Savannah Lee

Hi - well, you can't catch tuberculosis like that, no way. You have to be pretty close to someone for a long time for that to happen. In school, my daughter sat next to another girl who coughed and coughed and... you get the picture, heads bent over shared assignments etc. She had apparently come back from Thailand, where one of her grandparents had infected her, so we had to read up on it. Transmission is really hard, and not one kid in class was infected.
But apart from that, you are wrong anyway. Health problems do not spread across social boundaries like that. In Denmark, where we have socialized health care, it's still the poor and the uneducated who carry the burden of diseases, but socialized medicine means that the treatment available to rich and poor alike is mediocre. Compared to the US, the well-to-do die sooner. So your asshole is absolutely right. Socialized healthcare is not in his best interest.
That doesn't mean I agree with his stanze, but you have to make the case altruistically.

He might be an asshole, but to be fair, Canada, the nearest country that has socialized healthcare, doesn't actually have better healthcare according to the WHO; in terms of access, time, cost for expensive diseases (as opposed to generic "I have a cold"), Canada ranks #37, and we rank #38. So he may not have a very good measure for comparison.

I mean, I'd argue that if you're going to look at socialized healthcare, we should look at the *best* healthcare systems -- like in France, or Japan -- but in both of those countries, they're not dealing with the diversity of population we are, and the culture is a little bit more conformist. In Japan, being overweight is socially unacceptable, for example -- they make you weigh in and companies get docked if more than a very tiny percentage of their employees are overweight. And I'm sure we both agree that that's pretty eeeek.

So while I agree that socialized medicine is probably the better thing to do to support the middle and lower class (because, if nothing else, it costs the government less, even if Canadian citizens aren't treated any better for any significant diseases), socialized medicine is not an overall cure for the ailments of this particular society, nor would it *necessarily* work *much* better than what we currently have.

I'm so glad your daughter is okay--how about the other girl? I hope the strain she caught wasn't one of the new drug-resistant ones.

Thanks for enlightening me. I'll have to do some more reading...a few years ago, I know I read *something* where they were talking about a highly-infectious respiratory disease, the rates of which were increasing alarmingly in the Third World, and warning people they could catch it just from riding a city bus with an infected person. I thought they were talking about tuberculosis but apparently I misremembered.

As for the cafe man, I don't think altruism had much of a chance to fly with him, unfortunately. His whole point was that he *wanted* the "bums" to suffer. So, I had to figure out another approach. Since a lot of the rhetoric of American conservatism is based on fear, I decided to give that a try.

But I'm not totally ready to give up on the idea that all our fates are interlinked, maybe in ways we don't even perceive. We *are* all in this together, and even if not by literal infection, I know that the illness and suffering of my neighbors does affect me too.

Kim, your comment arrived while I was replying to Ulla...yes, he did start going on about Canada :)

I agree with you about France and Japan--we should be studying the systems that work really well and figuring out how to adapt their successes.

I think that the important thing for our country to do is just *start somewhere*. Our most pressing need is to get more people covered. Let's do that, and as we go forward, we can figure out how to make it work better given our circumstances.

Hi Savannah,
Yes, the other girl is fine, too. She was hospitalized for a while, though.
In Denmark, the hospitals are overburdened, and we increasingly turn to private insurance and private hospitals.
Once, I had a really scary experience - something that could be cancer. The public system told me I could be examined in 2 months... I couldn't and wouldn't wait that long, so we paid for an exam out of our own pockets.
The private hospitals are efficient and there is no wait. Capitalism really works, you know.
And that should be your line of attack with that café aquaintance: If he won't pay for basic health care, the workforce will be reduced. Supply and demand - great supply of ablebodied workers means low prices, more work done and more money earned.

Hi again, Ulla!

I'm very glad to hear that, and glad that your own scare turned out okay. Meanwhile, I'm sorry that Denmark's public health system is under strain.

Most progressive Americans tend to de-emphasize capitalism. Yes, it does work, but that's taken for granted in the United States. The problem here is that a lot of people think that capitalism, narrowly defined as just "generating profit anywhere you can," will fix *everything*. And it won't.

Ideally, there's a balance between the dynamism of free enterprise and the security and fairness of the state. We all just have to keep working towards it.

Hey Savannah -- on TB, take a look: http://www.nytimes.com/2008/12/07/opinion/07kristof.html?_r=1&ref=opinion

Thanks, Kim. The link goes to a column by Nicholas Kristof appearing in today's (December 7) print New York Times which sounds the alarm about XDR-TB, or "extremely drug-resistant tuberculosis."

It is currently incurable and highly contagious (paragraph 8). And more and more cases are being reported worldwide.

It's a product of "ineffective treatment," which, in my opinion, is code for "neoliberal economic policies forced on Second and Third World nations which led them to cut their public health budgets."

But however you think the "ineffective treatment" came about, it's glaringly obvious that establishing (or returning to) effective treatment for regular TB (and developing and implementing effective treatment for XDR-TB) is going to cost truckloads of public money.

It's not a big problem yet in the US (Kristof doesn't mention western Europe), but rates are climbing in the developing world, so that could easily change. Writes Kristof, "Anyone who thinks drug-resistant TB will stay in places like Armenia is in denial."

There's no excuse for this. As Kristof writes, "With public health threats, we all drop the ball."

Your average liberal would be tempted to ask, "Who's this 'we,' mister?" Part of the reason everyone hates liberals is because liberals go on about outrageously unsexy stuff like sewage treatment, hurricane levees, public health and making sure ALL the sick are properly treated no matter how isolated from 'the rest of us' they may seem. Everyone then (A) ignores the grating liberals, (B) ends up possibly staring an XDR-TB problem in the face, and (C) hates the liberals even more because the liberals told them so.

In any event, if XDR-TB does bust loose in the US, our vast pool of un- and under-insured citizens will be in immediate danger and our comparatively slender public health apparatus could have a bit of a challenge stepping in to avert disaster.