Wednesday, June 15, 2011
Systems Ahoy!
To those who cite the statistic which shows that more Americans leave the country for health-care than foreigners come to America for it, I respond here with the following. One, I never said that the U.S. health-care system was perfect. In fact (and, please, forgive me for repeating myself), I've said on many occasions that I'm for junking it entirely and replacing it with Dr. Emanuel's Healthcare Guaranteed model of insurance vouchers and health boards...........................................................................................................Secondly, statistics, in and of themselves, are meaningless. Yes, more Americans leave the country (for health-care) than foreigners enter it, but why? One possible reason is that Americans are far more mobile (more discretionary income) than foreigners. Another is that a lot of these people are getting these procedures while they're on vacation. You go to India for vacation (to see the Taj Mahal, etc.) and, yes, while you're at it, you get a hair transplant, angioplasty, whatever. And, finally, a lot of these procedures simply aren't available in the U.S. - not because we don't have the technology for them, but because the F.D.A. hasn't approved them yet (they're considered experimental, in other words)....You have to look at all of these mitigating factors, I guess is what I'm saying....................................................................................................P.S. The only reason that I entered this debate in the first place was for perspective. You've got people on both sides saying that the other fellow's policies are going to kill people, THOUSANDS OF PEOPLE! And, yes, me-buckos, nothing ever gets done here because of it. Look, if my progressive friends want to say that Republicans are worse when it comes to this idiocy, fine. They're worse! But, please, the rhetoric on your side hasn't exactly productive, either.....Oh, and did you know that those 96 million deaths due the banning of DDT is more than the deaths caused by Hitler, Stalin, Mao, Pol Pot, the Hamids, and Saddam Hussein COMBINED!! Just for some additional perspective, I'm saying.
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You go to India for vacation (to see the Taj Mahal, etc.) and, yes, while you're at it, you get a hair transplant, angioplasty, whatever.
Sorry Will, a BBC report I saw reported most of these medical vacations Americans are going on are for procedures they can easily get here in the States but are just too damn expensive.
A portion of these people have pre-existing conditions that at the time of the report prevented them from getting health insurance here in good old USA. They at least had the money to seek medical care elsewhere.
The other portion just wanted it done cheaply. In both cases the vacation aspect was secondary but I sure as Hell would not complain about a Mexican beach vacation while I recover from dental work, like the American dude they focused on.
One of the other things that I noticed, double b; not a lot of these Americans are going to Canada and England. They're going to Thailand and India (and, yes, it would be interesting to see just how many Canadians and Brits go there as well).......I agree, the system stinks. But I also believe that there's a way in which we can BOTH make it illegal to discriminate against people with preexisting conditions AND not have that particular requirement bankrupt companies. And all that it takes is for both parties to start thinking outside the box (which is usually typified as a debate between single payer and complete and total free market).
I'd like to see statistics (yes, those meaningless things) to support your reasons for:
1. vacation operations
2. not available in US
While that may be true in some cases, I doubt it is the majority, or even a significant minority, of the reasons.
Will: ...there's a way in which we can BOTH make it illegal to discriminate against people with preexisting conditions AND not have that particular requirement bankrupt companies.
There is a way. Single payer.
Also, people with preexisting conditions must be covered under ObamaCare. Are you saying that when this goes into effect (in 2014, I believe) health insurance companies will start declaring bankruptcy? I have not heard this claim before... and I do not think it is true.
Jerry, are you doubting the fact that Americans have more means to go overseas than the British?
What?!? Where did that come from?
There's a fundamental problem with Obamacare, wd. Yes, you have to buy insurance (the mandate) but the penalty is significantly less than the insurance premium. This is an incentive for people to forgo buying insurance and only purchasing it when they truly get sick (to which a company has to sell it due to the preexisting condition requirement). You think that Romneycare went over budget. You ain't seen remotely anything yet.
Jerry, the Brits and Canadian don't have the discretionary income to go globetrotting (for health-care) to the degree that Americans do. That President of Nova Scotia - he HAD the means and he exercised them.
Single payer is a terrible system, wd. I mean, just look at Medicare and Medicaid. 50% of doctors don't even accept Medicaid and Medicare low-balls providers to the tune that the rest of us on private insurance have to pick up the difference. Let me ask you something, if there isn't private insurance, who picks up the difference then?......Oh, yeah, I forgot, the wealthy.
Maybe they don't need to go globetrotting because they can get better care at a certainly a lower price at home.
Maybe the president of Nova Scotia came here because his money would not bump him to the top of the list at home.
I think your 50% figure is why high. Where do you get these numbers? I have yet to find a doctor that does not that Medicare for either my wife or me; same with my mother, and sister and her husband. In fact, now that I think about it, I don't know anyone who has been refused care because of Medicare.
However, I did have a hospital refuse to cover me because of the private insurance I had before I was illegible for Medicare. The same hospital takes Medicare. My wife recently had an operation there.
I say, open Medicare to everyone and let private insurance compete. People under 65 should pay premiums that cover the cost of their care, same as with private insurance. If private insurance is so much better, they should have no problem competing.
That's called capitalism! If they can't compete, they deserve to get out of the business. Why should we supplement an inefficient system when there is a better one already in place?
The 50% is for Medicaid. Half of doctors don't accept it. Yes, most doctors currently accept Medicare but, like I said, the reimbursement rates are low and the rest of us end up fitting the bill.
How can anybody compete with an entity that can lose money and not have it effect them (Amtrak anybody?)? I say the get the government out of it completely and just have private enterprises compete (replete, of course, with health boards for regulation and to ensure minimum standards).
Will, I am totally baffled as to why you'd say that private insurers can provide coverage at a lower cost than Medicare and Medicaid. The facts simply don't back up this claim.
Physicans for a National Health Program (PNHP) says, "Currently, the US health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($8,160 per capita), the US performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the US leaves 51 million completely uninsured and millions more inadequately covered".
I am a single-payer supporter all the way. How could providing insurance for everyone at a lower cost possibly be "terrible"? Your argument makes no sense.
Did you miss the part where I said, "People under 65 should pay premiums that cover the cost of their care"?
Republicans (and Will, apparently) believe that somehow (through the magic of competition I guess) for-profit is cheaper than not-for-profit? Either that, or they think profit is SO IMPORTANT that people dying is worth the cost... CEOs MUST receive their outrageous salaries.
It is my belief that providing the means to obtain health care and the profit motive are incompatible. Health care insurance should be strictly not-for-profit.
It sounds like Will wants to do away with Medicare and Medicaid. Maybe even the VA... he did say he wanted to get the government out completely. I thought you were concerned about costs, yet you think it would be a good idea to give our soldiers vouchers for their health care (which would be the infinitely more expensive way to go)?
FYI Will, DDT was banned in 1972, but efforts to eradicate malaria through the use of DDT were, according to the National Resource Defense council, "abandoned in 1969, its collapse traceable to three main causes: the onset of mosquito resistance to DDT, the insuperable logistics of indoor spraying in endemic areas, and a dawning awareness that DDT was toxic to more than just mosquitoes and other pesky arthropods".
Regarding the DDT ban -- the NRDC says, "DDT appears on the Stockholm Convention's original register of 12 banned toxins, but it is the only such item listed with an asterisk: nations meeting strict criteria of demonstrable need for fighting malaria are exempt from the DDT ban".
BTW, DDT was banned for good reason... it's pretty toxic stuff. I think the bottom line is that DDT is not the silver bullet you seem to think it is. Oh, and you're wrong about 96 million deaths being attributable to the "banning" of DDT (the truth is actually a little more complicated).
You guys seem to continuously imply that I like the current. Let me repeat, I am for abandoning it completely. And, yes, part of that includes getting rid of ALL government programs. Yes, they have a lower overhead, but the fraud rate is infinitely higher (and the reported rate is just the tip of the iceberg - believe me, I work in healthcare) and their refusal of services is actually WORSE than private insurance. Of course, competition is good.......And you didn't answer my question, if there is no longer private insurance to pick up the difference between the shitty reimbursement rates of Medicare and what the private insurers pay now, how do doctors and hospitals make up the difference? And if it's nobody, who in his right mind would want to become a doctor under those circumstances?
Come on, Will. More fearmongering? The health care industry is not supported by private health insurance, and it will not collapse if private insurance goes away.
Adjusting pay across countries by purchasing power, U.S. doctors get paid about two times as much as in others. Plenty of people in their right minds are willing to become doctors.
Our health care is over-priced. Private insurance supports this over pricing because the more they pay out, the more they make. Their interest is their bottom line, not your health.
From the article that Jerry linked to... "other countries understand that health care is a public good, not a commodity. Markets can't control health care prices, since it is health care providers who decide what care is delivered. When providers determine both demand and supply, market economics don't apply".
In other words, competition has not, will not, and cannot bring down prices.
YES Will, I get it that you are for abandoning the current system completely... and replacing it with one that is a lot worse.
If the fraud rate is high under government health insurance programs... how about we do something about it? Why would that be impossible?
Also, if reimbursement rates are "shitty" we can do something about that as well. Stop the AMA from restricting the number of doctors. That will open up the field to people who are willing to do the job for more reasonable rates. If some people who only got into medicine quit because their only concern was to get rich... I say "good riddance" to these people.
Also, instead of paying premiums to health insurance companies (premiums that include 30 percent profit), those premiums now go toward taxes that provide HC insurance for everyone on a not-for-profit basis.
You didn't answer my question... How can providing a service not-for-profit cost MORE than providing it for profit?
Doctors are overpaid. That's what you're going with, Jerry (you guys seem to think that everybody except for unskilled laborers and teachers are overpaid)? And fearmongering? It sounds like you're putting me in the same category as Sarah Palin - which is interesting in that I'm putting forth here a full-throated endorsement of a plan that has as its author, a man who spent a fairly long stint as one of President Obama's health-care advisers.
I'll answer your question, wd. A government system has significantly more fraud, administrative costs that are deceptive, inadequate cost controls (other than reaming doctors), and a politicized decision-making process. It also maintains the fragmented fee for service delivery system that is going to have to be replaced eventually. Basically, wd, single payer systems represent an outdated solution to modern medical issues. Look, you like reading, right? Why don't you go to Amazon and order a cheap copy of Dr. Emanuel's book, "Healthcare, Guaranteed". At the very least, you'll like the fact that SEIU President, Andy Stern, also gives it a strong endorsement.
Health-care insurance providers make a 30% profit, wd? Where in the hell did that number come from?
You want to make the U.S. Government the sole provider of health insurance in the country, a government that has a 14 trillion dollar debt, a government which has created entitlement programs that are presently staring dozens of trillions of dollars in unfunded liabilities in the face, a government that can't seem to protect its own borders, a government that can't even run a frigging railroad. Man, have you ever led a sheltered life.
Oh, and as for the heartlessness of private insurers, get this - according to the AMA's own National Health Insurers Report Card, Medicare actually denies a higher percentage of claims than private health plans. From their 2008 report, this; Health Net 3.88%, Humana 2.90%, United Health Care 2.68%, Cigna 3.44%, Anthem 4.62%, Medicare 6.85%. Now, this isn't to say that private insurers are perfect. And that is why Dr. Emanuel's plan also has health boards (similar to the Fed) to ensure minimum standards of care, negotiate disputes, etc.. His plan absolutely ISN'T simply a free market free for all.
Excuse me Will, I meant overhead, not profit.
I am NOT saying make government the SOLE provider of health insurance. I am saying open up Medicare to everyone with those under 65 paying premiums that cover the cost of their care and let private insurance compete. It will add nothing to the deficit. If private companies can put a better product out there, good for them. Let them do it.
I am not saying doctors are overpaid, but when we are paying twice as much as the rest of the world for health care with often poorer results, more money is going somewhere than needs to.
Why do doctors make twice as much in purchasing power than doctors elsewhere? Why do drugs cost often many times as much here as the same drug from the same company in other companies? Why does a stay overnight in a US hospital cost so much more than a similar stay in another country?
I once asked a doctor on another blog why US doctors make so much more than European doctors. His answer? "Because we can." Why do drug companies charge so much in the US. I suspect, because they can. Medicare is not even ALLOW to negotiate price.
Get government out of health care and costs will skyrocket like you have never seen.
We have the same goals, Jerry - 100% coverage. We just have a different strategy as to how to get there. But, please, don't put me into the same category as Sarah Palin or Betsy McCaughey. I actually want to solve the problem (as opposed to demagogue it).
We found an area of agreement. I am totally in favor of the government being able to negotiate drug prices for Medicare and Medicaid. According to the sources that I've seen, that one thing could save the government 15-25 billion a year.
Will,
Please do not misunderstand me. In no way or form do I put you in the same category as Palin. We have had many reasonable discussions and I think we agree on more things than we disagree on. I hope that they can continue on a friendly basis.
Do foreign doctors pay as much for their education? Do they pay as much for malpractice? I also think that a lot depends on what branch of medicine. Plastic surgeons make a hell of a lot more than my poor little GP makes.
100% coverage is important, but we also need some way to slow down the increase of costs. Private insurance companies have little incentive to keep costs down. They more they pay out, the more they make. They even have an anti-trust exemption which further reduces incentive to reduce costs.
Don't get me started on education. What we have to pay for a college education borders on criminal.
Yeah, we're good, Jerry. I'm just one of those old fashioned guys (a Rockefeller Republican/Boren Democrat) who thinks that both sides have some good ideas, and who wishes that there was compromise on occasion. Speaking of which, didn't the Democrats and Republicans just come together and eliminate ethanol subsidies? That's at least a start, no?
Interesting that they will go after ethanol subsidies and not oil subsidies.
That's (cost control) where the Health Boards would come into it. It is they, in Emanuel's plan, who'd set the minimum standards of care, do comparative effectiveness studies (conservatives would call it rationing), resolve disputes, etc.. Say there are 2 operations. They are equal in effectiveness. But one costs $10,000 and the other $25,000. The insurance would only cover the former. Now, if a rich fellow wanted to spend the extra $15,000 out of his own pocket, that would be a different thing. But it wouldn't be covered by the health plan. There, cost control!
Baby steps, Jerry. Baby steps.
Oh no, Will. Death panels. Death panels. Death panels! That's what the right calls Health Boards.
Will: I am totally in favor of the government being able to negotiate drug prices for Medicare and Medicaid.
If we got "the government out of it completely and just [had] private enterprises compete"... that would mean the elimination of Medicare and Medicaid.
So... under the system you favor, entities that no longer exist should be allowed to negotiate drug prices? I'm confused.
A review of Ezekiel Emanuel's book "Healthcare, Guaranteed" on Amazon says, "his solution is to provide a voucher from the government, to obtain private health insurance". The reviewer calls Emanuel's plan "Medicare advantage on steroids".
Will, Meidcare Advantage costs the government MORE (and we pay more in taxes when someone choses it)... yet you seem to believe that Emanuel's plan will cost less than ObamaCare. Sounds to me like it would cost more.
I do agree that ObamaCare was one of the more costly ways to "reform" health care insurance... but Emanuel's plan sounds like it would do an even worse job of bending the cost curve.
Emanuel's book is available for 1 penny on Amazon in NEW condition (total: $4 with s&h)... I don't think I want to spend that much.
wd, I'm saying that, short of implementing the Emanuel plan, that would be one of the cost savings ideas that I could get behind to extend the program. I understand that it would be immaterial WITH the Emanuel plan.............Also, that ONE reviewer doesn't give a complete assessment of the plan. Like I told Jerry, the Emanuel plan has health boards in it that would seriously control costs (through comparative effectiveness, a dispute resolution process, etc.). It is much, much, more than Medicare Advantage, bra.............Andy Stern likes the plan, too, wd!! That doesn't persuade you to keep an open mind? Is it just because I like it?
Will: Is it just because I like it?
No, it's because it relies on for-profit insurers. I think health care insurance should be strictly not-for-profit.
At the very least we should have a not-for-profit option, which is what opening up Medicare to everyone would give us.
Does Emanuel's plan involve some kind of government subsidy for lower-income folks? If not I think his claim of "Healthcare, Guaranteed" for all citizens is bullshit.
In any case, it certainly can NOT cost the least. For-profit will always cost more than not-for-profit. That is a fact that's impossible to deny... yet apparently you are... I don't get it.
Personally I support the plan outlined by John Edwards when he last ran for president. For details see the 7/21/2007 commentary I posted on my blog.
"No, it's because it relies on for-profit insurers. I think health care insurance should be strictly not-for-profit."
So, how about a multi-payer system of many competing non-profits?
"So, how about a multi-payer system of many competing non-profits?"
Absolutely...with one of the non-profits being Medicare!
I answered your question about cost before, wd (i.e., on how for-profit providers can be cheaper than the government). Here it is again - A government system has significantly more fraud, administrative costs that are deceptive, inadequate cost controls (other than reaming doctors), and a politicized decision-making process. It also maintains the fragmented fee for service delivery system that is going to have to be replaced eventually. Basically, wd, single payer systems represent an outdated solution to modern medical issues.
To answer your present question as to whether or not poor people get a subsidy - yes, wd, they get a voucher. They get the same voucher that a person making $100,000 a year. And that voucher includes a comprehensive health-care package with minimum standards of care. If anybody wants the Cadillac plan (which isn't necessarily better, mind you, just more expensive), yes, they have to pay out of pocket for it.............My God, you read one review on Amazon and you're already calling it bullshit. Even more amazing - Andy Stern is wrong!!!
Why does a government system have "significantly more" fraud (according to you)? You speak as if absolutely nothing can be done to address the issue. It's impossible to reduce fraud in a government system but totally possible in a private system? I don't buy that.
I didn't say Andy Stern is wrong. I said absolutely nothing about Andy Stern's position... because I don't know what it is.
Single payer is outdated? 16 of the 33 OECD nations use a single payer system, making it the most prevalent system in use.
My guess as to why it is the most prevalent? Probably because it is the best.
Yeah, and for thousands of years we had slavery. What in the hell does prevalence have to do with effectiveness (Arnold Schwarzeneger's movies were popular - not good)?......The fraud rate in Medicare and Medicaid is over 10%. And that's just the tip of the iceberg. There's an extraordinary amount of soft fraud, too (doctors and therapists using all of the visits even if they aren't necessary, etc.). Couple that with the fact they (the government) deny necessary services at a greater rate than the private providers and, no, I'm not exactly a humongous proponent of the Federal government being the ONLY provider.
"Dr. Emanuel's bold prescription is thoughtful and will challenge everyone involved in healthcare. As America addresses our unsustainable cost, quality and coverage problems, we must heed Emanuel's call to act." Andy Stern, President, SEIU....... Not exactly an endorsement but, still, he does sound impressed.
Single payer is slavery?
Single-payer is fascist, it's "one side fits few", it is a power grab of the ruling elites taking decisions away from the people, it creates an unaccountable monopoly, and it is very bad idea.
But slavery? Probably not.
Single payer, IMO, is a very GOOD idea. It will cut out the greedy insurance companies and save lives. A majority of Americans want it. Single payer will take the power out of the hands of the wealthy elites and put it in the hands of the people.
"Single payer, IMO, is a very GOOD idea. It will cut out the greedy insurance companies and save lives."
You can do the same with an accountable multi-payer system, without having to resort to an unaccountable monopoly. Simply require insurance companies to be nonprofits.
"Single payer will take the power out of the hands of the wealthy elites and put it in the hands of the people."
Now that is completely untrue.
No, single-payer isn't slavery, but it does create (as dmarks says) a highly powerful and centralized monopoly that once it's instituted would be very hard to get rid of. "The greedy insurance companies (which are owned by millions of people, btw)" - I thought that the progressives didn't have a problem with private enterprise.
And, really, what do you people think? You think that the insurance companies go to the Wharton Business School at Penn or the Harvard Business School and say, "Please, give us all of your most ruthless students. We want to make insurance executives out of them."? It's absurd. Insurance companies "discriminate" against people with preexisting conditions because it would be suicidal not to. Dr. Emanuel's plan creates a system in which it wouldn't be (suicidal).
I don't have a problem with private enterprise... where it is appropriate. Making a profit providing health care insurance isn't appropriate.
I agree with Jerry about opening Medicare to all. I wouldn't mandate that the for-profits shut down. They can try to compete if they want. They can flip to non-profit if they want. But single payer is, IMO the most efficient and will save the most money.
My notion that Health Care Insurance CEOs are ruthless is absurd? I don't recall saying that in this discussion, but I do believe it. Actually, I think many CEOs are sociopaths, and far from being absurd, it's a requirement in an industry where making the profit you want depends on killing people (by denying coverage). A normal person couldn't do the job and keep their sanity.
I quoted Thom Hartmann in my post on this subject (from 7/21/2007), who said, "I was staggered last fall when the Wall Street Journal revealed that William McGuire, the CEO of United Health Group -- the second largest health insurance company in the United States, took home 1.6 billion... His company's stock price tripled from January 2003 to January 2006. Net income in 2005 of 3.3 billion -- and this is a company that is basically just moving money -- moving paper around".
This is pure greed and it is morally wrong. The government NEEDS to step in and do something about it. Health care insurance should not be just another product or service on which making a profit is the most (or only) important consideration.
BTW, this McGuire fellow got in a little trouble when he and his company were accused of rewarding him with backdated stock options.
Finally, WTF is up with your questioning progressive's support for private enterprise... do you think we're a bunch of Commies who believe government should take over the production of all goods and services?
"I agree with Jerry about opening Medicare to all."
I strongly believed that Medicare should be limit to the needy/disabled/indigent. We simply don't need welfare for the well-off. It's not necessary at all.
Also, in regards to: "Health care insurance should not be just another product or service on which making a profit is the most (or only) important consideration."
There are a LOT of laws/regulations (intrusive, left-wing government) that prevent the private health care companies (more than 1000 of them!) from competing with each other across the nation. It's protectionism, and it gives insurers virtual monopolies within states. Want to drive down costs and narrow the profit edge? Get rid of the barriers to competition.
That's another good solution, and another good way to avoid the worst possible "Reform".
That worst possible "reform" is single payer, which gets rid of ALL choices and competition, and turns over control to one unaccountable entity, the only one with the legal right to imprison and/or shoot you if you don't obey them.
Well, cd, you sure as hell want to take over the insurance industry (hundreds of thousands of good, hard working people).......The stock price tripled? Yes!!!! I think that I have some of that in my 401K. Thanks for the good news, buddy.......Inappropriate - according to you and a bunch of other have-nots sitting behind the computer.......You don't trust corporations but you totally DO trust one of the biggest and most wasteful (and, yes, sometimes oppressive) entities on the planet, the federal government of the United States. You want the same idiots who run the Pentagon, Amtrak, the post office, the authors of that idiotic cash for clunkers idea, an entity that set up a bunch of entitlement programs that are presently running dozens of trillions of dollars in unfunded liability, etc. to take over MY health-care. I (and millions and millions of other Americans) have good health-care coverage. You want to take that away and give everybody a man-sized dosage of that good old British Isles caliber mediocre care/coverage. Way to go, fellow.
Will: Way to go, fellow.
Thank you. BTW, that stock price info for United Health is over 4 years old... you must not check your 401k very often.
Also, McGuire was sued because other major holders of the stock said the his backdated options depressed the value of their stock. And his 1.6 billion dollar payday came from policy holder's premiums...
in other words it was money that could have gone to paying for actual health care. I wonder how many people were denied coverage (and died) so this greedy bastard could be given more money than one person could possibly spend in several lifetimes.
Yes indeed... for-profit health care insurance is awesome! You've convinced me Will... profit IS more important than human lives.
WD, you have traded in profit for giving a huge amount of power to the ruling elites.
But no matter how hard you try, you have not convinced me that giving more power to the most powerful is more important than saving lives.
Why not consider the options I mentioned: competition (which reins in the excess of profits; always does) or requiring ALL insurers to be nonprofits.... both of which avoid the pitfall of giving more power to what Will described as " one of the biggest and most wasteful (and, yes, sometimes oppressive) entities on the planet, the federal government of the United States. You want the same idiots who run the Pentagon, Amtrak, the post office..."
dmarks, I totally OPPOSE giving more power to the wealthy elites. I'm in favor of giving that power to THE PEOPLE. You do realize that we live in a representative democracy, don't you? The people hold the power. Our representatives carry out our desires.
We don't have "ruling elites" in the United States. You must be thinking of some other country.
WD said: "I'm in favor of giving that power to THE PEOPLE."
Then you should be opposed to socialism, and supportive of as much decentralization as possible.
Actual control by the people requires that matters be left to the private sector. Not the rulers.
"You do realize that we live in a representative democracy, don't you? The people hold the power."
No, the government holds the power. Please read the Bill of Rights. It is there PRECISELY because the founding fathers realized that government was not "us" and needed to be limited.
"We don't have "ruling elites" in the United States."
In fact, we do. The US is not an anarchy, after all.
"You must be thinking of some other country."
Actually, I am thinking of every nation/country that exists now.
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