Impossible Promises

Obama says his health care plan will cut costs and increase patient choice. It won't.

John Stossel | August 6, 2009

I keep reading about health-care "reform," but I have yet to see anyone explain how the government can make it easier for more people to obtain medical services, control the already exploding cost of those services, and not interfere with people's most intimate decisions.

You don't need to be a Ph.D. in economics to understand that government cannot do all three things. (Judging by what Paul Krugman writes, a Ph.D. may be an obstacle.)

The New York Times describes a key part of the House bill: "Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person's medical history or current illness."

No more evil "cherry-picking." No more "discrimination against the sick. But that's not insurance. Insurance is the pooling of resources to cover the cost of a possible but by no means certain misfortune befalling a given individual. Government-subsidized coverage for people already sick is welfare. We can debate whether this is good, but let's discuss it honestly. Calling welfare "insurance" muddies thinking.

Such "reform" must increase the demand for medical services. That will lead to higher prices. Obama tells us that reform will lower costs. But how do you control costs while boosting demand?

The reformers make vague promises about covering the increased demand by cutting other costs. We should know by now that such promises aren't worth a wooden nickel. The savings never materialize.

Some of the savings are supposed to come from Medicare. The Times reports "Lawmakers also agree on proposals to squeeze hundreds of billions of dollars out of Medicare by reducing the growth of payments to hospitals and many other health care providers."

With the collapse of the socialist countries, we ought to understand that bureaucrats cannot competently set prices. When they pay too little, costs are covertly shifted to others, or services dry up. When they pay too much, scarce resources are diverted from other important uses and people must go without needed goods. Only markets can assure that people have reasonable access to resources according to each individual's priorities.

Assume Medicare reimbursements are cut. When retirees begin to feel the effects, AARP will scream bloody murder. The elderly vote in large numbers, and their powerful lobbyists will be listened to.

The government will then give up that strategy and turn to what the Reagan administration called "revenue enhancement": higher taxes on the "rich." When that fails, because there aren't enough rich to soak, the politicians will soak the middle class. When that fails, they will turn to more borrowing. The Fed will print more money, and we'll have more inflation. Everyone will be poorer.

The Times story adds: "They are committed to rewarding high-quality care, by paying for the value, rather than the volume, of [Medicare] services."

Value to whom? When someone buys a service in the market, that indicates he values it more than what he gives up for it. But when the taxpayers subsidize the buyer, the link between benefit and cost is broken. Market discipline disappears.

Listening to the health-care debate, I hear Republicans and Democrats saying it's wrong to deny anyone anything. That head-in-the-sand attitude is why Medicare has a $36-trillion unfunded liability. It's not sustainable—and they know it.

They've given us a system that now can be saved only if bureaucrats limit coverage by second-guessing retirees' decisions. Government will decide which Medicare services have value and which do not. Retirees may have a different opinion.

One may be willing to give up the last year of life if he's in pain and has little hope for recovery. Another may want to fight to the end. But when taxpayers pay, the state will make one choice for all retirees.

Comments

|8.6.09 @ 12:11PM|#

I bet Stossel was wearing a swastika and burning Pelosi in effigy while he wrote that.

Tomcat1066|8.6.09 @ 12:24PM|#

Yeah, John Stossel, but it's a "right"-at least according to some turdnuggets-for the poor to get the benefit of my labor simply because they exist. Don't you understand that?

Sean W. Malone|8.6.09 @ 12:26PM|#

Not that I intend to start a threadjack here, but did anyone else read the Washington Post article where they're now trying to push the Obama = Joker poster as "racist"?

Between that, the "Swastika" remark, Boxer's whiny idiocy and the White House' attempt to get people to rat on political dissidents, they seem to be imploding.


Anyway... Stossel ftw again.

stuartl|8.6.09 @ 12:26PM|#

Insurance is the pooling of resources to cover the cost of a possible but by no means certain misfortune befalling a given individual. Government-subsidized coverage for people already sick is welfare.

Nicely stated.

kilroy|8.6.09 @ 12:30PM|#

Right on target.

|8.6.09 @ 12:33PM|#

Racism thy name is Obama. Oh, some folk are upset that a poster might cast the nihilistic negro in a negative light. Such a shame.

|8.6.09 @ 12:35PM|#

Homeowner's insurance charges more for high-risk customers and refuses service to customers that are too risky. Auto insurance (require by law for all drivers) does the same things. Why is it suddenly an abomination when the health insurance industry does it. The bottom line is that people who will cost the system more money to cover should pay more. But, the supporters of the government option say this is wrong. However, many of these same people support tax increases on things like tobacco, sugary things and other things that are bad for you. They claim that this is to discourage the use and, for those who refuse to improve their lifestyle, help pay for the government programs associated with their increased cost of care. Sounds an awful lot like what the insurance companies are doing.

Amber Waves|8.6.09 @ 12:41PM|#

"Not that I intend to start a threadjack here, but did anyone else read the Washington Post article where they're now trying to push the Obama = Joker poster as "racist"?"

I'd pay one hundred dollars for a tee-shirt imprinted with this picture. One hundred dollars.

|8.6.09 @ 12:47PM|#

You're in luck

http://www.zazzle.com/barack_obama_joker_picture_socialism_tshirt-235202338790913782

http://www.blackbookmag.com/article/barack-obama-teams-up-with-the-joker-for-new-t-shirt/4928

Sean W. Malone|8.6.09 @ 12:48PM|#

Although I am a fan of alliteration, "Nihilistic" is hardly the word I'd use to describe Obama, LM.

The man believes. Hard. Only, he believes in the magical fairy tale world of Utopian planning and socialism.

Anyway, it's frustrating to watch people fail to understand the significant differences in ideas in play here or the difference that government vs. private transactions actually makes.

Yesterday, my mom emailed the whole family confused as to why universal health insurance/welfare was any different than the "government paid" insurance she and my father get as a result of his military service.

The minute I have to explain the difference between earning an income (including benefits), and getting "free" hand outs for doing nothing, is a really sad time. And no offense to the older people on this board - but I fear most of my folks' generation (baby boomers) fails intellectually in the same way.

|8.6.09 @ 12:54PM|#

Give me a break-

A man who has healthcare insurance and thus protection from going into bankruptcy due to illness, believes EVERYONE ELSE is whining.

I say, take away Stossel's insurance, give him a pre-existing condition, and see how happy he is with private insurance companies.

Also, give him a REAL JOB, not some well paid celebrity gig and everything he writes on this topic would be radically different.

my 2¢

Mad Max|8.6.09 @ 12:55PM|#

In addition to demonizing opponents of the health care bill, progressives need to get to work on pre-emptive excuses for any failure of the new system. After all, if the new system has flaws, then ignorant or careless voters might blame those flaws on those who cooked up the new system.

To avoid this, health-care reformers need to have some excuses in reserve. Allow me to suggest the following:

Everyone knows that single-payer would have been the best solution, but it wasn't politically feasible. And the reforms we *did* pass were messed with by the Insurance Lobby and other sinister interests.

And unforseen cost overruns, to be blamed on the Bush Recession.

And nobody could have predicted the problems, anyway, so it's not our fault.

And besides, Bill Kristol dodged the draft.

|8.6.09 @ 1:02PM|#

Dune:

What's your point? So you agree with him, but don't like him telling the truth? "Health Care Reform" has morphed into "Health Insurance Reform" which will simply drive up the cost of health care. How will this help?

stuartl|8.6.09 @ 1:03PM|#

I say, take away Stossel's insurance,...

After all, why should a guy who paid* for something get to keep it?


*Yes, due to the current laws that have screwed up health "insurance," his company actually paid, but it is part of his compensation.

|8.6.09 @ 1:06PM|#

That's it, I'm turning Stossel in.

|8.6.09 @ 1:07PM|#

Dune | August 6, 2009, 12:54pm | #
Give me a break-

So you ARE okay with taking things away from people who have earned their keep, either through brute-force work or by some amount of luck. The point is, if you want insurance: earn it. It's not a fundamental, or even secondary right. It's a product/service that amounts to a gamble. It's the only product you hope to never have to use.

|8.6.09 @ 1:10PM|#

"""The bottom line is that people who will cost the system more money to cover should pay more."""

But how would that work? Wouldn't you have to declare all your high risk activites to your insurance company? What foods you eat, if you're an adventure seeker, however that's defined. If I'm not really an adventure seeker but I decided to go rafting, or if I decided to go outside of my contractual diet would I need to get a waver or would I be denied services if I hurt myself rafting or choked on a 1000 calorie hamburger? Sounds like a lot of personal scrutiny. Or would a claim of that nature automatically increase your rates?

|8.6.09 @ 1:17PM|#

Sean-

As I too love alliteration, sometimes one must be prepared to sacrifice pinpoint accuracy.

However, one could argue that socialism, itself, is a manifestation of nihilism.

Sean W. Malone|8.6.09 @ 1:20PM|#

Also Dune, last I checked Stossel did grunt work for years as a news researcher in Portland. And then he spent many more years doing anti-business scare stories... Until he realized that it wasn't actually business at the root of the problems. So I think he probably has an idea what a "real job" is like.

In that, his story is like that of many libertarians actually. You do realize, of course that most of us aren't "raised" to be libertarian, but have to actually come to our own conclusions through years of observation, debate and research, right? A lot of us come in through studying history, some through economics and some through philosophy... Sometimes all of the above (me).

This is notably unlike, for example, republicans & democrats who tend to get brought up to be that way... Much like how most people wind up "choosing" their parents' religion.

Sean W. Malone|8.6.09 @ 1:22PM|#

You think LM?

It's clearly a belief though... I tend to view nihilism as the (supposed) absence of any belief. Not that that's possible in reality, since one would expect completely random actions in that situation and you will never find a "nihilist" who doesn't grasp physical reality in basic ways (eating, sleeping, etc.)

But by all means, elaborate on your idea.

creech|8.6.09 @ 1:23PM|#

Well, a police state could take care of the first and second of Stossel's worries. But "not interfering with intimate personal decisions?" Well, do you want universal "free" health care or do you want the keep the cops out of your life? It's surprising how many people who were upset with the idea that Bush & Co. might overhear some bon mots between them and their girlfriend, are o.k. with the kind of police state that would have to be imposed under universal health care.

|8.6.09 @ 1:24PM|#

Dune,

He's not talking about what to do about people who have existing conditions without insurance. There's myriad solutions to that problem without having to socialize medicine entirely.

|8.6.09 @ 1:26PM|#

Whenever Obama says we're only paying for "value" it reminds me of my HMO that said there was no value to sending me to specialists for my allergies and headaches.

"if you're an adventure seeker"

You won't be denied coverage, you will be given drugs to correct your dopamine levels, no more adventure seeking for you! It is dangerous and leads to avdenture.

|8.6.09 @ 1:30PM|#

But the rest of the industrialized Western world has it.

|8.6.09 @ 1:34PM|#

Wow. It's rare to see nonsense distilled to such purity. Stossel and his message-board acolytes confuse social insurance with market insurance; confuse lifestyle choices (which can be offset with vice taxes) with pre-existing conditions; and stubbornly ignore the consequences of having taxpayers cover the poor the sick and the old while the young, healthy and rich either (1) provide a cherry-picked risk pool to the for-profit sector or else (2) go without insurance and, when misfortune falls, free-ride on a society that is too decent to leave an uninsured car-wreck victim bleeding out in a ditch.

It's time to treat medical emergencies the same way we treat fire and police emergencies. Everybody pays in, and nobody free-rides when they need to dial out for help. It won't be perfect, but it will be good enough for us to move on and focus our private initiatives on more fruitful projects.

stuartl|8.6.09 @ 1:42PM|#

It's time to treat medical emergencies the same way we treat fire and police emergencies.

And food emergencies, clothing emergencies, chocolate fix emergencies,....

|8.6.09 @ 1:46PM|#

Yes, stuartl, we do treat food and clothing emergencies this way; although such emergencies are relatively rare and typically involve a natural disaster.

Of course, your chocolate example shows that you are contemptuous, sarcastic, and deeply unserious about meaningful debate. Maybe your doctor could prescribe you a STFU pill.

|8.6.09 @ 1:54PM|#

Dan,

You do realize that the entire expenditure in the US for uncompensated care is around 40 billion dollars. That is out of 2 trillion dollars of total health care expenditures, a meager 2% of the total health care cost.

Doing anything that significantly affects the 2 trillion dollars to try to allay the costs of the 40 billion dollars is utterly insane.

Gilbert Martin|8.6.09 @ 1:59PM|#

"A man who has healthcare insurance and thus protection from going into bankruptcy due to illness, believes EVERYONE ELSE is whining."

He obtained that insurance through his own efforts and abilities without whining for the government to make somebody else pay for it for him.

I suggset you do the same you WHINER!

|8.6.09 @ 1:59PM|#

Dan,

He's proving a point. At what point do we draw the line with "want" (gov shouldn't step in) with "need" (gov probably shouldn't step in, but does any, or for others, gov DEFINITELY should step in). Of course, it'd be silly to ask somebody to draw that line, but I think most libertarians would like government out of supplying most of both.

Gilbert Martin|8.6.09 @ 2:07PM|#

"go without insurance and, when misfortune falls, free-ride on a society that is too decent to leave an uninsured car-wreck victim bleeding out in a ditch."

Society isn't one iota more "decent" today than it was before the existenace of any government entitlement programs or government mandates about hospitals treating people in the emergencey rooms whether they can pay or not and dealing with all those things was left up to private charity.

Go back to leaving it up to private charity and get the government out of it. Nobody is stopping all the decent people from giving to charity to help others with healthcare. Those who want to mandate charity from others are merely attempting to pose as "decent".

|8.6.09 @ 2:20PM|#

Gilbert Martin -- when was this magical time before "government entitlement programs"? Give us a date certain: mm/dd/yyyy.

And we are not one iota more decent? Really? Post-Jim Crow; women's sufferage; decriminalizing gays; expanded free speech; drastically reduced poverty -- but you say were are now not even one iota more decent than we were in the pre-entitlement era?

You are of that school that takes ignorance as a point of pride.

stuartl|8.6.09 @ 2:20PM|#

Of course, your chocolate example shows that you are contemptuous, sarcastic, and deeply unserious about meaningful debate. Maybe your doctor could prescribe you a STFU pill.

Let me see, in your attempt for serious and meaningful debate, you said "..nonsense distilled to such purity. Stossel and his message-board acolytes..." May I suggest a dose of your own medicine? I hear those pills come cheap.

You also confused someone elses "lifestyle choice", not getting insurance, with an emergency I should pay for.

Danny has it exactly right. Where do you draw the line? When you remove personal responsibilty, you remove personal incentive.

|8.6.09 @ 2:27PM|#

"You also confused someone elses 'lifestyle choice', not getting insurance, with an emergency I should pay for."

Tadaaa! He does it again! Some one is born with a heart defect, and is denied insurance. This lack of insurance is then a "lifestyle choice." Thank you, stuartl. Your banal and tedious misanthropy is a gift that never stops giving.

Gilbert Martin|8.6.09 @ 2:36PM|#

"Gilbert Martin -- when was this magical time before "government entitlement programs"? Give us a date certain: mm/dd/yyyy."

Government entitlement programs started with FDR and the Social Security program. Go bone up on your history. It's not that hard.



"And we are not one iota more decent? Really? Post-Jim Crow; women's sufferage; decriminalizing gays; expanded free speech;"

Not a single one of those things has anything whatsoever to do with making one person pay to subsidize another's existence.




"drastically reduced poverty -- "

something you are incapable of proving

"but you say were are now not even one iota more decent than we were in the pre-entitlement era?"

Nope - not one iota. And you aren't the least bit capable of proving the case is otherwise. There is nothing decent whatsoever about forcibly stealing money from it's rightfull owners to give handouts to others.

|8.6.09 @ 2:41PM|#

So Gilly thinks that, before FDR and Social Security, there were no "entitlements", no forced "subsidies," and no "handouts." There it is, the irrefutable truth ... as Gilly sees it.

Gilbert Martin|8.6.09 @ 2:46PM|#

Here's the irrefutable truth, Danny boy:

Your welfare is not my responsibilty for any reason or under any circumstance.

There is literally not one single thing you have ever done in your entire life that ever had anything whatsoever to do with me having anything that I've got.

I don't owe you anything.

Paul|8.6.09 @ 2:49PM|#

They've given us a system that now can be saved only if bureaucrats limit coverage by second-guessing retirees' decisions. Government will decide which Medicare services have value and which do not. Retirees may have a different opinion.

They're already doing it. Medicare just reduced its reimbursement rate. The care organization I work for now has a revenue hole of $200,000 per month because of those reduced reimbursements.

Paul|8.6.09 @ 2:49PM|#

May I suggest a dose of your own medicine? I hear those pills come cheap.

If he's on Medicare, they're free.

Paul|8.6.09 @ 2:52PM|#

lifestyle choices (which can be offset with vice taxes)

Which lifestyle choices, Dan? Please provide a list. And I want it comprehensive. Go.

|8.6.09 @ 3:02PM|#

So Gilly thinks that, before FDR and Social Security, there were no "entitlements", no forced "subsidies," and no "handouts."

Some examples of pre-new Deal federal welfare programs would be nice, Dan.

|8.6.09 @ 3:05PM|#

Paul --

I won't be comprehensive, but an illustrative list will suffice. If tobacco puts a big strain on medical costs, a tobacco tax can offset it (and if smuggling is a problem a tax at the farm can be used.) Same with booze, marijuana (which should be legal), and even highly processed foods. (We already subsidize and/or tarrif foodstuffs based on political considerations; shifting to a rational health-based schedule is within reason.) No likey? Fine. But then quit pissing and whining like there is no possible solution to unfair subsidizing of bad health choices in a public health insurance system.

|8.6.09 @ 3:07PM|#

RC Dean --

Would you like to start with the Roman Empire, or something relatively more recent?

|8.6.09 @ 3:09PM|#

A.P.B., A.P.B. --

Gilly has vanished from the topic's radar screen. Last spotted losing altitude over Dittohead Valley. If any of you spot where he crash-landed, radio the coordinates back to base.

|8.6.09 @ 3:10PM|#

"Would you like to start with the Roman Empire, or something relatively more recent?"

I believe Gilbert and RC were talking about the US.

Paul|8.6.09 @ 3:14PM|#

Fine. But then quit pissing and whining like there is no possible solution to unfair subsidizing of bad health choices in a public health insurance system.

There is a solution to unfair subsidizing of bad health choices in a public health insurance system. Wanna know what it is?

Paul|8.6.09 @ 3:15PM|#

I believe Gilbert and RC were talking about the US.

Agreed. Europe has always been on welfare.

|8.6.09 @ 3:17PM|#

"There is a solution to unfair subsidizing of bad health choices in a public health insurance system. Wanna know what it is?"

No. Absolutely not. I could not possibly be less interested.

Paul|8.6.09 @ 3:19PM|#

No. Absolutely not. I could not possibly be less interested.

We know, Dan... we know.

|8.6.09 @ 3:22PM|#

I think we should ban private individuals from owning more than one type of stock. Why should they be allowed to spread their risk if insurance companies can't?

Paul|8.6.09 @ 3:26PM|#

Oh, generally on-topic, but how fast do you think this plan will go into deep red... like the Massachusetts and Washington plans?

|8.6.09 @ 3:27PM|#

You forgot the best part, Ian. The company whose stock you'll own picks you, and you can't tell them no or negotiate a better stock price.

Gilbert Martin|8.6.09 @ 3:28PM|#

"Gilly has vanished from the topic's radar screen. Last spotted losing altitude over Dittohead Valley. If any of you spot where he crash-landed, radio the coordinates back to base."

Translation:

Danny Boy is incapable of backup up any of his crap with actual facts.

Paul|8.6.09 @ 3:29PM|#

Ahh, public option health insurance... what could go wrong?

Premiums for Washington's Basic Health Plan will as much as double in January as part of a strategy to drive thousands of members off the popular but cash-strapped state-subsidized insurance program.

Ending weeks of deliberations, officials announced this morning that they will boost Basic Health's rates by an average of 70 percent as part of their effort to boot 30,000 to 40,000 working-class people off its rolls.

It increased choice and drove down costs by providing competition...riiiight?

Suhweet...

Gilbert Martin|8.6.09 @ 3:31PM|#

"Agreed. Europe has always been on welfare."

All the European countries have certainly been on military protection welfare from the United States ever since World War II.

Without it , not only would not a single one of them be able to afford ANY of their welfare state programs, not a one of them would even be in existence at all as independent nation states today.

|8.6.09 @ 3:32PM|#

"LiterateDog | August 6, 2009, 3:27pm | #
You forgot the best part, Ian. The company whose stock you'll own picks you, and you can't tell them no or negotiate a better stock price."

If they are offering the stock at a price that I feel is fair I'll buy it. If I don't like the price I won't. How hard is that?

|8.6.09 @ 3:41PM|#

Would you like to start with the Roman Empire, or something relatively more recent?

Something American, post Constitutional Convention. I am uninterested in the follies of foreign authoritarian regimes.

Sean W. Malone|8.6.09 @ 3:45PM|#

Heyyyyyy Dan.

Start HERE

Then please find your brain. Also, you asked Gilbert Martin (a regular reason poster and assuredly not a "dittohead" - we're not republicans here you dumbnut!) a facetious sort of question and gave him what a half hour before you start complaining that he's not here?

"APB!! APB!! OMFG, some dude on the internet didn't think I was important enough to come back to on my time table!! AWWWW WHAAAHHHH!!"

*Sigh*

Sean W. Malone|8.6.09 @ 3:48PM|#

And Paul... The system *starts* deep, DEEEP in the red, no?

I mean, any program that offshoots from, or annexes Medicare is F*cked from the start.

|8.6.09 @ 3:57PM|#

"Danny Boy is incapable of backup up any of his crap with actual facts."

So now Gilly thinks "I don't owe you anything" calls for some sort of fact-specific response?

In what sense is a crude and sneering declamation of Objectivist "1st principles" and invitation to discuss facts?

Okay. Fact is we may not owe one another anything a priori; what we have is a social compact, and we use democracy to determine its content. A public health insurance plan is no more or less legitimate than a public highway system, a public GPS satellite system, or a public park. So suck it up and write your check to Uncle Sam.

|8.6.09 @ 4:08PM|#

A public health insurance plan is no more or less legitimate than a public highway system, a public GPS satellite system, or a public park.

Of course it is less legitimate. Except for the very limited purview of what used to be called public health, health care is a completely private good.

While I agree with you that a public GPS system and a public park are inappropriately public, there is at least an argument that at least local highways are public goods and therefore are better provided publicly.

So, you are right. By the balance of your argument, health care should not be publicly paid for.

Paul|8.6.09 @ 4:09PM|#

Something American, post Constitutional Convention. I am uninterested in the follies of foreign authoritarian regimes.

Win.

Paul|8.6.09 @ 4:15PM|#

what we have is a social compact, and we use democracy to determine its content.

So the vote is a kind of violent act, then.

So suck it up and write your check to Uncle Sam.

We will, just as soon as you could give us a list of your personal lifestyle choices (including sexual activity and # of partners-- dates would be nice) so we can deduct the proper and fair amount from said cheque accordingly. Remember, privacy takes a back seat to social compacts and greater goods.

Sean W. Malone|8.6.09 @ 4:15PM|#

"we have is a social compact [Really? I don't remember signing anything], and we use democracy a Republic with a guaranteed Bill of Individual Rights to determine its content."

FTFY

Speaking of the Constitution, it actually says:

"The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;"

Now... I know everyone likes to cite the "general welfare" clause in there, but they almost always forget that part of the point is that the taxes imposed are supposed to be "uniform" throughout the US. Instead, we have some people taxed a ton, an others not at all, in order to provide for - not the "general" welfare - but the welfare of certain groups at the expense of certain others. So... Let's not invoke the whole "social contract" thing Dan, my boy.

|8.6.09 @ 4:19PM|#

"Something American, post Constitutional Convention. I am uninterested in the follies of foreign authoritarian regimes."

"Win."

Lose:

http://tinyurl.com/mzf9jq

Sean W. Malone|8.6.09 @ 4:20PM|#

PS: Mike P - The more I listen to Walter Block, the less I'm convinced that highways are a public good. You can make a case for their benefit originally - but now? 40,000 people die a year on our highways, they're often poorly maintained and designed and I'm starting to think there are more and more compelling reasons to look to private roadways or at least some private "center lane" expressways in places like Los Angeles.

|8.6.09 @ 4:28PM|#

Notice Dan, those welfare programs were administered at the state level. The federal government didn't get involved in welfare to any great extent until the New Deal. Prior to that, most welfare was handled at the state level or through private charities.

Gilbert Martin|8.6.09 @ 4:30PM|#

"we have is a social compact [Really? I don't remember signing anything], and we use democracy a Republic with a guaranteed Bill of Individual Rights to determine its content."

Indeed so.

And there is nothing contained therein about the government forcing some people to pay for the healthcare of others.


I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on the objects of benevolence, the money of their constituents."
-- James Madison

|8.6.09 @ 4:32PM|#

Correct, bookworm. So what?

|8.6.09 @ 4:36PM|#

"And there is nothing contained therein about the government forcing some people to pay for the healthcare of others."

Nor the GPS satellites of others. Good luck relitigating the Lochner era, spunkers. Americans are just salivating for a return to the social order of the Jazz Age. If only the MSM wasn't against you! You'd have a chance!

Chicken Bones of Justice|8.6.09 @ 4:41PM|#

"It's time to treat medical emergencies the same way we treat fire and police emergencies. Everybody pays in"

Everybody pays in??? Bullshit.

|8.6.09 @ 4:42PM|#

"Correct, bookworm. So what?"

There is no authorization in the Constitution for the US to administer a public welfare program. The general welfare clause in the Constitution means the general welfare or wellbeing of society as a whole and doesn't apply to taking money from some to give to others. If our founding fathers believed that, why didn't they have a welfare system? In fact, Thomas Jefferson used to bad mouth England's poor laws.

|8.6.09 @ 4:43PM|#

"It's time to treat medical emergencies the same way we treat fire and police emergencies. Everybody pays in"

We already are through emergency care.

Sean W. Malone|8.6.09 @ 4:44PM|#

Ooh... I want in on the quote game!

Thomas Jefferson wrote this:

"A wise and frugal government, which shall leave men free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned - this is the sum of good government."

He also wrote:

"Dependence begets subservience and venality, suffocates the germ of virtue, and prepares fit tools for the designs of ambition."

Annnnnd this:

"I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."

While we're at it, I love that Dan switched his argument from "it's a legitimate part of the Constitution (essentially)" to "well, it's how it is now, too bad fuckers!"

|8.6.09 @ 4:46PM|#

The more I listen to Walter Block, the less I'm convinced that highways are a public good. You can make a case for their benefit originally - but now?

That's why I qualified it to be "local highways". I meant city and town streets. Certainly point-to-point highways and freeways are private goods, especially with today's technology.

Chicken Bones of Justice|8.6.09 @ 4:46PM|#

"Some examples of pre-new Deal federal welfare programs would be nice, Dan."

The Freemen.

Chicken Bones of Justice|8.6.09 @ 4:49PM|#

"If they are offering the stock at a price that I feel is fair I'll buy it. If I don't like the price I won't. How hard is that?"

But if you don't buy the stock, the government will fine you 8% of your gross income.

Sean W. Malone|8.6.09 @ 4:49PM|#

I got your back Bookworm... see above!


Also, Dan is forgetting the 10th Amendment. Mostly because I think he must have failed civics as a lad. The Constitution (Dan) is a limit on the powers of government, and it very clearly states that what powers are not explicitly granted in the document are reserved to the "States or to the people".

That a state or local government does this or that welfare plan has no bearing on whether or not it's legal, preferable or right for the Federal government to do the same. Further, with the addition of the full text of Article 8 including the whole thing about making taxation (and subsequently benefits) "uniform" for any tax or any program, that would seem to be pretty damn antithetical to what's going on here.

|8.6.09 @ 4:50PM|#

Hey Chicken Bones. This ain't your football field, and you don't get to move the goal posts. Nobody demanded a federal example. They only demanded an American example. Go cry it out with your momma.

Chicken Bones of Justice|8.6.09 @ 4:52PM|#

"imposts and excises shall be uniform throughout the United States;"

shall be uniform? hmmmmm.....

|8.6.09 @ 4:55PM|#

This welfare clause/10th Amendment crap crashed and burned while your grandpas were still sporting flagellum tails. Everybody knows that the commerce clause and the 16th amendment are the core of the federal tax-and-spend power. Save your Jefferson and Madison quotes for your pet chinchillas.

Chicken Bones of Justice|8.6.09 @ 4:56PM|#

"Hey Chicken Bones. This ain't your football field, and you don't get to move the goal posts. Nobody demanded a federal example. They only demanded an American example. Go cry it out with your momma."

WTF???

Chicken Bones of Justice|8.6.09 @ 4:57PM|#

"Save your Jefferson and Madison quotes for your pet chinchillas."

Perhaps I'll change my handle to "Fuck the Founders" and link to the Federalist Papers.

|8.6.09 @ 4:59PM|#

Nobody demanded a federal example.

R C Dean | August 6, 2009, 3:02pm | #

Some examples of pre-new Deal federal welfare programs would be nice, Dan.

Chicken Bones of Justice|8.6.09 @ 5:06PM|#

Hey Dan! I'm space docking your mouth again.

Sean W. Malone|8.6.09 @ 5:10PM|#

I think we've had discussions about the Freemen program here before, no?

Federal - yes? Welfare... eh. Not really. It was a post-civil war Reconstruction Era program designed to recoup damages from a government imposed era of slavery and a massive, highly destructive civil war. That, as far as I'm concerned counts as restitution for crimes committed and hardly counts as a freebie handout.

MikeP: Nice!

|8.6.09 @ 5:13PM|#

"Would you like to start with the Roman Empire, or something relatively more recent?

Something American, post Constitutional Convention. I am uninterested in the follies of foreign authoritarian regimes."

You got all that was comin' to you, RC.
You want to turn this into a federalist rant, you're welcome to it.

Sean W. Malone|8.6.09 @ 5:32PM|#

Dan, you really didn't win that one at all... RC's comment was the thing that started the topic. It started out as a discussion of Federalism (which I suspect you're using incorrectly as a term, btw)... That by definition refers to American, post Constitutional Convention - and not yammering about what other nations have done in Antiquity.

That said, I'm personally glad you brought up the Roman Empire, since it was one of the greatest and biggest experiments in The Road to Serfdom I can think of, and shortly after Rome started trying to placate people with various happy welfare programs, it collapsed under it's own weight.

Gilbert Martin|8.6.09 @ 5:34PM|#

"Rome started trying to placate people with various happy welfare programs, it collapsed under it's own weight."

Speaking of which, the unfunded liability for Social Security and Medicare is now north of $100 trillion and counting.

|8.6.09 @ 5:38PM|#

So now Sean thinks this is all about federal versus state, and if we had a system like Canada, where the individual provinces run the programs rather than the national government, it would be hunky dory?

Tell me when you want to quit hiding the ball and start shooting it.

|8.6.09 @ 5:44PM|#

You're a bunch of damn Kulak wreckers:

http://news.yahoo.com/s/ap/20090806/ap_on_go_co/us_health_care_overhaul

WASHINGTON - The Senate's most powerful Democrat on Thursday scolded health care protesters dogging his party's lawmakers at local meetings, arguing that some critics on the political right have run out of ideas - and ditched their civic manners. Majority Leader Harry Reid of Nevada accused the protesters of trying to "sabotage" the democratic process....

Chad|8.6.09 @ 5:52PM|#

Only markets can assure that people have reasonable access to resources according to each individual's priorities.

Too bad there isn't, never will be, and never could be a market for most health services.

Health insurance is riddled with massive market failures regardless of who pays for it.

The only "solution" to this problem is to not have medical insurance in the first place...which leads to even worse problems.

I am sorry, libertarians, but you just have to accept the fact that the assumptions that underlie your market theory are grossly violated every which-way to Sunday when it comes to health care. Your theory simply doesn't apply, and your plans simply don't work.

|8.6.09 @ 6:01PM|#

Health insurance is riddled with massive market failures regardless of who pays for it.

Got some examples of these massive market failures?

hmm|8.6.09 @ 6:01PM|#

Krugman bash two paragraphs in. Pure win if for nothing more than that.

Paul|8.6.09 @ 6:05PM|#

Also, Dan is forgetting the 10th Amendment. Mostly because I think he must have failed civics as a lad.

Civics failed Dan... especially the segments on the U.S. Constitution. Clearly, he grew up in a time when government simply does whatever the fuck it wants, whenever it wants, however it wants.

But then again, so did I. I just paid attention in civics class-- even if the teacher didn't even believe what he was teaching.

Paul|8.6.09 @ 6:05PM|#

Health insurance is riddled with massive market failures regardless of who pays for it.

Name one.

Paul|8.6.09 @ 6:06PM|#

arguing that some critics on the political right have run out of ideas - and ditched their civic manners. Majority Leader Harry Reid of Nevada accused the protesters of trying to "sabotage" the democratic process....

*puts this into toolbelt for re-use on the left*

|8.6.09 @ 6:18PM|#

Listening to the health-care debate, I hear Republicans and Democrats saying it's wrong to deny anyone anything.

Dan falls in this category.

Let's leave aside the issue of whether some people should pay for other's health care for a second, and ask ourselves what is likely to happen in any system where you agree to provide everyone with all of the care they can use, up to the limits of biological and technological reality.

What you will get, is a massive ramp-up in demand, which will cause cost escalation (which we are already seeing), and eventually rationing. The present health care bill however, basically makes it illegal for private insuance companies to do any rationing, by barring them from not covering pre-existing conditions and denying coverage to anyone.

Basically, that will put all the private insurance companies out of business. Not because the public plan "competes with" them, but because they've basically made it impossible for them to turn a profit.

The public plan will experience similar cost escalation, which will result in one of two possibilities: (a) messive deficits and accordingly inflation and currency devaluation, or (b) price controls and subsequently shortages of services and equipment that iti s no longer profitable to produce.

Ultimately, the debate comes down to this. Not a question of whether there will be rationing or not, but whether the rationing is done by you, your insurance company, or the government. I guess I'm just one of those people who want decisions about whether a procedure is worth the price to be in MY hands, rather than some official's.

Sean W. Malone|8.6.09 @ 6:18PM|#

"So now Sean thinks this is all about federal versus state, and if we had a system like Canada, where the individual provinces run the programs rather than the national government, it would be hunky dory?

Tell me when you want to quit hiding the ball and start shooting it."

No... I don't, I think it's about sound economics & reasoning and idiocy. State vs. Federal doesn't change the fact that these things are bad ideas. It just means that what you want to do at a Federal level is completely, 100%, no kidding unconstitutional & illegal.

They were made unconstitutional & illegal because most of our founders knew that you don't have a "right" to take stuff by force from some people and give it to other people.

Health care, like anything else, is a combination of goods and services which you often need to improve or maintain your life. Those goods and services are provided by real, live, human beings who have to work their ASSES off going to med school, pharmacology school and spend years (and billions of dollars) researching ways to help other people. These people are not your slaves. So you don't get to walk up to a doctor and demand that he treats you without offering any compensation.

Most people are generally aware of this... So instead, you try a different approach. A coward's approach actually... Instead of pointing the guns directly at the doctor - who you know won't do very good work for you (or become a doctor at all for that matter, if he knew what you were planning to do to him) - you point your guns at the generic "taxpayer". Or even the specific "rich taxpayer". So you say stuff like:

"So suck it up and write your check to Uncle Sam."

By which you mean: Give me your money (which is merely the abstraction we use to show value of work, after all) or I'll have these thugs (IRS) throw your ass in jail and take your stuff.

Now, I'm not exactly naive enough to think that taxes are going away any time soon, but lets at least be honest about what we're doing here, huh?


Now. From that starting point, it's one thing to lay & collect identical taxes from everyone to support a good that *everyone* uses regularly and has access to. It's quite another to collect taxes on one group of people to subsidize all the rest, especially in an area that has as diverse needs & concerns as medicine.

Would you care for me to go on? I have more, you know.

We could talk about the economic calculation problem that completely fucks any government program's ability to function effectively...

We could talk about the heinous destruction of incentives to produce & innovate as a result of underpayment and ever-increasing restrictions/control which will wind up with massive shortages...

We've already covered the destruction of incentives for people to even bother becoming a doctor to begin with... especially smart, talented people...

Shall we talk about the sheer amount of force you're going to have to start applying against people to control their personal decisions? The campaigns against smokers and fat people are baby's kisses compared to what you're going to have to do to "control costs" in the future with shit like this...


How is all this unclear? Have I shot the ball enough for you yet Dan?

Chad|8.6.09 @ 6:26PM|#

Paul and MikeB:

From Wikipedia:

Finally, some markets can fail due to the nature of certain goods, or the nature of their exchange. For instance, goods can display the attributes of public goods or common-pool resources, while markets may have significant transaction costs, agency problems, or informational asymmetry. In general, all of these situations can produce inefficiency, and a resulting market failure.

I highlighted the three that are the major problems for health care. Agency is the biggest of the three. You, your doctor, and your insurer all have massive biases when it comes to deciding whether a particular treatment is worth the cost. This is a classic agency-style market failure, and is why a distant bureaucrat can plausibly out-perform any of the three people listed above. The bureaucrat's relative lack of specific information can be easily offset by his lack of bias.

Chad|8.6.09 @ 6:32PM|#

We've already covered the destruction of incentives for people to even bother becoming a doctor to begin with... especially smart, talented people...

Really? My cousin is a nurse anethesist, which typically requires a 4-year nursing degree, a few years as a practicing nurse, then three years of graduate-level specialty training. Once finished, he STARTED at a higher salary than the average mid-career Ph.D scientist makes.

The medical profession is far from underpaid relative to alternative professional career paths. Medical professionals also a lot more flexibility to work wherever they want than most other professionals, which should in theory result in a lower salary.

With ridiculously-paid banking jobs dropping like flies, and real-estate flippers dead and gone, I don't know what career path you think leads to more money than medicine...but would be interested to know.

|8.6.09 @ 6:34PM|#

The only "solution" to this problem is to not have medical insurance in the first place...which leads to even worse problems.

In fact, the most fundamental reason for high health care costs in the US is that we as a society are overinsured. We are insured through our employers because that insurance is bought with pre-tax money, so far more is purchased than is desired. We are insured through blind Medicare remunerations with little or no attempt to manage expense. And, between these, we are inured to think that health insurance should cover simple doctor visits rather than actual financial calamities.

So you are correct: The solution is a massive decrease in the use of medical insurance by removing the wildly inappropriate public subsidies of health care for the middle and upper class.

Unfortunately, Obama and Congress are headed in exactly the opposite direction. It is tragic, really.

Sean W. Malone|8.6.09 @ 6:34PM|#

Damn, I really love it when Chad pretends to know shit about economics. It's so funny.


Hey Chad - when there's an actual MARKET in health care (which there hasn't been for several decades, I feel compelled to remind you), THEN maybe you can wax philosophical about "market failure" in health care.

Until then, STFU, yah?

Sean W. Malone|8.6.09 @ 6:40PM|#

Also amusing that Chad is thinking I was talking about how things are *today*, when I was clearly talking about how things end up over time in a socialized system. As their salaries start to decrease by fiat and their numbers start to dwindle, let's see how many more of your cousins will go down that road.

It's also cute how Chad's forgotten that salaries are rather high in Medicine right now largely due to the cartel created by the AMA & our own Congress.

Typical Chad though, really... Ignore massive interventions in the market, pretend it's "free" then cry foul when all the government involvement he pretends doesn't exist fucks it up.

|8.6.09 @ 6:43PM|#

You, your doctor, and your insurer all have massive biases when it comes to deciding whether a particular treatment is worth the cost. This is a classic agency-style market failure

You are kidding. Pushback from an insurer is not a market failure. That is a market working.

and is why a distant bureaucrat can plausibly out-perform any of the three people listed above. The bureaucrat's relative lack of specific information can be easily offset by his lack of bias.

Now I know you are kidding.

If you actually think the insurance company is untouchable by any market forces that might offset their desire to deny coverage, exactly what do you think you could do about the bureaucrat?

Sean W. Malone|8.6.09 @ 6:45PM|#

Also Chad, we currently have a doctor shortage even by the government's own standards, created again by the AMA's idiocy backed by government force. Or hadn't you noticed?

"In theory", we have a supply problem - not enough of them to meet demand - that... "in theory" leads to higher prices. And by god! Lookie, lookie, doctor's get paid a lot more than other people! You do understand why we have a supply problem though, right?

Hint: "Market failure" isn't on the list of options.

Chad|8.6.09 @ 7:51PM|#

MikeP | August 6, 2009, 6:34pm | #
The only "solution" to this problem is to not have medical insurance in the first place...which leads to even worse problems.

In fact, the most fundamental reason for high health care costs in the US is that we as a society are overinsured. We are insured through our employers because that insurance is bought with pre-tax money, so far more is purchased than is desired. We are insured through blind Medicare remunerations with little or no attempt to manage expense. And, between these, we are inured to think that health insurance should cover simple doctor visits rather than actual financial calamities.

So you are correct: The solution is a massive decrease in the use of medical insurance by removing the wildly inappropriate public subsidies of health care for the middle and upper class.

Unfortunately, Obama and Congress are headed in exactly the opposite direction. It is tragic, really.

Yes, your "solution" is to gut insurance by increasing co-pays and deductibles. We have been trying that. And what has happened is that long before these co-pays and deductibles make any significant cost reductions, they start bankrupting people left and right. It just doesn't work.

There is no appropriate size for deductibles that provide adequate market incentives AND adequate protection. Not even close, honestly.

Chad|8.6.09 @ 7:53PM|#

Sean W. Malone | August 6, 2009, 6:45pm | #
Also Chad, we currently have a doctor shortage even by the government's own standards, created again by the AMA's idiocy backed by government force. Or hadn't you noticed?

No, Sean. There is a shortage of primary care physicians. This is the result of

A: The AMA restricting supply

B: Over-compensation of specialists.

Primary care physcians actually are paid reasonably close to what other similar professionals are paid. It is the specialists who need to take the big hits.

Chad|8.6.09 @ 7:56PM|#

And yes, Sean. The AMA is a cartel, I agree.

Chad|8.6.09 @ 8:00PM|#

You are kidding. Pushback from an insurer is not a market failure.

It is when that pushback isn't based on facts, but on one's pocketbook. Find me an insurer who isn't biased by that, please. The insurer has every incentive to deny anything it can, the patient has every incentive to consume, and the doctor has every incentive to provide. All three are hopelessly biased. The doctor is probably the LEAST biased, and if doctor pay were modified such that providing more services didn't line their own pocket, things would be better. It would still not be perfect, though, as doctors would still have a strong bias towards a suffering individual right next to them over a faceless insurance company.

Paul|8.6.09 @ 8:07PM|#

You, your doctor, and your insurer all have massive biases when it comes to deciding whether a particular treatment is worth the cost. This is a classic agency-style market failure, and is why a distant bureaucrat can plausibly out-perform any of the three people listed above.

I... I... I'm stunned. I'm utterly stunned. There's so much wrong with this statement, I can't even begin to figure out where to start in my response.

I guess I'll start with the classic rubber-meets-the-road point:

And this 'distant bureaucrat' will affect these value decisions via...pppprice controls. And what, Chad, has Mr. Mugabe learned about price controls?

Paul|8.6.09 @ 8:10PM|#

It is when that pushback isn't based on facts, but on one's pocketbook.

You're conflating two entirely different things. Making a decision based on ability to pay is not in contradistinction to fact, it's simply a factor in the decision as to the value of a certain thing. You might as well be comparing apples to the space-time continuum in your argument.

|8.6.09 @ 8:11PM|#

Find me an insurer who isn't biased by that, please.

There is a difference between bias and market failure.

If you want an example of an insurer who hasn't ever unreasonably rejected any claim I or a family member has had, then please take the examples of every single one of the five different insurance companies that I have had in the past.

I actually have no examples of the opposite. Sorry.

Paul|8.6.09 @ 8:13PM|#

Oh, and my I remind all of our reliable liberal commenters that Obama is not instituting a single-payor system? All he's doing is instituting a public option (which will drive up overall costs and reduce quality)

So, Chad, you'll get to see your distant bureaucrat make his unbiased decisions, just like they did in Massachusetts and Washington.

Paul|8.6.09 @ 8:17PM|#

There is a difference between bias and market failure.

In addition to this, it's a completely false notion that the "distant bureaucrat" (I love how that term is now positive in the minds of some) has no biases. This is counter to fact. The bureaucrat has all manner of biases, one of those being the pocketbook. Even the bureaucrat has a pocketbook he must look after. To wit:

Premiums for Washington's Basic Health Plan will as much as double in January as part of a strategy to drive thousands of members off the popular but cash-strapped state-subsidized insurance program.

Ending weeks of deliberations, officials announced this morning that they will boost Basic Health's rates by an average of 70 percent as part of their effort to boot 30,000 to 40,000 working-class people off its rolls.

Here are a large group of "distant bureaucrats" making a decision based on the pocketbook. Chad, we don't have to look very far to see how public healthcare looks. It's all over the place, and failing spectacularly.

|8.6.09 @ 8:20PM|#

You, your doctor, and your insurer all have massive biases when it comes to deciding whether a particular treatment is worth the cost. This is a classic agency-style market failure, and is why a distant bureaucrat can plausibly out-perform any of the three people listed above. The bureaucrat's relative lack of specific information can be easily offset by his lack of bias.


Hilarious.
First of all, all parties in ANY transaction are "biased". If you think me and the Qwik-E-Mart clerk aren't "biased" as to what the price for a bottle of Coke should be, you are living in fairy land.

When I go to get my even fixed, I want to pay less while getting more repairs done, my insurance company wants to pay for less (and doesn't care about what gets done), and the repairman wants to charge as much as possible for as many repairs and services as possible. Somehow the auto repair market works anyhow.

Secondly, it's naive to think that the distant bureaucrat is going to be "unbiased". Aside from the obvious opportunities for direct corruption, you will have rent-seeking at the congressional level as medical companies attempt to have their own procedures and technologies legislated into the system. You're effectively talking about having a bureaucrat grant niche-market monopolies to specific businesses. You think congressmen aren't going to lean on them to grant it to the MRI manufacturer in their constituency?

Sean W. Malone|8.6.09 @ 8:20PM|#

Ok Chad, time for you to figure out HOW the AMA restricts supply though. You're soooo close! It's right there buddy. Just go one more step, and realize that this isn't something the AMA could do all on it's own. It needs help restricting medical professionals. Guess who provides the help....

And let me correct you. Pushback from the insurer is SUPPOSED to be from the "pocketbook" stand point. That's what would keep costs down, you ninny!

Doctors + Patients push for best quality care available, Insurance providers push for lowest price. In between, is the "right" price point & treatment for the individual in question at that given time.

In the meantime, Doctors compete with each other, driving quality of care UP, and insurance companies compete with each other, driving costs DOWN. Cept insurance companies & doctors don't compete. Patients have no incentive under the current (or by the looks of it, future) system to personally evaluate doctors or costs - and insurance providers have very little competition and none what-so-ever between different states, and doctors as a result have little to no incentive to either control costs or drastically improve their services.

Everything that would be an appropriate market pressure - the things that drive quality & costs in the right direction in every other industry - don't exist in health care. Grasp that, and you may put your brain on some real solutions.

And by the by, I have perfectly "adequate" coverage - emergency only - a $3000 deductible, a low, $10-15 copay for prescription drugs and $56 premium for my own health insurance. You have to be fucking insane if you think the vast majority of the currently uninsured couldn't afford that.


I will, however, give you a C+ for this effort - only because accidentally, you've touched on a few key issues.

1. You recognized that the AMA is a cartel (you just failed to realize how they've managed to acquire that position, or who funds them/prospective doctors).
2. You almost grasped that doctors, patients & insurance companies are at odds withe each other. You figured out that they are "biased" but you failed to realize why that's a good thing.
3. You glossed over, but did admit that we have a shortage of GP doctors. If only you could have figured out how this happened, you'd have been in B- range.

|8.6.09 @ 8:20PM|#

Er ... when I go to get my CAR fixed.

|8.6.09 @ 8:24PM|#

Yes, your "solution" is to gut insurance by increasing co-pays and deductibles. We have been trying that.

We have? When? HSAs and catastrophic insurance are still not easy to come by. And given that the government or the employer are gatekeepers, I don't see them getting easier to come by. The current legislation will effectively abolish them by enforcing floors of coverage.

And what has happened is that long before these co-pays and deductibles make any significant cost reductions, they start bankrupting people left and right. It just doesn't work.

While I don't buy your "bankrupting people left and right" claim, I will grant that the poor and the sick will have difficulty with high deductible insurance. That is, of course, not a market failure. That is a market working.

But if you are worried that the poor and the sick can't access health care, then please in the name of all that is holy limit your solutions to that worry and that worry only!

The health care system needs to be freed of its shackles. The ever increasingly wealthy middle and upper classes need to learn to pay for health care out of their own freaking pockets, and the poor and sick need help in the form of free government care or food-stamp like vouchers for insurance.

No one -- I repeat no one -- needs the increased nationalization of the entire health care industry represented by the current plans.

|8.6.09 @ 8:35PM|#

The cost problem is a result of our attempts to provide universal coverage. Between employer-provided insurance, Medicare, and Medicaid, we've set up a cost-escalation spiral that is driving middle class and healthy people out of the system. The cost-benefit ratio doesn't make it worth it for them.

The real problem in health care right now isn't the inability to GET health care for the poor and/or elderly, it's the escalating costs that are hurting people who would otherwise be able to afford it and driving them out of the insurance system.

|8.6.09 @ 8:35PM|#

Oh, and most importantly, the individual should get the same tax treatment when buying health care or health insurance himself as he gets when his employer does it.

Paul|8.6.09 @ 8:38PM|#

At least Hazel is attempting to scratch the surface that I wouldn't touch at 5:00pm.

Rent seeking
Corruption
Perverse incentives
Price controls based on limited information (information is always limited)
Bureaucratic bias
Short term decisions based on political gain
"Distant Bureaucrats" holding the power of life and death in their biased hands
Rationing.

It just goes on.

It never ceases to amaze me how even liberals admit that the Soviet system failed due to all of the above problems of market manipulation, but sincerely believe that this market can be controlled by "distant bureaucrats".

|8.7.09 @ 12:00AM|#

Two observations.

#1 Thomas Jefferson owned slaves, talk about living well off the hard work of others. Interesting that Libertarians would quote him.

#2 When someone without healthcare turns up at an emergency room they are taken care of, this care is subsidized by the county [taxes] or higher insurance rates for those that do pay. In order to reduce taxes and or insurance costs the Libertarian solution is what? Dig mass graves and tell them to go off and die? Oh what a brave new world that will be.

d|8.7.09 @ 12:41AM|#

"banal and tedious misanthropy"? "declamation"? Seriously, Dan, stop posting in-between SAT verbal study sessions. I mean, did you think we couldn't tell?

|8.7.09 @ 1:53AM|#

#1

"Do not mistake me. I am not advocating slavery. I am not justifying the wrongs we have committed on a foreign people... On the contrary, there is nothing I would not sacrifice to a practicable plan of abolishing every vestige of this moral and political depravity." -- Thomas Jefferson

#2

Uncompensated health care amounts to a paltry 2% of the total health care expenditures in the US. Two percent.

The uninsured in emergency rooms is not where cost-cutting for taxes or insurance rates is to be found. And it is utterly certain that requiring -- requiring! -- these people to have health insurance will cost everybody far, far more than the current unpleasant situation costs.

Sean W. Malone|8.7.09 @ 3:04AM|#

FUCK.

I just typed out a lengthy thing in response to Mr. Grognard.

But it disappeared. Fuck me.


Anyway, basically, yes Grognard, libertarians have dozens of fine solutions to the high cost and none of them involve rationing or grave digging. You're confusing us with socialists like Peter Singer. Fail.

I have to encourage you to start by figuring out why the costs are high to begin with, when you've learned that then it will be much easier for you to fully comprehend the following selected cost-reducing measures:

1. Eliminate the Congress' allegiance to the AMA and quit restricting the number of medical licenses granted in the US. Anyone who can pass the tests/do the work should be allowed to be a doctor... End of story.

More doctors = health care providers are more widely available and cheaper across the board.

2. QUIT dictating prices and wages!!! Price controls invariably cause shortages and discourage anyone from entering the business. (If you are forced, as many hospitals & drug companies are) to take a loss every time you deal with Medicare, you will either pass your costs onto someone else (private payers/insurance companies) or you will just get out of the business. This screws everyone pretty hard. A free price system is ABSOLUTELY crucial to the success & improvement of any economic exchange.

3. Quit restricting competition!! Allow insurance companies to compete nationally and stop dictating the types of coverage they have to offer. There should be many different price-points of medicine that reflect the diverse means & needs of customers. I, for one, as a healthy 26 year old who hasn't been to a doctor in years and years, rarely ever gets sick and doesn't do a lot of "high risk" stuff - so frankly, I would much prefer a very high deductible and a $10-15 a month premium. Current laws prohibit stuff like that however.

Sidenote: Make insurance ACTUALLY insurance, like it should be - a precaution for catastrophes, not a 3rd party payer for everything that might ever come up.

4. (Wishful thinking) Do away with the FDA. It costs 6 years & around $1 Billion for each new drug produced. Is it any wonder the number of companies producing medicine is dwindling and the ones remaining are giant international corps like Merck & Pfizer? Let a multitude of private agencies rate safety like we do for other things (Underwriters Laboratory for electronics for example). Police them heavily for fraud & such. Reducing cost to innovate = savings to end consumer of drugs & technology - be that insurers, hospitals or patients directly.


Has this been useful Grognard? I sure hope so. So much more to go though.

Chad|8.7.09 @ 7:09AM|#

Sidenote: Make insurance ACTUALLY insurance, like it should be - a precaution for catastrophes, not a 3rd party payer for everything that might ever come up.

Ahh, yes. Wonderful catastrophic insurance.

There are so many delightful stories out there about how people have had such glorious interactions with these plans....which don't cover all sorts of things and will be yanked from you for any of a hundred and two reasons the day you cost the insurer a penny more than your premiums.

As Krugman pointed out in one of his editorials, the number of people employed by insurers this decade is up dramatically, while the number of people they insure has been flat.

Wtf do you think all these people are hired to do? KEEP OUT SICK PEOPLE AND BOOT THEM IF THEY DO FIND A WAY IN.

I almost lost my health insurance this year, for "not paying" a single bill - a bill which I never saw (I was moving at the time, who knows what happened to it). The insurance company, not wanting my business, sent me no warning, no second bill, no phone call, or no email to warn me about the payment deadline which would terminate my insurance permanently. Fortunately I spontaneously thought of it on my own, called them, and got the check in the mail on the last possible day.

|8.7.09 @ 8:58AM|#

Wow!

What a great thread. It was very instructive (not to mention entertaining) to see everyone chastize Dan for being a Kool-Aid drinker!

Sean W. Malone|8.7.09 @ 9:27AM|#

Chad.

I'm not sure why your brain has such a massive disconnect, but right NOW the incentives are completely fucked up and no one actually has truly catastrophic-only insurance. That is illegal.

Further, as I said, the insurance industry has little to no competition, and factoring in the other high costs, cutting out dead-weight (like people who don't pay their bills) is one of the only things those guys can do.

I'm not sure why you persist in pretending that what I suggested we make as *changes* are the way the status quo is now... I'm explicitly recommending these actions because they are NOT things we currently have.

Quit being a dumbass, please?

|8.7.09 @ 2:36PM|#

Jefferson: talked the talk but did not walk the walk. The slaves he owned were sold, not freed, when he died.

"paltry 2%" Now up to 3% and rising quickly, also that covers total heath costs which include everything from antacids to ER. Also the cost is not proportional, inner city hospitals can have as much as 35% of their ER visits come from the uninsured, and after the visit you can have the costs of medication, followup visits etc. If the true cost of the uninsured was only 2% there would be no demand for universal coverage, the uninsured would show up for free health care at the ER and everyone would be happy.

Insurance. You can't compare car/home types of insurance with health insurance, two different animals. Car insurance costs are base on one time events, an accident is paid for and that is the end of it. Health is a different matter entirely, dialysis, MS, and a variety of other disabilities are long term, and costly, care. I would be open to removing some government mandates but how coverage is determined, paid for, etc. would have to be a straightforward process for proper evaluation by the purchaser.

FDA, I work in the medical industry, you want the FDA. In the Libertarian world bad companies would go out of business, but what is not mentioned is the amount of damage and suffering they could cause before that happens. The Libertarian model might work for toasters where if it doesn't work no big deal. Health is a different matter, finding out that a drug that is ineffective or even dangerous to take should not be done in the marketplace. The FDA is there for a reason and it is a good one.

AMA, etc, Agreed, pass a test and show proficiency and your good to go. Note that the testing would be extensive, an open heart surgery test is not the same thing as a drivers license test.

|8.7.09 @ 3:36PM|#

If the true cost of the uninsured was only 2% there would be no demand for universal coverage, the uninsured would show up for free health care at the ER and everyone would be happy.

Except for two things:

1. People confuse health insurance with health care. The government does not need to guarantee the former to guarantee the latter.

2. Most who are pushing for universal coverage are doing so to signal compassion to other people. Most people are happy with their own health coverage, but they are unhappy with the health system as a whole. As usual in matters of politics, most people make no effort to educate themselves.

|8.7.09 @ 5:05PM|#

I'm always amazed at how deep the special pleading goes, how this or that case is just so, well, different that only guys with guns can force people to Do The Right Thing.

Which means, of course, directing society politically in each and every aspect of individuals who make it up.

|8.7.09 @ 7:33PM|#

Ohhh.oh...

John Stossel and all you agreeing with him.

You're names and info are being sent to [e-mail].

Tow the party line, or else. As Obama says, you have NO RIGHT TO TALK! (http://www.breitbart.tv/obama-dont-want-the-folks-who-created-the-mess-to-do-a-lot-of-talking/)

Chad|8.7.09 @ 11:59PM|#

Sean W. Malone | August 7, 2009, 9:27am | #

I'm not sure why you persist in pretending that what I suggested we make as *changes* are the way the status quo is now... I'm explicitly recommending these actions because they are NOT things we currently have.

The changes you keep suggesting are things we already do more than anyone else, and are a key ingredient in our epic failure of our system. Charging full speed ahead in the wrong direction is idiotic in the extreme.

Even if you could get to the promised land of a truly free-market system (which would never, ever, ever ever ever EVER EVER EVER EVER happen), it would still fail. You get so caught up in arguing that it wouldn't fail that you fail to realize that whether it would or wouldn't is irrelevant anyway, as we will never have such a system.

Here in REALITY, we will have a public/private mix. Our current mix is a mess. Deal with it.

Sean W. Malone|8.8.09 @ 4:05AM|#

"The Libertarian model might work for toasters where if it doesn't work no big deal."

The libertarian model DOES work for toasters, except, instead of toasters burning down people's homes, they're tested by the Underwriter's Laboratory. Which is a private organization. Why exactly can a similar situation not apply to health care Grognard? The only response I've ever gotten to that question has been essentially: "But, but... we've always had an FDA and companies would do bad things!"

A broad complaint directed at the other libertarians here... Why does everyone come here and make a comment like;

"In the Libertarian world bad companies would go out of business, but what is not mentioned is the amount of damage and suffering they could cause before that happens."

...as if we've never heard that before? Some 90% of these arguments I in fact had thought about by the time I was around 16. Of course, what's actually not mentioned by people like Grognard are the lives lost from the myriad drugs which have been approved after years and years which were perfectly safe from the beginning. I guess we don't care about the suffering that we could have prevented. And they really never mention the instances where the FDA has approved something that later turned out to be dangerous.


Grognard... When we're talking about altering body chemistry, performing surgery and generally anything else in the health care world, risk is impossible to eliminate. It's impossible to eliminate period. The world is not made out of nerf. Believing that somehow the FDA or any government agency can make life risk free is just one more example of magical thinking that has no basis in reality. Grow a pair of bollocks and welcome to life.

Chad, I'm talking to you on that one as well...

Here in REALITY we have a public/private mix in virtually all aspects of our life, but a little bit of free market goes a hell of a long way - this is why, even in our fucked up system, we still produce vastly more innovations, have more doctors & hospitals and equipment per capita than anywhere else in the world and we are the world's primary supplier for medicine.

As for "charging full speed ahead in the wrong direction"... YES Chad, that IS idiotic in the extreme, I'd suggest you quit advocating that. It would make you less of a moron, though that seems rather unlikely at this point. It's always funny to get lectured about "Reality" by someone who doesn't understand even the basics of supply and demand and who doesn't even have the slightest bit of understanding (or desire to learn) about how the health care system in the US is what it is now. When you actually enter the realm of reality, let me know buddy.

Sean W. Malone|8.8.09 @ 4:31AM|#

So, I've offered a series of economically sound solutions to the problems plaguing our health care system. Like all economic problems, the biggest and most important aspect is increasing production to meet demand, thus drastically lowering price. From doctors to medicine to MRI machines to insurance plans... AND, contrary to Chad's reading comprehension problems, I didn't even suggest things that actually require the elimination of government!

1. License as many people who can meet the standards to be MDs, no more AMA
2. Get insurance companies to compete for real, nationally.
3. Stop doing idiotic stuff like wage & price controls which ALWAYS cause shortages of goods & labor.
4. Make all health care tax-free making individual plans cheaper and breaking the tie of health care to employment.
5. Tort/mal-practice reform.
5. (And if ever possible) fix the FDA shit... or abolish the FDA (which I would obviously prefer) to where it costs less than $1 Billion per new drug.

These solutions really aren't that hard. They are all things that could be done within the existing structure of medicine, and they would all actually reduce costs and thus make better quality care more widely available to all people. If we did just those things listed above we'd see an increase in the number of doctors who would be able be paid less - except who also wouldn't have to pay $50,000 a year in malpractice insurance, an increase in the production of drugs, 40-60% cheaper insurance for individuals who want to buy their own coverage just from taxes alone, and then even cheaper/more customizable insurance as a result of legitimate competition among insurance companies.

Reduction of costs across the board from doctors to treatments to insurance to drug manufacturers = more people have more ability to pay... Keep going that direction, produce more and more and eventually, problem solved entirely.

The only real problem with them is that they require people like Chad to accept the fact that they are not smart enough and won't *ever* have enough knowledge to plan the health care of 300,000,000 people.

We just need some people to have some goddamn humility for once and quit thinking that if only the "smart" people ran the world, they could think of everything, plan for everything and "distribute" the resources of the world in a fair way. No one can. The best you can do is create a one or two size "fits all" system that jams millions of oddly shaped individuals into your round & square holes. And in the process you'll fail so hard at actually producing anything that we will run out of the basic supplies within a few years anyway. Here we are sitting on $100 Trillion of unfunded medical liabilities for the US Government and we keep running full speed ahead with socialist idiocy (which is the actual direction we've been running for 50 years, Chad).


That's hardly what I call progress, progressive.

Chad|8.8.09 @ 8:47AM|#

Sean W. Malone | August 8, 2009, 4:31am | #

1. License as many people who can meet the standards to be MDs, no more AMA

The AMA should no longer be the gate-keeper into the profession, agreed. There is no reason to "eliminate" it as a general professional organization.

2. Get insurance companies to compete for real, nationally.

It's already trending that way in the first place. But they all are awful because they all face the same mis-aligned incentives. A choice between a half dozen piles of dung is still shitty, isn't it?

3. Stop doing idiotic stuff like wage & price controls which ALWAYS cause shortages of goods & labor.

It depends on the prices, now doesn't it?

4. Make all health care tax-free making individual plans cheaper and breaking the tie of health care to employment.

You got it backwards. All health care should be taxed. But your general point of leveling the playing ground between employee-sponsored insurance and private insurance is correct.

5. Tort/mal-practice reform.

Agreed. It should be essentially impossible to sue your doctor except for wilfull misbehavior.

5. (And if ever possible) fix the FDA shit... or abolish the FDA (which I would obviously prefer) to where it costs less than $1 Billion per new drug.

No. 95% of people are simply not smart enough to separate truth from fiction on this matter. When is the last time you read JAMA?

These solutions really aren't that hard.

They aren't hard, but they won't solve the problem, which is the massive market perversions that are inherent to insurance. You refuse to come up with viable solutions to these problems, because you don't have any that fit within your ideological framework.

We just need some people to have some goddamn humility for once and quit thinking that if only the "smart" people ran the world

Actually, I think only 1% of people should even have the right to vote. Notice we are getting smoked by China, which essentially works that way.

...socialist idiocy (which is the actual direction we've been running for 50 years, Chad)

Really? Government spending as a fraction of GDP has been more or less flat for decades.

Jesus|8.8.09 @ 9:37AM|#

Does the guy sitting behind in the movie theater have TB? He might if he works as a janitor somewhere that pays minimum wage and he can't afford decent health care. So what do we do as a society? Have no one be the janitor and everyone be the high paid CEO that can afford great insurance? Who will mop your piss?

What if you you're born retarded or develop CP? Should you take out a few more 100 thousand in student loans and get an advanced business degree so you can get a really high paying job as a Wall Street Bank exec? Or maybe we just grind the unfortunate into sausages.

What socialist societies are collapsing Stossel? The CCCP -- Nazi Germany? Those types of institutions were militant-totalitarian, not democratic socialist. There are socialist nation states doing quite well that WE have to borrow money from everyday to support our new breed of corporate national government -- which is fascism by definition.

Obama will fail, but not because single payer can't work and compete effectively with private insurance lowering rates and improving quality. He will fail because that's not what the plan will be. He will fail because the plan that will be approved will be another mandated redistribution of middle class wealth to the richest 1 percent. Just like the law passed that forbids Medicare to negotiate with pharma for bulk rates.

Sean W. Malone|8.8.09 @ 12:03PM|#

"Really? Government spending as a fraction of GDP has been more or less flat for decades."

That's a lie, first of all, and you know it. We're pretending that that's the case through bad accounting and ignoring inconvenient facts like 100s of Trillions of dollars in unfunded liabilities. Why don't you actually be honest about that and look at the projections from the CBO on this issue?

If you actually take a longer view, you're not even close to right about that. If you only look at the last 50 years, sure, it's hovered around 18-20%... And we've inflated the ever loving shit out of our currency in that time as well ($1 in 1913 is worth merely 4 cents today), which has allowed government to do exert massive amounts of control that they could not possibly have done otherwise. But I'm sure that's a bit over your head...

That said... The idea that merely reviewing government spending is any measure of socialism at all is ridiculous Chad. The point is how much control is exerted over the economy. Are we going to play definitional games now?

And how can you possibly bring up China and not realize what they've done in the last 60 years!? China is "smoking" us right now ONLY because of their attempts at market *liberalization* over the last 50 years. Their markets have gotten consistently freer, our have gotten consistently more controlled. They actually started learning lessons from Hong Kong. Are you really that dense?

China is an example for why we should be pushing more freedom in our markets, not why we should squeeze them harder!

"Actually, I think only 1% of people should even have the right to vote."

You don't say? I suppose only the smart people should vote huh? The unwashed masses are too stupid to be allowed to have a say in decisions that affect them. I rarely use this word, Chad - but you are just fucking evil.

And I mean that. Your evil may be a result of your ridiculous arrogance and stupidity, coupled with your belief that you can force people & the world itself into a shape that suits you, but it's evil none-the-less.

Fuck you.

"You got it backwards. All health care should be taxed."

I'm sorry, Chad... I forgot. Everyone should be taxed on every little thing they do. Government owns us after all, right? Every aspect of our lives should have about 40-50% shaved off the top to support government. Oh wait, it basically already is!

"Just like the law passed that forbids Medicare to negotiate with pharma for bulk rates."

Care to provide a link on this one?

Because last I checked Medicare regularly UNDERPAYS for drugs and medical services.

And Jesus, if that is your real name, all socialist programs are mandated redistribution of middle class & poor wealth up to rich people. When economic decisions are made for political reasons, who in the hell do you think is going to benefit? Rich people who are connected to the politicians. Duh. Are we all really that ignorant of how socialist/communist societies actually work/have worked, that this is unknown now? Go talk to some Romanians who lived through the USSR, or Estonians... Or even the Russians themselves. Spending 5 hours a day standing in lines only to find out that there is no bread left is *not* a life I want to live.

For godsake, Cuba couldn't even centrally plan the provision of fucking toilet paper! And how hard is that?

Of all centrally planned goods, one would think that toilet paper would be possible... there's only 2 variables really! X citizens & Y rolls used per month = Produce and distribute XY number of toilet paper rolls per month. FAIL.

|8.8.09 @ 1:20PM|#

Sean
In my job I deal with TUV, CSA. the FDA as well as UL and a variety of other private and governmental agencies. The big difference between UL and the FDA is that UL can ask you to remove their label, the FDA can close your doors and seize your product. As a governmental agency the FDA also has investigatory powers that UL does not posses. Nowhere did I state that it was a "magical" agency that catches everything. In fact just recently a medical company was found to have used ghost writers to make what looks like phoney research papers to prove the efficacy of their products, a UL type entity would ask them to remove their label, the FDA can walk in and close their doors and remove their products from every hospital in the US as well as abroad. If you gave a UL type agency the power to close doors and recall product then you have basically created a quasi governmental regulator. And would the subscribers to a regulator that powerful want some governmental oversight?

Sean, Chad

Tort reform. I don't see how the Libertarian world would solve the problem of lawsuits. With no governmental oversight the only recourse for injury is the courts. Using the previous example anyone damaged by taking a product that was approved using phoney research could of course sue the company for fraud. But they could also sue the UL type regulatory body, hospital , insurance company, and the doctor for not doing due diligence as far as the approval or use of the product. If you put limits on liability or damages then you have just as much governmental meddling as the interest groups continuously vie for defining those limits.

Sean W. Malone|8.8.09 @ 1:38PM|#

I'm not talking about limits on damages or liability actually, I'm really talking about something as simple as making the loser of the suit pay all costs.

The cost of lawsuits isn't largely a problem because of actual deliberate or negligent malpractice or from drugs/treatments that were known to be unsafe. The high cost has much more to do with the massive amount of ambulence chasers out there who see doctors, hospitals & insurance companies as a cash cow and who don't put up any significant risk if they lose.

If you go to court and have your suit thrown out on the grounds that it was frivolous, you cost everybody time & money through lawyers fees and everything else. I'm not looking for government "meddling" in the sense that you limit the damages - but just a small change in the structure of the court that would put a more even burden on plaintiffs & defendents in terms of covering costs. If you take a doctor to court just to extort some money out of them, and you fail, then you should have to cover *all* fees associate with the trial. Just get rid of the incentive for lawyers to go for the "deep pockets" and sue everybody in sight for any reason imaginable and we should be alright on that end.

The main concern I have is drastically increasing the supply of medicine & doctors, and those are both screwed up hardcore by actual government meddling.

Sean W. Malone|8.8.09 @ 2:02PM|#

"If you gave a UL type agency the power to close doors and recall product then you have basically created a quasi governmental regulator."


Except that it would be voluntary, contractual and one of several possible competing organizations.

Say "we", by which I mean an organization of concerned medical professionals & consumer advocacy people, create a licensing organization... Let's call it the "Medical Technology Review Council" or MTRC.

Like the UL, we trade on the respectability of our name and the fairness & accuracy of our rulings. Consumers (and retailers) want to know we've reviewed the drugs their getting, because they (or their doctors) are concerned with the safety, and medical suppliers want to get our approval because otherwise no one will likely buy their products - or sell them.

Part of our contract with any company who wishes to obtain our approval is that we will continue to randomly & routinely inspect their product for a period of X years following the initial review if approved and if, within that time, we find that your product is not safe over the long term or that your production standards have dropped over time - you must remove the product from the market immediately until we have decided it is safe.

If you reneg on that contract... If your product fails to meet our standards over time, we tell you about it, and you still refuse to take your product off the market - Then we will sue you massively for breach of contract (and win), we will widely distribute press-releases and use the damages recovered from our lawsuit to fund a series of highly publicized ad campaigns informing the public about your behavior.

If you don't like the MTRC's terms - you can go to another similar organization with different terms that better suit your concerns, but knowing that we also review and publish our findings on the standards of other ratings organizations and constantly work to inform the public at large and all retailers of the importance of high safety standards. We do this, partially because we are concerned professionals (as noted above) but also because as a safety ratings organization, our credibility is our primary product and we need our customers to know when competing organizations have lower credibility than we do.

***

There could be dozens of such competing organizations, though I'd imagine only a few are really necessary, much like the UL.

However, this is how you pit different interests against eachother. I have a desire to take safe drugs (personally, I avoid taking any drugs as much as possible) so my doctor and I actually check whether or not the medication has been reviewed by the MTRC - if not, we find something that has been. The MTRC itself has the incentive to work as hard as they can to only approve good drugs, since their credibility is at stake. And if a group of doctors, me personally, or a class-action group thinks the MTRC has made a mistake or deliberately approved something unsafe, we sue their asses and sue their asses hard.

All the while, companies just do what they've always done - make products at as with as high profit margin as they can and not piss anybody off.


At least this way, the MTRC way, there are a dozen checks and balances of people working against each other in ways that push towards higher safety, better quality and cheaper prices. And if something goes wrong, there's actual recourse (contrary to your point, to some extent). Whereas with the FDA. If you think they fucked up, good luck suing them. And if we discover that some drug companies have been simply bribing FDA officials to circumvent the $1 Billion/6 year cost of approval? What do we do? Get mad at the company, sure... but the FDA itself? No problem... they keep chugging along. No worries.

The thing I've really never been able to understand about this kind of stuff is that anyone who's really afraid of big business and fraud *SHOULD* adopt the libertarian positions on things. Ours is the only way that A. doesn't rely on magical thinking, and B. Actually recognizes a functioning system of checks and balances.

Chad|8.8.09 @ 2:58PM|#

Sean W. Malone | August 8, 2009, 12:03pm | #
That's a lie, first of all, and you know it.

You say it's a lie, but then one paragraph later, you back up MY claim with numbers? I am confused.

If you only look at the last 50 years, sure, it's hovered around 18-20%...

Exactly. And note that this has been true while spending on health care and Social Security have gone up substantially. This means spending on everything else (military, infrastructure, the judiciary, executive, and legislature, education, etc) has gone down on net. And we wonder why bridges are falling on peoples' heads.

And how can you possibly bring up China and not realize what they've done in the last 60 years!? China is "smoking" us right now ONLY because of their attempts at market *liberalization* over the last 50 years. Their markets have gotten consistently freer, our have gotten consistently more controlled. They actually started learning lessons from Hong Kong. Are you really that dense?

Are you so dense that you cannot realize that there can be both TOO MUCH and TOO LITTLE government. China had too much, and is reducing it in a fair intelligent manner. We have too little, and can't even put our damned shoes on in the morning without some lout shouting "Get your damned government hands off my Medicare!".

You don't say? I suppose only the smart people should vote huh?

Yep, IQ of 135 AND proof of passage of a comprehensive civics test, or stay home, please. A stupid vote is far worse than no vote.

Your evil may be a result of your ridiculous arrogance and stupidity

Well, I surely ain't stupid, and there is no reason to be arrogant about talents I was born with. It is just a fact that you shouldn't base your decisions on the opinions of uninformed idiots. Yet our nation plods down the path chosen by the 50.1% voter, who is demonstratably about as smart as a pig.

|8.8.09 @ 6:37PM|#

Sean

Thank you for an excellent dissertation on how a free market MTRC would operate. So how would this effect me as a consumer? First in order to choose an insurance plan, and knowing there are no government mandated minimum standards, I would need to choose an MTRC equivalent for insurance. I have to research the various insurance plan rating agencies as well as the agencies that review hospital standards, equipment, and drugs. Of course every company touts their company as being the best so I have a lot of work to do to sort out fact from fiction. Also note that some of these ratings might be something I have to pay to see, after all these are for profit companies. So I do my investigation of these regulatory companies and arrive at a decision, I pick an insurance plan from a company I can trust, am I done? No, knowing that some regulatory companies might relax their standards to gain more customers I also have to do a periodic review. OK not too bad but what about other products? Home owners insurance, car insurance; again, no standards set by government so to due diligence is up to me, a laborious process. Product safety? Again more research because there are no standards. I want to buy a can of beans, sure the grocery store will want to insure the products they sell are safe but again no standards and I have top look on the product label to insure the food inspection was done by a company I approve of. I want to buy a car, no standard crash test standards or safety ratings, so again due diligence is up to me. I'm not saying that the Libertarian model will not work but I am saying that a lot of things regarding product safety and standards that we take for granted now would have to be on us, requiring a lot of time and effort.

The second issue would be for the providers of any product or service. Due to competition the companies that rate products could be fairly close in their performance, and that could get into a problem with preferences. MTRC company A is preferred by a group of hospitals, company B is preferred by a consumer group. A region of the country might like company C. In order for me to sell my product nationwide I might forced to subscribe to everyone that regulates my company, and the cost of doing so is passed on to the consumer. In stead of dealing with so many entities it is very possible that companies would ask for a monopoly company, like UL, to do the regulatory job and if so are things that much better? By the way I am a big fan of Robert Nozick and think his book Anarchy, State, and Utopia is a must read to truly get an idea of what a government should do, in short everyone is right, it is all a matter of preferences.

|8.9.09 @ 2:04PM|#

What IS Obama's plan? I haven't seen it yet. He talks about his plan. The media talks about his plan. The only plans I've seen are from the House and from the Senate?

Sean W. Malone|8.9.09 @ 2:58PM|#

Chad, I'm going to be ignoring you from here on out... Sorry - but your level of evil no longer warrants a response from me. At least not here.

Grognard; Thanks for actually having a discussion!

"I'm not saying that the Libertarian model will not work but I am saying that a lot of things regarding product safety and standards that we take for granted now would have to be on us, requiring a lot of time and effort."


This is true... But I'm not advocating a 100% shift in the span of a year or whatever. These things take time to adjust. Obviously, the American Medical Association, the American Cancer Society, the Heart Association, etc. didn't spring up in a day with the credibility that they have now. They took several years of consistency to garner solid reputations and now they are all widely respected. The Underwriters Laboratory is the same way. But the UL actually does set the industry standards for a whole host of safety procedures with respect to consumer products.

I'm talking about expanding a similar role into other organizations in other fields.

But of course, if you are 65 years old and have been expecting & planning on Medicare covering your health treatments past retirement, no one - or at least certainly not me! - is talking about simply stripping that away. Our government has made a lot of promises to a lot of people that frankly, are completely unsustainable and impossible to keep over the long term. As costs spiral, we go more and more bankrupt.

Chad doesn't realize that... He seems to believe that there are enough rich people out there that we can just keep pushing up tax rates and borrow money and somehow make it work. We can't. Medicare & Medicaid together have over $100 Trillion in unfunded liabilities. Most humans can't conceive of that number properly, but to quote physicist Richard Feynman,

"There are 10^11 stars in the galaxy. That used to be a huge number. But it's only a hundred billion. It's less than the national deficit! We used to call them astronomical numbers. Now we should call them economical numbers."

The problem, as I keep saying here, is that we simply cannot pay for all this stuff. Social Security, Medicare/Medicaid, our Military hegemony. We cannot afford any of it. We've been living on borrowed money & borrowed time for decades.

I'm 26. Most people I've met my age already laugh at the idea of getting anything from the Social Security system which we pay into year after year. It started out with I think 40 people paying in to every 1 collecting benefits, and now we're at 3:1. The US government has it's ass so far out on the line for the promises politicians have made over the years, that any suggestion of further expansion is pure insanity at this point.


But all those promises have affected people's lives over the years.

People retiring now were told all their lives that they would get social security benefits. So instead of saving more for their own retirements, they've assumed that they would get government payouts. They paid IN to the system after all, so why shouldn't they? But the money doesn't exist, and the more we tax the citizens of this country the less we are able to expand & produce and increase the real wealth of the world. This is a severe problem. But it's obviously unacceptable to pull the rug out from under a bunch of seniors who's only real crime was believing their government had magical powers to circumvent economic law...

Anyway - so a transition period away from the FDA and things of that nature can't happen over night. It has to be a roll back. Say starting with simple things like allowing patients to take non-FDA approved treatments upon the signing of a series of waivers assuming all liability if things don't work. The FDA can still exist, but if there is a new cancer drug that was approved 5 years ago in Sweden that you'd like to try but hasn't been FDA approved yet, you should have the right to try that drug - assuming all risks and promising not to sue anyone.

From there, other organizations could/should be allowed to compete with the FDA. If the American Cancer Society wants to evaluate the Swedish drug, they should be allowed to do so. Even if they have to put a label on it that says, in bold letters:

THIS DRUG HAS NOT BEEN APPROVED BY THE FDA, BUT THE AMERICAN CANCER SOCIETY REVIEW BOARD HAS FOUND EVIDENCE THAT IT MIGHT HELP ___

Etc.

Then you can go to your doctor, and say, look... I'll try anything, and this looks promising, I promise not to sue you or the government or the American Cancer Society, but can I please try it.


What exactly is wrong with that?

And eventually, more organizations like that can pop up evaluating specific things. For ever Pfizer or Merc, there are hundreds, maybe thousands of people who are skeptical and even filled with hatred of pharmaceutical companies. For every drug they produce, why shouldn't there be a watchdog organization out there warning of its risks and evaluating/double checking their work?

For me, I would trust a dozen "MTRC" style groups made up of people who's major stock in trade is their reliability and trustworthiness, combined with hundreds of watchdogs made up of people who hate Pfizer, than the FDA, who is requiring Pfizer to spend $1 Billion and 6 years of their precious time to appease.

The higher the approval costs, the less likely it is that Pfizer would ever want to make a change after they've spent $1 Billion, as well! What if they know there's a minor, but generally correctable flaw in their formula for something - but if a change would mean another $1 Billion and another 6 years, they'll either try to hide the flaw or scrap the drug entirely. What good is this doing anyone?

I say none.

Chad|8.9.09 @ 4:26PM|#

Chad, I'm going to be ignoring you from here on out... Sorry - but your level of evil no longer warrants a response from me. At least not here.

Yes, I am evil, because I point out the obvious fact that most peoples' votes are worth less than zero. In case you may have missed it, our founding fathers agreed with me. They feared the tyranny of the majority and deliberately structured the constitution in order to limit who could vote and to seperate voters from actual policy by layers of representation. They didn't do it fairly by any means, but their intent was clear and not misplaced. We will never have a sane society when Joe Six Pack has the deciding vote.

Chad doesn't realize that... He seems to believe that there are enough rich people out there that we can just keep pushing up tax rates and borrow money and somehow make it work. We can't. Medicare & Medicaid together have over $100 Trillion in unfunded liabilities.

Wrong. I have repeatedly called for higher taxes on EVERYONE. That means YOU and ME and anyone reading this. A 5% VAT and a carbon tax would hit everyone. Corporate taxes should be dropped to 25% as to be consistent with the rest of the world, but capital gains taxes should go up in return, and in a manner that results in a net tax increase. The "rich" can also pay a surcharge of 1-2% on FICA, which would take a huge bite out of their projected shortfalls.

Most humans can't conceive of that number properly, but to quote physicist Richard Feynman

Yet you want people who cannot even conceive of these numbers to be able to vote on them. Do you not understand the problem?

I'm 26. Most people I've met my age already laugh at the idea of getting anything from the Social Security system which we pay into year after year

Even if SS was unchanged, there will still be enough coming in from our kids to pay ~65% of the promised benefits. If you are relatively poor or working class, you will probably get most of what you are promised. If you are a professional or otherwise be wealthy, a lot of your SS will be means-tested away.

For me, I would trust a dozen "MTRC" style groups made up of people who's major stock in trade is their reliability and trustworthiness

Yeah, it worked great on Wall Street. Such organizations are hopelessly riddled with conflicts of interest, it is hard to put much faith in them.

Sean W. Malone|8.9.09 @ 8:47PM|#

"Yeah, it worked great on Wall Street. Such organizations are hopelessly riddled with conflicts of interest, it is hard to put much faith in them."

Ok, apparently I am going to respond to Chad again.

You dumbfuck. Wall Street isn't regulated by a damn one of those organizations and doesn't REMOTELY fit the private - or even market-based - system that I just got done talking about.

The financial industry is regulated by DOZENS of government entities. Maybe you've heard of some of them:

The Securities & Exchange Commission
The Commodity Futures Trading Commission
The Federal Reserve
The FDIC
The Financial Industry Regulatory Authority
The Office of the Comptroller
The US Treasury
The National Credit Union Administration
The Office of Thrift Supervision...
etc. etc.

Exactly how does that fit even the slightest bit of what I was just talking about? It doesn't.

Does it ever get tiring arguing with strawmen all the time?

Fuck, Chad. And for the record, you are *EVIL* because you envision a world in which the masses are merely serfs controlled by the "smart" overlords... Smart as defined by a meaningless IQ test and a "civics" exam (which if it were about the US Constitutional system, you would fail, incidentally!) - and the exam is written by WHO exactly, Chad? Written by other "smart" people who know what's best for all the stupid, unwashed plebeians out there?

No, Chad, the electoral college is one of those protections against the tyranny of the majority - but what you're advocating is even worse than that kind of tyranny. What you keep advocating time & time again is the no-kidding, and much more palpable tyranny of a goddamn literal oligarchy. And it might very well be the worst of all kinds of oligarchies - one in which all the members are people who think they know more than everyone else. The kind of people who have 100% certainty in the righteousness of their plans for a better world... for the "greater good". What could possibly be worse than that?? An oligarchy made up of "experts" who "know what they're doing" and if you disagree or have a different idea... well, you only have a BA from the University of North Dakota, I'm sorry to say, and your masters got their Ph.D's from Yale & Princeton, so obviously you don't know dick and they know all. This is the tyranny of pretentious assholes who cannot even conceive of a world in which they are wrong, much less a world in which they are incapable of knowing everything. (And I say all this with a masters from an Ivy-league school)

No really, what could possibly be worse than a dictatorship made up of arrogant dicks who think they know more than all of the stupid rubes who's very lives are dangling in the balance of their actions? I can't think of anything.

FUCK YOU Chad. No... Really. Fuck you.


And NO, Chad I don't want people who can't conceive of a trillion as a number voting on how to spend that amount of money (btw, all politicians are Humans, are they not? Humans who have the same difficulty conceiving large numbers as every other non-politician human... So, you have a severe logic fail right off the top). But no Chad, if you hadn't realized it over our many exchanges, I want a world where no one has that kind of power, so I don't want people "voting" to contribute trillions of dollars of other people's current & future money, and all of their grandchildren's money to ANYTHING you nimwit! NOTHING. You don't have the goddamn right to conscript people, or their children, or their grandchildren into supporting some special "plan" you have for the world.

No one does. So no - I'm not suggesting people who can't even conceive of astronomical economic GOVERNMENT numbers like $100,000,000,000,00+ "voting" on anything of the sort. NO one should be voting on shit that patently violates the system of individual rights on which our country was founded. We're a REPUBLIC, Chad. Not a democracy. This is a fact you persistently miss (and why you'd actually fail any properly administered civics exam litmus test).

People deserve to make their own plans, free from you and your condescending horseshit. If people are stupid, let them make mistakes and learn from them. If they don't learn from them, well I guess that's the world we get Chad. But you don't get to decide for them what they should be doing. Not you, not me, not Stephen Hawkings, not Noam Chomsky. Not anyone... GET IT? And they don't get to use $100 Trillion stolen from ordinary, productive people to do it either.

You dictator-worshiping wannabe henchman taint-sore.


And PS Chad, in this Brave New World that is Chad's personal Utopia where everyone is controlled by their intellectual "betters" and personal choice is a thing of the past... What exactly makes you so certain that you won't be lumped in with the rest of us "idiots"?

God damn it... I honestly, seriously... Hate. You. Seriously dude... I haven't said that about another human being in years... I don't even think there's another person I'm aware of who I could say that about right now.

Congratulations, you self-righteous twat.

Sean W. Malone|8.9.09 @ 8:49PM|#

/rage


And Grognard - if you want to continue a real conversation, happy to do so anytime :)

Chad|8.9.09 @ 11:20PM|#

Sean W. Malone | August 9, 2009, 8:47pm | #
The financial industry is regulated by DOZENS of government entities. Maybe you've heard of some of them

Sean, I was talking about such epic failures as S&P, Fitches, and Moody's. If libertarian theory worked at all, it would require these types of companies to get things very right, when they have yet to do so once. This is because it is all but impossible for them to eliminate conflicts of interest. The government agencies you listed did not and do not have the power they should have to regulate banking, which far and away is more deeply infected with rent-seeking and unfair business practices than any industry on earth. Frankly, I think banking should be regulated to the same degree as utilities are currently. There is no real "innovation" in what they do, which is fundamentally the same thing that has been going on for thousands of years.
Hiding what you are doing in a veil of complexity is not innovation, yet that is largely what the banks focus their energy on.

The kind of people who have 100% certainty in the righteousness of their plans for a better world... for the "greater good".

Wrong again, Sean. We don't have 100% certainty. We just play the odds.

No really, what could possibly be worse than a dictatorship made up of arrogant dicks who think they know more than all of the stupid rubes who's very lives are dangling in the balance of their actions? I can't think of anything.

A dictatorship made up of a moron who can't tell a billion from a trillion…which is precisely what we have now.

And NO, Chad I don't want people who can't conceive of a trillion as a number voting on how to spend that amount of money

Well, the fact is that they DO vote, and they SWING votes. Politicians bust their balls to raise money so they can buy ads that are so transparently vapid and wild distortions of the facts that there is no possible way anyone with more than a quarter of a brain could be swayed by them. Yet politicians wouldn't buy them if they didn't work, which shows how many people ARE dumb enough to buy such garbage.

(btw, all politicians are Humans, are they not? Humans who have the same difficulty conceiving large numbers as every other non-politician human...

Not the ones I vote for. I refuse to vote for anyone for anything more important that dog-catcher unless theyare at least as smart as I am.

We're a REPUBLIC, Chad. Not a democracy. This is a fact you persistently miss (and why you'd actually fail any properly administered civics exam litmus test).

Sean, I am advocating we become more of a Republic and less of a Democracy. I want several layers between Joe on the street and the people making decisions. When the country was founded, there was more than there are currently. For example, Senators were once not directly elected, nor were presidential electors tied almost directly to a popular vote. Our overly-direct democracy, combined with the advent of television, has gummed up the entire system with partisan bickering. We are standing nigh-paralyzed and can't solve any long-term problems.

And PS Chad, in this Brave New World that is Chad's personal Utopia where everyone is controlled by their intellectual "betters" and personal choice is a thing of the past... What exactly makes you so certain that you won't be lumped in with the rest of us "idiots"?

Sean, rest assured, your "personal" choices will be left untouched. Now, how many of your choices are truly personal? That is a question you really need to think about.

God damn it... I honestly, seriously... Hate. You. Seriously dude... I haven't said that about another human being in years... I don't even think there's another person I'm aware of who I could say that about right now.

I am proud to keep you on your toes. I was a little libertarian partisan just like you at your age. Hard to believe, eh?

|8.9.09 @ 11:41PM|#

Easy there fellas.

All I know is I'm Canadian and lemme tell ya, I laugh my ass off when Democrats/Liberals actually say with a straight face that they'll be "able to control costs." What a bunch of bull shit.he

Yes, the right are misusing facts about the system but, I feel, they're getting the overall gist right. The left for their part are over estimating it. Not that they care about things like "costs" and "efficiencies."

Let me preface by what I'm about to say with, Canada produces and has produced great doctors and scientists. Our med schools are among the top in the world. As a wealthy nation, no one should be scared of coming to our hospitals. The problem we face is more functional than anything. Indeed, no system is perfect.

So...

Some things to consider: Universal health care systems such as Canada's (and it varies from province to province since health care falls under provincial jurisdiction) have seen: overall quality of care drop, rising expenditures (Canada now spends c. $5000 per person. Second to the US), ridiculously long obscene wait times (don't remind me it's so frustrating. To the point we go private now. In Quebec, we have private options. Forget too long to explain. Move along), doctor and nurse shortages (because, well, you know the government runs it), millions of Canadians without a GP and without one good luck. You ain't going to see a specialist. And if you do, it takes months to see both, the system be scammed by foreigners, lack of proper advanced equipment, people lying sick in the hallways puking in front of everyone in the hall ways (some dignity), as much as 75% of costs go to labour, massive fiscal mismanagement, report after report after royally annoying Royal Commissions that state the obvious (more wasted money), how poorly we do relative to the OECD, and on and on.

Sure, I admit, some of these can be argued but the basic tenet remains: "Mom, no one told me it was going to be THIS hard!"

And we're just 30 million people! Imagine you guys! Now to be fair, some days are better than others and you come out saying, "hey, that wasn't so bad. I'm proud to be Canadian! But overall? I think we can do better.

I don't see why you just have insurance reform if that's been the problem. Furthermore, if the facts about the 45 million people uninsured is true (and apparently factcheck.org confirms this) then why in the world would you want to piss off everyone (conspiratorial bull shit aside) for, what, 15 million people?

Are you guys nuts? Like, Paul Krugman nuts?

Now, if you see universal health care as a means to an end like, everyone is covered so fuck it it's all worth it. So be it. It IS a nice perk. But it's only as good as you can maintain it. It's incredibly complex.

But be forewarned. It ain't easy. Our system is not patient-centric; it's cost-oriented.

Now, I know some Canadians will get wind of this and call me a right-wing nutcase or take issue with this but seriously, better to know a worst case picture than a good one, no?

Last, so no one thinks I'm some deranged Canuck with Dudley-Do-right posters all over my room, I worked for one year behind the scenes helping to launch a web directory for private clinics in Canada. We spoke exhaustively on the phone and visiting, to hospital administrators, politicians, doctors (on both sides), nurses and patients (and boy were the emails we got special) and quite frankly it's not a secret the system needs a massive overhaul. Anyone who denies this is clinging on to rhetorical abstracts and only serves to prolong the need to reform it.

Sorry for the length.

Sean W. Malone|8.9.09 @ 11:57PM|#

No Chad, you don't keep me "on my toes" intellectually.

Intellectually, you are a limp-dicked control freak who persistently and irritatingly fails at both basic logic and anything approaching sound economic reasoning. You are not pushing for a Republic in any sense that the US Constitution means the term because you have 0 respect for liberty. What you want is called oligarchy.

Look it up sometime.

And if I'm "partisan", it's the kind of partisan who doesn't belong to any parties, has no interest in parties and picks fights with other libertarians as well. The word you probably actually want to use to describe me is more aptly "iconoclast". Unfortunately sir, you have merely failed to convince at every given opportunity and now you're whining about it and trying the pitiful "you're young and you'll change when you grow up" ad hom. The thing that you still don't get is that nothing you've said to me - not one thing - has been something I hadn't heard by the time I was 17

I've written volumes and published papers & essays as well as taught & led numerous sessions in the philosophy of liberty. And I probably even have a better educational pedigree than you do (not that I actually put much stock in such things, but I know how much you care...) And... For the record Chad, I'm much, much smarter than you.

And STILL, I will fight for your freedom to be the retard that I truly hope you realize you are. And although I am much smarter than you, unlike you, I don't believe that that grants me some god-given position of authority over people like you. I get that it's a catch 22, since on the flip side, you would be more than happy to subordinate me anytime the next time I wanted to buy some "ChineseCrap" or did something that offended your effete sensibilities.

Don't compare yourself to me in any way.

Ever.

Got it?

If you were ever anything remotely resembling a "libertarian", and this is what you've become then it's safe to say you've never understood the principle of liberty or the non-aggression axiom.

|8.9.09 @ 11:58PM|#

Sorry for the grammar above.

I just want to make another quick point. Just because the Canadian system is in trouble doesn't mean single payer can't work. 'Cause in theory it can.

The Europeans seem to have found a decent compromise. Although I hear the UK is in crisis, but overall I think things are ok in places like Sweden, Holland, Germany, France and Italy.

Now whether they control costs or have rising expenditures I don't know.

So I wouldn't be terrified of it so long as you know what you're getting yourselves into because you have one advantage: you can learn from Canada, the EU and even Australia.

Sean W. Malone|8.10.09 @ 12:02AM|#

Earl - you're picking up some of the last clashes from a months-long head-to-head on a wide variety of topics. Mostly I just make fun of Chad, but sometimes... Like today... His lust to control everyone else in the name of his own idiocy is too much for me.

Anyone who can be that big a shill for dictatorships eventually makes me insane.


Good post though.

Chad|8.10.09 @ 6:56AM|#

From Earl.

as much as 75% of costs go to labour

There is the white elephant stampeding around the room that few are willing to talk about. Like any business, the health care industry's primary expense is labor. There is no way in hell that costs will be "contained" without medical workers taking a hit. This largely means our grossly-overpaid specialists, but will run up and down the entire spectrum.

Chad|8.10.09 @ 7:06AM|#

Sean W. Malone | August 9, 2009, 11:57pm | #

If you were ever anything remotely resembling a "libertarian", and this is what you've become then it's safe to say you've never understood the principle of liberty or the non-aggression axiom.

I simply reject your narrow concept of "liberty". Freedom is the ability to do what you want to do, not be free of any government control or influence. A person who cannot leave their job because they would lose their health insurance is taking a far larger hit to their "freedom" than someone who (Heaven Forbid!) has to pay some taxes.

The non-aggression axiom is childish foolishness. The social web on which we live is wound so tight that you cannot even breath without being "aggressive" towards someone else. Therefore "force" is constantly justified, and libertarian theory actually does a piss-poor job of defining how much force is either justified or obligatory.

Sean W. Malone|8.10.09 @ 10:57AM|#

Actually, Chad... The libertarian philosophy does a fabulous job at that in about 95% of all interactions with other people.

There are a few cases in which the gray area is really hard to work out, and for that, we tend to favor arbitration to sort through the relevant issues. But let's just run through a list and see if we can determine who's the aggressor (if there is one) in the form of two people, A & B - Let's assume that whoever the aggressor is is brought to court and made to pay compensatory damages, sentencing will depend on the severity, danger & whether or not the act was malicious, negligent or accidental:

A steals B's purse: A
B breaks A's window with a baseball: B
A offers B a joint for $5, B accepts: Nobody
A offers B a joint for $0, B accepts: Nobody
B offers A a joint for $0, A doesn't accept, B punches A in the face: B
A trespasses on B's property: A
A promises B a working car for $5000, B accepts, but then A gives him a car with a broken transmission & engine: A


The reality is, as much as you like to see externalities in everything, the vast majority of everyday situations don't really have any. Most things are as simple as the examples provided above because your ordinary, every-day interaction with other people is pretty routine. And before you start whining about multinational corporations who've got all this power, it would behoove you to stop and realize that there's only 2 ways they can get that big:

1. Giving their customers exactly what they want consistently, cheaply and without pissing many of them off - i.e. the libertarian way

or

2. Going to government, asking for special favors like tariffs on international competitors, special zoning privileges to keep out local competitors, bailouts and generous tax exemptions & subsidies - thereby giving them a government-provided advantage over their potential competitors. This would be known as the evil way...

But the evil way only exists when we allow governments the kind of power it takes to make those things possible. Eliminate the power, and you fix that problem as much as possible.

And good lord man, "positive liberty" isn't liberty Chad and this is logic 101. If you have a "right" to be "given" stuff, then that implies the "right" to take it away from someone else by force. You simply don't have that right, and shouldn't in any society even approaching what we'd call "civil". You're also starting the story in the middle as if the employer provided system wasn't a creation of previous government intervention... It was. We all know that. That fact is about as irrefutable as any piece of history gets. So government creates a problem, then your solution is always the same. More government. Let's learn from our mistakes, shall we?

And again, private health insurance can be made vastly cheaper if A. we actually treated it as *insurance* instead of a blank check paid by someone else, and B. if we got rid of the incentives that make it 30-50% cheaper for companies to provide it than for individuals. But instead of doing that (which is also much easier), you would rather see a triumph of tyranny and bad economics.

Of all people, you lecturing people on childishness, when your entire world view is essentially "Gimme Gimme!" is laughable. There is nothing redeemable here Chad.

Safe travels.

|8.10.09 @ 5:11PM|#

He doesn't even bring up the argument that getting rid of insurance would lower administrative costs. Isn't that one of the cornerstone arguments of the reformers?

Chad|8.10.09 @ 6:29PM|#

Sean W. Malone | August 10, 2009, 10:57am |

Actually, Chad... The libertarian philosophy does a fabulous job at that in about 95% of all interactions with other people.

You can't get out of bed in the morning without doing something that affects every other human being on earth in a negative way.

There are a few cases in which the gray area is really hard to work out, and for that, we tend to favor arbitration to sort through the relevant issues.

A few? More like everything you do. And "arbitration" only works when just a handful of people are involved, which is rarely what I am talking about and rarely the problem.

But let's just run through a list and see if we can determine who's the aggressor (if there is one) in the form of two people, A & B - Let's assume that whoever the aggressor is is brought to court and made to pay compensatory damages, sentencing will depend on the severity, danger & whether or not the act was malicious, negligent or accidental

Now, who has to pay for the cops, judges, legislators and tax collectors that make all that possible? Me I supposed. Guess I am affected. Sorry, try again.

Not to mention that I'll have to pay for someone to shelter, feed, and educate A's kids while he rots in jail, and probably more again in the future when these parentless kids turn out bad.

Oh, and with the increase in crime in my area, my neighbors all put up fences, raise big nasty dogs, and buy shotguns. I have to follow suit because I don't want to look like the easy prey.

Boy, I am sure glad I am not affected by this "personal" interaction between A and B.

The reality is, as much as you like to see externalities in everything, the vast majority of everyday situations don't really have any.

I bet you can't find ANYTHING where I can't rattle off a list of externalities. Seriously, if you as much as breath or sit on the can, there are externalities.

1. Giving their customers exactly what they want consistently, cheaply and without pissing many of them off - i.e. the libertarian way

Which is usually meshed with "confusing and deceiving your customers, hiding the truth, and using unfair business practices to undermine competition".

And good lord man, "positive liberty" isn't liberty Chad and this is logic 101.

The difference between positive and negative liberties are in practice, a distinction without a difference.

If you have a "right" to be "given" stuff, then that implies the "right" to take it away from someone else by force.

For the most part, I don't consider "your" stuff as yours. YOU personally only "earn" a tiny fraction of what you manage to capture. The vast majority comes from our social network system, where individuals are irrelevant. Ask yourself how much you could "earn" if trapped alone on an island. That much is more or less how much you earn personally.

You simply don't have that right

I don't grant you the right to the things you think you "own". Your right to property, like any other right, is contingent on circumstance and how it interacts with society and other peoples' welfare.

Chad|8.10.09 @ 10:36PM|#

Of all people, you lecturing people on childishness, when your entire world view is essentially "Gimme Gimme!" is laughable

This has to be the biggest lie you tell of all. You damned well know that I consistently call for my own taxes to be raised. It is YOU who keep screaming like a little piggy every time I suggest that you be forced to pay for some of the things you use and the damage you cause.