Here's the problem with reggae : its primary adherents in North America are hippies. Upper-class white kids with belabored dreadlocks. You know, morons. We don't much cotton to hippies here at Latewire, so therefore we don't really listen to reggae. Calypso, ska, rocksteady, dub, dancehall, jungle, yes. Reggae no. In case you hadn't noticed, it's not standard procedure here to 'lively up oneself.'
Recently, I've begin to reexamine this prejudice. In a car I rented recently, there was the newfangled satellite radio, so I tuned to the reggae station (called, of course, "the Joint" BAAAARF). I heard, in rapid succession, gritty, forboding tunes by Max Romeo, Culture, and Peter Tosh that I realized were not only non-hippie, but also objectively good. I began to think : why do I readily accept reggae as a part of a rap tune (cf. KRS-One, Ice Cube, Run-DMC) or neopsychedelia (Massive Attack, Tricky), but refuse to countenance it on its own? It's because hippies stink. But I realized that it's not th' fault of th' reggae artists themselves that their Stateside champions are these kinds of RABS poser slime :
So after coming to grips with this simple PR disaster, I gave a bunch of reggae tunes a listen and liked many of them. Toots, Max Romeo ("Lucifer!"), Dennis Brown, and th' standard output of Horace Andy all met with my approval. I've been a fan of Damian Marley since his breakout hit "Welcome to Jamrock," and I guess that while I've considered him dancehall because of his toasting style, th' music has more to do with traditional reggae than I was willing to admit to myself. One thing about Jamaican music (best typified in dub, which is always great) is that it nearly always includes crushingly heavy bass, which is something we could all use more of in our lives.
So, take some Thorazine, stay in yr house, and give some real dire Jamaican reggae a listen. Not any kind of bullcrap California pansy stoner rubbish, either. You might find as I did that reggae isn't just for $%&holes any more.
As a special treat, here's the original (rocksteady) version of one of everybody's favorite Massive Attack cover tune, "Man Next Door." This gem written by John Holt (also of "The Tide Is High" fame) is here performed by his group the Paragons. Nice wailing stuff.
For crying out loud though -- can anybody give me a reasonably sane explanation of what in blazes "Tu Sheng Peng" is?
BONUS! Here's the hard-to-find uncensored version of "Welcome to Jamrock." Funnyman a get dropped like a bad habit, apparently.
As I've stated before, I'm a libertarian and a medical student currently seeing patients in the field. As such, I'm uniquely annoyed by all the goings-on in DC lately. I'm sure most people reading this think it's all over--that the socialists/corporatists in power have "won" and that there's no use even talking about it anymore. Of course if we've learned anything from these systems of central planning, we know that eventually, they all fall down. If the current health bill passes, it's likely to actually make our unsustainable system even worse for all the same reasons it's currently failing (which this article is about). The debate is not over, it's just been put on hold for a few years--until the government's new plans to screw up their mess even further can come into fruition.
I propose a different approach: not more government, but less government. Then there's the obligatory argument about the number of uninsured being "too high." I posit that the best way to reduce that number is to make healthcare less expensive and more accessible rather than just accept the huge costs and setup government programs to cover it. The easiest and most effective way to reduce prices is the free market.
84% of Americans already have some form of health insurance. If the free market were allowed to reduce costs by say, 30%, how would that "84%" figure grow?
Our system fits the classic Harry Browne line, "Government is good at one thing: It knows how to break your legs, hand you a crutch, and say, 'See, if it weren't for the government, you wouldn't be able to walk.'" The Government is responsible for the high cost of healthcare and therefore the high number of uninsured, and the only way to fix their mess is to get them to stop doing what they're doing.
I know many people reading this will say "but we already have a free market, and clearly it's expensive and ineffective!" Of course, those same people really don't know what a "free market" is--that is, a market where the government does not regulate, subsidize, or fix prices. Our medical system, though not outright socialist or fascist, is about as close to capitalism as the Titanic is from docking in New York.
Most people don't understand how cheaply healthcare could be done if we allowed the industry to evolve like other industries. Many of the things we as doctors do require equipment and drugs that are either cheaper than dirt or have alternatives that are. The high cost of doctors' time could be supplanted in most cases by trained nurses or even the injured/sick individual themselves. The folly of those who don't see this is a failure of imagination. Rest assured, however, Medicine is no different from other industries (eg Unlicensed individuals service their own cars all the time, and most medical procedures are far less dangerous or could at least be made that way by the demand to do so). Given the opportunity to evolve, quality care would be as ubiquitous as color televisions
I imagine a country where an uninsured person living in poverty will be diagnosed with cancer, and even the most bleeding-heart socialist will unsympathetically say "Well why the hell didn't you buy health insurance? It's cheaper than your smoking habit. Here's $10, go get some chemotherapy"
Indirect Health Care Subsidies - Tax Incentives
59% of Americans with health care receive it through their employer. The reason the employer does this is because the government taxes cash reimbursement (wages) not only through the Federal Income Tax (Median ~20%), but also Unemployment (6%), Medicare (6%), and Social Security taxes (12%). Paying for employee healthcare incurs none of these taxes. Therefore, the government is effectively partially paying for employee healthcare by so heavily taxing other forms of compensation.
This is an indirect subsidy which, again raises prices universally. In addition, like the direct subsidy, recipients of this care will use much more of it because they are not responsible for paying the premiums. (* See explanation below)
The way to end this is more complicated than ending a direct subsidy--if we continue taxing wages**, we must then start to tax all forms of employee compensation, including health care. This would start to push people towards paying their premiums directly instead of getting insurance through their employer. Sounds like a bad thing, but theoretically you could reduce the federal income tax (and other wage taxes) to match the massive influx of revenue generated by this tax.
Also, remember that "15% of Americans are uninsured" statistic? Well 1/3 to 1/2 of all people currently uninsured are uninsured because they're in between jobs that provided them with insurance. If they paid for their insurance themselves, they'd have it now. Therefore, we could eliminate the number of uninsured by 33-50% almost immediately by simply transferring the employer's policy to the employee. Eliminating the tax incentive to do otherwise would certainly fix the problem.
** Optimally, we would tax neither wages nor other forms of compensation, but that's even more of a pipe dream than any of the other things I've mentioned.
Direct Health Care Subsidies - Medicare & Medicaid
28% of Americans with health insurance have it totally paid for by the government. This is an obvious subsidy and leads to higher prices for those who do not enjoy this subsidy. Moreover, recipients of this care will use much more of it because they are not responsible for paying the premiums. (* See explanation below)
Indirect Governmentally Managed Care - Tort
This argument you've surely heard before: Health Care Providers change their care to accommodate an altered risk/benefit ratio strictly because they're afraid of getting sued. It's unknown how much this actually contributes to costs, but there are a few studies that show it being greater than 25%. That's not including the change in the culture of medicine, which may actually bring quality down in the end.
Several states have started implementing tort reform and not surprisingly it's been a complete success.
Direct Governmentally Managed Care - Health Care Regulations
Americans are universally turned off by managed care, yet they are inexplicably in favor of Government managing their care through regulations.
Health Care is one of the most regulated industries in the United States. From compulsory licensing of physicians to the drug approval process, the market is mired in government ineptitude, sloth, and corruption. Nearly every step of patient care is delivered exactly according to government edicts.
Giving people a choice between licensed and unlicensed physicians (for instance, allowing a nurse to write prescriptions and perform simple procedures without a doctor) would drastically reduce costs and therefore insurance premiums.
In addition, giving people a chance to buy drugs that haven't been through the FDA's 12-year process would save thousands of lives and allow the market to find better and faster ways of ensuring drug safety. Meanwhile, the actual FDA could be privatized and run by Ralph Nader (or some other ostensibly incorruptible person) and its approval being available for people who are untrusting of drug companies.
* 3rd Party Payer - The Bugbear of Subsidy
73% of all Americans (87% of the insured) not only receive a government subsidy for care (directly or indirectly) but are also not responsible for paying their own premiums. This is the biggest reason prices are rising both through the indifference and profligacy of the recipients (nobody "shops around" for care before they get it) as well as recipients actually taking worse care of themselves as they are not responsible for the bills that come of it.
For instance, if a private insurance company were to give breaks for people who ate right and exercised, this would start a trend that may even fix America's obesity problem. It sounds far-fetched, but that's only because you have no idea how much the actuarial tables would change for a healthy population as opposed to ours (with 1/3 of Americans being overweight and another 1/3 obese). The premiums for these "fit" people, especially in their later years, would be halved.
The current incentive structure encourages the opposite--if you're not fat, you're not getting your money's worth for healthcare. After all, by taxation or reduction in cash wages, you are paying the premiums to be fat whether you want/need to or not. It could be that our "good" healthcare is what's killing us.
The Current Healthcare Bill (Dec 23, '09) Is More of the Same
The current healthcare bill will expand all of the problems with American healthcare--direct subsidy, indirect subsidy, direct regulation, and indirect regulation:
Direct Subsidy - This bill mandates that everyone pay a private corporation for healthcare. In addition, it increases Medicaid and pays for private health insurance for people who 'can't afford it'. I thought they called this Fascism. It'll be interesting to see how they determine who gets paid and who doesn't--who draws the line between 'fully paid' and 'forced into poverty by paying obscene premiums'.
Indirect Subsidy - This bill gives money to [small?] businesses who can't afford to provide healthcare to their employees. Government giving money to private corporations... I couldn't fathom how corruption could ensue!
Direct Regulation - This bill adds at least a thousand pages of healthcare regulation, especially on insurance companies. Insurance companies make a tiny profit margin as it is. Take it away, you don't increase competition, you bankrupt competition. Many think this new bill will be a boon to insurance companies because of the compulsory addition of 30+million new customers. I'd advise those who believe this to look at the remaining 1,000+ pages of the bill and see if that makes you want to start an insurance company.
Milton Friedman was always railing against 'central planning' for its inherent immorality. However, he also said that we were lucky in that these systems had the added detriment of inevitable failure. Our healthcare system is like Frankenstein--sewn together from all manner of dead and dysfunctional parts, then artificially reanimated and left to run amok. Eventually, the people will grow wary of its rampage and destroy it. The question is: how many people will die in the interim. (219,607)
This is a draft I posted to reddit that seemed to go over pretty well, so I decided to post it here. ----------------------- I am a 3rd year medical student seeing patients about 50 hours a week. I am also a libertarian. The news these days, as you can imagine, has been a bit of a distraction.
Back to Reality
With health care, the first thing you have to accept is that there is literally not enough wealth on the planet to give everyone the best and most convenient healthcare possible. There is medical technology out there so advanced and on the bleeding edge it makes NASA look like a 7th grade science class.
Even if we had the money, there are other things we'd much rather be spending our money on than our health. It ends up the case that health care can never be cheap enough, fast enough, or good enough.
Think of it this way--The following is what I want from my health care:
* Fast * Effective * Cheap
Now pick two.
What We Get For Our Money
People look at this system and say that it's way too expensive--that it's bleeding money from every orifice and needs to be patched up by government.
People use life expectancy as evidence for this. Since we're not number 1 (or even number 10), surely this means that our system's results are inferior.
However, using life-span as a measurement of health care is wrong.
Americans, as we all know, are fat. Only about 1/3 of Americans are not fat. Moreover, 1/3 of Americans are not only fat but obese. This fact alone has some huge effects on health care costs, but when you factor in the general lack of health in America due to lack of diet moderation, exercise, and weight control, that's when things get a little heavy (pun intended. deal).
Complications from weight excess, bad diet, and exercise deficiency dwarf even tobacco in morbidity and mortality by several fold. Heart disease is the number 1 cause of death, 8% of Americans have diabetes (+90% of which is type 2), CVA and stroke are up there too. Not to mention the fact that nearly all cancers have increased morbidity and mortality in the obese. This lack of self-maintenance of health has cascading effects on nearly every biological process in the body.
Death is cheap. If people would simply just up-and-die from every heart attack or diabetes exacerbation, it'd save the system a lot of money. However, as our life-expectancy indicates, people don't die from these diseases much in our country. Only a few years of life span is shaved off our average. This is an amazing feat: to actually bolster our abysmal lifespan with the might of our economy.
When people point out that 15% of our GDP is spent on healthcare, I'm actually surprised at how little that is.
Insurance Companies
Nothing would make me happier than to tell you that just removing profit from the insurance companies would make things cheap. I'm a libertarian, but I'd support it if it were just that simple a sacrifice. The problem is, that's totally wrong.
You would be hard-pressed to find a medical insurer in the US that makes more than 7% net income. Up until the past few years, 5% was an astronomical profit and insurers were hovering at cost.
People like to blame insurance companies for the high cost of care. Would cutting 7% off your medical bills be all that earth-shattering?
In a recent interview with Bill Moyers, one former executive at Cigna stated the hideous practice of trying to disqualify high-cost beneficiaries by technical flaws in their paperwork. Indeed they did do that, but it doesn't actually happen that often.
People decrying our system seem to think that nobody with an expensive and potentially deadly disease gets healthcare. If that were true, my health insurance as a fit, healthy young student with no prior conditions wouldn't be $2,000 a year. More than enough people dying of horrific diseases in this country are covered. I know, some of them are my patients and family members.
Insurance companies pay 97% of all claims. (by the way: Many of those claims are made with the health care practitioner knowing full well that they wont be reimbursed, but do so anyway)
HMO Vs PPO
If you saw Michael Moore's Sicko, you know about HMOs. One of the not-so-subtle implications of Mr Moore's movie is that insurance companies to this day still manage care. He even took footage from 10-year-old congressional committee meetings that made a convincing case against managed care.
The problem with this is: we don't have managed care anymore, and we haven't for some time now.
You can look up the "HMO Act" yourself, but basically this act of congress under Nixon made HMOs the standard of American care until it expired in the mid 1990's. HMOs fell by the wayside and PPOs took over. That, combined with a decline in healthy lifestyle, is why health care costs skyrocketed.
HMOs (AKA Managed Care) basically tells doctors straight away which procedures are allowed to be used for each set of symptoms. If you have a cough, you may be able to get a chest x-ray, but you can't get a kidney function test (even though you can have kidney ailments that are involved with cough, they're just rare).
If you had a devastating illness, HMOs did an okay job of covering you most of the time. It's by no means perfect, but remember: it was cheap!
The HMO tells you which doctor you can see (the doctor had to agree to work under the plan), and tells the doctor what they're permitted to do.
In contrast, if you come to a doctor's office with a PPO backing you, it's basically a free-for-all.
One thing I will say for HMOs is that they were cheap, and they provided most of what you want out of a health care plan.
Since the advent of PPOs, it has become very hard to even find a company willing to sell you a HMO plan. When you find a plan, you have to jump through several hoops to qualify. However, even now, HMO's usually cost 30-40% less.
Because HMO's so tightly managed care, they became vehemently opposed by Americans. When the HMO Act came up for renewal, it was voted down by congress and lead to the extinction of the practice.
HMOs Vs Single Payer
Single payer systems are managed care, by definition.
The single payer manages what physicians can do for their patients, puts conditions on care (eg "Quit smoking if you want your arteries fixed"), and sets prices.
When countries allow the single payer to compete with private insurers, some patients and doctors choose not to participate in the single payer program at all. This is why many systems do not allow private competition.
Latest Health Care Plan By Obama Et Al
As far as I can tell, the new health care bill on the table now is going to make it illegal to not have healthcare.
Even if I weren't a libertarian, I'd probably still say that forcing people to buy health insurance is about the most fascist thing this government has done in a long time.
More Health Care = Less Personal Responsibility ?
It's no coincidence that the people who put the least amount of effort into maintaining their health are usually those who have the best healthcare.
I know libertarians are up in arms over medicare, but the fact remains that these patients get superb care. There's a reason why the medicare program is on a rocket-sled to bankruptcy, and it's not that they pay out too little. Medicare pays more per capita than any socialist system in the world. They get everything they want from motorized chairs to unnecessary joint replacements. No private or public managed care system hold a candle to Medicare.
It's true that there's a lot of red tape and that doctors routinely get paid less (or are unexpectedly denied payment)--a lot more than a PPO. However, recipients still live like kings on the plan.
It's no wonder, therefore, that the obesity rate in the elderly is higher than any other demographic, with a close second being the poor (who get coverage under Medicaid).
Yes, it's harder to take care of yourself when you're old, but it's a mistake to think that these people are incapable of diet and even a modicum of exercise. Proof of this is simply by comparing our elderly obesity rates to those of other countries.
It really doesn't matter who pays for it, having a lot of health care makes you lazy about your health. The government directly subsidizes the poor and the elderly, but employer-provided health care is also indirectly subsidized. Basically, government made it more lucrative to both sides to give more reimbursement in the form of health insurance than wages. Just like with wages, employee health care reduces profit, which reduces corporate tax. In addition, it is currently untaxed by the labor tax (aka the personal income tax), nor is it taxed by FICA or Social Security. In fact, employers didn't start providing employee care until government started heavily taxing other forms of employee reimbursement (wages).
Torn
As a libertarian, I'm mortified by the prospect of government manipulating care. However, as a future physician, I can't shake the feeling that maybe having managed care will bring back personal responsibility for health in the US.
It's very conflicting, but in the end, you just can't argue in favor of slavery, even if it will make people safer from themselves. (112,861)
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As I've stated before, I'm a libertarian and a medical student currently seeing patients in the field. As such, I'm uniquely annoyed by all the goings-on in DC lately. I'm sure most people reading this think it's all over--that the socialists/corporatists in power have "won" and that there's no use even talking about it anymore. Of course if we've learned anything from these systems of central planning, we know that eventually, they all fall down. If the current health bill passes, it's likely to actually make our unsustainable system even worse for all the same reasons it's currently failing (which this article is about). The debate is not over, it's just been put on hold for a few years--until the government's new plans to screw up their mess even further can come into fruition. 
Our system fits the classic 
Direct Health Care Subsidies - Medicare & Medicaid
The current healthcare bill will expand all of the problems with American healthcare--direct subsidy, indirect subsidy, direct regulation, and indirect regulation:
Trial and Error
