Deepak, I'll try to answer your meandering rant as succinctly
as possible, yes I registered to reply to you because your post
shocked me with its contrast to the reality on the ground here:
I
have lived in the US for about 15 years. I attended RGS and RJC and
then an Ivy League University in the States, then a large public
university for my masters. So I lived the first 23 years of my life
among fairly elite crowds. I am a legal resident with all the
rights of a citizen as my mother was born in the States. I am a
Professor at a local college. I make about US$40 000 per year. I
have also worked with underprivileged youth ( those you so kindly
refer to as gangbangers) as a counsellor. My younger sister went to
Harvard and then medical school. She is currently doing her
residency at a large teaching hospital in the south. University
hospitals are not free.
It
is very difficult for a Singaporean to understand how America works
without actually navigating the system. Your posts show that you
assume the USA functions along some sort of consistent logic
through all stratas of society. There is not such thing. There is
instead a maze of competing government bureaucracies and private
interests. American society is very fractured and very complex.
I
will answer your questions 1 by 1.
1.
No, Singapore doesn't give out food stamps. But I'm not trying to
make a comparison. The info you quoted below does not play out the
way it sounds in real life. I refer you to an article in today's
New York Times
http://www.nytimes.com/2009/07/12/opinion/12ehrenreich.html. The
dynamics it describes are common knowledge outside of elite
circles. This will answer some of your "questions" better than I
can. In Singapore, you can safely assume that if the government
says it will do something, it will do it. In the States, you can
assume that the words are platitudes, and that efforts will be
unevenly implemented and inadequate.
I
myself have received the Earned Income Tax Credit when I was a
student. I received about as much as it cost to file my income tax
return. According to your info, the most you can receive is
$320/month which would be 40% of your income, meaning with the tax
credit your monthly take home is $1120. There is nowhere in the USA
where this income is a livable sum for 1 person, much less a
family. The cost of living is much much higher here. Furthermore,
this Earned Income Tax Credit is distributed once a year as a tax
rebate. Not a consistent monthly payment, causing many poor people
to borrow from high interest credit companies which operate in poor
neighborhoods for precisely this reason. It is an unregulated
business. So yes, they give some small handouts but too small to
make a real difference, I often wonder why they bother at all.
2.
"Officials reported 46% of all gangs were Hispanic/Latino, 34%
African American, 12% Causcasian, and 6% Asian. A third of all
gangs were reported as having significant numbers of more than one
ethnic group. "
http://www.uic.edu/orgs/kbc/Floors/Facts.html
Nice of you to quote a study done by the University I got my
Masters from. Gangs are definitely a problem, and yes, they are
idiots. But, there are 50 million uninsured Americans. There are
not 50 million gangbangers.
There is NOTHING in the USA like Singapore's Medishield system,
which at least provides basic catastrophic coverage. You've
misunderstood the WHO rankings. They are not solely based on money
spent. It is a factor. But #1 France spends quite a bit. In the WHO
rankings of national health care systems, Singapore ranks 6th and
the USA ranks 37th! 37th ! I know it's difficult to believe but
it's true! http://www.photius.com/rankings/healthranks.html
1
France
2
Italy
3
San Marino
4
Andorra
5
Malta
6
Singapore
7
Spain
8
Oman
9
Austria
10 Japan
11 Norway
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei
You can argue all day about how WHO came up with these rankings but
there's no denying the US has a pretty lousy system. France spends
about half what the US does and gets much much better results.
Singapore could probably spend more. If I was designing the
rankings Norway would rank above Singapore.
3.
Medical procedures in the USA are often denied by insurance
companies on the grounds of being " medically unnecessary". This
happens even for things like heart bypasses, which are never really
elective surgery. You don't choose to have a bypass. If you need
one, you need one. Doctors in the USA then have to furnish proof,
usually several times, get on the phone, argue with a bureaucrat
etc, get a 2nd or 3rd opinion from another Doctor employed by that
insurance company ( imagine the conflict of interest) etc etc etc
and then hopefully the insurance company will pay. Chances are, the
patient will be dead by then, which what the insurance company
wants.
http://www.healthreformwatch.com/2009/05/14/health-insurance-administrative-costs-to-doctors-31-billion-per-year/
http://www.pnhp.org/single_payer_resources/administrative_costs_in_us_hospitals_are_more_than_double_canadas.php
Health Care Insurance companies profits have increased tremendously
in the last decade. Forbes magazine reports that William W.
McGuire, CEO of UnitedHealth Group) received compensation of $124.8
million in 2005. Managed Care Magazine also says that the
average executive compensation (excluding unexercised stock
options) for an executive of a ‘top 10 for profit health plan’ was
$11.7 million and that was back in 2000.
http://blog.aflcio.org/2009/05/27/health-insurance-profits-soar-as-industry-mergers-create-near-monopoly/
http://blogs.webmd.com/mad-about-medicine/2007/08/ceo-compensation-who-said-healthcare-is.html
http://healthcare-economist.com/2006/02/14/united-health-ceo-earned-1248-million-in-2005/
Please watch this interview conducted by one of the most respected
journalists in the US, He speaks with HIC whistle blower, this guy
has also testified before Congress. Watch all 4 parts.
http://www.youtube.com/watch?v=0-M10jDkmm0
You can also watch SICKO, by Michael Moore. You can say he's
a bleeding heart liberal whatever but the stories are real.
4.
The US has the most advanced, best medical care in the world this
is true. However, unless you are wealthy and well-insured you will
never get to use that system.
5.
In my city there are about 1 million uninsured. There is 1 hospital
that will serve them, there are more than 10 for insured persons (4
million). The county hospitals ARE NOT FREE. They take insurance
and bill you like any other hospital, it's only that if you really
cannot pay ( and you have to prove this via a complicated system of
means testing) then you will have your debt forgiven rather than
sent to a bill collector. Get the idea that the US has a safety net
out of your head. It is more like a band aid for a gun shot wound.
" Regardless of ability to pay" doesn't mean free.
6.
The income in the US IS NOT EVENLY DISTRIBUTED. Get the idea that
Americans are well paid out of your head. There is precious little
manufacturing left in the US. Most has been outsourced to places
like China. Go on, try buying something stamped " made in USA".
Every time I see that I do a double take.
$23 an hour is NOT ENOUGH, especially if you have kids. The cost of
living is much much higher here. A medium cup of coffee in my city
costs $2.00 ( at local kopi tiam, not starbucks), a movie ticket is
$12. After federal, state,city, FICA taxes that's about $16/hour.
Even at poverty level you have to pay taxes. The living wage in
Chicago, one of the cheaper large cities is estimated between $13
and $16. The federal minimum wage is $5.15. It's a JOKE. Federal
poverty level guidelines are a JOKE. Something like $10 000 per
year per individual, $20 000 for a family of 4. There is no where
in the US that a single person can live on $10k a year. ( Ok, some
people do it by living in a rural area, growing their own food and
cutting their own firewood, they're wierdos). Sociologists speak of
poverty in terms of percentages, e.g. So and so is 250% above
poverty level. When you hear this you probably think " oh, that
person is ok", I don't blame you. When an American says that they
really mean the person in question is still very poor. It's not
till you get above 400% of the poverty line that you are ok. The
semantics are completely different.
Here are the statistics for wealth distribution in the States.
http://sociology.ucsc.edu/whorulesamerica/power/wealth.html
As
you can see the top 20% own 85% of the country. That means the
bottom 80% have access to only 15% of the wealth!!!
Tuition at state schools is still quite reasonable if you go in
state. Tuition at an Ivy League is about $40k per year. AT my
teaching college it is $20k per year. Most students borrow to
finance their education and then start adult life already in debt,
even at state schools. Many American parents do not pay for their
children's higher education. Outside of elite schools, students
work at least part time to make ends meet.
9.
So being under-insured is worthless, then why bother with being
insured in the first place?
There are many reasons: It's hard to know how well you are insured.
The language is so obtuse in the plans that it's impossible to
understand without devoting weeks to reading all the fine print.
You will think something is covered, but there will be some
loophole you'll only find out about when you go to use the
insurance and by then it's too late. Few people have the time. Also
Americans are very badly educated to understand economics. It's not
required or offered at most high schools, so they have very
simplistic ideas about how their economy works, so they are easily
exploited.
Also, people hope that something is better than nothing, so they
accept whatever they can afford. Basically, if you are paying less
that $400 for an individual policy per month it's probably
worthless.
Read the NYT's resident economist's blog about the subject. He won
the Nobel prize this year so you can't say he doesn't know
anything.
http://krugman.blogs.nytimes.com/2008/06/10/underinsured/?scp=2&sq=underinsured%20&st=cse
10. Every single expatriate I know in the US from Canada, UK,
Spain, Italy, Scandinavia, France, Japan, Taiwan, Singapore etc
maintains insurance in their home country. Every single one without
exception. We joke about how when you go home, first you see your
Grandma, then your doctor, then your dentist. I pay into the
Singapore system because frankly, it's great value for money
compared to here. If I was living in the UK or Canada, I probably
wouldn't. Also, I may want to move back some day, for not just for
money, but also family, weather, there are many reasons.
If
I am a quitter or an underacheiver because I decided to become a
college professor ( a low paying job in the US) instead of a
corporate tool. Well then I'm proud to be one. I don't feel the
need to organize my entire being around money.
11. "The US Medicare and Medicaid is funded by the government and
not by individual citizens, it's more like a benefit provided by
the US government to her citizens."
Are you stupid? Medicare and Medicaid are paid with TAXES, they are
not FREE!! We have FICA taken directly out of paychecks every
month. You can't use Medicare till you are 65. Even then there are
complicated parts. Medicare part A is free, but you have to buy
Medicare part B, about $100 per month. Prescription drug coverage
is not necessarily covered and many seniors pay 100s each month out
of pocket. That said, most seniors use it and appreciate it,
because the alternative is so much worse.
Look I don't know why there are 600 000 S'poreans not covered by
Medishield. Obviously that should be fixed immediately. I am saying
don't look to the US as a model to fix whatever problems there are
in Singapore's health system, look to France, or Canada, look
anywhere but here. It's a disaster here for most people.
Most Americans would love to have a chance to go to a Singapore
polyclinic. What is that now? SIN$8? The average co-pay for a
simple doctor's visit here ( with insurance) is $30. Most cannot
afford any preventive care so serious diseases are not caught early
and chronic conditions become emergencies. Most Americans would
really appreciate Medishield because they have NOTHING
comparable in terms of cost vs benefits. Most insurance plans won't
pay anything till you have spent a certain amount out of pocket,
usually thousands.
"If the US government wanted to institute Medisave/Medishield, all
the US Senate has to do is come up with a bill, to make it
compulsory for citizens to set aside a certain percentage of their
income, for future medical expenses."
This is hilarious. The US is not a 1 party state like Singapore.
You can't just write legislation and pass it overnight. There are 3
competing branches of government: the Senate, Congress and White
House. Within that you have republicans and democrats. Whatever 1
group proposes the other group opposes. Nothing gets done easily.
It's a constant stalemate. Right now there are 60 Democrat
senators, that's barely enough to push through legislation without
a filibuster ( a time wasting review procedure). And that's only if
every single one tows the line, which they won't. Even if they get
something done, the President can veto it if there's something he
doesn't like and then it's back to square 1. Years go by. IT HAS
BEEN MORE THAN 40 YEARS SINCE THEY PASSED ANY PROGRESSIVE HEALTH
REFORM.
I
know it's hard for Singaporeans to imagine having a government that
is so useless. You can't think of the American government as a
single entity. You must think of it as figure with 3 heads, none of
whom can agree on anything, even the time of day. When I hear
non-Americans say about the American government I just roll my
eyes. There's nobody in charge here except Wall Street. But
Americans are also to blame, they are very much against anyone
forcing them to do anything, even if it's for their own good.
They'll never go for forced savings, most people have to spend
everthing they earn anyway. Currently the public mood is very much
in favor of substantial reform and the Senate and Congress are
debating several plans. We'll see in a few weeks if we get
something actually reformative or we get something so watered down
it preserves the status quo. In the 15 years I've been here I've
seen the country go from so-so to terrible. Honestly, the average
Singaporean enjoys a higher standard of living than the average
American when you factor in things such as crime, maintenance of
infrastructure, environment, consumer protection, employment
benefits...
I
hope you have a better picture now. You might want to consider
toning down your considerable anger and condescension. It makes it
sound like you have more attitude than substance.
