Selected letters to the editor (and responses).

Regarding your journalistic efforts on

"I've made an effort to encounter a range of perspectives on all the issues I've presented here."

I'm sorry, but you haven't. Your entire article argued for reform and government-run health care.

Have you ever lived in another country that has socialized medicine? I'm an expat living in Russia. Their medical system is a mess. Granted, the country is much poorer than America, but it is still an industrialized nation. Most Russians would rather immigrate to the US to get an operation than have to endure their own health care.

In addition you state, "Why the US health care system is among the worst in the developed world," then go on to say, "We're ranked 30th in the world for life expectancy, lower than Bosnia and Herzegovina." Don't you think that has more to do with our lifestyle choices (i.e. overeating and lack of exercise) than with our health care system?

I appreciate what you're trying to do, and that you've amassed the info you present on this site. But don't kid yourself that you've created a facts-only, unbiased site. It's your opinion - an editorial, plain and simple, with carefully-inserted facts that support your view only. And to call it anything else is not good journalism.

Matt: Thanks very much for your thoughtful letter. I've tried to craft a thoughtful response. ...

I had two goals with Primarily, I wanted to explain why the US health care system is being reformed - presenting its problems in as clear and stark a fashion as I could. Secondarily, I wanted to provide a clear, straightforward explanation of what the government's health care proposals are, and what they're trying to achieve.

I hope my site doesn't head off any healthy debate about how reform should progress. That's definitely not my intention. But in the US these past few weeks, that vital debate has been short-circuited by something far more corrosive -- a flurry of myths about what the government's trying to do and why. We can't have a healthy debate about health care policy that starts from the premise that reformers are trying to kill their grandfathers. If we can have an honest understanding about what reformers are trying to fix and how they're trying to go about it, then we can have an honest debate about what should be done.

As for the journalistic nature of the site, I agree with you completely. is certainly an editorial, not a just-the-facts recounting of events. But I also believe a good editorial is good journalism.

When I said, "I've made an effort to encounter a range of perspectives on all the issues I've presented here," note the word encounter. That means I've sought out the best libertarian and conservative visions for US health care, as well as the best progressive ones. Consequently, I think one can make a number of compelling cases for how the US health care system should be altered.

But that's beyond the scope of When I explain the current health care proposals, I've avoided trying to make a case for or against any of them; I've kept myself to explaining what they are. Believe me, I've got opinions on which measures I like and which I think are lame; I'd be curious if you can read through my presentation of the proposals and tell me which are which.

Regarding the strength of my argument against the US health care system, I chose life expectancy because it's a stark, universal, easily understood measure of what a health care system should provide. Every government that measures the effects of its health care system tracks life expectancy, because the system's capacity to sustain and improve human life might be our most basic expectation for it. The world's far-and-away leading spender on health care should at least have one of the best life expectancies for its efforts. But it doesn't, and I think that's a strong argument.

That said, you're completely right that there are a number of measures that capture many more nuances of health than life expectancy. One that I especially like is Umair Haque's "Potential Years of Life Lost" measure.

And you asked whether I have experience with socialized medicine. (I'll stress once again that socialized medicine isn't really under consideration in the US right now, some would say unfortunately.) And yes! I was born in a Canadian hospital* and became a naturalized citizen of the US in my early 20s. Partially in response to your email, I called my mom this morning and asked her how she liked having the most major medical care of her life in a single-payer health-care system. "It was fabulous!" she said. She gushed for several minutes about getting to choose any doctor she wanted, stay in the hospital as long as she needed to, and have an all-around stellar experience without having to worry about the bill.

My mom, incidentally, works in the US health care system.

* Note: I wasn't born in a government-run hospital, so many experts would dispute that this is an experience with socialized medicine. But Canada is a single-payer system, which is farther towards socialization than the measures under consideration in the US, so I think the point stands.

If I get enough thoughtful letters like this one, I'd love to start a Google Group or something to have a good reasoned debate on this stuff, so keep 'em coming!