The Middle Class Is Not ''Normal''

About Nicaragua? No but about what gets discussed here quite often in a whole assortment of ways. Here are a few:

  • Nicaragua has a small middle class. That needs to be fixed.
  • In the good 'ol USA, we have a big middle class.
  • We need to stop handing out things to people -- they need to work to get them.

You get the idea. For a lot of us older guys, we remember the post-WWII boom. A lot of us saw it as Capitalism working. Since then, things seem to have stalled. Typically we like to blame people and/or too many government handouts. An article in Truth-Out offers another possibility.

Despite what you might read in the Wall Street Journal or see on Fox News, capitalism is not an economic system that produces a middle class. In fact, if left to its own devices, capitalism tends towards vast levels of inequality and monopoly. The natural and most stable state of capitalism actually looks a lot like the Victorian England depicted in Charles Dickens' novels.

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This NYT article titled The American Middle Class Is No Longer the World’s Richest helps put this in perspective.

After-tax middle-class incomes in Canada — substantially behind in 2000 — now appear to be higher than in the United States. The poor in much of Europe earn more than poor Americans.

While there is the after-tax disclaimer, that seems reasonable considering the services (such as health care) that a Canadian gets from the tax they pay.

Non-profit profits

An article titled Big profits in not-for-profit charter schools offers another look at how what should be good Capitalism is doing an end-run around the intent to increase profits. I find this particularly bad as their non-profit status robs the tax base a second time.


Education doesn't work well with a capitalist model -- it might work well with a cooperative model (and some UK universities are closer to that), but it's one of the things that works well as a socialized endeavor, like the military, if the people are committed to public education as a net good for the community.

Rebecca Brown

I'm sorry for getting dragged off track

The forum topic is not about one bad medical system vs. another. It is about how Capitalism eliminates the middle class unless some adjustments are made.

I mentioned highways as a government responsibility. This article is about how the Highway Trust Fund is basically bankrupt. Those that are in favor of a good highway system are probably not the same as those who feel everyone should have guaranteed access to medical care.

It sounds like neither big party is willing to stick their neck out to address the problem. It is another example of pooled money to support the public good. Is the idea of public roads too socialistic for pure Capitalism?

I knew a Bircher in high school (math teacher)

…who said some of her group believed roads should be all toll roads and public money should not go to them, though that wasn't a common position.

Reading in early 20th Century newspapers, road maintenance used to be much more community based volunteer work rather than paid work for the state.

Who's responsible for the roads can get interesting even today in rural areas. Developers will build projects and expect to turn road maintenance over to the local government, which sometimes is less than thrilled especially when developers don't build to code. The other typical thing that happens are people buy on dirt roads (and there are an amazing number of them even within 60 miles of DC) and then try to get the state to pay for paving them.

We've got an interesting problem in Jinotega Department with a private development that is now in solely Nicaraguan hands (third owners), but with no roads back to individual lots (currently in cattle and grass). If the roads are built by the municipality or national government, they will be open to the public. Are those putative householders owed roads back to their properties or not? My feeling would be not if the roads are private.

And that also tends to be making for interesting issues in the US where a landowner would like a right of way to be closed especially when the old road is no longer used from end to end.

My guess is that people who are in very highest fraction of one percent don't really care what happens to the US and would prefer not to pay taxes (good commentary about the high tax rate in the US past was that there was no incentive to pay CEOs giant salaries, so the whole production crew got higher salaries to avoid paying very high taxes at the very highest level). Raising taxes tends to be a non-winner in US politics, though the Californians seem to have gotten over choking their educational system and are putting more money into that.

In the past in both Roman Europe and in the Andes and other parts of the Americas, all roads were the government's mostly for maintaining order and moving troops. Civilian usage of the road system was secondary. Also, prior to the steam engine, the record for travel between London to Edinborough was by horseback (relays) to let King James know Queen Elizabeth was dead. Three days on relays of horses on the North Road.

So, this is another change -- and the highway system that we have today is based on having cars, motorcycles, and trucks for transport. Between the first rail lines and the early part of the 20th Century, this would have been rail and canal as projects for connecting parts of the US.

Swings and roundabouts -- who owned the roads? Lot of early intercity roads and some now were toll roads. The Interstates were partially built as defense roads, using the Autobahns in Germany as models, but they cut travel time in half between some areas.

The Constitution established that the US would have socialized post roads and postal system -- and saw examples of how private enterprise failed to do those in ways that pulled whole countries and populations together.

British recent history shows that the fantasy of "if we privatize it, we'll have better service from competition" to be a myth. It's particularly pernicious in education where the system has state funding with private companies wanting to get their hands on the money without any real understanding of education and without an commitment to education of the whole population. Most studies show that the charter schools only do as well as public schools when the public schools are still intact. Otherwise, it's pay the actual teachers as little as possible, lie to the parents, and pay the investors as much as possible.

Contrast with the various Depression era and WW II era expansions (from the original landgrant colleges) of post secondary education (including a GI bill that paid for graduate school) with the squalid horror of University of Phoenix. This educated a range of people for better than industrial and farm incomes, from skilled medical technicians and nurses to doctors and scientific researchers (Berkeley had first rate science programs).

Rebecca Brown

True enough

A 'normal (Gaussian) distribution of money over the population is not possible in a purely capitalistic system. But where can you find that? Government regulators are beating back the greedy monster hogs as we speak. (Sure they're way behind, but who ever said something worth fighting for would be easy?)

And yes, the 'middle class' in America may have been the accidental outcome of recovering from WWII. So? Aren't we all aiming for rule by consent of the governed?

Though a purely socialistic system may approach an equitable distribution, it fails miserably in 'creating' wealth. Sure, it can employ its citizens to harvest or dig raw wealth out of the ground. But it fails to create new wealth because people require incentives, motivation to make something new. Peoples' Hero Awards may work for a few, initially. Ration coupons for vodka or FdC will take you a long way, but not all the way, and besides that's capitalism in sheeps' clothing. And, by the way, 'new wealth' is necessary because of new, little citizens and older, sicker, worn-out citizens.

Great creations which benefit all require large organizations with people of specialized skills, which means differentiation among the masses. Consider the most primitive example: leaders & followers - separate classes develop from simple societies that find strength in hunting/working together, before any laws or systems of governance exist, because of human nature, simple psychology. Similarly a purely socialist government must necessarily be made up of people of different skills, of different ranks in the pecking order that decides, enforces & distributes.

A black & white world is silly. 'Isms' are passé. So is the total annihilation of an 'enemy' or their 'ideas'. Yes, we learn from each other, especially our 'enemies'. As far as I'm concerned, humanity is a biological experiment that fluctuates between rational & irrational behaviors.

Douglas Adams agrees

As far as I'm concerned, humanity is a biological experiment that fluctuates between rational & irrational behaviors.

The mice that were using earth to conduct experiments on humans agree. :-)

I think we agree on the rest as well. There is no out of the box socio-economic system that works. Anyone who says pure {insert favorite socio-economic system here} works is, well, "lleno de caca". Unfortunately, the needed adjustments get implemented from inside the system that doesn't work. Let me offer an example.

Let's say that we decide access to medical care is a basic right. If you try to implement a system to supply this right within a US-like system you build a huge structure with lots of overhead. If you implement it in Nicaragua you get a really free, low-overhead but inadequate system.

Um, a lot of countries do this reasonably well

…and Nicaragua's inadequate includes some stuff that really works well, and keeps the private system from being too expensive and bloated with insurance companies.

A writer, Liz Hand, posted an article to Salon this week about Obamacare saving her life. Her annual income was something like $60K over three years -- not uncommon for writers not to be rich. Among other things, she writes reviews for the Washington Post. Cranks tend to deprecate anything that sort of works well enough to save people's lives. I sometimes think this is why cranks are so opposed to vaccinations -- it's a cheap way to save lives and it works most of the time (I'm old enough to remember before the polio vaccines and had at least one class mate who wore a leg brace from the damage).

Rebecca Brown

Not the point

I don't want medical insurance, I want medical care. If it is a right, it is absurd to add a level of indirection -- insurance companies -- into the mix. It should be the job of the government to make sure said service is delivered.

Now, in Nicaragua, the government is in the health care business. That might work if there were the proper incentives for people working there. But, incentives are pretty low and many will seek for profit care because it is generally better.

Obamacare is not a health care system. It is a huge scam for the insurance industry. The insurance industry's goal is to make money for themselves. They are not caregivers.

Something a bit closer to reality is the Canadian health care system. Private doctors, hospitals, ... and one non-profit who pays the bills which happens to be provincial governments.

Another interesting but slightly different model is Costa Rica. Health insurance is optional but, if you want it there is one insurance provider -- the government.

There is absolutely no way you can add a layer of multiple for profit intermediaries and improve the Canadian or Costa Rican system. They are not perfect but they are certainly more cost-effective. Even on the doctor end, only having to deal with billing one entity instead of multiple entities makes a big difference in the costs the doctor faces.

Just the fact that you start talking about someone's personal income shows the problem. If something is a basic right, the government needs a plan to provide it -- just like roads, public safety services and such. It could even make public debate about the government a bit more interesting if people could see that a new hospital could mean less money to build another bomber.

You Paint Such

a rosy picture but the reality is quite different.

Just as Obama and everyone else who can afford it DO NOT sent their kids to the government schools, people in Italy, Canada, and Costa Rica use alternative medical delivery. Nor will Obama and his friends, the Congress, and anyone with any juice at all, use ObamaCare.

Ii have a business client in Montreal who is convinced that his mother would not have died from a brain tumor if she could have received her treatment in a timely fashion. Canada rations expensive procedures, with a waiting list;; it's a small fraction who are adversely impacted to that extreme. The Canadians who can afford it, come south to the US for medical care rather than wait to be treated in Canada.

Shelley assisted at an operation a couple of weeks ago on an old lady, 79 as I remember, who broke a hip. They gave her a new hip. The alternative would be a painful, short life. She's lucky she broke her hip this year, -- next year or the year after, she probably wouldn't get one.

When I was in Italy a few years back I got into a conversation with a restaurant owner in Milan. He had had a restaurant in New York, saved his pennies and opened up a really nice place a block from La Scala. We started talking about the free medical care, and he said that nobody who could afford it used the socialized medicine provided by the state.

When I was in CR, none of my Costa Rican friends used the government provided medical service. They all went to CIMA (which looked like a hospital in the US), and they used private physicians (who also worked for the government service in the mornings).

If you want to trust your health to Obama,and the likes of the Post Office, the DMV, and the Chicago public school system,, that is certainly your right.

I'd like a bit more of a sure thing, and a doctor I could trust to do what's right for me. That is going to be increasingly hard to find in the coming years -and a lot more expensive.

I'll just squeeze in here

If you have a CR residency, by law you have to pay 13% of the amount of income you specified when you applied for residency in Costa Rica to Caja (health care).

When did that change?

It needed to happen but that was not the case when I lived there (2002-2003). For a year I had health insurance which cost about $40/mo.

With the new Ley General de Migración y Extranjería,”

The Reglamento published May 17, 2012 enacted the rule. Same time as the new monthly pension income requirement went up to US$1,000.

Costa Ricans have been paying all their working lives….

….so the lower rates worked with the costs for people who spent their entire lives in Costa Rica. Retirees haven't been. So minimum $130 a month more fairly covers the costs of having an aging community in the country that didn't pay into the system while they were younger and working. (This may explain why some expats left Costa Rica, not just the need for more monthly income, but the additional health insurance cost).

How will Nicaragua deal with aging expats. If we're ever using the public system in considerable numbers, encouraging retirees to come here might be a money losing proposition for the country unless it has a similar system to Costa Rica's and puts retirees on INSS.

Rebecca Brown

A better link on the law

Look as though it could be quite a bit cheaper if they do in fact waive the disability and death portion as the article suggests.

Costa Rica also has a Luxury Home Tax

I think they're managing their gringos better than Nicaragua is managing its gringos.

Waiving the disability portion might be problematic -- going to be more expensive for this in the US.

Rebecca Brown

Roger knows his stuff

Roger Petersen is "Mr. CostaRicaLaw". He did my residency and some other stuff when I lived there. He was recommended to me by a friend and I have since recommended him.

He knows the players and the rules so it is extremely likely that if he says it, it's true.

I get sick of hearing this same example

Canada has a shortage of brain surgeons, period. That's the reason for the frequently cited waiting list for brain surgery.

"...Canada Has A Shortage . ..

And why is that? What creates a shortage? Isn't this precisely what is happening in Venezuela?

And I understand that it's not just brain surgery? A number of procedures have long waits.

WHY can a Canadian come to the US for treatment, with no wait? Is this not a clear failure of the system, and what we will start to see in the US as ObamaCare kicks in? It's not just Canada, the UK rations care too,,, specifies treatment modalities (one size fits all).

ObamaCare does guarantee contraception for nuns, has a lot of really great features like that.

Many US doctors are already moving to "concierge medicine". This will be a boon for the people with that kind of money. For the rest of us, most of us had good insurance, that we were happy with, that worked great. We were lied to: "You can keep your existing insurance, you can keep your existing doctor" is a line Obama used over and over.



Canada has a shortage of brain surgeons because Canadians as a rule have very large brains. Thus, any problem that requires brain surgery becomes a complex and time consuming process, given that the solution requires navigating through a large and complicated network of meat and neurons.

Because Americans have rather smaller brains, brain surgery is a more direct and simple process, requiring less expenditure of such resources as time, money and knowledge.

Also, because Americans have brains that are simpler and smaller, there is less impact if the brain surgery fails.

For example, consider all the "normal" Americans who believe that Obama is a Muslim cleric, that Pell grants are an example of socialism, and that global warming is a natural phenomenon barely influenced by human activity. Compare them to Americans who are brain damaged. What exactly is the difference in terms of human cognition and behaviour ....

You Missed On


He´s a gay communist Kenyan Muslim . . .how that all fits together I haven´t a clue. I´m just anxiously waiting until our misery is over and we can move on. It will be nice when people in the US can get jobs again

He put together a lot of small coalitions to get elected.

But, what happens to the Canadians with their bigger and more complex brains when they have to come to the US for brain surgery ??

Or, are these Canadian trained brain surgeons working in the US for the better money?

The shortage

The shortage is because not enough students go into brain surgery.

I'm sure you believe it's worse than it is because there are many US companies making a fortune on sick Americans and they're trying to break into the Canadian market to do the same thing. So if by "precisely what is happening in Venezuela" you mean US interference, you're correct. Yes, rich Canadians sometimes go south to be treated in luxury, and poor Americans just die.

Everyone has a shortage

I went to a presentation on Health Care in Canada about 30 years ago. I learned a lot including how it really worked vs. what the US media and politicians were saying.

The panel had a nurse, a doctor, an ex-MP and, I believe, a fourth person. The ex-MP (who was working at Harvard University at the time) said "Health care is rationed everywhere. In the US it is rationed by your ability to pay, in Canada by need."

In Canada, fees for procedures are negotiated with doctors by "the insurance company". Access to specialists requires you to go to a GP first.

So, back to my example. Just like police protection, new highways, ..., I said that if access to medical care is a a basic right, it should be the responsibility of the government to make sure everyone has it. Clearly it will be "rationed" just like that new highway you think should be built from your house to your workplace. The only real question is how to ration it.

One problem is that life is a terminal condition

Someone dies of brain cancer -- it's not clear that this would have happened anyway even with aggressive treatment. If someone died because a compound fracture was ignored, then people might have a case (an artery severed can kill pretty quickly, so that's even that is a big "might").

One of my professors had a Rotary scholarship to study in the UK. While there, he had pneumonia and NHS treatment. When he got back, the Rotary wanted him to speak about his experiences with the NHS. He was completely complementary and thought highly of it. He was not invited to speak again.

Rebecca Brown

Most Specialist Visits

are a result of a referral from a GP. The ideal arrangement is consistent oversight of a patient's health by a GP, who then recognizes something that requires more attention. It's the basis of he system we have had in the US for a long time. . GP's are utilizing more physician's assistants and nurse practitioners for the initial. This is a good direction, much of the utility burden can be removed from the physician and he does what he does best. This is the relationship I had. My doctor would make a point of stopping in, asking a couple of general questions, shake my hand, and move on -if the problem was minor. That gave him the time he needed to review my annual blood work in detail (something he was big on as a predictor of future problems).

There was nothing wrong with this system. It worked great.

ObamaCare has already spent enormous sums of money re-engineering something that was not broken. They incorporated a variety of "social justice" fixes, like the contraception for nuns, that really went beyond providing health services. Six million Americans lost health insurance when their plans didn't meet the (again, mostly social justice) guidelines of ObamaCare. The wide availability of different plans that could address specific needs has disappeared. It's now Obama's way or the highway.

I agree that some solution was necessary for the chronically uninsured. Valid reasons exist for people needing a little extra help. I question whether Rebecca's example of a woman who made $60K in three years is one of them. This is more an example of someone asking ME to subsidize THEIR life style. My answer to this woman: get a real job that pays your way.

I see the problem

(Yeah, still on medical but another good example here.)

I agree that some solution was necessary for the chronically uninsured.

One other thing from the Health Care in Canada talk I picked up is that the only way a solution works is if it is for everyone. If access to health care is a basic right then there is no such thing as the chronically uninsured -- because there isn't anyone who is uninsured. Or, more accurately, anyone who does not have access to health care.

The continual problem with a pure Capitalist solution to anything is that the goal is always profit. The needed adjustment is that if something is guaranteed then providing the service must have a higher priority than profit. So, we are right back in the same loop. We (the people) need to decide what the government will guarantee (not easy, of course) and then make sure their delivery is not controlled by profit.

This is pretty easy if, for example, you just guarantee that everyone has a bicycle but gets a lot more complicated when you are delivering medical services or killing people on the other side of the world.

How about that highway?

Or the police or fire department? After all, we usually don't need the fire department -- why not pay on an as needed basis.

Again, my point is that if a government (hopefully as requested by the citizenry) decides that access to medical care is a right then the government needs a plan to deliver the service, hopefully in a cost-effective way.

I always find it interesting that on the political right, socialism in the form of bombing the shit out of Iraq, Afghanistan, Nicaragua or Vietnam is a good thing but directly serving the needs of citizens is bad socialism. Personally, I would rather have free (and I mean that is both senses) access to medical care and have to pay if I want Iran bombed.

Bad Socialism - Good Socialism

Submitted by fyl - I always find it interesting that on the political right, socialism in the form of bombing the shit out of Iraq, Afghanistan, Nicaragua or Vietnam is a good thing but directly serving the needs of citizens is bad socialism. Personally, I would rather have free (and I mean that is both senses) access to medical care and have to pay if I want Iran bombed.


"interesting"is hardly the right word!
We lost every one of those wars & they still hate us as much as they always did.
If we had those bucks now the budget would be balanced & Romneycare would be paid for in advance forever.

trouble is

without those wars we would all be speaking Russian.

``Socialism works fine until you run out of other peoples` money``

Margaret Thatcher


See China and anyone who conquered it. Also, more Russians were speaking English than Americans were speaking Russian.

The trouble with conquering places is that the places seduce your young men and they marry the local women or end up Decembrists. If the US hadn't conquered Japan, would anyone have heard of Zen Buddhism? My brother has been practicing on and off for years at the NC Zen Center.

The fantasy was that there was something about communism as opposed to the garden variety of military dictatorship that make it more resistant to change and that it was overwhelmingly good at brainwashing and stuff. That didn't turn out to be so. What North Korea looks like is a garden variety of military dictatorship with a ruling family and a faint overwash of communist rhetoric (they're changing the economic system as I type).

Supposedly the old fashioned right wing dictatorships would peacefully evolve into democracies and the left wing dictatorships wouldn't. Um, no.

Vietnam won its war with the help of the US population that wasn't into rape and torture of people simply for being commies, and isn't the repressive left regime of right wing wet dreams. It used the left as long as that was convenient, and called the Japanese investors as soon as the round eyes and their collaborators flew out on the helicopters.

Russia does its conquering in its usual sphere of influence. The Chinese under Mao sent them packing and started sending rather large numbers of graduate students (whose spouses did not accompany them) to the West for education. One of my fellow graduate students at SUNYA ended up studying "Paradise Lost" with the Russians who made Satan the hero of the poem and with a British Canadian of a aristocratic Scottish family who wasn't impressed by Satan and was sure Milton was clear about his faith.

It's fairly obvious that no large scale continental country can really be occupied. There's simply not enough manpower to do this, especially in a country like the US. The USSR had trouble holding on to its European periphery; the US has had trouble holding on to its periphery; and the UK is facing electorial dismemberment of the Home Islands if the Scottish independence movement gets sufficient votes.

Sometimes, the winning side simply has a better idea -- Alexander the Great made the people he conquered citizens instead of slaves; Genghis Khan pretty much did the same thing and also added religious freedom and good policing to the mix. His mother and his first wife were both kidnapped and raped, so the ideal was that a Mongol virgin with a sack of gold should be able to ride from one end of the empire to the other without being robbed or insulted. He also promoted commoners to good positions in his government. Better boss than the local boss -- so his grandson ended up half Mongol and half Chinese culturally.

Lots of people like not having their religion messed with, and you've got to pay taxes to someone anyway. Communism and the Chinese were rather brutally kicked out of Indonesia.

Rebecca Brown

Government, by the government, for the government

I have been reading "Secrets" by Daniel Ellsberg. I will write a review when I am finished but there are so many things to learn from the book. One is about how the government, independent of political party, has been willing to trudge ahead in someone's preferred direction in spite of all the facts they have that shows it won't work. That, of course, is not just the US government -- in what Ellsberg is writing about we get to see what the French did as well.

Another thing the book confirms is that the highest priority in the life of a politician is getting reelected.

Is there anybody in the world

that needs to read a book to know:
Submitted by fy - Another thing the book confirms is that the highest priority in the life of a politician is getting reelected.
All the books and all the studies fail to recognize the basic root cause of bad government:
Voters elect the politician that promise to satisfy voters individual personal greed.
Thus countries are governed by liars that promise and then serve themselves.
Over... & over... & over... - Voters never learn.

Party politics

My comment was addressed at those who continue to deny this -- basically Democans and Republicrats that seem to think their party is different. As Emma Goldman said over 100 years ago, "If voting changed anything they'd make it illegal".

Yes but all this is another variation of

the "Glass Is Half Full" negativity with no workable solutions included.
In spite of all of the evil doings of the US government personal opportunities are un-paralleled there. It still has an enviable median & average income and living standard compared to other countries in the world (excluding oil kingdoms where citizens have no rights.)
A kid can still get a good, nearly"free" socialized education through college and thus the US is still are the technology leader of the world. Foreigners who desire a better life are begging to come there and the "best of the best" & "richest of the richest" flood US colleges with applications to get a superior education.
YES things could be better - The middle class is losing ground & the country seems to be going broke!
But survivors still do well.
Reality Check: Compare the US to the sewer of non opportunity for a middle/lower class child in Nicaragua (Your chosen country?)
Virtually none of then experience any positive guidance from society or parents and the public school system is pathetic. Most kids (and adults as well) with any initiative are in Costa Rica or other countries for the opportunities there.
The genuinely brave and productive have achieved the dream of all dreams to get ahead - They are in the US sending remittances back to their impoverished family in Nicaragua.

Solutions to fix the middle class problems - Not gripes are what is needed to fix the US and those are few & far between.

individual personal

individual personal greed

This is why the communist systems don't work, since human greed/selfishness has no outlet, and the pure capitalist systems fail, because where greed is good, only a handful really benefit. A system that recognizes the best and worst of our human nature, and seeks emphasis on our inherent goodness, while limiting our weakness is needed.


And that's going to be a dynamic system and can fail on either side.

Rebecca Brown

Praise Indeed

BTW, is that number the national debt?

I'm for single payer

World is messy -- the fantasy that everything will work out if only, or that outcomes are fair is precisely that, a fantasy. The imperfect change that we have in the health care system has improved things for my brother the accountant's clients and for people like Liz Hand.

That was an aside that even successful people in the arts don't make that much money except a very tiny fraction (and apparently, some pornographers). Having money isn't the affirming proof of worth that some imagine it to be.

I've suggested to a woman I know with government connections that those of us with legal residency be allowed to buy into the INSS system. Don't know what will come of that.

US health insurance industry has too many tentacles in the economy to pull them out while the country's still recovering from a recession.

Pennsylvania used to have Adult Basic. My brother who was being an artist at the time got on it and had reconstructive surgery done to his hand. First rate work. The doctors who work in the system tended to be as good as any. Mercenary isn't a good thing for a doctor to be -- I've had one and fired her and went with the clinic my brother used to set up his surgery.

My eye doctor and my ear, nose, throat doctor both worth in the public clinics. I doubt they do different jobs depending on whether the patient is private or public. Fred Lamb went to the public hospital for treatment for pneumonia and didn't have any complaints, either. Swedish x-tray tech said that his father-in-law's treatment here seemed to be up to Swedish standards. US retina specialist thought that Dr. Muñez was quite competent and picked up new procedures fast than he'd expected (might be a reflection of US bigotry, or maybe not).

Medicine that did anything beyond handholding and explaining the course of the disease to the family and community is relatively recent -- late 19th Century for effective surgical anesthesia, 1930s for effective antibiotics that were far far safer than mercury. I've had two operations that were probably for the surgeon's benefit (tonsils and hysterectomy) and two that were worth it -- cataract surgery which gave me two working eyes rather than one and a half, and gall bladder surgery.

Talking about health care as a right in the days when a doctor's intervention was more likely to be problematic than having a midwife deliver a baby at home -- not really worth the hassle. Even worse when the treatment for any number of things was bleeding. Now, interventions can make a positive difference in life expectancy and quality of life. Catching the politics up to the science will take time.

I'm not a big believer that there are any basic rights other than what communities or factions in communities agree to. Being able to own slaves was a basic right in the South that only affected around 25% of the population, but it was an aspirational right that motivated a lot of people.

There's an underlying US conservative wish that the pesky inconvenient poor people just die before costing their betters money that stops the US from having a better health program. Nicaragua doesn't seem to have that wish.

Having an educated population is a disaster for an export crop economy and not always what people want with mill economies (the agency I used to work for had a program for first generation college bound students, and the mill supervisors accused the program of "stealing our best workers"). Healthy? Depends on the cost of replacing the labor. If labor is common and cheap, then having some of them die off doesn't affect the bottom line. Most cities prior to the 19th Century had negative population growth -- sort of like human roach traps -- and depended on recruitment from the countryside to keep the population figures up. Health, smealth -- more where those came from.

Worst excesses in agriculture labor abuse, either slavery or nominal free but landless, have been with absentee landlords who lived in places like Natchez and even Paris, and didn't have to live with the health problems in plain view, or risk being infected by their diseased help.

Rebecca Brown

ObamaCare & Socialism

You can bet your last dollar that anyone who can afford and obtain insurance outside of ObamaCare, Including our esteemed president, will take the alternative.

This happens everywhere that I've been that has socialized medicine --certainly Nicaragua included.

The rest, well:

A man goes to a doctor for a vasectomy. Before the procedure, a very attractive nurse comes in and takes his vitals, then tells him to take all of his clothes off.

When he is fully undressed she instructs him to lie down on the table. The man obeys. The nurse then takes all of her clothes off and climbs on top and has her way with him.

Upon the completion of the act the man catches his breath and asks what that was all about. The nurse informs the patient that studies have shown that before a vasectomy if the man has an ejaculation, he will be more relaxed and that the cord is easier for the surgeon to locate and sever, thereby making the surgery safer, more efficient and quicker. The nurse then wheels the patient to the operating room.

While they are going down the hall the patient looks through a window to the right and sees six men in a room masturbating. Curious, the man asks," What are they doing in there"?

The nurse responds, "They're preparing for vasectomies too, but you have Blue Cross, and they have Obama Care."

Middle Class

Excellent article. Thank you!

Social Democracy….

….see Sweden and 17th Century Holland -- which had a tax on servants: and It also helps if a country can get neighboring countries to do something stupid to encourage migration of skilled labor. Helps to have seaports and a good merchant marine.

Rebecca Brown