The Chains of Reality

One of the things that irritates this penguin are ideologues who substitute their pet ideology for reality. For example, I ride motorcycles. I have experimented with WD-40 and found that it increases chain life with modern O-ring chains to over 20,000 miles (in case you're wondering, that's very good). Yet people still insist that their pet sticky chain loob stuff that costs ten times as much as WD-40 is better because it has ingredients X, Y, and Z "which are better than some old light oil formulation". Yet chains don't last as long with that expensive sticky chain loob stuff, and I have the data to prove it.

So why do people keep using the sticky chain loob stuff? Ideology, pure and simple. Ideology passed down from motorcycle shop owner to motorcycle owner over the eons, ideology which has the net result of enriching motorcycle shop owners who sell sticky chain loob stuff and chains (doh!) while ignoring a practical, inexpensive alternative which actually works BETTER than the expensive stuff. Ideology that says, "if it's more expensive, it must be better", or, "if it was explicitly designed for motorcycle chains, it must be better", or, "if it wasn't better, they wouldn't sell it," notions that they've never tested against reality. Indeed, the idea of testing their ideology against reality simply never occurs to them.

The same applies to health care. A practical realist like myself looks around for the health care system that works best -- that has the most doctors, the most high-tech equipment, the most hospital beds per patient, the best outcomes, that extends life the longest. Then we say, "that's the health care system we want for the United States." The ideologue, on the other hand, doesn't care about reality. He uses the same sort of moronic ideological reasoning that afflicts the sticky chain loob crowd -- "if it's more expensive, it must be better", or, "if it's provided by government, it can't be good", etc. You present these people with data that shows that France has the best health care system in the world on every single measure -- has more doctors per patient than the United States, has more high tech equipment and hospital beds per patient than the United States, etc., yet provides this better care for 40% less money per patient than in the United States -- they start plugging their fingers in their ears and start shouting, "I can't hear you! I can't hear you!" and start shouting about "waiting lists" and about "I want to be able to choose my own doctor", objections which do not apply at all to the French system (where as many surgeries are done by private hospitals -- reimbursed by the French state-owned insurance company -- as are done in publically-owned hospitals).

I'll be blunt: This reluctance to face reality is why the political system in the United States is utterly dysfunctional. Our entire political system has become a bunch of Catholic theologians fighting about how many angels can stand on the point of a pin, arguing about theological issues utterly divorced from reality. I don't give a flyin' flip about whether something is "socialist" or "government-run" or "free enterprise", what I want is the best life for me and mine.

Now, practically speaking, experience has shown that for *most* things, private enterprise works better than government-run businesses. I don't want a car made by a government-run business, for example -- they typically suck (see: the old British Leyland company, or Fiat or Renault). But that's not a case of me having a religious attraction to free enterprise and making theological arguments about its superiority. That's a case of me looking at the observable facts and saying, "government doesn't work for making cars".

But when we talk about health care, I look at the observable facts and say exactly the opposite. Ever since for-profit hospitals became legal here in the United States (prior to the 1980's most hospitals were non-profits owned by local doctors with roots in the community), the standing of the United States health care quality relative to other nations has plummetted. Where once we were #1 in the world, now we're #30 or so, with all European nations and many Asian nations having more doctors per citizen, more high tech medical equipment per citizen, etc. than we do. France, for example, has 2.5 times as many doctors per citizen as we in the United States have. It is clear that private enterprise has been an utter failure at providing affordable and readily available health care for the majority of U.S. citizens, especially in poorer areas or rural areas where there is little access to medical care on the part of U.S. citizens. Comparing the U.S. health care system to France, we spend close to 75% more money, yet have fewer doctors, less high tech equipment, and poorer results on every measure.

Now, we can make theological arguments about how many angels can dance on the point of a pin, or how "socialist" health care just can't work because of religious beliefs A, B, and C. But facts are facts. And the facts say that if we want better health care for less money, there's an easy and effective way to do this: adopt the French system for funding and providing health care. That's the facts. All the religious zealotry in the world won't make the Earth quit going around the sun rather than vice-versa, or make privately-provided health care as effective and inexpensive as the French mixed private-public system. For those of us more interested in reality than in religious zealotry, it's a no-brainer: adopting a time-tested, proven system that has been shown to work beats religious zealotry every day.

So why do people still insist that a French-style health care system couldn't possibly work? Probably for the same reason that my motorcycling buddies insist that WD-40 can't possibly work and that sticky chain goop is worth the premium price it costs -- this is what other people have told them, along with some reasons why it can't possibly work, and damn the facts, their mind is made up! But WD-40 still gives me 20K+ miles on a motorcycle chain, giving me more chain life than the sticky goop for less... and a French-style mixed public-private health care system still works better than an American-style private-insurer health care system, giving better quality care for less.

There's no ideology necessary here -- just observing reality, and then accepting reality. For those of us who are practical engineering types, all that ideological gobblety-gook is just plain hot air -- all we care is whether it works. WD-40 works. A French-style health care system works. In the America that I was born in, that's all we cared about -- whether something worked. Alas, today's America is more concerned about how many angels can dance on the head of a pin... which is why this nation now has a worse health care system than any other OECD nation other than Mexico. Hmm, Mexico is the new Mississippi, and the U.S. is the new Arkansas... who woulda thunk it?!

- Badtux the Reality-based Penguin