Nice try, Dr J. I don't eye Cuba warily. I eye YOU warily. And clearly with good reason.

I suspect the extra money we spend on health care buys us benefits that don't show up in simple life expectancy stats–such as freedom to sue, for example. And I suspect that solutions that work well in small, homogeneous European countries wouldn't scale up well to ours. Is that sounding more rational?

No. It sounds more honest — a straightforward statement of your beliefs as opposed to trying to trap me into giving an answer when I don't know the question — but it does not sound more rational.

You are right, of course, but my rhetorical hope is to establish some common ground between us.

It's perfectly reasonable for you to eye Cuba warily–it's a third-world country with 1/300th of our GDP, a completely different culture, and a totalitarian government that engineers its own weird reality. Though it musters some surprisingly good health outcomes, you're right that importing their system is a crackpot idea. Behind each of those nice-sounding stats probably lurks 10 drawbacks we don't know about. And we are so different from Cuba in so many ways that it's virtually guaranteed that programs that work in Cuba wouldn't scale up to our giant, multicultural, non-totalitarian country.

What I've been hoping you'll say is “maybe there's more to it than just these outcome and cost stats” because that would establish our common ground. I balk at importing Europe's health care system on the basis of those stats, for similar reasons. Quick summaries of outcome statistics don't do justice to what I'm sure is a complex reality, and to be frank I haven't seen any single-payer champions go much deeper than “Europe is better! At half the cost!” European countries are much smaller than ours–more comparable to one of our states. They're poorer, and they're more culturally homogeneous. Though governments don't tend to be totalitarian, citizens have a different history and different relationship with the government than we do.

I suspect the extra money we spend on health care buys us benefits that don't show up in simple life expectancy stats–such as freedom to sue, for example. And I suspect that solutions that work well in small, homogeneous European countries wouldn't scale up well to ours. Is that sounding more rational?

I have no inclination or disinclination for the Cuban system. I have not studied the Cuban system, know nothing about the Cuban system, and never thought about the Cuban system. I'm not balking at it, I'm not jumping at it. What I know is that you are trying to play some kind of game with me here about Cuba's health care system or political system or social system or economic system or SOMETHING. And I still don't know exactly what it is, but I'm getting tired of it. Stop trying to maneuver me and manipulate me into giving you some answer that you have in mind which you can then use to prove whatever point it is that you have in mind, if indeed you do have one.

I don't have the patience of a saint, Dr J, and you are starting to SERIOUSLY annoy me. As my father used to say, piss.or.get.off.the.pot.If you have something to say, SAY.IT.

And in terms of health care systems, Cuba's has much to recommend it. Government pays 90.7% of all health care costs, more than any country in Europe (though Luxembourg at 90.6% is a close second). The mortality rate due to cancer is 129 per 100,000 people, compared to 134 in the US, 141 in Germany, 143 in Spain. Life expectancy at birth is 68, only 7% behind Sweden. Their infant mortality rate is the same as the UK's. They have 59 doctors per 10,000 people, more than twice the US's 26. Yet they spend only 7.1% of GDP on health care, less than any western European country and only half as much as the US.

Cuba's system isn't perfect, but the outcome numbers look pretty good, and the cost numbers look phenomenal. These numbers say it's a great position for us to build from–especially since we have so many more resources to apply to the job.

Yet whereas you regard importing a European system based on cost and outcome numbers to be the only rational choice, importing the Cuban one based on the same analysis is silly and crackpot? There's a stark contradiction here. What's making you balk at the Cuban option?

As for doggie, I don't have one yet, but here is a leading candidate:

http://www.petfinder.com/petnote/displaypet.cgi…

Read the update, I definitely had not seen that before. And it's such great news. If I'm remembering correctly, this is much more and faster progress than you had dared to hope for initially. I'm very happy for all of you.

As for doggie, it'll be a while, still. I'm being extremely careful about my choice this time, because I made some hasty, heart-overrules-head decisions in the past. Of course, I was on the rebound then, but still, I want to be cautious and realistic about what dog qualities and characteristics will fit my lifestyle and physical limitations.

I talked to Maggie (my daughter) about it, she is still leery, but here is one funny comment she made: “Mommy, what are you going to do when it's icy outside? You know how much trouble you have keeping your balance on the ice even w/o a dog!”

The sad part is, she's right.

I just have to find a small dog, gentle, walks well on leash, and gets along with cats. It is surprisingly hard to find all of those in one dog. But here is a leading candidate:

http://www.petfinder.com/petnote/displaypet.cgi…

Yes, she is coming home Thursday!!

YEAH!!

And If you didn't catch the initial update from a few days ago (the one I referenced to Dorian) here it is – Victoria update.

BTW – when does your new doggie come home?

Their health care system looks better, not their political system. I really and truly am not understanding your logic here, Dr J, and even though I could not disagree more with your worldview, I have never understood you to be silly, or a crackpot.

I'm merely reapplying the same reasoning I keep hearing from you and others: Health care in Europe costs less than America for outcomes that are at least as good, therefore there's no rational argument for not adopting their system. By those standards, Cuba looks not only a little better than Europe but a lot better. So why shouldn't we adopt their system wholesale, whatever it is?

I'm still not sure if this answers your question, but I'm trying.

Does it have something to do with your daughter? Is she coming home?

Yes, I went back and realized you did. I wasn't sure at the moment as I received a lot of very nice comments, yours included, and a simple check on my part would have found yours.

Thanks again, and this Thursday is going to be a wonderful day at the Roth household.

btw – on an interesting side note, Vicki found out that while they are flying her back to Texas, they will not provide her transport to the airport! She is on her own for that.