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How do countries that have a single payer system handle people with preexisting conditions and special needs specifically?
I’m British.I live in the United Kingdom.I was born in the United Kingdom.We don’t have a single payer system. At least, we don’t call it that. We have the National Health Service.The NHS is funded from general taxation. It covers all residents* (note residents, not just citizens, and not just taxpayers), for all medical conditions, from cradle to grave. Actually, from before birth (e.g. antenatal care).Let that sink in for a while.There are no pre-existing conditions. There can be no preexisting conditions from before you were born. Unless you consider genetically transmitted or hereditary diseases.In my case, I was born in 1974. I was being taken care of for most of the nine months before then. Once I was born, I needed NICU care, and was in an incubator for a month. It, and all subsequent health issues, were completely covered. Completely. Not by a single payer, as in we were not given a bill by the hospital and then had to get it paid or reimbursed by this mythical single paying entity.The NHS has existed since 1948. My mum was born in 1947. So maybe you could consider any genetic diseases she had as being pre-existing, as could any inheritable disease she developed in the first year of her life. If you want to be an arse.My care was provided by Doctors and nurses who were paid salaries by the NHS, in an NHS-run hospital, using supplies paid for by the NHS, procured, stocked and managed, by salaried NHS workers**.Just like your local DMV or post office is run, split into regions for administrative purposes, but with each office having a budget for staff, supplies, and equipment, and operational procedures and guidelines for how to provide the service they set out to provide. Ok, so maybe these are bad examples of how the “gubmint” works. Think how they run embassies and consulates around the world, or military bases, or NASA.Special needs are covered in a variety of ways, not all neccesarily by the NHS.Medical needs are covered by your GP primarily (a “trust” or “practise” working for the NHS), and by a community support team of support workers and occupational health workers (another NHS “trust”). Equipment, such as wheelchairs, or at-home medical equipment is provided on loan for free, or to purchase at a discount, by a community equipment service (often a private contractor to the NHS).Other services, like meals on wheels, social activities etc., are provided by local councils, or private contractors contracted to the council. The council is a different “payer” from the NHS. Local councils are predominantly funded by business rates (local business tax) and council tax (an annual property tax based on the value of your property). They also receive government grants (for example the national government pays local councils in part to maintain police services to the national standards).Special education resources are also provided by the local council, either in the form of special schools, or specially trained staff and equipment in “normal” schools.* Anyone resident in the country, on a non-temporary visa, including students and short-term workers are covered.** As it was then. It’s a bit more complicated now, hospitals are run by healthcare “trusts”, not quite private enterprise but certainly not public departments, under the aegis of the NHS. Many staff, like cleaning or catering, are private contractors.
Is it compulsory to be an American citizen to work as a medical doctor for NASA?
To be a NASA employee, you have to be a U.S. citizen. No exceptions. However, employees of NASA contractors do not necessarily have to be U.S. citizens.The Chief Health and Medical Officer at Kennedy Space Center is a Medical Doctor, a NASA employee and a U.S. citizen.The physicians who work at the Occupational Health clinic at Kennedy Space Center are Medical Doctors, employees of a company that is contracted to provide that service to NASA, and may or may not be U.S. citizens.That’s the distinction.
Is Capitalism morally justifiable?
If any person had told the Parliament which met in perplexity and terror after the crash of 1720 that in 1830 the wealth of England would surpass all their wildest dreams,... that London would be twice as large... and that nevertheless the rate of mortality would have diminished to one-half,... that men would be in the habit of sailing without wind and would be beginning to ride without horses, our ancestors would have given as much credit... as they gave to Gulliver's Travels. Yet the prediction would have been true.--Thomas Babbington Macaulay, "Southey's Colloquies on Society,"Edinburgh Review, January 1830Capitalism is pretty much the only thing that is morally justifiable. In fact, anti-capitalism is contemptible.Look at the chart above. That's the modern history of world poverty in absolute terms defining poverty as earning less than $1.905 (with 2011 purchasing power) a day. That's quite some improvement in just ten generations, even as human population has grown.Every single bit of that improvement owes directly to free enterprise, also known as free trade in a more global sense and as capitalism in a more technical sense (a term that comes from Marx's Russian translators that turns out to be quite apt because, as economists of the mid-19th century well demonstrated, it is the intelligent application of capital to the process of production, and only that, that creates wealth and therefore can raise living standards). I'll get to how that works, but first, this staggering thought:99% of the wealth in the history of mankind has been produced during the time of this chart!Were you to extend the poverty line out to the left of the chart toward the dawn of neolithic man eight and nine millennia ago, it would simply keep moving closer to 100%. The natural state of mankind is poverty. Had you been a colonist at the founding of the United States, you would have had a 49 in 50 chance of having farming as your primary occupation.Poverty, the Natural State of MankindIs poverty bad? Not inherently; it is the natural state of mankind. I have had friends who were raised in early neolithic conditions: all food hunted, fished, foraged or grown via scratch-earth farming - no use of money - no electricity or running water - dirt-floor, self-made dwellings - tribal medicine - walking the only form of transport. Were they more compromised than us moderns? No, if anything, they were more resourceful and well-adjusted than us. In fact, when I met them, they were moderns too... many of them executives at Silicon Valley technology companies.My own mother was raised a sharecropper in rural Mississippi during the Great Depression. During her school years, she never had a store-bought dress or toy but did work very hard days in the cotton fields with her whole family. But she and her six siblings all turned out educated, professionally successful and simply warm and generous people, not at all scarred by poverty.Why worry about poverty then? Here's why. Just to the left of this chart a few decades there was a paradigm change. It had lots of roots but the main one was the repercussion from Columbus's voyage and Spain's and Portugal's exploitation of "the new world." In the 16th century, the Spanish treasure fleet purloined 36 tons of gold and more than that of silver--unimaginable wealth--and brought it to the royal treasury. For their troubles, they reaped a ruined economy. Inflation (calculated recently at a mere 1.5% a year) strained an "economy" in which the widely-held pre-modern expectation was that the present and future are necessarily supposed to resemble the past.The Seedbeds of a New, Protean EconomicsWho benefited? Primarily the Dutch and the English, who, in order to get Spanish gold had to start coming up with things the Spanish wanted to buy. A proto-form of free enterprise--mercantilism--was born. Still, the most expedient way to get Spanish gold was to lay on a treasure-bearing galleon with a privateer and simply take it.That's because the earlier paradigm, as with most species, was simply "territory and resources." In that paradigm, "take wealth" made a lot more sense than "make wealth" (which didn't yet make any sense). At the left side of the chart above, Honoré de Balzac claimed "Behind every great fortune lies a great crime," and he was absolutely correct.In that earlier paradigmA living person was 20 to 40 times more likely to be killed by another living person as conquest and plunder represented the surest route to individual and clan survivalSlavery was considered humane as the common alternative was simply wholesale slaughter of the conqueredCaesar's "saw"--"With money we will get men, and with men we will get money," represented advanced economic thinking. Most economies were founded on gatekeeping, toll-taking and other unproductive (what we now call corrupt) activities.And so it is that wide-spread poverty is not conducive to optimum society.What changed the paradigm was the addition of the idea of production, in particular, the idea of investing in production. This new way of looking at things owed primarily to two economists, Adam Smith and Jean-Baptiste Say. Economics itself had been born primarily as the effort to understand how Spain and Portugal, so obviously blessed, instead stood wracked.But in my opinion, the man who made it real was Richard Arkwright , an English tailor's son so poor that his only education was from a cousin who taught him to read. He died almost a billionaire in today's terms (leaving £500,000 at his death in 1792).That was unprecedented and shocking to the world. Arkwright devised a better dye for men's wigs and took the revenue from that to invent machines to increase textile production.Two things were shocking. First, Arkwright made wealth rather than take wealth. Even more, a poor man was allowed to become rich!That was the first requirement for free enterprise: You get to keep your wealth. It's okay for poor people to end up with more than dukes and earls or even kings.Second, your good ideas are a form of property, and the government will allow you a head start in profiting from them when protected by patent.Third, you can own the means of production, the tools of your trade, and direct their usage. You can also enter into contracts to buy, sell, hire, lease as you see fit. And all of this is subject only to reasonable equal taxation and being justiciable.And that is capitalism. It is obviously not an ism in the sense of ideology. It is an ism in the sense of mechanism, a way of achieving a result. The result is self-motivated mutually cooperative behavior, plus, an ever-increasing supply of good stuff to buy.IrrationalityCapitalism also resulted in a lot of irrational behavior:When Arkwright began to introduce his spinning, carding and framing machines in 1760, England was home to 5200 spinners using spinning wheels and 2700 weavers--7900 people employed in cotton-textile manufacture, and they were up in arms over the threat machinery represented to their jobs. Riots ensued that were forcibly put down.By 1787 the number of people employed in cotton-textile manufacture had jumped 44-fold to 320,000 and wages were well up. Yet, that experience was not reassuring. Further introduction of mechanization of textile manufacture, particularly in the making of stockings, resulted in the Luddite movement and more riots. By the end of the 19th century, there were 100 times as many stocking workers. (And this doesn't count the increasing employment in machinery manufacture.)There was further irrationality. English textile mills created enormous demand for long-staple cotton from the Caribbean and the US South. By 1850, some twenty planters in Natchez, Mississippi, were millionaires, half of all the millionaires in the US. Farmers millionaires! And, as more luxuries could be afforded, that was extending to sugarcane and tobacco farmers as well. The invention of the cotton gin was threatening to make the easier-to-grow but harder-to-process short-staple upland cotton a boom crop as well, a proximate cause of our Civil War as it would have increased demand for plantation slaves.The instrument of labour, when it takes the form of a machine, immediately becomes a competitor of the workman himself.--Karl Marx, Das Kapital, Volume I, 1867To the people of the early 19th century, capitalism was "lightning in a bottle." Average people were getting wealthy, often really wealthy, while many others languished. There was no rhyme or reason; well, in fact there was, but squirreled away in economics tomes that were not exactly smash bestsellers. Real knowledge spooled out ever so slowly as get-rich-quick schemes and hucksterism grew leaps and bounds. Many a grubstake was lost on hare-brained schemes.And there was pseudo-economics. Friedrich Engels of Barmen, (now Wuppertal, Germany) got prosperous in the English textile trade. He set about to collaborate with Karl Marx on a method for all the working class to capture this "lightning in a bottle" and all rise as one. Communism was the result, and it had a logical flaw: Marx claimed that in the transition from capitalism to communism, workers would continue to see their standard of living rise; however, he provided no variable to express that. That variable is now known to be capital intelligently applied to production, the very thing that made Arkwright wealthy and English textile workers much more prosperous (yet, which, as you can see from the quote above, was an idea that made Marx bilious). Fatally, Marx made no room in his new economics for capital or increasing worker productivity through the use of machinery, with the result that the various attempts to make socialism work have simply represented folly and setback.So, How Does Capitalism Work?How does capitalism uniquely allow all to prosper (to the extent they engage in it)?As each of us can only purchase the productions of others with his own productions – as the value we can buy is equal to the value we can produce, the more men can produce, the more they will purchase.--Jean-Baptiste Say, 1803That's a basic statement of Say's Law. Another is "supply constitutes demand" (in other words, "build it and they will come").Every new invention, every new product or service starts when an enterprising person looks to the future and sees an opportunity to make profit, money above and beyond the necessary costs to get underway. That vision is turned into a shopping list. Facilities are leased, workers hired, materials and supplies purchased, services contracted and so on. Appreciable money flows out into the economy before the first gadget ever rolls off the assembly line. That is precisely what Say meant by "supply constitutes demand"... the money to buy the eventual products was pre-added to the economy.Let me explain the implication of that. I saw a news broadcast back in the Carter administration of a Soviet emissary being shown a modern American supermarket. "Yes," he scoffed to the camera, "but who can afford to buy such quantity of such nice goods?" Say's Law says we all can; to create new supply is to create the demand (purchasing potential) to buy it! [Fun addition: What grocery shopping in the USSR was like [video]] * (more fun at footnote)At some point, after the product has been sold for a while, a point is reached at which the landlord has been cashing his checks and is not inclined to evict you, workers have been paid and are showing up to work, vendors are still happily doing business with you and so on, and there's extra money in the account: profit! The only source of wealth, which is anything that can be used discretionarily. Typically, particularly in the early stages, discretion demands that wealth is routed straight back into the business... new workers, new machinery, more marketing. Then comes a stage in which your workers have become particularly adept at what they do and you pay them better to keep them from answering some other entrepreneur's siren song. Finally, comes the phase the entrepreneur and his or her investors has awaited, the "milk cow" stage when some of the profits can go to increasing their standard of living.Increased Standard of LivingAnd so standards of living are created all around. We are, most of us, at one and the same time consumers and producers. Our purchasing power, or standard of living, can come from either increased range of goods at reduced cost or higher productivity leading to higher wages; usually a combination of both. Forget money. As Say himself said, we get to buy exactly as much as we can make.Right there is the compulsion of capitalism. You want more? Then do more. Make more. Be fruitful. Be productive. Pay attention to the needs of others and cleverly and efficiently serve those needs. Serve the needs of your employer and his vision, or have your own vision and serve the needs of your market.In this way, every successful new business also increases demand for other new businesses. A new brick works makes it easier for someone else to start a window company. A new insurance agency helps create demand for an ice cream parlor. A whole new industry, say automobiles, makes it easier to start another new industry, say computers. The more wealthy people there are, the easier, not harder, it becomes for other people to become wealthy.The productivity cycle is the key. As long as new supplies of goods and services are being created, wealth is being created and distributed widely. The only necessity for getting in on that distribution is to participate in the economy, inevitably as consumer but, if as worker, with less risk and less, but more predictable, reward. If as a principal, then with appreciably more risk but also a chance of greater reward. The choice is yours. There is nothing but lack of know-how or moxie to prevent anyone from becoming a capitalist, and I've just covered the know-how.The New Paradigm and Its Moral JustificationAnd so we have arrived at a world in which 99% of the wealth ever created by man exists now with all of us as the beneficiaries.Make wealth has supplanted take wealth as a preferred tactic in the world, making plunder and conquest much rarer.Only in the least advanced economies of the world does slavery make enough economic sense to survive.We all enjoy greater health and longevity and many times the number of options for the life we want to lead with each new generation.You can start your worker-owned cooperative, your commune, your collaborative venture, your charitable enterprise, your philanthropic foundation, with all the socialist overtones you want. Free enterprise is perfectly compatible with socialism, at least to the extent you don't make it a futile effort by forgetting to invest in worker productivity.It forces attention on the needs of others and preferable ways to satisfy them, so much so that free enterprise can address needs not even yet articulated! It is precisely where innovation enters our lives.That is one helluva lot of moral justification. So why all the agitation over capitalism? There are still plenty of Luddite thinkers among us.* * * * * * ** It was September 16, 1989 and Yeltsin, then newly elected to the new Soviet parliament and the Supreme Soviet, had just visited Johnson Space Center.At JSC, Yeltsin visited mission control and a mock-up of a space station. According to Houston Chronicle reporter Stefanie Asin, it wasn’t all the screens, dials, and wonder at NASA that blew up his skirt, it was the unscheduled trip inside a nearby Randall’s location.Yeltsin, then 58, “roamed the aisles of Randall’s nodding his head in amazement,” wrote Asin. He told his fellow Russians in his entourage that if their people, who often must wait in line for most goods, saw the conditions of U.S. supermarkets, “there would be a revolution.”“When I saw those shelves crammed with hundreds, thousands of cans, cartons and goods of every possible sort, for the first time I felt quite frankly sick with despair for the Soviet people,” Yeltsin wrote. “That such a potentially super-rich country as ours has been brought to a state of such poverty! It is terrible to think of it.”CT: All that misery for lack of understanding the productivity cycle.