I would imagine that the US is also among the greediest countries in the world.
Odd how it can work out that way with percentages.
[edit: grammar]
No charity has, or ever will, end major problems like hunger or poverty.
Make a Wish Foundation crows about spending 76% of funds on programs. If the SSA were as efficient as Make a Wish Foundation, it would have an overhead of an additional $185 billion a year (i.e. approximately equal to all federal payroll expenditures).
The government probably has a worse QALY because it runs Medicare, but that's not the government's fault -- anyone who runs the medical care program for old people is going to have horrible numbers there.
(You are more likely to die if you are on Medicare than if you are uninsured. This isn't because Medicare is killing you, it's because old people are on Medicare.)
In addition, we'd have to examine marginal-QALY versus average-QALY. Depending on the question one or the other could be more important.
Americans freak out whenever anyone tries to do QALY measurements, so we don't know just how good (or bad) our various programs are, public or private.
From http://www.charitynavigator.org/index.cfm?bay=content.view&#... we learn that:
- Total giving to charitable organizations was $298.42 billion in 2011 (about 2% of GDP). This is an increase of 4% from 2010.
- Giving by individuals (which includes bequests and family foundations) is critically important as it represents nearly 9 out of every 10 dollars donated.
- 32% of all donations, or $95.88 billion, went to religious organizations (down 1.7%). Much of these contributions can be attributed to people giving to their local place of worship. The next largest sector was education with $38.87 billion (up 4%).
- Donations were up to health charities (2.7%), to public benefit charities (4%), to arts, culture, humanities charities (4.1%), to International charities (7.6%), to human services charities (2.5%), to environmental and animal charities (4.6%).
For comparisons to Europe, check out: http://www.american.com/archive/2008/march-april-magazine-co...
- Per capita, Americans give 3.5x than the French, 7x Germans, 14x Italians.
- Americans are 15% more likely to volunteer than the Dutch, 21% more than the Swiss, 32% more likely than the Germans.
The pattern holds true across many demographics (education, age, income).
My observations are that Americans definitely look out for themselves. People tend to give (as you stated) in ways that directly or indirectly benefit themselves.
These are broad generalizations but having lived here for 30 years I'd not consider our society to be generous by any stretch of the imagination.
Now, in the techy world I work in, I can find a wealth of self centered pretentious types who are more concerned about how their seen that what they see.
Second, while many of the donations were to religious organizations, many food banks, shelters, etc are run by the same institutions. Assuming those categories are mutually exclusive is risky at best.
"Medicaid" is the program you're looking for, not Medicare. Anyway, Americans did willing give money to "help the poor" get medical treatment. There were various organizations that operated charity hospitals (Shriners and the Catholic Church come to mind) where you paid what you could pay, and Americans donated generously to keep those hospitals running. It was normal for doctors to put in some amount of unpaid time in charity clinics because that was considered the right thing to do.
But the government crowded all that out, and since it's been a few generations people don't remember.
>I would imagine that the US is also among the greediest countries in the world.
This isn't even close to being right.
Don't remember where I read it, but someone had a good line about youth pastors essentially playing the role of cruise ship activities coordinators.
That's right, they will let you get sick enough to need intervention, and if you can't pay, they'll try in the meantime to find a gov't program to foot the bill.
Our current method of deciding is to stick our fingers in our ears and pretend it doesn't matter. Anything has to be better than this.
Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.
No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means.
Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees.
People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that.
But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.
We are in agreement. My point is that society is stuck on this (note that I have made no value judgment in these comments myself) and until and unless that changes, market forces are implicitly ruled out.
See my comment elsewhere on the swiss model.
It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost.
Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.
It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house".
Most people do not have a maximum price on something they consider priceless.
I'd fully support your right to opt out of taxes if you also opt out of each and every benefit society otherwise provides you.
Personally I'm far more comfortable with a board under democratic control setting rules based on clinical considerations for whether or not someone is suitable for care, than having someone with a profit motive to avoid paying for my care making that decision.
In general, I think this kind of decision is highly personal and dependent on circumstance, and cannot possibly be regulated at the federal level.
In the UK this is handled by NICE: http://www.nice.org.uk/
They conduct appraisals of technology and medicine, and the NHS is required by law to provide treatments that NICE recommends.
The NHS trusts may elect to provide funding for additional treatments, though.
A number of their working groups etc. are open to healthcare professionals, and some are open to patient representatives, carers and lay people. Consultations are open to anyone. On top of that they are accountable to their sponsoring department.
Overall, this system works. You hear people complain about wait times for non-essential treatments, but everyone gets treated.
As opposed to the democratic decision that's already being made in board rooms?
Nobody's killing anybody. People die. It happens. Maybe someday I will have a heart attack. On that day, I'm not going to rob somebody at gunpoint and demand they give me $33k. Equivalently, I'm not going to have the government threaten fellow citizens with jail time and garnished wages if they don't pay their taxes to pay for my treatment. And I'd appreciate it if they'd extend me the same respect.
Why bother eating right or exercising? Fuck, why not just off ourselves and save all the hassle.
There's absolutely no difference amongst the different kinds of things people can die from, especially ones that are easy to fix and ones that we can't do anything about.
Hey, we actually came back to the point, kinda! There's a lot of things you can die from that fall in between "easy to fix" and "can't do anything about it". Where you draw the "fuck it, people die" line is hugely variable between different people, and it's not something you'll find a shred of consensus on across the 300,000,000 people in the USA. It's better for people to negotiate coverage with individual hospitals (and voluntary charities) than to have standards of care dictated by a central authority.