wealth is enough to effectively make a caste system. But this is also untrue. Since "wealth" is not merely cash but the ability to create value for others on the open market, its transmission from one generation to the next is not straightforward. In the first place, the new inheritants of wealth may or may not inherit the intellectual and psychological habits and attitudes of their parents who created the wealth and may therefore struggle to maintain it. In the second place,
the demands and conditions of the market may change and the new generation may struggle to adapt not on account of any weakness on their own part but simply because times have changed (or because a competitor has managed to get the State to impose some onerous new regulation that makes the old business prohibitively expensive).

In fact, it seems to me that the best way of creating a caste system or a "ruling class" is not to get into the business of producing wealth but to get into politics (the Bush and Kennedy dynasties being only the two most obvious U.S. instances of this).

But anyway, you don't "feel" that taxation is based on force, so I guess your "feelings" will suffice to repel everything I've said.

Mike Fagan said...

"As Jenna has alluded to, you can't work if you're sick. The alternative of telling someone who is infirm to "get a job" isn't terribly useful."

Readin - I am not arguing that that is the alternative (Jenna is though).

What Jenna is doing is operating on presumptions rather than facts. For example, she presumes that only rich people got educated prior to State involvement in education. Perhaps you might feel ignorance can be excused?

But then she also presumes that I am in favour of the current U.S. healthcare and insurance system even though I have already hinted that I favour the production of both healthcare and health insurance via mutualist associations competing on a free market (the production of certain drugs is clearly more difficult to produce on a free market absent IP laws, but that is another discussion). She seems to be responding more to the demons in her head rather than what the people who are actually talking to her are saying.

"It looks like some posts got re-ordered and two that I submitted were lost. I'm not sure what's going on."

I noticed the same thing yesterday when I was posting. Part of the problem was one of my posts did not get submitted because I entered the spambot code incorrectly (sometimes the text is so screwed-up that certain letters appear ambiguous). The other thing is that it looks like the comments are being re-ordered after they are posted but I don't have any explanation for this.

" of the big problems with American health care is that it already has so much government interference."

Yes; historically, the monopolization of the medical professional licensing system by the AMA (thus establishing a racket for the licensing of doctors), was an early and decisive act of interference by government. Whereas today, the call for government involvement is made with the denouncement of high prices, in those early days, the call for government involvement was made with the denouncement of low prices!

In both cases the "free market" gets blamed, and in both cases the charge is simply not true. Yet there will always be people who believe it due to the power of confirmation bias added to the absence of historical knowledge and the absence of intellectual curiosity.

Readin said...

"With too much social welfare, you lose a sense of social ambition, incentive and self-sufficiency, and it makes it easier for corruption to take root.

But with too little, you have a nation of people who don't care about their fellow man.

I disagree with that second part. With government provided social welfare, everyone figures that taking care of their fellow man is the government's job. "I've paid my taxes so I don't need to do anything to help - there are welfare, government health care, food stamps and social workers to do the job of caring so I don't have to."

Back before we had the welfare state there were organizations like the Lion's Club and Shriner's Club that did things to benefit the community. Almost any parade would have Shriner's dressed up as clowns raising money for children's hospitals. There was a sense of community that has largely disappeared. Noblis Oblige is rarely thought of anymore.

As the government runs takes over the job of compassion, the people stop being compassionate.

Lief said...

Nicely written, glad everyone is relatively OK! Hope you do go hiking again -- bad luck can happen anywhere.

Mike Fagan said...

So are you going to allow any more comments?

Jenna Cody said...

Michael -

At the end of it, I feel Taiwan's National Health Insurance is less costly (costly, to be sure, but less so) than what the free market wastes in the USA, and offers the people better care. Every other developed nation in the world agrees with this basic principle, although I do quibble with the idea that actual care should also be government-run (that clearly does not work). It simply works better than health insurance on the free market. Nothing you've said has proven that free market insurance can be an inherently profitable endeavor for the companies who sell it - because it isn't. You have yet to prove me wrong on that, and have yet to convince me.

Also, I do stand by my notion that only the wealthy were educated in pre-government education America. The middle class, such as it was, and the poor, if they got maybe a grade school education were lucky. The middle class mostly didn't go to college, and the poor didn't even get to high school. Now, while college is still too costly (I'd like to see that be a public good, too), at least more people have a shot at it.

All I can say is that I think it's fine to pay for health insurance for all through a tax and manage it through a nationwide risk pool. Taiwan has proven that this works. It works better than the free market ever did for health insurance. You don't. Fine, but I still disagree.

Readin: the problem with your notion is that the wealthy didn't really get involved in helping others before the government - sure, philanthropy existed, but the divide between rich and poor was larger and harder to overcome, and while I wont' disagree that government money doesn't always go where it should, neither does the donated money of the wealthy and corporations.

I'd rather have the government, which at least I vote for in some way, tell me where my tax dollars are needed (although I wasn't too fond of them using them in Iraq) than to allow the wealthy to decide who needs what. I trust a congressman more than a businessman.

But I'm not going to argue with you anymore. You have shown yourself in comments on previous posts to be so judgmental (especially towards people whose morals differ from the ones you've decided are universal, when they are far from it) that I just don't want to talk to you.

Mike Fagan said...

"I feel Taiwan's National Health Insurance is less costly (costly, to be sure, but less so) than what the free market wastes in the USA..."

Jenna, health insurance in the U.S. is in no sense whatsoever a free market for reasons that have already been given and for other reasons too. You are entitled to form your own opinions, but you are not entitled to your own "facts", and until you can demonstrate an ability to get your "feelings" under control and actually deal in facts, then I cannot afford to waste time trying to convince you of anything. I might as well be talking to someone in the throes of an acid trip.

Jenna Cody said...

The USA has about as close to free market health insurance as exists in the world. There are entitlement programs, and there are regulations, but at its heart health insurance in the USA is something provided by private companies.

How is that not free market?

Jenna Cody said...

Either way, regardless of what the USA is or is not, on theoretical grounds I do believe that privatized and/or free market health insurance does not work and can never work. It's not directly profitable and can't be: the profit in health insurance is felt in other areas of society - much like public transit (which can be profitable but often isn't) and education. It's not profitable in that way because, unlike other insurance setups, it's something everyone will eventually use. The issuing company can never win. As such, having a health insurance system that is free market/private company based will not work. You haven't yet convinced me otherwise, and I doubt you will.

Mike Fagan said...

"There are entitlement programs, and there are regulations, but... How is that not free market?"

Have you ever wondered how thick a castle wall is?

"You haven't yet convinced me otherwise..."

I'm not even trying.