Thank You for Being Expendable | Hacker News Reader

Thank You for Being Expendable

nytimes.com

51 pointswhyenot52 comments

It's strange to me that people still held the view that soldiers fight for their countrymen's freedom. It's not like Vietnam or Iraq were on their way to invade America in any foreseeable future.

Wars are fought for profit of the few, lives of soldiers are just part of the expense, which they try to minimize through propaganda and false promise of future care.

talk to any soldier about this and they will acknowledge that america's security is not directly threatened in todays world, and believe that the military mostly acts as a "preventative force" to keep it that way.

You are taking the term fight for their countrymen's freedom way too literally. Do you think that generals and military surgeons actually fought (as in combat) anyone at any time? Just because an individual did not see combat, this does not mean that they are not considered to be fighting. The spirit of the armed forces is that they their efforts either in training, studying, or actual combat are all part of a unified effort or fight.

The for freedom part goes back to the founding. The primary mission of the military is to protect the homeland from invasion and occupation. Though they do other things when there is no direct threat, this is still the primary mission today. Just by their presence we remain free. Do you think if the military was abolished tomorrow that we would be free people 2 years from now?

To your examples, Vietnam was fought because communism was seen as in indirect threat to American freedom. Much the same as the goal of overthrowing Saddam Hussein was to start a ripple effect of democracy throughout the middle east. Of course with such uncivilized people, with their constant conflicts and bloodshed over religion, stability and prosperity was never realized. The thought though was that democracy and personal freedom (at least in the west) has generally caused countries to become more prosperous, civil and less threatening to other countries freedom and sovereignty.

Brilliant article. I would add that Tom Ricks's book The Generals is an excellent complement to this piece (I wrote more about it here: http://jseliger.wordpress.com/2012/12/18/the-generals-tom-ri... ). Since Korea we have developed the habit of lauding generals who lose wars, instead of finding other duties to them.

A general or Secretary of Defense who screws up gets sweet six-figure "retirement" and widespread respect. He is at little if any risk of personal harm. A private who screws up, or just gets screwed by the system, dies.

It is worth contemplating what that asymmetry means.

"The Generals" also shows up on the UK Ministry of Defence reading list (in the "partners" section http://militaryprofessionalreadinglists.com/reading_list/19-...), so his suggestions are getting some official showing in military circles.

"War is a racket" by 2 time CMOH recipient Maj. Gen. Smedley D. Butler (USMC) details how corporate interests profit from warfare.

http://www.ratical.org/ratville/CAH/warisaracket.html

When I went through infantry training at Ft Benning I learned that the term "infantry" referred to a nation's ability to field soldiers, which is dependent upon the birth rate.

More infants = more soldiers.

Thus, by extrapolation, soldiers, especially infantrymen, are considered to be expendable.

Sadly, bureaucracy has allowed the care given to our veterans to fall short of expectations, but for many of those with military experience such treatment is par for the course.

I don't understand why there is a VA. Just give them Medicare or another health insurance. I can see a need for facilities that can treat combat specific injuries but I guess most veterans can be served by the regular health system.

Name a health care provider that would cover them then? Which health care provider would you want to take that kind of assumed risk?

> Medicare

Medicare for example.

> Name a health care provider that would cover them then?

Any of them would, it's required by law; there are no more pre-existing conditions.

The VA predates the rest of the medical care run by the federal government. When it works, it is actually fairly cost effective. They are actually going the other direction on this -- trying to more closely link active duty and VA care, although there are some commercial providers in the active duty system, especially for dependents.

[I have used VA healthcare, I have several friends who work for the VA Health Administration, and I have many friends who use VA healthcare.]

When the VA system works it treats the whole person. For example, if you have PTSD it may exacerbate conditions that may appear unrelated. In theory, all care-givers (MDs, therapists, etc) meet about an individual vet's conditions on a regular basis (every 2 weeks if memory serves correctly) to identify and develop longer term treatments for co-morbid conditions (I can only confirm this for one VA hospital).

Even if there weren't an attempt to treat co-morbid conditions, there are so many combat specific injuries that it might be a moot point. For example, I have a friend who is a Vietnam Vet that suffers from agent orange related illnesses; these illnesses exasperate more common conditions, namely diabetes. Throw in PTSD and anxiety, and now you have someone dealing with such a plethora of different symptoms - symptoms that are common in the veteran community but not in other communities. Would a typical GP have the expertise to handle this? Most likely not.

I have a feeling something like this is coming. The government is running too many slightly different health plans right now. Some future President or Congressional leader will likely run on "eliminating waste" or some such and consolidate them all...likely weakening or strengthening the lot of them (depending on the politics of the day) when it happens.

"If you want to know what the price of freedom looks like, go to a V.A. waiting room — wheelchairs, missing limbs, walking wounded, you get all of the above."

That quote just really drove it home for me.

That's actually the price of warfare. We have a habit of just pretending everyone's being killed and mutilated for freedom because it's a lot more comfortable that way. Makes their sacrifice seem worthwhile and not just a horrifying waste. Maybe in some cases it's even true, but it's not true in general, and I'd even go so far as to say it hasn't been true of the last, say, 60 years of US history.

We should take care of our vets, but we should also stop making so fucking many of them.

Completely the opposite with me. No matter what those soldier may have thought before enrolling, freedom is not why they have suffered personal losses. Just merely an excuse for an aggressive foreign policy from their government.

Maybe this generation will have a bigger impact on the general US population to not support this kind of war during the current century. Or maybe North America needs to have it own internal armed conflict to learn that war is a bad bad thing.

Why don't we just pay for veterans to go to normal hospitals? Why on earth would we think these government run hospitals would work?

The US has the highest per-capita health care expenditure in the OECD, by a substantial margin, despite being the only OECD country which does not provide universal health care.

Why on earth would we think that private sector hospitals work any better?

I've never heard of anyone being forced to wait for weeks for this kind of stuff in a normal hospital in the US. Government run health systems overseas have well documented wait lists.

Furthermore, privately run systems should be more efficient because consumers have a choice. Don't like your current doctor? Go get a new one. To be clear, I don't object to government funding these things, just running them. Monopolies are bad.

Okay, I live in France, the quintessential socialized health-care system. The wait at hospitals is short, I can choose my doctor as I please, and an appointment costs me all of 23 euro. I have nothing against the health insurance being government-run, which does not entail that the whole system is government run. Most GPs, for instance, are independent.

Adding to my previous comment: the French health "insurance" is a bit of a misnomer. It is as much an insurance as a wealth redistribution mechanism, and the "premiums" are not a function of your health risks but of your income, i.e. it is effectively a tax. If you believe that health-care should be granted at the same level regardless of material status, it makes sense.

In other words, the French health "insurance" is meant to at most break even, or run a deficit (which it does).

Every country in Europe has a private healthcare industry in addition to the public one. Not only is there no "waiting list crisis", but people still have the ability to choose whatever private healthcare provider they want, provided they can pay for it.

As a European who only recently moved to the U.S., it's bizarre to see the rhetoric being used here. The news are littered with "Europe is on the brink of collapse", "Will the Eurozone survive?", and "Healthcare waiting lists longer than ever in Europe", but mention those headlines to most Europeans (at least in Northern/Western Europe), and they'll look at you quizzically before asking what you've been smoking. And indeed, nearly every study into healthcare systems and their effectiveness prove many of those headlines to be wild exaggerations or downright untruths.

Consider if you should take what you're reading at face value--very large corporations are heavily incentivized to mislead you. Manufacturing Consent is chillingly relevant.

So poor people can suffer in the public hospitals and rich people can buy the very best care their money can provide? How is that a good thing?

I seriously don't understand what's wrong with a system where the government gives people money to participate in a truly free market (see comment in a sibling reply about how the US market is not currently free). This is the best system: everybody is covered and there's no big, lumbering, inefficient government running the show.

Poor people don't suffer in public hospitals in Europe. Also, in most countries, the government pays for specialty private care when necessary (it often isn't, since doctors make a very good living in the public system.)

Because healthcare shouldn't ever be a free market.

A free market implies that a doctor should be charging as much as he can get for a procedure in order to maximise his profits. Standard econ 101 stuff. However, when someone is dying, they'd happily spend every penny they have even if it's just for simple cheap antibiotics. Therefore, you can't let the standard "the price is what people are willing to pay" economics take control. Healthcare cannot ever be a free market in a just, moral society.

That's not to mention the socio-economic aspect of the healthcare system. If people are dying simply because a procedure is being charged at its free market value, then the poorer end of your workforce will be decimated. And yet, the poorer end make up the vast majority of jobs! Socialised healthcare of some sort is absolutely essential to a well functioning society.

The obvious counter argument is that I could pay for my highly skilled, valuable workers to have private healthcare. The free market at work! But what about the people who don't work for me yet are essential to my business? How do I ensure the guys who build and maintain my roads survive that potentially dangerous job? How do I ensure that the guys who take my trash out are covered? These are all fairly low paying jobs where the downward wage pressure would push them into not being covered.

Yet these people are absolutely essential to my business running.

Then there's my customers. I try and sell to all walks of life, rich and poor. Where's my market if all the poor are dying due to not affording healthcare?

/rant over

There's just so many reasons why free market healthcare is bad. Socialised healthcare isn't just good morally, it's good for business too.

I don't think that you understand "econ 101" as well as you think you do. If markets worked like you described, nobody would be able to afford to buy anything. Yes, suppliers try to maximize the price they get for what they're selling but somebody has to pay for it. That's what drives the price down - if almost all the doctors charge $x for something and one guy charges $x-1, all the sudden people start flocking to him and he makes more money. In a truly competitive market, long term profits are zero (http://en.wikipedia.org/wiki/Perfect_competition) because everybody sells their goods at exactly what it costs to manufacture them because that's the only way to sell any units at all. Of course I'm not claiming that health care can be perfectly competitive - there are many reasons why it can't be. But there's no reason why the current market needs to be noncompetitive.

Furthermore, as I've said up and down this thread, I'm not opposed to funding poor people's private care through government subsidy. The important piece is that the people participate in the free market and can choose how to use the money - not where the money comes from. This is how this discussion started in the first place - I believe the government should just give veterans money for health care instead of trying to actually provide it.

Having one central administration for a whole sector of the economy is inefficient. The Soviets thoroughly proved this with their (mis)adventures in central planning. Fostering free markets aren't just good morally, they promote better outcomes for patients and more innovation in the sector.

The market isn't the solution to every problem, it is in fact sometimes immoral to solve a problem with the market because money is sometimes not the correct incentive. Healthcare should not be a free market issue, the quality of your care should not depend on the depth of your wallet, nor should it be profitable to deny service to those in need of them.

The terribleness of healthcare in America isn't really about private versus public, it's more about the system of healthcare being horribly regulated.

Let me say this: The healthcare market does not function like a normal healthy free market.

It's hard to see how it ever could. How do you know which is the best doctor or hospital? You don't. You can't. You could if you had an education in medicine and had worked at all the hospitals but obviously that doesn't happen. Besides, patients often don't have time for window-shopping.

How do you know which is the best doctor or hospital?

That isn't really the problem we're trying to solve. As a patient, I'd like to receive adequate health care. I don't imagine that my health is somehow more important than that of every other patient in the nation. That isn't to say I wouldn't like more information about health care providers, but maybe I can't be trusted with that...

That doesn't really change the fundamental problem. It just changes the question to "How do you know which doctors or hospitals are adequate?".

> Furthermore, privately run systems should be more efficient because consumers have a choice. Don't like your current doctor? Go get a new one.

You are assuming an efficient market. That would imply that patients have access to perfect information about quality and cost of care, and make decisions rationally. I find this extremely questionable.

> Monopolies are bad.

I am far from convinced that the US health care system is competitive in any meaningful sense of the word.

> I've never heard of anyone being forced to wait for weeks for this kind of stuff in a normal hospital in the US.

This is not evidence that the US health care is more efficient, it is evidence that the US makes a different trade-off in cost:quality of care. Without question, a subset of the US population receives better care for non-emergency medical issues. But also without question, this improved service comes with a substantial increase in cost.

Hospital capacity is extremely expensive. A Canadian (say) hospital operates at nearly 100% utilization, nearly 100% of the time. In order to do this, it must maintain queues for non-emergency care, in order to smooth demand. By comparison, in order to avoid queueing, an American hospital must maintain capacity to satisfy peak demand, which means it does not fully utilize its capacity most of the time. Both systems maintain large bureaucracies (I have been party to Canadian health care workers marvelling at how an American hospital might dedicate an entire floor to its billing department). Which is more efficient? This is hard to say. Do Americans have the freedom to choose where they stand on the cost:quality-of-care spectrum? It seems not, to me.

> Without question, a subset of the US population receives better care for non-emergency medical issues. But also without question, this improved service comes with a substantial increase in cost.

I'm not convinced that even this is a given: A large percentage of those costs are the result of articial inflation that benefits pharmaceutical and insurance companies tremendously, but costs the average American a fortune. A month's worth of chemotherapy in the U.S. can easily cost ten times more than the equivalent in any European country (not factoring in insurance.)

The rich getting quality care never seemed a particularly convincing argument against healthcare overhaul. It's even more ridiculous when you consider that there is world-class private healthcare in Europe as well.

I never said the current US system is efficient. Go back and check. In the current system, people don't chose their own medical plans - their employer does. If you lose (or leave your job), it's hard to get good, affordable health care. Further, each state has their own laws about what health care providers must provide - and people can't buy across state lines. Also, many people are on Medicare, in which the government essentially dictates that price to the hospitals/doctors that it will pay for things.

What I favor is a free market system, where everything is run privately. This can be funded through taxation and income redistribution if needed, as long as people are free to choose their hospitals, their doctors, their treatments, etc. The government shouldn't make any demands on what people need to buy for health care coverage.

Of course, contract law and medical safety standards still need to be enforced.

Wait times in normal hospitals in the U.S. only include those people who can afford medical care (including those with insurance). They don't include the millions of people who can't get on the list at all.

In other words, average U.S. wait times are pretty good if you exclude people whose wait times = infinity.

> I've never heard of anyone being forced to wait for weeks for this kind of stuff in a normal hospital in the US.

That's because here they can't afford healthcare at all and they just die. Seriously, criticizing better healthcare systems for problems that don't exist while ignoring all the worse problems with our system, c'mon.

You're spewing the same ignorant bullshit you'll find on Fox News; you're brainwashed.

"That's because here they can't afford healthcare at all and they just die."

http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

The life expectancy in the United States is lower than most European countries, but not that much lower (e.g., 81 for the UK, 79.8 for the US). I suspect much or all of this would go away if you controlled for overweight, violent crime, motor vehicle accidents, etc.

The data is not consistent with masses of people dying in the streets because they can't get medical care.

So the US has lower life expectancy despite spending more per capita than any other country?

> controlling for overweight

I'm not sure what this means. Removing all the over-weight related illnesses obviously reduces death rates, but so what? Obesity causes chronic problems and not treating those health problems causes death.

You're trying to shift the goal posts, but okay.

Life expectancy isn't the only measure. Convenience and speed also count, when it comes to quality of life. That's why you see (e.g.) wealthy Canadians crossing the border to get treated.

"I'm not sure what this means."

The United States has a higher rate of obesity than many other countries. Similarly, it has high rates of violent crime and motor vehicle accidents. These likely account for some of the difference in lifespan, but are not (as far as I can tell) directly related to the presence or absence of socialized medicine.

Anyway, we have Obamacare now, so everything is wonderful, right?

Obesity and the health problems caused by onesity are treated by healthcare. The lack of affordable healthcare has an impact on treating those problems. Diabetes kills people (eg diabetic foot) so giving people access to healthcare means they are more able to control these chronic illnesses and more able to avoid mortality associated with those problems.

I'd agree the Canadian system sucks.

But if being a destination country for "health tourism" is a good thing then England appears to be a great system.

No one said mass people in the streets, and the data shows 45k people a year dying[1] from lack of healthcare. So stop looking at life expectancy and trying to infer deaths from that and just look at the data on deaths from lack of healthcare. It's been studied, no need to try and infer it.

[1] http://news.harvard.edu/gazette/story/2009/09/new-study-find...

This is a ridiculous statement. Only around 15% of the country is uninsured and only a small percentage of that number would be "dying" at any given time. Most people in that number are young and relatively healthy. There aren't huge masses of people dying in the streets from treatable diseases and if that's what you believe, you ought to go outside more often.

Regardless, as I've repeatedly said, I'm not arguing for the status quo. The status quo is bad. We do not have a free market currently. If we decoupled health insurance from employers, provided subsidies to the poor, elderly, and our veterans, and removed ridiculous restrictions that prohibit purchase of insurance across state lines we would be well along the way to having a system with universal coverage without the drawbacks of central planning.

This isn't "ignorant Fox News bullshit". Central planning has been repeatedly tried and proven to be less successful than the market mechanism we trust with every other sector of our economy. We simply can't anticipate supply and demand as efficiently as humans as the market (as a force of interacting people) can. I'm not trying to spew some reactionary propaganda - for Christ's sake, I'm advocating the government give people subsidies to help them get insurance in this proposed truly free market. Free market doesn't mean no government or even no government regulation.

The claim that I'm brainwashed carries significantly less weight when you've ignored my comments up and down this thread.

> This is a ridiculous statement. Only around 15% of the country is uninsured and only a small percentage of that number would be "dying" at any given time.

You ought to stop relying on your gut so often and look at actual data. 45k people[1] a year in this country die from lack of healthcare. The only thing ridiculous here is you.

> Central planning has been repeatedly tried and proven to be less successful than the market mechanism we trust with every other sector of our economy.

In regards to healthcare, absolutely false; socialized systems in the world work far better than market based systems, this is simply a fact.

> I'm advocating the government give people subsidies to help them get insurance in this proposed truly free market.

Subsidies are a shit solution to any problem, they don't work in free markets because markets simply raise prices to feed off the subsidies. See college tuition rates.

[1] http://news.harvard.edu/gazette/story/2009/09/new-study-find...

> Why on earth would we think these government run hospitals would work?

It's a silly question, why do you assume they wouldn't? Government doesn't equal bad.

Just for a start veterans have specific injuries (both mental and physical) that general hospital will be hard to have the expertise to deal with.

We are talking about people that freak out/enter combat mode when they see a garbage can or a box near the road. Why - because for them for 10 years it has been a real and present danger. And those are the very mild cases.

If the VA didn't exist hospitals would have the appropriate resources, especially those near bases.

Actually, I think the opposite would be truth.

If the VA didn't exist limited resources would get spread too thin among regular hospitals, though maybe not as badly in those near bases.

They would simply not get insurance because of the high risk of expensive injuries.

>>>Why on earth would we think these government run hospitals would work?

Because lots of nations have successful government-run hospitals?

Kind of a downer man. I'm trying to have a BBQ over here. Maybe talk about depressing things after my day off.

Please don't be alarmed by the fallout of war. The President (past, present, and future) wants you to go back to shopping and sportsball.

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