No, this post is about the costs to our healthcare that arise from our social isolationism. Okay, so the title is a bit misleading, it says individualism, but I tend to not see a dramatic difference. Individualism encourages us to look to no one but ourselves for our necessities, which when taken to its logical endpoint, means we become more isolated. Semantics aside, my argument is pretty simple: our isolationism is costing us in our healthcare spending – and big time.

One thing that we don’t really hear about in healthcare debates, particularly when comparing the United States to other countries is that virtually all of the other countries with universal healthcare also have much tighter social webs, community life, and place less emphasis on individualism. I don’t think there is a direct 1:1 correlation between community attachment and healthcare spending, only that there is an indirect link that probably hasn’t been studied very much. A few areas strike me here as very likely areas where this matters a lot:

1) the elderly. Older people are notoriously lonely, especially in the US. In my relatively limited travel, I’ve noticed that older people rarely live alone in other places, they usually live in multi-generational households. They watch their grandkids (or great grandkids) and their children take care of them. The psychological toll of that constant loneliness really gets to people and lonely people are more likely to be depressed, get sick, and generally be less happy. I imagine that older people like to see their doctors more because they have someone to talk to. Hell a lot of older people I know base a good chunk of their social lives around discussing their health conditions and ailments. Who better than a doctor . . . which leads me to . . .

2) Hypochondriacs. People who think they are always sick. Have a sore thoat? Maybe it’s tonsilitis. Oh God! a bump on your neck? must be a tumor…or so WebMD suggests. More information isn’t good if the person receiving the information doesn’t know how to interpret it properly, but that’s an aside. Without people, family, close friends, co-workers to give us that reality check and tell us it’s ok, every sneeze sends us to the doctor and every chest pain demands an MRI. Which of course leads to . . .

3) Pill Popping. Suburban housewives are huge drug users. They just pop prozac and antidepressants. They put their kids on ritalin because they’re hyper (really? a hyper kid needs medication? Really? God what would have happened to me if ritalin were widely prescribed when I was 5). We turn ourselves into blank zombies. We’re not any happier because of all of the pills. We don’t feel any better. If anything our isolation and self-medication make us feel worse, hate our lives, and become depressed. Which leads me to . . .

4) Psychiatric Care. Now I’ve never been to a psychiatrist, a psychologist, or a therapist of any kind. Some who know me well enough might suggest it could help. Maybe, maybe not. I have, however, known many people with severe problems who were and are on multiple meds and seeing multiple therapists. Some people genuinely need this. For a lot of people, however, I get the feeling that having a loving family around and good, supportive friends would be as good or better. Even people with serious issues could probably benefit from a tight social network. I’m not spouting here, because I’ve seen the difference in people (primarily with depression) who deal dramatically better with their issues when they’re around family and friends than when they feel alone.

And of course all this stems from the belief that *I* (not me specifically, but the Ego “I”) am a special and unique snowflake and my life is worth an infinite amount of money (well as long as I’m not picking up the tab) and of course so are my loved ones’. Now when it comes to *your* life  and you will cost a million dollars for the possibility of living another two months, to hell with you. Ah the Ego bias.

This isn’t nuts, it’s probably a series “well duh” things. I know. But no one’s talking about it.

Point being that we can do a lot to “fix” health care by expanding coverage, cutting costs and all that jazz, but we may still face higher costs than we have to because of our culture of isolation and individualism. I’m not suggesting we all hug and sing kumbaya. I’m not suggesting we have group hugs (although I do enjoy hugs). Point simply being that we’re treating conditions more than we need to or that probably shouldn’t exist as a result of our culture. I don’t know how to “fix” it. I don’t know that it can be “fixed.” Just an observation.

Power = Access + Process

The new members are:

1. Former Springfield Mayor Karen Hasara
2. Timothy Koritz, a staff anesthesiologist at Rockford Memorial Hospital
3. Pamela Strobel, retired executive vice president and chief administrative office of Exelon
4. Carlos Tortolero, the president of the National Museum of Mexican Art.

This time he beat the machine by lasting more than 20 questions.  On the 24th attempt, the machine finally ventured a guess.  It didn’t get “Constitution” but the answer was still intriguing.

The item the machine guessed was “a receipt.”  Professor Klugman urged me to share this with the blog, noting he thought the answer was surprisingly intellectual.  In many ways the Constitution is a receipt for our democracy.

Incredulously,

Ragnar

Consider the set back DADT posed to the Clinton Administration, and how it compromised health care reform.  I’m sure Rahmbo has. Despite an evolution on DADT in the public mind, moving the issue to the forefront will undermine Obama’s efforts to extend affordable health care to all Americans.

I submit that more gays are harmed by the lack of health insurance than by DADT.  And more gays are harmed by the global financial crisis than DADT.  These are broad American problems that are too important to allow distractions from any narrow activista interest group.

You can’t expect smart progressives to take up polarizing fights on issues effecting a small subset of Americans at the expense of possibly losing political wars of paramount national importance. Be patient.

Brian, it’s still early in the Obama presidency.  Don’t get angry yet.  There will be time to hold him accountable.  Timing is everything.   Imagine you’re a senior White House advisor.  When would you tell him to take up the issue if your interest was serving the American people and President Obama instead of just the LGBT community?  I’d like to see him take this issue up right after the 2010 election, preferably in a lame duck session.

I share the growing fear that the Obama administration has decided to distance itself as much as possible from gay rights issues, and that it has no plans to act on behalf of the gay community unless it is absolutely forced to. It’s hurtful and disappointing and, for a president who has been fairly gutsy on national security and foreign policy, genuinely surprising to me.

But today’s announcement from the court brought about a different wave of frustration, rooted in the fact that the Obama administration’s argument and the court’s decision are legally correct. “Rational basis” is a level of scrutiny that the government is almost always able to meet, particularly in a context involving military policy. And while Lawrence v. Texas, the 2003 case striking down sodomy laws, isn’t the most clearly written opinion in the world, it’s pretty clear that it applies rational basis and finds a violation of an individual right to privacy.

That might sound like a pretty progressive ruling, just as the Massachusetts Supreme Court same-sex marriage ruling sounded pretty progressive in its holding that denying LGBT people the right to marry is irrational. The problem with them is that they make for pretty weak precedent. There are basically two approaches courts can take on gay rights cases. First, they can avoid recognizing the rights of LGBT people as LGBT people and instead root their decisions in broad individual rights (like privacy) or strike down laws as completely irrational. But privacy is only going to apply in certain areas (whereas it would have no bearing on, say, same-sex marriage, or DADT), and finding that laws are irrational is pretty legally tenuous and unconvincing. Alternatively, courts can recognize that the LGBT community constitutes a class of people not unlike women or racial or religious groups that have been historically targeted by the majority. If the courts were to make these kinds of decisions, then the level of scrutiny they could apply to laws affecting gay people could jump up, such that the government would be required not just to show the “rationality” of the law but a compelling need for it.

Ultimately, DADT was always destined to be an issue dealt with by Congress and the White House rather than the courts. But the resistance by the courts to provide LGBT people with heightened protection affects marriage rights, employment rights, immigration, and so on. While the courts, predictably, have been the most willing of the three branches to protect gay rights, all three branches have been pretty weak on these issues. The bulk of my anger will remain focused on the president, but he’s not the only one failing to protect equality.

With the money we are spending we could build coast to coast high speed railroads, develop a fleet of natural gas cars and trucks, hell we could build a tunnel to Brittan!  A new power transmission grid fed by new advanced nuclear reactors, all dangerous spent nuclear fuel should be safely buried a mile deep in solid bedrock below Nevada at Yucca Mountain.  We should be completely energy independent from the nuts in the Middle East.  Lets revitalize our steel industry.  A nation that doesn’t make its own steel is in decline.  Let’s measure this “great” administration’s success by how much they BUILD (lest Atlas shrugs and all the builders go away).   Crap, I’d settle for a fleet of Zeppelins!

Recently Sen. Specter, a moderate, endangered Republican, stated he will not vote for cloture to bring the card check vote to the floor.  Now a compromise proposal is being floated, but both main interest groups are opposing it.  All along both groups have vowed that no compromise would be acceptable.  I suspect that position will hold, at least through 2009.  But the reason isn’t Arlen Specter.

In the media we may hear lots of stories about why the bill is held back.   The story may center on specific moderate Senators, or we may hear a narrative about how the EFCA is too bloody of a battle to fight now when we are facing economic disaster, or that the Dems are waiting for Frankin, or that unions need to wait for the economy to recover to weaken the business’s gloom and doom predictions.  But what’s really going on?  It all comes down to money.  This is the kind of fight that employs a great many lobbyists, many of whom have less and less other paying work due to clients cutting their lobbying budget or being unable to pay their bills.  Too many people on both sides are getting paid for anyone to want to draw thier guns.  Why fight the war when after it’s waged the retainer checks will stop coming in?  And until the vote takes place, both unions and business groups will stay especially interested in fundraisers for moderate, endangered members like Specter.

Well, first off let’s get on the table that this won’t fix all of your problems, but it’s a start.

Sick of paying high property taxes? Taxes that pay to send her kids to school? His golf course that you never use? The library with the musty books? That black hole of a mass transit district?

The plan: Incorporate your own low-tax municipality! Within months you’ll see business flock to you and residents clamor for housing and you can sit back and bask in the fact that your property taxes are 20, 30 or 50% lower than that guy in that place. Just follow these easy steps!

1) Now this one’s a little tricky, but you have to either a) find yourself a nice plot of undeveloped land adjacent to a (relatively) big city or b) find an area of relatively low-intensity use with high average incomes within an existing municipality or unincorporated area

2) Incorporate! Make a city charter and become your very own city!

3) Form a mass transit district with no bus or rail services so that the mass transit from the city can’t start serving your area and you can keep property values high. This means you can keep taxes low while generating higher revenues.

4) Turn all of your major thoroughfares and arterial roads into state highways. You get the road, the state picks up the tab!

5) Zone all of the land near major roads commercial and with those low low property taxes, businesses will trip over themselves to get into the action!

6) Avoid expensive, ongoing public works projects. This means no or few parks, no library, no museums. That’s why you have to be next to a city. They pay for the stuff and you get to use them – at no or low cost! Oh sure you might have to pay to use the library, but then only the people who use it pay, not all the rest of us.

7) Zone to restrict apartment buildings. More people per unit of land = more chance of children = more schools. Keep the density low! In fact, if you can help it, restrict single family dwellings too. They’re a tax drain. Commercial = good for city coffers, residential = bad.

8) Don’t have a fire or police department. Contract them out to the city. You’ll save the capital costs of maintaining the building and won’t have to worry about labor relations or spikes in cost. Contracting is great for your new little muni because you don’t pay the full  cost of the service. Don’t worry though, you’re not stealing it, it just doesn’t make sense to have a full police and fire force for your little piece of Mayberry.

9) Join the best school district in your area. They’re not tied to municipal boundaries and people will pay a premium to see their kids going to the best school around.

10) Keep it homogeneous! I know I know. This isn’t as easy as it sounds. Homogenous how? Well start with income. You want everyone roughly equal so that no one feels like they’re paying more. If you can exclude other undesirable types, that’d be great too. Remember, people will pay more for services for people who are like them.

With these simple guidelines, your taxes will be low, stay low, and your town will be rolling in revenue. No municipal crunch here folks!