Those who say we can't afford national health care need to be pressed to spell out what they mean: Do they want to save money by forcing some people to go without medical care? Who?

If they don't mean that people should go without care, then I don't see what "affordability" has to do with anything. Somebody is going to pay for that care, whether it's the government or not. Why can our society afford a private-sector solution if it can't afford a public-sector one?

Undoubtedly someone will try to make the private-sector-efficiency argument. But when it comes to health care the evidence points the other way. The American healthcare system has more private-sector involvement than any other first-world country, and it's the most expensive. 

Yeah, here's my thinking: Through some horrible accident, or maybe some Manchurian global conspiracy, Bob Samuelson's brain was downloaded into Tom Friedman's Iraq-war-damaged shell of a psyche. Tom--come back. It's not too late to repudiate the dark side! Besides, we're not done with the old Tom!

Why would anyone take anything Friedman says seriously? Surely by now we know the man doesn't know much about much of anything.

And, who is the brilliant brain behind the canard that taxes cannot be raised? Of course they can be raised.

The Greatest Threat to America's Role in the World  is....     that Friedman is back from vacation. Can't we just exile him to India so he can interview cabdrivers and high tech tycoons all day while writing "The World is Triangular" and "Attitudes and Platitudes"?

On TPMcafe we learn today that Iraq will cost 1 to 2 trillion bucks, ie, roughly the entire US budget.  Given the disaster we've created, it's hard to think of any time in our history when the commander-in-chief  has screwed up so badly at such high cost! 

The solution: why, obviously cut down Medicare and Social Security!

Please, New York Times, increase the TimesSelect fee to 1 million dollars, so no one is even tempted to read the Friedman brain soup that passes as "analysis."

Most of Tom Friedman's viewpoints are rather too simplistic. I heard him at a national meeting in November 2005, his 30 minute verbalization of the contents of his World is Flat book. Unfortunately, there are many people who swallow his stuff like gospel. (I know two - a colleague's mother, and a close personal friend of mine who is trying to get him to keynote an event at UC Irvine). He connects the dots, so to speak. Being a columnist at NY Times opens many doors for him, so he is able to travel around and get firsthand information, and then connect the dots. So it is important to debunk some of the simplistic notions he peddles.

First off, I don't buy his notion completely that the world is happy that America is a benign protector and glad that it spends money on armaments, letting them spend on non-defense arenas. Japan is beginning to consider a more aggresive defense force for its own national security, and rapid deployment of US troops from South Korea, in the face of its pacifism towards its northern brother, as well as strength reduction in Europe (Germany primarily) is on the cards for 2006. Any of the fancy weapon system and Future Combat Services (FCS) that is Congresionally mandated by 2015 will NOT help US defense partnerships. Even a real threat from China towards Taiwan will NOT bring US troops to a face to face confrontation. Then who in the world is happy about USA's benign role as the globo-cop? No one. Yes, there will be countries who will co-operate with US on military matters (India, my country of origin is one such - probably will grant US FOLS rights, against considerable internal sentiment). But no one will base their national defense strategy on US cooperation alone. Each country has much stronger local and regional imperatives that will guide its security related spending.

 But he does highlight what is an increasing budgetary problem for healthcare in US. As Paul Krugman has argued, we spend more per capita in healthcare than most, and get little value (except in specific cases). There are several inefficiencies, but two that can be addressed more readily are: lack of universal health coverage, which is driving up the actuarial costs of those who do have coverage (whether company sponsored or self covered), and rapidly increasing cost of delivery mechanisms. This second one can be addressed by telemedicine and other technological innovations. But when it comes to the first, Friedman's simplistic answer about Medicare only muddles the issue.

I have a sneaky feeling that the drug prescription program with its 47 different choices, incorrectly printed reading material, and May 15 2006 looming deadline, will drive many unfortunate seniors out of much needed medical care! 

So glad I didn't take that discount intro offer on TImes Select. The writers on this blog are far better than that guy from the frozen lands of Minnesota where the water is just so slightly tainted with... ???...

The USA already spends twice as much ($5,000 per person-based on total population and dollars spent) on healthcare (not including $$ spent on pet health care). That is over twice what the rest of the western world spends. Lots of the US healthcare money goes, of course, to overpaid CEO"s. advertising and insurance overhead and paerwork. The rest of the western world uses their piddling $2500 per person to cover everyone in the country. Maybe we should look at how Castro does it-or at least Australia. 

One reason there is not more outrage is that what Jacob said Friedman said is not quite accurate.  He was not arguing that healthcare was not important.  He was saying that with Baby Boomers starting to retire the pressure, caused by the problems in healtcare, on Medicare is going to start sucking up more and more resources from other American needs.  He ended his column with the presumption, seems a politically correct observation, that raising taxes to deal with the shortfall is not viable.

The question that should have been asked if taxes can't be raised and Medicare is going to put enormous strain on our resources then how to convince Americans to pay more in taxes.

Taxes can be raised? Clinton did it without a single Republican votes.  Democrats will barely mention the word taxes.  When the Republican governor of Alabama tried to raise taxes Republicans campaigned against him.  

The Democratic campaign will be weaken the military and raise taxes?  I would not believe a Republican will be able to succeed Bush.  I fear that will be wrong.

Friedman should stop driving around in a Mercedes, like many of our wealthy, while using the elderly's  retirement to pay the country's expenses.  

I had no idea how much welfare the wealthy received from the working people until the Bushites took office.  It is time they pulled themselves up by their bootstraps and paid their share of the taxes.

Here is one theory about the rich, business and taxes.  The rich threaten to leave the country and take the jobs overseas.  That doesn't scare me.  We can start new businesses and boycott those who leave.  A lot of people would love to pay taxes on money they would make off of a business.   They would love to make money period.

We  can speed up patent times, if they take them with them. We have the biggest military, unless Bush has drained it totally, so what could they do about it?

Thinking about it makes me realize we have been held hostage to the oil and health businesses, to name a few, for too long.  We need to move on.

My dad told me the depression was caused by too much money in too few hands.  The rich wouldn't spend it to create jobs. Roosevelt took care of them.

The powers that be may have worked on the demise of Social Security and Medicare for a long time.

The push to get rid of Medicare and Social Security is some want us to be dependent on the stock market for retirement and they want 30% profit off our medical needs.  There is no way the stock market can be depended on to support the elderly and it is a ridiculous idea.  Even with going international, it may work for some, for awhile, but it would be a tragedy at the end.

Many retirees say that it is costing them $8000 a year, since they retired, for medical.  People are making some money off the stock market, but the average Joe will never make enough from investing off the medical funds to pay that $8.000 a year, let alone the total of $200,000 they are predicting it will cost the elderly after they retire.  

There is some funny business going on with Medicare.  We have paid into Medicare 1.45% from every paycheck and the employer has matched it.  It is put into FICA just like Social Security is.  The total 2.90% is charged on every cent of the pay check from highly paid CEOs and famous sports players to the least of us.  There is no cap on Medicare like there is with Social Security.  

There was a large surplus in part a or b of Medicare, when Bush "fixed it" now it is almost bankrupt.  

I read there is talk of them putting the elderly veterans into Medicare, but I don't know if they did it or not.  

The thing is, the tax haters know they owe Social Security a lot of money, and they know they will have to start paying us back when we start cashing in our surplus bonds in 2018.  They would rather dismiss it as greed of the elderly than work out the problem.  

I don't know the exact figures, but if they would stop borrowing it now, then it wouldn't be nearly as hard to pay it back.  Maybe we could buy foreign bonds with the remainder of the surplus or put it in the stock market until it is needed, in ultra safe funds.  When they talk about how much Social Security will cost, they are projecting into infinity and aren't allowing for "how great the market is going to do."

Those who have paid SS in shouldn't have to pay themselves back.  Since $90,000 is the SS cap, maybe we could put a small surcharge on federal income taxes on over $90,000 incomes plus dedicate the estate tax to paying back the SS bonds.  The repayment tax could be spread over different areas and it wouldn't hurt any person or group too much.  One big problem is they hate to give up their gravy train of Social Security.  They know they will have to increase taxes to replace what they are using of Social Security, then later pay more taxes to pay back what has already been borrowed.

They are saying we will live to be 120 years old, but statistics show we live 2 to 3 years longer now than the average person did in the year Social Security was set up.  More are living to age 62, but that means more are paying into the system.

American health care costs more and delivers less than that of countried that provide nationalized health care. How could it do otherwise, the way it's set up?

As a nation, we have hundreds of insurers each with its own processes, standards of care, and preferred providers. Employees move in and out of this patchwork of systems as they change jobs with increasing frequency. Providers must know how to bill each or they go unpaid. When they go unpaid, either through bureaucratic snafu or from treating patients who can't pay, they raise prices overall. Patients can't make wise decisions as consumers because the process is unintelligible. Workarounds, such as poor patients using the ER to get free care for sniffly kids, abound. The waste in this process is an untapped fortune.

Make one national health care plan, with one set of rules and one standard of care. Make every American a member and every licensed provider a part. Don't tie anything to employment, so nothing changes when a patient is hired or laid off, and foreign employers don't face the health care roadblock to bringing their jobs here.  Just cut the waste and inefficiency in US health care and the whole affordability picture changes.

For any financial shortfall that remains, I'm with John Kerry: roll back the tax cut for the top fraction-of-one-percent. And use all that's left over to start paying down the national debt.

We have this all wrong and Friedman isn't helping.  The problem is that America is facing real competition for the first time and it doesn't like the threat.  His argument, which he doesn't make clearly, is that we will be have to make choices in the future because the competition will force us to.  We have a set of budget priorities that are untenable in a globalized economy so we will have to choose between keeping taxes low or raising them, and between entitlement programs and other stuff like defense.  The problem is that we thought we could have it all and that the gravy train would never end.  Whoops!
Right now we are trying to have it both ways: we want to keep our programs and we want to be the world's enforcer.  In the face of competition we will have to recognize for the first time that we can't do both.  So which is it: cut back our world role and let the Chinese take over as the super power?  Or slash back our social programs?  My money is that America will do a Europe and go for the former.  Maybe we'll be suffering from French disease in another 50 years or so.
It didn't have to be that way of course: we could have kept a tight budget and financed our social programs properly.  We could have protected the Social Security trust fund.  We could have opted to keep defense spending focused on defense and not offense.  We could have developed a more efficient health care program [aka a social program].  
That would have meant higher taxes all along, and a recognition that American power was limited.  It would have meant cooperating with partners rather than bossing the world around.  It would have meant admitting that free wheeling all American capitalism doesn't always produce the best social results.  It would all have sounded so "Old European".  The real American hubris is that the electorate really thought it could have it both ways and it hates to learn that it can't.  So we get angry and lash out at people like Friedman who annoy us because when they try to tell us that.
BTW the aspect of his column that no one seems to have commented on, but really must annoy our foreign friends is the astonishing assumption that he makes regarding world governance.  He seems to think the world likes having America act as enforcer [he says 'governor' because it sounds more pleasant].  I doubt that they do.  It must get a little tiring having all the world's big decisions being made in Washington where no one outside of America has a vote.  That looks and quacks a lot like an empire to me!

And all this time I thought the greatest threats were a Lexus and an olive tree!  What a maroon!

 I see the linking of Social Security and Medicare again.  That is a GOP talking point. Let's stop that and call attention to it when we see hacks like Friedman doing it too, OK?

Of course, I meant "hardly MORE likely than tax increase."

Let’s raise taxes.  That way the people who have worked their entire lives and paid their taxes can support all the people who are economically challenged.  We can also extend the 41,000 hotel rooms we taxpayers are paying for through the next hurricane season so that those economically challenged individuals will have a place to live.  Let’s pay for universal health/life/disability insurance for all people.  Heck in Florida I wish someone would pay the car insurance of the last two people who hit me.  Lets all make a pledge to work as hard as we can and pledge to live in squalor so that everyone who is poor in our country can have more stuff.
Hmmm “The Greatest Threat to America's Role in the World”  is the gimmeee generation.

I agree that Friedman was less than clear and anyone who discusses Baby Boomers should separate Social Security and Medicare.  However, I find that Friedman bashing is often a both a substitute for thinking, I am not suggesting this about you, and it is also an attack on what seems to me the necessary centrist solutions to many of our problems in a world that is going to get more global, older, more technological and still needs the United States in a leadership role.

It seems to me it's the centrists who want it all ways and who won't make the hard choices.  I'd gladly give up the global leadership role, which means buying half the global weapons arsenal, and spend it on universal health care.  I just don't have that choice on my ballot.