Ezra Klein's Confusion Over "Rationing"

Ronald Bailey | August 28, 2009

Washington Post blogger Ezra Klein is taking exception to Post columnist Charles Krauthammer's depressing op/ed on how health care "reform" will likely play out. Krauthammer's op/ed argues that the public option is dead, as is end of life counseling, and imposing treatment choices through comparative effectiveness studies will be downplayed. The notion that health care reform will cut costs will also be dropped. So what will happen? Krauthammer predicts:

Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement.

What's not to like? If you have insurance, you'll never lose it. Nor will your children ever be denied coverage for preexisting conditions.

The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it. And government will subsidize all the others who are too poor to buy health insurance. The result? Two enormous new revenue streams created by government for the insurance companies.

And here's what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage -- but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop and how much they can limit their own liability, they will live off government largess -- subsidized premiums from the poor; forced premiums from the young and healthy.

It's the perfect finesse -- government health care by proxy. And because it's proxy, and because it will guarantee access to (supposedly) private health insurance -- something that enjoys considerable Republican support -- it will pass with wide bipartisan backing and give Obama a resounding political victory.

Krauthammer paints a very plausible scenario. The ultimate result is that government expenditures on health care will explode. Klein's specific beef is Krauthammer's observation that this will inevitably lead to "rationing." Klein writes:

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

Like most left-leaning folks, Klein clearly doesn't know the definition of rationing. Take this one from Britannica: 

Government allocation of scarce resources and consumer goods, usually adopted during wars, famines, or other national emergencies.

Klein evidently thinks that market outcomes that he dislikes mean that government should step in and impose outcomes that he does like. All right, let's admit it; the health insurance market and the rest of health care are royally screwed up as a result of decades of government interventions and mandates. Consequently we don't actually find the usual benefits of falling prices and improving products and services that we experience in normally operating markets where robust competition and choice reign. 

As I explained in an earlier column where I tried to clear up New York Times economic columnist David Leonhardt's similar confusion over rationing: 

...what is rationing? Leonhardt is correct when he writes, "In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources." The crucial question that Leonhardt misses is that "rationing" depends on who is allocating the scarce resources. It's not rationing if an individual decides to spend his money on a 16-ounce steak—but it is rationing if he can only purchase a USDA prime rib eye when he has a coupon issued from a government agency. In other words, true rationing occurs when individuals are forbidden from spending their money on products or services they want to buy.

Imperfect as private health insurance markets are, if a customer [or his employer] doesn't like the decisions made by Blue Cross Blue Shield, Kaiser Permanente, or Golden Rule insurance bureaucrats, he can look elsewhere for his health insurance coverage. But if the government health care scheme becomes a monopoly, when the bureaucrats at the new Health Benefits Advisory Committee decide that a treatment should be withheld, that treatment will be withheld. That's rationing.

I concluded: 

"Americans should get the first chance to limit their own health spending," Rep. Jim Cooper (D-Tenn.) observed recently. "Once they learn the true cost of what they are buying, share a larger portion of the cost, and can judge the benefits—if any—of treatment options, then they will choose more wisely than the government." He's right. Congress should think about "rationing" health insurance and health care the old-fashioned way—through the market.

But through the usual lack leftwing lack of imagination and a truly touching and naive faith in the efficacy of top/down government "solutions," Klein ends up advocating for government rationing and for imposing a government monopoly on health care, instead of for more competition and choice. 

Comments

Warty|8.28.09 @ 3:12PM|#

That's way too many words to waste debunking that whiny little half-man. Ezra Klein is a self-refuting argument.

|8.28.09 @ 3:15PM|#

Really, Ezra Klein is like the fat kid at the dodgeball game; its just too easy.

The abuse of the term "rationing" is classic lefty Newspeak: take a perfectly good word with a reasonably clear meaning, and beat it until it says what you want.

Joe M|8.28.09 @ 3:15PM|#

Ugh, Krauthammer's scenario is disturbing, moreso because I can totally see it happening. I'm not sure if it's a good thing that he wrote that or not; on the one hand, he may have given someone the idea, but on the other, he's warned us all about what to expect. If the GOP jumps in we're screwed.

creech|8.28.09 @ 3:23PM|#

Krauthammer's scenario has probably always been the fall back position. The only ones left to bitch are the libertarians and, hey, who cares about 2% of the vote?

Fluffy|8.28.09 @ 3:26PM|#

Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement.

What's not to like?

One thing not to like is that this will raise the price of insurance for healthy people beyond the point at which it makes economic sense to carry insurance.

The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it.

Of course. Since buying insurance will no longer [and already does no longer, in most cases] make any economic sense for young and healthy people, they'll HAVE to be forced to do it at the barrel of a gun.

Nick|8.28.09 @ 3:38PM|#

That definition of rationing is clearly cherrypicked. Neither dictionary.com or Merriam-Webster use the word "government" in their definition of rationing.

max hats|8.28.09 @ 3:38PM|#

Since buying insurance will no longer [and already does no longer, in most cases] make any economic sense for young and healthy people

Strongly disagree. All insurance is a losing proposition in the macro sense - that is how insurance companies make money. Given 10 million young healthy people, their total health costs are lower than the cost of those 10 million buying insurance. But one individual is not 10 million in aggregate. If something goes wrong, we individually seek out individual protections against individual catastrophe. That is the essence of all insurance - a net expected loss taken voluntarily to hedge unacceptable catastrophe.

JB|8.28.09 @ 3:39PM|#

We make it too expensive for everyone to afford.

Yes, we are waving a magic wand making things expensive. So all we have to do is wave Klein's magic wand and make them cheap.

What a fucking moronic loon! You can't debate people like Klein. It's like debating a wall. Again, you don't debate zombies. There is only one thing to do with zombies.

I suggest Klein leave for somewhere more to his liking before it gets to that point. He has choices and can shop for more socialism. Freedom-loving Americans have nowhere to go.

WWJGD|8.28.09 @ 3:44PM|#

For a man who can't figure out Netflix, he sure does have great credibility on health care.

crackertyasscracker|8.28.09 @ 3:45PM|#

That definition of rationing is clearly cherrypicked. Neither dictionary.com or Merriam-Webster use the word "government" in their definition of rationing.

so after WWII, when stopped rationing, we didn't really stop rationing?

"allocating" doesn't mean the same thing as "rationing". And yes, "rationing" has a more negative connotation, for a damn good reason.

classwarrior|8.28.09 @ 3:47PM|#

More semantic game playing. If a private insurance company denies payment it is not rationing because it's not done by the government, but the effect is the same. The "insured" will have to raise the funds themselves or go without, because there is no one else to turn to in such a situation. Get real!
Also, as a Canadian let me talk about the situation in my country. We have a single payer system that is for the most part privately delivered. I can choose any doctor I want. Even under our system, about 30% of health care expenditures are private (employer provided extended health benefits for instance). There is no absolute monopoly- people are free to travel elsewhere to seek treatment, though very few actually do. In fact, private insurers now have the right here to offer coverage if wait times in the public system are unreasonable, but to date NOT A SINGLE ONE has started selling such policies.

|8.28.09 @ 3:47PM|#

Nick: I was looking for concision. Do you like this one from the Free Online Dictionary better?

ra·tion (rshn, rshn)
n.
1. A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity.
2. rations Food issued or available to members of a group.
tr.v. ra·tioned, ra·tion·ing, ra·tions
1. To supply with rations.
2. To distribute as rations: rationed out flour and sugar. See Synonyms at distribute.
3. To restrict to limited allotments, as during wartime.

Implicit is a distribution by a centralized authority.

|8.28.09 @ 3:48PM|#

You know, there's more than one entry for a word in most dictionaries:

rationing - A regulated allocation of resources among possible users.

and

Rationing is the controlled distribution of resources and scarce goods or services.

There is corporate rationing. There is also government rationing. Government rationing is meaningfully different than corporate rationing if it uses the power of the state as an enforcing mechanism, of course, but that means only if:
a) You can't opt out, and/or
b) The government prevents you from buying outside their options.
Both situations would be bad. But neither is on the table (with HR5200 or Waxman-Markley). And only (b) would lead to your "rationing" scare scenario:

But if the government health care scheme becomes a monopoly, when the bureaucrats at the new Health Benefits Advisory Committee decide that a treatment should be withheld, that treatment will be withheld. That's rationing.

And that's not on the table, and will never be on the table. As the public plan stands, the government doing the above is no different than an insurance company doing the above - and the insurance company has even more incentives to do so. Even on the public-plan-magically-takes-over due to magic sparkle ponies situation*, they're not going to block supplementary insurance or paying out of pocket, any more than Medicare does.

Second, you blame all Healthcare issues on government market distortion. Apart from the No-True-Scotsman issue here (something can't be the fault of the market if the market isn't pure!), many of the Healthcare market distortions are inherent.

You can't "decide" whether or not you're going to get sick or be hit by a car; and we're never going to deny care in certain situations even if the person hasn't paid for it, by choice or otherwise. This is going to distort the market quite a bit. And given the time lapse between getting insurance and using it, and the impossibility of determining much of the relevant information about insurance when you get it, the feedback mechanisms are going to be weak.

Mindless deregulation won't necessarily help - notably, selling insurance across state lines, which will create a giant confusing mess of plans and regulations. This is especially true if that idiot Schumer gets his "retaining protections for citizens of his state", which would lead to different regulations for every pair of source and destination state rather than one per state.

Now, rather than a straight public plan a fair amount of regulatory change targeted at incentives is going to work better than what I know of HR 5200 (see the recent Atlantic story), but your demagoguing about rationing doesn't really apply.

* I'm aware that there are some democrats that have the public plan as a Trojan for single payer. I just don't think it will, and you don't bother to make an actual argument.

Craig|8.28.09 @ 3:49PM|#

The end result is the liberal dream of universal and guaranteed coverage -- but without overt nationalization.

i.e., fascism

|8.28.09 @ 3:51PM|#

Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement.

The insurance industry's only real objection is to the public option -- the mandate without the public option, combined with any other regulations is still a huge financial gain to the insurance industry.

I don't know what exactly "insurance company reimbursment" is in Krauthammer's world, but it doesn't seem like anyone is talking about limiting the price of premiums. With the added risk of pre-existing conditions, premiums are of course going to spike, and with the mandate there isn't much anyone will be able to do about it.

So I don't see how this "hellish" scenario is anything different than what the GOP is currently pushing for.

|8.28.09 @ 3:51PM|#

strech: Please see my column "The Beginning of the End of Private Health Insurance" for how the public option will likely end up as a government insurance monopoly.

max hats|8.28.09 @ 3:51PM|#

Nick: I was looking for concision. Do you like this one from the Free Online Dictionary better?

ra·tion (rshn, rshn)
n.
1. A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity.
2. rations Food issued or available to members of a group.
tr.v. ra·tioned, ra·tion·ing, ra·tions
1. To supply with rations.
2. To distribute as rations: rationed out flour and sugar. See Synonyms at distribute.
3. To restrict to limited allotments, as during wartime.

Implicit is a distribution by a centralized authority.

This is absurd. Families can ration, companies can ration, and I can ration myself.

Tomcat1066|8.28.09 @ 3:51PM|#

"And that's not on the table, and will never be on the table."

You can see the FUTURE?????

|8.28.09 @ 3:51PM|#

Forget healthcare, I want to know when the government is going to do something about all the lobster, mansion and Corvette rationing, because having those are rights too, darnit.

At least they should be for me.

Craig|8.28.09 @ 3:52PM|#

If something goes wrong, we individually seek out individual protections against individual catastrophe. That is the essence of all insurance - a net expected loss taken voluntarily to hedge unacceptable catastrophe.

Yeah, unexpected catastrophes like routine checkups, outpatient visits, sub-$200 prescriptions, etc.

|8.28.09 @ 3:56PM|#

It's all about "equality" and "fairness" with these lefties. They don't just feel bad when some poor person gets sick and can't afford treatment, they feel bad when some rich person gets sick with the same disease and can afford treatment, because it just ain't "fair." To these people a system where we all run the same risk is better than a system where 15% of people run a moderate risk and 85% of people run a low risk; that's "equal" and "fair."

|8.28.09 @ 3:56PM|#

It's the perfect finesse -- government health care by proxy. And because it's proxy, and because it will guarantee access to (supposedly) private health insurance -- something that enjoys considerable Republican support -- it will pass with wide bipartisan backing and give Obama a resounding political victory.



Just as long as my chronic intense rectal pain (which flares up like clockwork in the presence of "bipartisan consensus")is covered.

|8.28.09 @ 3:57PM|#

You can see the FUTURE?????

Apparently, only the libertarians can.

That's why they keep telling me that the public option will quickly morph into governmnet run health care where they will make your decisions for you and your doctor, and the government will force private insurers out of the market place and eventually everyone will be forced to sign up for the government plan.

Only libertarians and the GOP have future predicting powers, apparently.

|8.28.09 @ 4:01PM|#

They don't just feel bad when some poor person gets sick and can't afford treatment, they feel bad when some rich person gets sick with the same disease and can afford treatment, because it just ain't "fair." To these people a system where we all run the same risk is better than a system where 15% of people run a moderate risk and 85% of people run a low risk; that's "equal" and "fair."

No it's about a belief that the poor and the rich should both have the fucking cure for what ails them. Regardless of whether they can afford it.

It's a belief that whether or not you get to live or die if you get sick shouldn't depend your economic status or that hopefully some charitable organization will help you.

There are lots of things that people should learn to live without if they can't afford it. Health care isn't one of them.

Fucking lefties wanting eveyone to be able to see a doctor or go to a hospital when they are sick -- pure evil I tell you.

Seward|8.28.09 @ 4:03PM|#

strech,

And that's not on the table, and will never be on the table. As the public plan stands, the government doing the above is no different than an insurance company doing the above - and the insurance company has even more incentives to do so. Even on the public-plan-magically-takes-over due to magic sparkle ponies situation*, they're not going to block supplementary insurance or paying out of pocket, any more than Medicare does.

They don't have to if they force everyone to pay for the plan. Furthermore, right now at least some of the plans call for the government plan to undercut any private insurance that an employer might buy. Only governments can really do the latter, even though it is quite stupid on a number of levels.

Apart from the No-True-Scotsman issue here (something can't be the fault of the market if the market isn't pure!), many of the Healthcare market distortions are inherent.

We hear a lot about these inherent problems, but they always lead back to some form of government meddling.

You can't "decide" whether or not you're going to get sick or be hit by a car; and we're never going to deny care in certain situations even if the person hasn't paid for it, by choice or otherwise.

People are denied care all the time in nations which have public mandated or provided health care; indeed, in situations which would not happen in the U.S.

What the whole "deciding" you are going to be sick argument reminds me of is the "ticking time bomb" scenario people used to justify torture with. It is very rare for people to be in that sort of situation yet that is the "norm" which is being used to discuss all healthcare choices and options with.

|8.28.09 @ 4:04PM|#

|8.28.09 @ 4:06PM|#

Medicare/caid works in large part because costs connected to treating the people *in* the program can be shifted onto people *out of* the program.

What happens when everybody is *in* the program?

|8.28.09 @ 4:08PM|#

Ron: The part of that article where it goes from "popular government option" to "government monopoly" is what I have an issue with:

The worst case scenario is that the public option plan would eventually absorb what remains of the private health care system. This could happen as the political constituency for private health care and insurance shrinks while more and more Americans become covered by government insurance. In addition, it will be hard for politicians to resist forcing wealthier patients to join the government plan as a way to make up for eventual shortfalls in revenues.

"could" and "hard for politicians to resist" are not very convincing. Especially since they don't seem to reflect political reality -

A) Both the private health insurers and the people using them will have lots of money. Lots of money, meet Congressmen. Congressmen, meet lots of money.
B) Cries of "Socialism" and "Big Government" remain tremendously popular, in opposition to banning private plans. On the other side will be the issue of the government spending money it doesn't have, something it has never had any problem doing.

There's also the issue of what's been done with Medicare. Notably:
1) There are lots of supplement plans. While supplement plans aren't an ideal fix, they would prevent the rationing scare situation you posit. And given that these people would already be giving the government money, your only political rationale wouldn't apply.
2) What little movement on Medicare there has been has moved away from government control (Medicare Advantage, even if they are currently messing with it).
3) There's been no movement away from people paying their own way even if they have Medicare.

So while there are hints of a non-optout single-payer, I simply don't see even any interest - let alone the political will - for the restrictions you're suggesting will show up.

Speaking of Old People|8.28.09 @ 4:09PM|#

"Of course. Since buying insurance will no longer [and already does no longer, in most cases] make any economic sense for young and healthy people, they'll HAVE to be forced to do it at the barrel of a gun."

An insurance "draft" of sorts.

|8.28.09 @ 4:11PM|#

Ezra Klein is one of those people (perhaps, even, like some people who post here) who, if you could eavesdrop on what he tells his analyst, would learn that he has dreams that the State has a giant schlong, so he can fellate it.

|8.28.09 @ 4:12PM|#

"This is absurd. Families can ration, companies can ration, and I can ration myself."

Yes, but using that wide of a definition renders the term meaningless. If I can't afford a BMW at the price i'm willing to pay, is that rationing?

If so, only infinite resources (which would be free) are NOT rationed. Follow that line of logic and the government should be fixing prices on everything.

Rationing via government fiat IS different in kind from affordability. Particularly in health care. Like it or not, most people are not comfortable with the government deciding who gets what for how much. The market doesn't have feelings and doesn't have special interest groups.

|8.28.09 @ 4:12PM|#

You people don't buy insurance because it is not in their interest to do so. An insurance mandate does nothing to decrease costs. If someone is sick their treatment will cost the same reagardless of whether they have insurance. All mandating insurance does is hold up young healthy people for money to subsidize the care of the old.

Cujo|8.28.09 @ 4:13PM|#

Nick:
You are correct, but really the dictionary doesn't have the best descriptions of rationing. A better source is an Economics definition such as the following:

http://www.economist.com/research/economics/searchActionTerms.cfm?query=rationing

Speaking of Old People|8.28.09 @ 4:15PM|#

"Only libertarians and the GOP have future predicting powers, apparently."

I agree, given that Obama has made some extremely poor predictions (e.g., that his "mandate" would enable him to do anything he wanted).

Seward|8.28.09 @ 4:16PM|#

stech,

Fact: As it is right now those in favor of the public plan are outspending those opposed.

|8.28.09 @ 4:16PM|#

What the whole "deciding" you are going to be sick argument reminds me of is the "ticking time bomb" scenario people used to justify torture with. It is very rare for people to be in that sort of situation yet that is the "norm" which is being used to discuss all healthcare choices and options with.

The issue about "deciding" is this:
If you're seriously ill (any sort of illness, though the sudden injury sort of thing has an even greater relevance), "not getting better" isn't really an option. This means that pricing it out of people's reach isn't primarily going to be a function of a cost benefit analysis; it's going to primarily be a function of what they can afford. This is incredibly distorting on the entire market and is going to remove a lot of price pressure.

|8.28.09 @ 4:18PM|#

This just in: Following the Ezra Klein logic, President Obama has just said, "People always call socialist---I mean, 'liberals'--like me 'big spenders.' What's wrong with that? Big spending goes on all the time in the private sector. If people can spend their own money, why shouldn't I be able to spend their money?"

In a related story, President Obama demonstrated even further expertise in economics by refuting Margaret Thatcher's remark that socialism always fails because eventually we run out of money. "That's whack," the former community organizer asserted. "If we ran out of money, I can just print some more! I'm the Chosen One, dammit!"

Mark|8.28.09 @ 4:18PM|#

The way to limit people's tendency to overuse the health resources is to have much bigger co-pays, whether it is another $10 or $25 for a requested visit or extra test, or 10 or 20% of each bill. People want unlimited services because they are free. Share the cost and demand will decrease.

|8.28.09 @ 4:20PM|#

Fact: As it is right now those in favor of the public plan are outspending those opposed.

"In favor" includes the insurance companies, I believe. A political calculation (and concession) that's not going to apply if it's about them going out of business. And the other rich aren't directly under threat from the public plan. So of the two groups I named, one is spending for the public plan side and one doesn't have much of a reason to spend money.

|8.28.09 @ 4:20PM|#

This is absurd. Families can ration, companies can ration, and I can ration myself.

Thus is a word stripped of all useful meaning.

"Only libertarians and the GOP have future predicting powers, apparently."

Sure looks that way, although I'm not too sure about the GOP.

No it's about a belief that the poor and the rich should both have the fucking cure for what ails them. Regardless of whether they can afford it.

Well, that will only happen in a totally socialized system that outlaws private medicine. Sure you want to go there, CT?

It's a belief that whether or not you get to live or die if you get sick shouldn't depend your economic status or that hopefully some charitable organization will help you.

Instead, it should depend on the politics of state healthcare funding and utilization panels?

mr simple|8.28.09 @ 4:20PM|#

CT,
No, not evil, just ignorant. First, in emergencies, no one can be denied medical care. Second, no matter how much you think people should have something, it doesn't mean anyone has a right to it or that the government needs to provide it. Food and shelter are pretty important, but those are not supplied through government edict. It also does not give you the right to take other people's property to supply them with what you think they need; the government does not have money of it's own. If you think it's that important then give to charity. I encourage that, but the government should have nothing to do with this.

max hats|8.28.09 @ 4:20PM|#

You people don't buy insurance because it is not in their interest to do so. An insurance mandate does nothing to decrease costs. If someone is sick their treatment will cost the same reagardless of whether they have insurance. All mandating insurance does is hold up young healthy people for money to subsidize the care of the old.

Most people I know post college change jobs a lot for a few years - I definitely did - leading to a nightmare of COBRA and paperwork waiting periods for insurance to kick in at a new job and forms no one quite understands, which all together makes a substantial impediment to buying insurance. Also, young people tend to have more troubles with money than older people. I'm not sure young people in general do not want health insurance, so much that they often feel it is a luxury when they are fighting for necessities. There may be some study saying otherwise - I'd be interested in seeing it. My anecdotal experience tells me that young people want insurance, but see it as priority 79 on their list when their still working on 3, 4 and 5.

TallDave|8.28.09 @ 4:20PM|#

You can "ration" food by not letting poor people have as much, or we can all stand in bread lines. Etc.

We can either have lots of inefficient food (or health care) or very efficient but very little food (or health care). So far 100% of people die in both cases anyway; the benefits are all marginal and become ever more marginal the more you spend

Yes, U.S. healthcare is less efficient, in the same way U.S. food consumption is less efficient than in North Korea, where people get just enough to avoid starvation (in some cases, less).

By this measure, though, the poorest countries in Africa probably have the most "efficient" healthcare, because the first ten dollars of healthcare go much further than dollars 3,490 to 3,500.

MRIs are a good example. Do you do an MRI in a situation where there's a 10% chance it will find something, or only 20% or greater? The second is generally going to be more cost-efficient, because MRIs are expensive, but overall outcomes will be slightly worse.

|8.28.09 @ 4:21PM|#

Klein sets a high standard in the Ezra Klein Matt Ygelsias biggest douschbag in the universe contest.

max hats|8.28.09 @ 4:22PM|#

RE: Rationing:

Thus is a word stripped of all useful meaning.

Perhaps it is a bad idea to base a tirade against someone based on one particular definition of the word then?

Seward|8.28.09 @ 4:23PM|#

Strech,

If you're seriously ill (any sort of illness, though the sudden injury sort of thing has an even greater relevance), "not getting better" isn't really an option.

Sure it is. You assume that everyone's personal utility function on this issue is the same, which is just, well, anti-economic and rather stupid. Lots of people would end it on their own terms given the nature of their conditions, but the state, that entity you defend so much, of course gets in the way of that. That's just another distortion introduce by government meddling.

Furthermore, most people get sick in rather predictable ways.

...it's going to primarily be a function of what they can afford.

And what they can afford is not determined primarily by the market; the prices for medical care are largely determined by the state or quasi-state bodies which ration the number of doctors and the like.

|8.28.09 @ 4:23PM|#

Great post Tall Dave. An efficient outcome isn't always a desireable one. Too bad douschbags like Klein are too stupid to figure that out.

|8.28.09 @ 4:26PM|#

There are lots of things that people should learn to live without if they can't afford it. Health care isn't one of them.

Food and shelter I would imagine are tops in that category of "shouldn't live without." Yet we can't imagine the guvmint proposing Universal Groceries, so that everyone can eat, or Universal 3BR/2BA, so everyone can be sheltered. We, as a society, have a work ethic and expectation and that everyone will pull their own weight and buy it themselves.

We do this for the poor and while we can disagree on what should be the proper nature of assisting the poor and needy, we can agree that a means tested, *temporary* assistance is not an unrealistic proposal. (That said, federal public housing is just this side of hell. It's not something to point to and be proud of as something the guvmint provides.)

But that's not what is being proposed with ObamaCare. To suggest that ObamaCare is a public aid program is dishonest. It's a un-means tested, permanent entitlement, pure and simple.

Oh, And I will spend far more in a typical year on food and shelter than I will on medical care.

|8.28.09 @ 4:26PM|#

What's still missing from the debate:

Government will set "minimum" standard.

But if insurance companies can't prevent people from moving from one plan to another, despite "pre-existing conditions", no policy with benefits above the "minimum" standard can endure.

If there are premium plans in the market, iInsureds will sit in a less favorable (and cheaper) plan until a significant morbidity, then transfer to the better plan. Examples would include the incidence of cancer, AIDs or just plain old age (at that time that near-end-of-life care becomes important).

If you can transfer into a better plan despite a "pre-existing condition", it is no longer "insurance" but a simple dollar-for-dollar transfer from healthy to unhealthy insureds in the plan.

Under these new ground rules, the government "minimum" is also the maximum, and the federal standard dictates the ONLY health care plan that will be available to consumers.

Forget the "public option", the real issue here is whether there will any more be diversity of insurance opportunities in the United States of America.

The prognostication that a simple, blanket prohibition on underwriting (!) -- in other words, the factoring in of pre-existing conditions -- would garner more Republican support than the plans on the table is frightening. Conservatives need to get organized immediately and turn the debate to insurance plan diversity.

|8.28.09 @ 4:26PM|#

You can see the FUTURE?????

Apparently, only the libertarians can.

That's why they keep telling me that the public option will quickly morph into governmnet run health care where they will make your decisions for you and your doctor, and the government will force private insurers out of the market place and eventually everyone will be forced to sign up for the government plan.

Only libertarians and the GOP have future predicting powers, apparently.

Anyone can predict the future, the trick is to do it correctly. The GOP has displayed no ability to do so. Only we libertarians Cassandrans have the intellectual prowess, heathy skepticism and cynicism to do that.

|8.28.09 @ 4:26PM|#

"And that's [government monopoly] not on the table, and will never be on the table."

If that is the case, the single-payer advocates are sure wasting their time throwing their support behind Obamacare.

Seward|8.28.09 @ 4:27PM|#

R.C. Dean,

Anyone who thinks that government run healthcare won't be class based and two-tiered has spent little time looking at the rest of the developed world's two-tiered, government run healthcare systems.

|8.28.09 @ 4:27PM|#

"It's a belief that whether or not you get to live or die if you get sick shouldn't depend your economic status or that hopefully some charitable organization will help you."

Ted Kennedy championed this following his cutting edge brain surgery at Duke and world class cancer treatment at Mass General, followed by bed-side care until his death.

Lets not confuse things- there will ALWAYS be a class component to who gets the best treatments. And the people championing the progressive programs the most are also the last to abandon their personal privileges.

The Angry Optimist|8.28.09 @ 4:28PM|#

Perhaps it is a bad idea to base a tirade against someone based on one particular definition of the word then?

No, maybe you should try a little intellectual honesty and stop expanding concepts beyond all meaning just "win" the debate.

highnumber|8.28.09 @ 4:29PM|#

Not only can libertarians predict the future:

[Lefties] don't just feel bad when some poor person gets sick and can't afford treatment, they feel bad when some rich person gets sick with the same disease and can afford treatment, because it just ain't "fair."

They can read minds, too.

|8.28.09 @ 4:30PM|#

The problem is that Klein is using "rationing" ambiguously, a fallacious way to reason.

With private health care, the consumer votes with his dollars for the best outcome for him. With the public option, the government votes with your dollars for the best outcome for government. That means it will make its choices primarily on political grounds, secondarily on serving the public health needs.

Joe M|8.28.09 @ 4:32PM|#

Ted Kennedy championed this following his cutting edge brain surgery at Duke and world class cancer treatment at Mass General, followed by bed-side care until his death.

Lets not confuse things- there will ALWAYS be a class component to who gets the best treatments. And the people championing the progressive programs the most are also the last to abandon their personal privileges.

Just in case anybody missed it the first time.

mr simple|8.28.09 @ 4:35PM|#

A free society is not equal; an equal society is not free. I forget who that (paraphrased) quote is attributed to.

|8.28.09 @ 4:37PM|#

And that's [government monopoly] not on the table, and will never be on the table

Social secrity numbers will never be used as national ID numbers.

mark|8.28.09 @ 4:38PM|#

But through the usual lack leftwing lack of imagination and a truly touching and naive faith in the efficacy of top/down government "solutions," Klein ends up advocating for government rationing and for imposing a government monopoly on health care, instead of for more competition and choice.

First of all that's one too many lack's.

And that sentence reminded me of Barack having trouble with the teleprompter at the DNC: "At the start of this campaign, we had a very simple idea. Change in America doesn't start from the top up [sic], top down, it starts from the bottom up."

|8.28.09 @ 4:39PM|#

Joe M, Seward,

There's no two-tiered healthcare system in Canada.

No, strike that. There is. It's called the U.S. healthcare system.

max hats|8.28.09 @ 4:40PM|#

No, maybe you should try a little intellectual honesty and stop expanding concepts beyond all meaning just "win" the debate.

What? Look, the entire post by Bailey is based on a clearly cherry picked definition.

|8.28.09 @ 4:42PM|#

No it's about a belief that the poor and the rich should both have the fucking cure for what ails them. Regardless of whether they can afford it.

I think I should be able to cure what ails me regardless of whether or not the cost/benefit analysis from HHS says my hip replacement is worth it at 70 years old.

It's a belief that whether or not you get to live or die if you get sick shouldn't depend your economic status or that hopefully some charitable organization will help you.

It should depend on the loving kindness of omnibenevolent political appointees and bureaucrats with absolute power and zero responsibility.

The Angry Optimist|8.28.09 @ 4:42PM|#

It's based on the relevant definition. The way you want, "all choices are rationing, ergo, nothing is rationing". Gosh, why would that irritate people? I'm so fucking confused.

Seward|8.28.09 @ 4:43PM|#

J sub D,

Correct and excellent point. There are a plethora of government agencies, etc. which were either "temporary" or which were never predicted to do X, which are now permanent and now do X.

Oh, and remember, we also have no plans to attack Iraq. ;)

|8.28.09 @ 4:43PM|#

I agree with Rep. Cooper, more or less. The first group of people who should abstain from excessively costly mandates are the healthy young, who should simply not buy into this health insurance scam. It's called civil disobedience, and it's a long-honored tradition in the U.S. when the government is simply unresponsive to your needs. Some (probably small) number of seniors have never signed up for Medicare -- are they prosecuted for it?

As to the meaning of the word "ration", the question is not what it means to some (usually self-appointed) authority, the question is what did the speaker mean by it. The answer is obvious, I think.

Seward|8.28.09 @ 4:44PM|#

Deregulator,

Isn't the Canadian Supreme Court in the process of dismantling Canada's government run healthcare system?

|8.28.09 @ 4:46PM|#

"No it's about a belief that the poor and the rich should both have the fucking cure for what ails them. Regardless of whether they can afford it."

This isn't a world of infinite resources, ChiTom. Under any system, some people won't get what they want; under any system, something will be unaffordable. The question is who decides who gets what.

|8.28.09 @ 4:46PM|#

"It's called civil disobedience, and it's a long-honored tradition in the U.S. when the government is simply unresponsive to your needs."

That's been neatly accounted for. The IRS simply garnishes your wages for you. Unless you want to go completely off the grid, they've got you.

max hats|8.28.09 @ 4:47PM|#

It's based on the relevant definition. The way you want, "all choices are rationing, ergo, nothing is rationing". Gosh, why would that irritate people? I'm so fucking confused.

Look, Bailey says:

Like most left-leaning folks, Klein clearly doesn't know the definition of rationing. Take this one from Britannica:

So, the definition of the word is entirely relevant, and using a cherry picked definition to say someone "doesn't know the definition of" something is bubkis.

|8.28.09 @ 4:49PM|#

Sure it is. You assume that everyone's personal utility function on this issue is the same, which is just, well, anti-economic and rather stupid. Lots of people would end it on their own terms given the nature of their conditions, but the state, that entity you defend so much, of course gets in the way of that. That's just another distortion introduce by government meddling.

I have no love for the state; I just don't dryhump the market either. As I mentioned before, I think modifying incentives would be more effective than any sort of public plan, but the market is not perfect in all situations. And I didn't say "Personal Utility Functions" or however you'd like to term them would be identical; I said they'd be primarily based on what people can pay.

|8.28.09 @ 4:50PM|#

It's based on the relevant definition. The way you want, "all choices are rationing, ergo, nothing is rationing". Gosh, why would that irritate people? I'm so fucking confused.

Bullshit. Rationing is not definitionally governmental! A corporation can ration office supplies in an economic downturn. A small business can ration toilet paper purchasing. Rationing = an organization limiting access to resources. Acting like it only counts if it's the government is doing it is insane. And I think Klein (who is a douchebag, don't get me wrong) is pointing out that there is already rationing with insurance companies, because some people are denied procedures based on cost. And some people will be denied procedures in Government Cross, or whatever. If you want to talk about your theory that any government insurance plan will a priori lead to a single-payer government plan with no alternatives, be my guest, but acting like it's only rationing if the state does it is tremendously disingenuous.

max hats|8.28.09 @ 4:50PM|#

As to the meaning of the word "ration", the question is not what it means to some (usually self-appointed) authority, the question is what did the speaker mean by it. The answer is obvious, I think.

On liberal blogs there has been the argument made for some time that the current healthcare system via insurance is, effectively, rationing. Thus, the use of the word as it was on Klein's blog.

And to cut it off at the pass - yes, it still does fit within the definition of rationing.

Done with dictionary wars here.

|8.28.09 @ 4:50PM|#

First, in emergencies, no one can be denied medical care.

You are talking about emergencies. Try to get chemotherapy or ongoing treatement without an ability to pay.

Sure you can go to an ER and get stabilized, but that isn't the same as getting cured or getting health care.

And then they send you to collections. Your credit gets fucked, and the rest of your life becomes more expensive as you are now a risk.



Second, no matter how much you think people should have something, it doesn't mean anyone has a right to it or that the government needs to provide it. Food and shelter are pretty important, but those are not supplied through government edict.

Right, that's why there is no food stamps, or other welfare programs. Like Craig T. Nelson, conservative actor/genius said: "I've been on food stamps and welfare, did anybody help me out? No"

It also does not give you the right to take other people's property to supply them with what you think they need; the government does not have money of it's own. If you think it's that important then give to charity. I encourage that, but the government should have nothing to do with this.

Blah blah blah blah blah.

Shorter: the poor deserve to die unless some charity decides to take pity on them.

Sorry but civilized societies don't actually work like that. There's a reason why every industrialized nation has some form of government provided health care.

The Angry Optimist|8.28.09 @ 4:50PM|#

max hats - enough. you're trying to completely destroy the concept to win the argument. So is Klein. That's what irritates people in this discussion: "LOL Kroger's rations when it won't give you free food!"

Really...STFU.

|8.28.09 @ 4:51PM|#

"So, the definition of the word is entirely relevant, and using a cherry picked definition to say someone "doesn't know the definition of" something is bubkis."

By cherry picked, do you mean "relevant to the conversation"? Because that's what it sounds like from here. But i'm cherry picking my definition.

Klein's definition is nonsensical, and Klein (lets remember) is the one responding to Krauthammer in the first place. If he wants to be understood (or intellectually honest more importantly) he would partake in the definition of the person he's rebutting. Or else explain why his definition is more fitting (he wont, because it isn't).

|8.28.09 @ 4:51PM|#

Social secrity numbers will never be used as national ID numbers.

If you can explain how "people are lazy" (the cause of the overuse of SSNs) will lead to the banning of private healthcare, be my guest.

|8.28.09 @ 5:00PM|#

How's the old saying go? Something like this, I think,

In communism they take over your life and do what they want. In fascism, they hold a gun to your head and make you do what they want.

The Angry Optimist|8.28.09 @ 5:01PM|#

What Mark Buehner said - argue with the definition as it is used; don't point to the dictionary in an attempt to go "HA HA, when you don't spend money you RATION too!".

That's what we call false equivalence.

Fluffy|8.28.09 @ 5:01PM|#

Strongly disagree. All insurance is a losing proposition in the macro sense - that is how insurance companies make money. Given 10 million young healthy people, their total health costs are lower than the cost of those 10 million buying insurance. But one individual is not 10 million in aggregate. If something goes wrong, we individually seek out individual protections against individual catastrophe. That is the essence of all insurance - a net expected loss taken voluntarily to hedge unacceptable catastrophe.

It's only an economically sound decision to purchase that individual protection if the cost of the protection is reasonably related to the actuarial risk I face.

Your argument boils down to "No matter what the premium is, for an individual it always makes sense to buy insurance" which is of course absolutely moronic.

If an informed actuary acting without state compulsion or market-distorting regulation would set my premium at $X, it does not make economic sense for me to purchase insurance at $2X or $3X. Making that purchase makes no more economic sense than playing blackjack at a table that only pays 0.5 to 1. Sure, under certain extraordinary circumstances I can still "win" at that table, but I would have to be an idiot to play there.

Citizen Nothing|8.28.09 @ 5:02PM|#

Again, I have to wonder how much compassionate Windy City Tom gives to charity himself?

Fluffy|8.28.09 @ 5:04PM|#

ChicagoTom,

Always remember this:

As soon as the last remaining links between what you pay and what health care you consume are removed, I promise to make it one of the chief aims of my life to squander as much health care resources as I can.

I will make every health care provider's life a living hell by making sure I piss away as many resources as possible.

Why? Because fuck you, that's why.

Fluffy|8.28.09 @ 5:10PM|#

And I can't believe people are actually humoring the morons here who want to argue that all markets with prices are "rationing" goods and services. They obviously have never lived a day under a true rationing system.

A rationing system is one where no matter how much money you want to spend, you can't buy a good or service because the state says it's not permitted or it's not your turn.

If you show up at a gas station with money in your pocket but aren't allowed to buy gas because your license plate ends in the wrong number for buying gas that day, that's rationing. Walking up to a gas station with no money and asking for gas and not getting it is not rationing.

I don't think the various versions of Obamacare that we've heard so far would lead to literal rationing, because you would be able to go outside the system to directly purchase medical care using non-insurance dollars. But the people crafting the plan definitely want as much state control as possible over what you are allowed to buy in terms of insurance. They aren't "rationing" insurance as much as they're simply destroying it.

max hats|8.28.09 @ 5:10PM|#

max hats - enough. you're trying to completely destroy the concept to win the argument.

The concept of saying somebody doesn't know the definition of, then looking around for a dictionary that says what you want to say? Okay, sure.

Michael Kennedy|8.28.09 @ 5:11PM|#

class warrior, there are private clinics opening all over Canada although they are technically illegal. They are not being prosecuted because of the Supreme Court decision that a health care system is not the provision of health care. You might be interested in this: http://www.nytimes.com/2005/06/09/international/americas/09cnd-canada.html

Tony|8.28.09 @ 5:12PM|#

Krauthammer:

Give the insurance lobby what it wants, and capitulate to GOP scaremongering on every issue they randomly decide to bring up.

Got it, thanks.

|8.28.09 @ 5:15PM|#

If everyone has insurance, and there can be no differentiation for risk profiles, then it isn't insurance at all, it's just a big clearing house for the payments and the bills.

The Angry Optimist|8.28.09 @ 5:16PM|#

max hats - again, it is disingenuous as all hell to say "ALL IS RATIONING". If you want to keep being deliberately obtuse in this matter, it's your nickel, Conrad, but you can dance by yourself, little man.

|8.28.09 @ 5:19PM|#

People die every day. Since death happens all the time, govt shooting people at random hardly qualifies as 'murder'.

Fluffy|8.28.09 @ 5:20PM|#

The concept of saying somebody doesn't know the definition of, then looking around for a dictionary that says what you want to say? Okay, sure.

No, asshole.

What Klein is doing is the equivalent of my saying, "No blizzard fell on the streets of Miami yesterday," and Klein jumping up and saying, "No, you're wrong!" and showing me a picture of some guy dropping a milkshake outside a Miami Dairy Queen. All that would prove is that Ezra Klein is a great big cunt.

|8.28.09 @ 5:20PM|#

As soon as the last remaining links between what you pay and what health care you consume are removed, I promise to make it one of the chief aims of my life to squander as much health care resources as I can.

I love this line of argument. It's the most absurd line of attack ever. It has absolutely no basis in reality.

You think that people who have insurance just love them some doctors visits? That insured people that have a small co-pay treat going to the doctor like going on vacation?

Do you have any idea how many people who have good insurance still put off going to the doctor because of the hassle, the inconvenience, and the general dislike of being poked and prodded and stuck with needles and just a general aversion to doctors and hospitals??

It's the height of stupidity to pretend that if you cover people that they are en-masse going to start going to the doctors just because they can, or that somehow they will be asking for colonoscopies because someone else is paying for it.

Look Fluffy, just because you enjoy getting anal probes doesn't mean the rest of us are going to unnecessarily start requesting them -- even if they are free.

Seriously, that's your argument? If people aren't forced to pay for it themselves and ration is based on their bank account they are gonna go nuts wasting as many medical resources as they can and hospital stays like going to a resort? Health care isn't a fucking T-shirt at a sporting event. People arent just want it because it's free.

The Angry Optimist|8.28.09 @ 5:21PM|#

And as another clue, it is not "cherry picking" when you're picking a definition for fucking relevancy!.

|8.28.09 @ 5:22PM|#

again, it is disingenuous as all hell to say "ALL IS RATIONING".

This is true.

It's equally disingenuous to pretend like private insurance doesn't engage in the type of rationing that many folks predicting will happen if government gets involved.

|8.28.09 @ 5:22PM|#

Fluffy: If you don't like the definition Klein used, ok, but note what Klien was responding to:

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So the person Klein was responding to was also using the more general definition that you consider incorrect (you can purchase private healthcare in the UK; Canada's system is crap). So his point at least still stands if you (say) substitute "ration" with "allocate".

Tony|8.28.09 @ 5:22PM|#

What's really behind the "rationing" scaremongering anyway?

I have mine, and if we enact a government option, somebody else (you know, one of those people, might get in line ahead of me?

Because obviously your access to medical care should depend on your ability to pay for it. Exactly like your access to yachts. Yup, that's the best system there ever could be.

The Angry Optimist|8.28.09 @ 5:22PM|#

ChicagoTom, the "Libertarian" Statist.

ChiTom loves him some big government and doesn't listen to reason on this subject, so there's really no point in arguing with him.

Heather Graham is hot, Katheri|8.28.09 @ 5:23PM|#

The Washington Post should be ashamed to give this halfwit a soapbox. What has he ever done for a living but spew leftwing platitudes and economic gibberish. He is supposed to be their economics and domestic policy guru ("economic and domestic policy, and lots of it"; haha, your sense of humor is retarded too Ezra). What a joke the Post is to employ this guy and Greg Sargent simultaneously.

Joe M|8.28.09 @ 5:23PM|#

It's the height of stupidity to pretend that if you cover people that they are en-masse going to start going to the doctors just because they can, or that somehow they will be asking for colonoscopies because someone else is paying for it.

AT THE MARGIN

The Angry Optimist|8.28.09 @ 5:23PM|#

It's equally disingenuous to pretend like private insurance doesn't engage in the type of rationing that many folks predicting will happen if government gets involved.

Yep. And the grocery store rations because it won't give you free food. And the BMW dealership rations 'cause you cannot get a free fucking car.

you guys are so incredibly dishonest, it's appalling.

|8.28.09 @ 5:24PM|#

We do need solutions to those problems: preexisting conditions, getting dropped and freeloaders. What are the alternatives to regulation? I don't believe the market will handle any of them. I'm convinced they are what will doom our system in a truly free market. I'm assuming we will not let people die in front of the E.R., so everyone needs treated.

The Angry Optimist|8.28.09 @ 5:25PM|#

It's so funny too, because people who wave the bloody shirts of the "victims" of "recission" want to take over the whole system, instead of fixing just that problem!.

It's no mystery as to why.

|8.28.09 @ 5:25PM|#

Of course. Since buying insurance will no longer [and already does no longer, in most cases] make any economic sense for young and healthy people, they'll HAVE to be forced to do it at the barrel of a gun.

But the laughable part is that the reason young, healthy people currently avoid insurance (which, after all, would be relatively cheap for them), is that they tend not to have much wealth or income. So the idea that forcing young healthy people into the risk pool is going to make the economics work is completely absurd. Hell, I wouldn't be surprised if the government ended up having to subsidize coverage for the young people it forces to buy insurance.

|8.28.09 @ 5:28PM|#

The Democrats will never give up on federalizing and unionizing the healthcare industry. Millions of new AFSCME members will result in hundreds of millions of dollars for the left's campaign coffers.

|8.28.09 @ 5:29PM|#

Either you believe that health care is a right that a mature culture provides it's citizens, or you believe that it's a commodity to be sold like bacon. I guess if you've got yours and don't give damn about most others, you'd be a bacon-sider.

And Chicago Tom, fuck you too. We're already plaqued with your ilk and long ago worked out an efficient method for booting your narcissistic asses out of the office.

The Angry Optimist|8.28.09 @ 5:31PM|#

I'm a "bacon-sider" who pays a shit-ton a year for independent insurance.

because I am have more commonsense than a houseplant, I know that insurance is important.

|8.28.09 @ 5:31PM|#

Question One: Is any sort of ban on private insurance being discussed?
Question Two: Does Britain ban private insurance?
Question Three: Did Krauthammer describe Britain's NHS as rationing?

If you cannot fucking figure out that Klein was using the same definition as the PERSON HE WAS REBUTTING, you probably can't figure out a keyboard. So anyone still putting their fingers in their ears and pretending like the only definition of rationing is when the government doesn't let you buy silk stockings is being a disingenous dickhat. Jesus.

|8.28.09 @ 5:31PM|#

Shorter: the poor deserve to die unless some charity decides to take pity on them.

Under the ChiTom system:

ChiTom, unless you outlaw the provision of healthcare outside the government system, the evil rich will still get care that the deserving poor don't. So if your goal is complete equality, that's the road you have to take.

That road doesn't lead to infinite resources, though. It leads to government allocation of resources, hence:

We all deserve to die unless some government agency decides to take pity on us.

Tony, Tony, Tony. This

Give the insurance lobby what it wants, and capitulate to GOP scaremongering on every issue they randomly decide to bring up.

is what Krauthammer predicts the Dems will do, so I'm guessing you're going to be really pissed at the Dems when they do pass healthcare reform.

|8.28.09 @ 5:33PM|#

ChiTom loves him some big government and doesn't listen to reason on this subject, so there's really no point in arguing with him.

As soon as you start putting out a reasonable argument I will listen.

And no, merely yelling "RATIONING" is not reasonable.

Yep. And the grocery store rations because it won't give you free food. And the BMW dealership rations 'cause you cannot get a free fucking car.

See what I mean. Not even a remotely reasonable argument.

How does this idiotic example relate to me getting denied coverage for a procedure my doctor deems appropriate when my premiums are paid in full?

Why is it ok when a corporate bean counter says no to valid coverage, but the end of the world if it were to be a government bureaucrat? (And don't give me the bullshit -- you can always change providers. You CAN'T always change providers -- more often than not you can't change providers, you get what your employer decides you will get)

There are plenty of places where government has no business being involved. I just don't think health care is one of those places.

If that means I fail the free-market-fellating-at-all-costs regardless of how it hurts real people purity test, so be it.

|8.28.09 @ 5:34PM|#

Either you believe that health care is a right that a mature culture provides it's citizens, or you believe that it's a commodity to be sold like bacon. I guess if you've got yours and don't give damn about most others, you'd be a bacon-sider.

Put me down as a bacon-sider.

Of course, I work for an organization that writes off millions of dollars a year in health care for poor people, so I think that providing health care to poor people is something that can be accomplished without Mo Bigga Government.

|8.28.09 @ 5:35PM|#

Why is it ok when a corporate bean counter says no to valid coverage, but the end of the world if it were to be a government bureaucrat?

Strawman alert: Nobody said it was OK for an insurance company to say no to valid coverage.

Carry on.

|8.28.09 @ 5:36PM|#

Ted Kennedy championed this following his cutting edge brain surgery at Duke and world class cancer treatment at Mass General, followed by bed-side care until his death.


And yet for all of the resources invested, the outcome was basically inevitable. Did his top-notch treatment extend his life? Probably. But obviously not by much.

Which raises the question: how much of a subsidy is society at large supposed to provide for end-of-life-care? If somebody who isn't as well-to-do as a Kennedy is terminally ill, are taxpayers supposed to foot the bill for treatments that will not change the fact that everybody, at some point, dies?

Those who preach about "fairness" and "equal access" seem to forget that for all of human existance, there has never been "fairness" and "equal access". Some live longer than others and when your number is called, there's often very little you can do to hold up the line.

Tony|8.28.09 @ 5:37PM|#

R C Dean,

Krauthammer is rarely right about anything, so I'm not worried.

daveinboca|8.28.09 @ 5:37PM|#

Like most left-leaning folks, Klein clearly doesn't know the definition of rationing. or of many other elements of the economy or democracy.

Ezra Klein got the job at the WaPo to counter the sane mature well-balanced views of Krauthammer, who is occasionally wrong, but always able to justify his arguments.

Klein is an entitlement moppet, kinda like Yglesias and Benen and a bunch of other Ivy agitpreppies who feed each other on blog sites like Memeorandum etc. The other Klein, an ur-Commie named Joe who writes for the rapidly-dying Time Inc. mag., doesn't bother to argue. He just says the GOP or independents or other citizens simply have no right to oppose ObamaCare, because it is transparently the only solution.

Sound a little like "Die Endloesung?"

|8.28.09 @ 5:37PM|#

ChiTom, unless you outlaw the provision of healthcare outside the government system, the evil rich will still get care that the deserving poor don't. So if your goal is complete equality, that's the road you have to take.

No one is demanding complete equality. Let the rich have their botox and face lifts and breat augmentations.

Your implication seems to be that necessary care would somehow not be available to both the rich and poor within the system, and the rich will be able to get it outside the system. In my world, necessary care will always be available within the system so the rich will have no reason to go outside the system.

Your whole argument rests on the premise that the care people need won't be available -- that's pretty flawed assumption.

The Angry Optimist|8.28.09 @ 5:38PM|#

Why is it valid for some bean counter at the Piggly Wiggly to deny you food your doctor undoubtedly says you need?

Aww, poor baby, the world doesn't owe you an existence.

Fluffy|8.28.09 @ 5:40PM|#

It's the height of stupidity to pretend that if you cover people that they are en-masse going to start going to the doctors just because they can, or that somehow they will be asking for colonoscopies because someone else is paying for it.

That's exactly what will happen.

Check out any message board populated by cheap-ass housewives who specialize in freeloading. Mothering.com, for example. My wife reads it for potty-training advice and to laugh at the absolutely conscience-free welfare queening people describe there. I've seen a lot of it, and I can promise you this: If the bill develops the way it looks like it will develop, and we get community pricing + no bar on preexisting conditions + mental health covered the same as physical health + complete prescription coverage + developmental services covered the same as illnesses, there is about trillion dollars of pent-up welfare queen demand about to be unleased on the system.

Hell, even I will be a part of it. If the feds put some subsidized public option out there, I will force my way on to it and walk down to the doctor and fake the symptoms for a Ritalin prescription. Because I'm definitely making sure the system loses money on me. Like Joey Tribiani said when he heard that the Vegas buffet was free and all you can eat: "This is where I make my money back."

My toddler is hyperlexic, and as a result it would also be a trivial matter for me to convince a developmental specialist to write me a piece of paper saying he's on the autism spectrum. HELLO 100 g's of free services a year under Obamacare for Fluffy!

I'll think of more ways to fuck with the system later. It's really easy for me. I have distinct weasel tendencies, and if you construct a system that rewards weasels, I will milk it for all it's worth.

robc|8.28.09 @ 5:41PM|#

Max hats,

Strongly disagree. All insurance is a losing proposition in the macro sense - that is how insurance companies make money. Given 10 million young healthy people, their total health costs are lower than the cost of those 10 million buying insurance. But one individual is not 10 million in aggregate. If something goes wrong, we individually seek out individual protections against individual catastrophe. That is the essence of all insurance - a net expected loss taken voluntarily to hedge unacceptable catastrophe.

Wrong!!! While most of what you just said is right (heh, makes my "wrong" funny, doesnt it), risk management has a value to it (this value varies with different people). If the net expected loss is greater than the value of managing risk, then it no longer makes sense to buy the insurance.

|8.28.09 @ 5:41PM|#

Strawman alert: Nobody said it was OK for an insurance company to say no to valid coverage.

Then why aren't you people screaming about the current rationing going on, but are so upset by the potential rationing you think is going to happen in the future?

And you personally RC Dean, have argued in defense of insurance companies use of rescission (like when people forget to tell their insurer that they once saw a dermo for acne, and then they are dropped if they get breast cancer) to deny claims to people once they get sick under the auspices of "fraud"

Your dishonesty is amazing.

Clarkspoon|8.28.09 @ 5:42PM|#

Fairness demands that any system of reform charges patients based on their utilization of medical resources.Sick people should pay substantially more than healthy people. Hypochondriacs more than the doctor-averse. Women more than men. The old more than the young.

Tony|8.28.09 @ 5:42PM|#

Marc,

If a wealthy person wants to pay to extend his miserable existence, I'm sure there will be no shortage of providers willing to take his money and provide it for him. This whole bullshit about rationing and death panels, even if it had factual merit, is appallingly classist in tone. We need to let the poor die in the streets because they might make my gold-plated health plan a little tarnished if they get their dirty little fingers on it!

|8.28.09 @ 5:42PM|#

TAO: I will use small words to make this clear. The plan (as if there is only one, but let's be broad) put on the table is, in your metaphor, opening Federal Food Mart. Federal Food Mart will not provide every food stuff (caviar? trans fats?) to every visitor to the store. This is no different from what the Piggly Wiggly does. But when the government does it, OMG RATIONING.

If you would like to demonstrate to me that any plan being discussed involves the equivalent to outlawing Piggly Wigglies, go for it. If you want to talk about how there's a slippery slope, leading straight to such a ban, cool. But don't fucking act like every single goddamn commentator calling the healthcare bill as written "RATIONING" is not using the same goddamn definition you claim does not exist.

The Angry Optimist|8.28.09 @ 5:44PM|#

Then why aren't you people screaming about the current rationing going on

More dishonest use of language.

ChiTom - why is that you cannot just support limited recission reform? Why must you wave the bloody shirt of its "victims" while refusing to fix the problem?

Ah, yes, because recission is a convenient bludgeon, not something you actually give a shit about.

Seward|8.28.09 @ 5:45PM|#

Strech,

And what people can pay is based primarily on what the government or quasi-governmental bodies say it costs. The primary problem is that the price mechanism is undermined by government action. That problem will only continue to get worse.

robc|8.28.09 @ 5:45PM|#

ChicagoTom,

There are lots of things that people should learn to live without if they can't afford it. Health care isn't one of them.

Bullshit. Fuck you.

You are a slaver. Fuck you in the fucking head. Fuckhead.

You are EXACTLY morally equivalent to a fucking slave owner.

The Angry Optimist|8.28.09 @ 5:45PM|#

DeepOmega - yeah, I know, you think everything is rationing. It wasn't right the first time, and it isn't right now.

Not interested in continuing with your blatant dishonesty and transparent attempts at distortion, "small" words aside.

|8.28.09 @ 5:45PM|#

That's exactly what will happen.

Another libertarian Nostradamus.

Check out any message board populated by cheap-ass housewives who specialize in freeloading.

Oh well, if that's where you are getting your "data" from.

We should also use YouTube comments to judge the intelligence of the average web surfer too.

I'll think of more ways to fuck with the system later. It's really easy for me. I have distinct weasel tendencies, and if you construct a system that rewards weasels, I will milk it for all it's worth.

You go for it Fluffy. You take that time off of work to get see your doctors to "make your money back"

I know you think that is somehow a convincing argument -- but the fact that some people will find a way to game the system doesn't mean the system shouldn't exist.

you and your attitude are the exception, not the rule.

Fluffy|8.28.09 @ 5:46PM|#

If you cannot fucking figure out that Klein was using the same definition as the PERSON HE WAS REBUTTING, you probably can't figure out a keyboard. So anyone still putting their fingers in their ears and pretending like the only definition of rationing is when the government doesn't let you buy silk stockings is being a disingenous dickhat. Jesus.

No.

If Klein had argued, "Obamacare is not a rationing system" there are various lines of argument he could offer that would make him right. The three questions you ask would be among the lines of argument he could have pursued.

But he didn't do that.

He said "It doesn't matter if Obamacare would lead to rationing, because price systems also are rationing".

That is definitely not using the same definition as the person he was rebutting.

|8.28.09 @ 5:46PM|#

We need a law which compels the casinos in Vegas to pay off a "two" or a "twelve" the same as a "six" at the crap table.

That would be fair.

|8.28.09 @ 5:47PM|#

TAO: Let's try this. How is any healthcare plan being discussed rationing, then? If extra-governmental care isn't being banned, then how is it rationing?

The Angry Optimist|8.28.09 @ 5:47PM|#

yeah, ChiTom, no one would EVER overuse a system they perceive as "free".

|8.28.09 @ 5:48PM|#

Bullshit. Fuck you.

You are a slaver. Fuck you in the fucking head. Fuckhead.

You are EXACTLY morally equivalent to a fucking slave owner.

More of those reasonable arguments from the glibertarians.

You know who else provided government health care? Hitler!

Anyone who supports government health care is just like the Nazis

When did Libertarians morph into Larouchies?

The Angry Optimist|8.28.09 @ 5:49PM|#

DeepOmega - how is that relevant? We're talking about whether Klein was using the same definition - he isn't, because he's saying the way markets work is also "rationing".

And Federal Food Mart is not going to survive on user fees alone, so it has an element of "rationing" in it as well, in that not everyone is going to get to go into Federal Food Mart (i.e. Rich people).

Tony|8.28.09 @ 5:50PM|#

Fluffy,

I think the point is to recognize what's the bad thing about rationing. It's (I guess) that somehow the health care (some) people enjoy will be diminished in quantity or quality because more people will have access to health care (as if the health care system were a fixed size).

Now compare this to the current system, where the quantity and quality of health care you have access to without going into bankruptcy is determined by whatever insurance companies can legally deny you based mostly on their bottom line calculation. Who really gives a fuck what it's called?

Seward|8.28.09 @ 5:51PM|#

ChicagoTom,

If you believe that government involvement in healthcare can simply be cordoned off from the rest of your life then you are more confident of that sort of thing than I am.

mark|8.28.09 @ 5:51PM|#

It's the height of stupidity to pretend that if you cover people that they are en-masse going to start going to the doctors just because they can, or that somehow they will be asking for colonoscopies because someone else is paying for it.

It's funny you brought that up. Did you know that 30% of Americans have had a colonoscopy while only 5% of Canadians have? So even though Canadians might be asking for colonoscopies, they're not getting 'em. And Americans might not be asking for one, but get them anyway, because hey, someone else is paying!

|8.28.09 @ 5:51PM|#

imadoc:
If health care is a right, then someone is obligated to not just pay for it, but to provide it. Will the government then force people to enroll in medical school in order to ensure that there are sufficient doctors to ensure that the citizenry gets its right?

Tricky Prickears|8.28.09 @ 5:51PM|#

and fake the symptoms for a Ritalin prescription.

I would holdout for Adderall or Desoxyn. That's already happening. All you have to do is go to the doctor and say you're having trouble concentrating while reading. Doctor's are handing out Adderall prescriptions like fucking candy. And yes, your private insurance will likely cover it.

|8.28.09 @ 5:52PM|#

You're an idiot. Here's the voice of one of your own false reactionary Gods (William Safire) quoted from the Oxford English Dictionary:

1979 W. SAFIRE in N.Y. Times Mag. 9 Sept. 16/1 Rationing by price, a system in which economic goods go to the people who are most willing to pay for them. This is the normal way of distributing goods in capitalist countries, and is increasingly used in Communist countries.

Hey, but what do those British fagots know about English? And Safire was a Jew, after all.

robc|8.28.09 @ 5:53PM|#

More of those reasonable arguments from the glibertarians.


You made a demand that I work for you. You are a fucking slaver. This isnt about hitler/nazis. You claim a piece of my life. Go fuck yourself hard.

|8.28.09 @ 5:53PM|#

Two great quotes:

"We should like to have some towering geniuses, to reveal us to ourselves in color and fire, but of course they would have to fit into the pattern of our society and be able to take orders from sound administrative types."
Joseph Priestley

"We haven't got the money, so we've got to think!"
Ernest Rutherford

Paul|8.28.09 @ 5:54PM|#

We also ration Ferrari's and Flat Screen Plasma TV's because I have neither.

robc|8.28.09 @ 5:54PM|#

That applies to a bunch more of you too, not just ChiTom.

Fuck you all. Microslavery is slavery.

The Angry Optimist|8.28.09 @ 5:55PM|#

I am so tired of you guys trampling my 'right' to a Beamer, by *not* providing one to me!

HEARTLESS BASTARDS!

|8.28.09 @ 5:55PM|#

why is that you cannot just support limited recission reform? Why must you wave the bloody shirt of its "victims" while refusing to fix the problem?

What the fuck are you talking about?

I'm supposed to ignore the fact that insurance companies do this to people and make their lives miserable (if not end them prematurely) because you think that's waving a bloody shirt? Their decisions have real consequnces that effect real people. Sorry that you don't want to face reality, but it happens. And one time is one time too many.

I am offering a solution to the problem. Regulate the shit out of insurance companies or get them out of the health care industry all together, and change the system so that rescission can't happen.

Just because you don't like my solution doesn't mean I don't want to fix the problem. I'm just a bit jaded on pretending like loosening regulations on the poor/innocent/victimized insurance companies is going to fix what's wrong with our health care system.

yeah, ChiTom, no one would EVER overuse a system they perceive as "free".

Because government run health care is exactly like going to an all you can eat buffet or staying at a hotel for free.

|8.28.09 @ 5:56PM|#

Quoth a Canadian doctor I met, when I asked him to tell me about the health care system in Canada:

"Well, it's bad in that it sucks, but it's good in that it sucks for everybody equally."

robc|8.28.09 @ 5:56PM|#

reasonable arguments

What is unreasonable about, "If you want a fucking service pay for it your fucking self".

|8.28.09 @ 5:56PM|#

This whole bullshit about rationing and death panels, even if it had factual merit, is appallingly classist in tone. We need to let the poor die in the streets because they might make my gold-plated health plan a little tarnished if they get their dirty little fingers on it!

As opposed to the envy-politics argument:
"If that guy can have fifty Chemo treatments, then everybody has to have fifty chemo treatments."

Lloyd Doggett (D-TX)|8.28.09 @ 5:57PM|#

"Another of the arguments I heard this morning and I saw on the signs across the street concerns 'rationing' of health care. What do you think we have right now? In 2006, 22,000 people died because they didn't have health insurance. They got rationed right out of their life and sustenance."

Fluffy|8.28.09 @ 5:58PM|#

Oh well, if that's where you are getting your "data" from.

We should also use YouTube comments to judge the intelligence of the average web surfer too.

When people who freely offer stories about how they game the student loan system, the food stamp system, the housing rent voucher system, and every other government spending system, are spending their time on message boards offering advice to each other on how to game Obamacare, YES, that's good data.

By the way - it's absolutely clear to me that YOU intend to consume more health care services in the future than the insurance system will allow you to afford. It's transparently obvious that it's your own personal desire to freeload that motivates you in these discussions. I don't know if you've got some kind of pre-existing condition or what, but I know there's SOMETHING going on there. If you weren't going to get more health care in the future than you can get now, you wouldn't be as motivated as you are.

It's the very fact that people want to make this policy change in the first place that proves that my argument is right. If people aren't going to consume more health care in the future, if people are already consuming all the health care they want, why would we need a reform?

|8.28.09 @ 5:58PM|#

How does this idiotic example relate to me getting denied coverage for a procedure my doctor deems appropriate when my premiums are paid in full?


That's called one of these things:

1. A bad contract
2. Breach of contract
3. Fraud

It's not called:

Rationing

The Angry Optimist|8.28.09 @ 5:59PM|#

ChicagoTom - if you cared that much about recission, you wouldn't be using it as an excuse to reform the whole system. You would support fixing recission and recission only. The fact that you do not tells me that the alleged existence of "recission" is merely a convenient emotional bludgeon with which to shut down your enemies.

And you full well know it.

|8.28.09 @ 6:00PM|#

You made a demand that I work for you. You are a fucking slaver. This isnt about hitler/nazis. You claim a piece of my life. Go fuck yourself hard.

Right, and welfare, and food stamps, and medicare, and defense spending, and the VA, and the police, and the fire department, and roads. It's all just a form of slavery.

Idiot.

|8.28.09 @ 6:00PM|#

Because government run health care is exactly like going to an all you can eat buffet or staying at a hotel for free.

Of course it wouldn't, because there would be rationing.

Health \'Reform\' Advocates|8.28.09 @ 6:01PM|#

If people aren't going to consume more health care in the future, if people are already consuming all the health care they want, why would we need a reform?

Because little old ladies, children and puppies are starving on the streets.

DUH, Fluffy, what are you, some kind of monster?

Wait, what? Fix recission? Why the fuck should we want to do that? It provides us such a convenient scapegoat!

|8.28.09 @ 6:02PM|#

if you cared that much about recission, you wouldn't be using it as an excuse to reform the whole system. You would support fixing recission and recission only.

If rescission were the only problem with the system, maybe. But that isn't the only problem of many.

You are stupider than I thought if you think that's the only problem that I want fixed.

The Angry Optimist|8.28.09 @ 6:02PM|#

Right, and welfare, and food stamps, and medicare, and defense spending, and the VA, and the police, and the fire department, and roads. It's all just a form of slavery.

Do you think you're entitled to those things on the back of someone else?

I doubt it.

The Angry Optimist|8.28.09 @ 6:02PM|#

ChicagoTom - what other problems do you want fixed, then?

Paul|8.28.09 @ 6:04PM|#

Someone must also be rationing career ambition, because I don't have any of that, either.

The Angry Optimist|8.28.09 @ 6:04PM|#

ChicagoTom, stop rationing Beamers and cough up the dough - I am entitled to one.

Why? 'Cause I said so. RATIONER!

highnumber|8.28.09 @ 6:05PM|#

You are EXACTLY morally equivalent to a fucking slave owner.

um...okay...wow.

Do you really think that?

robc|8.28.09 @ 6:05PM|#

Right, and welfare, and food stamps, and medicare, and defense spending, and the VA, and the police, and the fire department, and roads. It's all just a form of slavery.


Yes it is. Dude, I wouldnt be surprised if the police switch from tasers to whips. The police example proves my point. :)

Idiot.

I know you are.

|8.28.09 @ 6:05PM|#

That's called one of these things:

1. A bad contract
2. Breach of contract
3. Fraud

It's not called:

Rationing

Another stupid person enters teh debate.

That is exactly what rationing is.

When the insurance company has a policy that it isn't going to cover certain treatments because of their price (or what they say is the limited effectiveness) it's rationing (and it is exactly what people are bitching that the government is going to do)

The Angry Optimist|8.28.09 @ 6:06PM|#

The facts are as follows:

- There are maybe, tops, 10 million people in the United States not eligible for insurance. This is a problem, albeit a small one.

- For the other 320 million people who are or should be covered, there sometimes are contractual disputes. This is a problem, albeit a small one that could easily be fixed.

So, what do health care 'reformers' want? To take those two small problems and employ them to destroy the American health care system, the greatest and freest in the world.

To that, I say 'fuck you'.

robc|8.28.09 @ 6:06PM|#

Do you really think that?

Yes. How can I not?

If you make me work for you for nothing against my will, I am your slave.

The Angry Optimist|8.28.09 @ 6:08PM|#

When the insurance company has a policy that it isn't going to cover certain treatments because of their price (or what they say is the limited effectiveness) it's rationing

When the Piggly Wiggly has a 'policy' that says that bread is 2 dollars, and they won't give it to me for 1 dollar, that's 'rationing'.

ChicagoTom's failure to buy me a Beamer is 'rationing'.

In other words, because scarcity exists, all is rationing. SO DISHONEST.

The Angry Optimist|8.28.09 @ 6:10PM|#

ChicagoTom - name one thing, using your definitions, that is not 'rationing'.

|8.28.09 @ 6:10PM|#

Memo for Ezra Klein:

Rationing is often followed by....revolution. And, if revolution comes to pass, who's side are you gonna be on?

Choose wisely, Grasshopper.

Seward|8.28.09 @ 6:10PM|#

Arguing over how a term is defined is a very sterile but common form of debate on the internets.

We can call it rationing, the price mechanism, or anything else you want to. Just as with planning the question is, who does the rationing? Who creates the prices?

I'd say that it is demonstrably clear that private actors create the prices, "ration," far better than governments do. This is part part explained by Hayek in the socialist calculation debate.

Fluffy|8.28.09 @ 6:11PM|#

I think the point is to recognize what's the bad thing about rationing. It's (I guess) that somehow the health care (some) people enjoy will be diminished in quantity or quality because more people will have access to health care (as if the health care system were a fixed size).

Now compare this to the current system, where the quantity and quality of health care you have access to without going into bankruptcy is determined by whatever insurance companies can legally deny you based mostly on their bottom line calculation. Who really gives a fuck what it's called?

Here's my issue. Since you asked.

Obamacare in its last iteration envisioned forcing all new insurance plans to be sold via a government insurance exchange.

A team of bureaucrats in charge of that exchange would be empowered to act as a gatekeeper for the exchange, devising the benefits packages it would legal to offer. The decisions of these bureaucrats would not be subject to judicial review.

So essentially, as soon as we have an administration that appoints board members who say one simple sentence to themselves [one that's said all the time in Canada] - "We shouldn't have a two-tier medical care system" - those bureaucrats would be empowered to prevent any insurer in the US from offering a benefits package that is better than that provided by the public plan. All they have to do is use their unilateral and unquestionable power to say, "No, you can't sell that on the exchange."

Voila. Now no matter how much money I want to spend, I can't get an insurance plan that is better than the one the government thinks I should be allowed to buy. That's effectively fiat rationing, albeit in a novel form.

As others have pointed out, it probably won't even be necessary for the bureaucrats to directly outlaw superior insurance. By allowing system participants to change insurers at will, and by not allowing insurers to refuse to cover pre-existing conditions, this incentivizes every last customer to buy the cheapest plan when they're healthy and switch to the plan with the best benefits once they're sick. As a result, it will be impossible to offer a plan with better benefits than the public plan, because you'd automatically lose money on it as an insurer, due to all the freeloaders switching to it after they've already been diagnosed. So again, we have fiat rationing in a novel form - by making it business suicide to offer a plan with better benefits than the public plan, the state has forestalled my ability to obtain better insurance than that offered by the public plan, no matter how much I am willing to pay.

|8.28.09 @ 6:11PM|#

I was in an online conversation in which a Brit apologist for the NHS said, with a straight face "There is no rationing, although sometimes there aren't enough available beds."

In a profit driven system, hospital beds are the enabler of revenue, so there is an interest in avoiding a shortage. In a govt system, they are cost centers, sinks, so there is no incentive to have more.

Paul|8.28.09 @ 6:12PM|#

And I like totally know they're rationing hot wimmen, cause I definitely don't have any of those.

|8.28.09 @ 6:12PM|#

what other problems do you want fixed, then?

Well off the top of my head:

Prices are too high and rising too much.

Many insurance companies set their policy to deny valid claims and make their customers file appeals to get the coverage they pay for.

There is no legitimate reason to have to get pre-authorization for procedures/hospital stays. I shouldn't have to warn them when I am going to use the insurance I pay for.

Too many exclusions. Too many gotchas or gaps in coverage that people don't always know.

Insurance shouldn't be tied to my employer.

That's just some of the problems that need to be fixed.

Seward|8.28.09 @ 6:13PM|#

TAO,

Well, for you, it is only worth $1. Both are subjective.

With so much government involvement in what is charged regarding health care it is no wonder what the price mechanism doesn't work to make what is cloudy, clear.

robc|8.28.09 @ 6:13PM|#

Insurance shouldn't be tied to my employer.


I agree with you on that one. Lay the blame at the proper place - FDR.

robc|8.28.09 @ 6:14PM|#

How about we fix that one first and see how the system shakes out 10 years later?

I think separating insurance from employment will solve a lot of the other problems thru competition. I will choose to go with the "actually pays" insurance company over the "screw you" insurance company, even if it costs $10 more per month.

The Angry Optimist|8.28.09 @ 6:15PM|#

Many insurance companies set their policy to deny valid claims and make their customers file appeals to get the coverage they pay for.

There is no legitimate reason to have to get pre-authorization for procedures/hospital stays. I shouldn't have to warn them when I am going to use the insurance I pay for.

Too many exclusions. Too many gotchas or gaps in coverage that people don't always know.

These are all contract problems. The fact that you aren't willing to listen to any alternative options to solve any of these problems tell me that, yes, you have an ulterior motive. You want others to pay for your care, and you don't care how it happens.

Jim Treacher|8.28.09 @ 6:16PM|#

Your Good Buddy Johnny Clarke: Forget healthcare, I want to know when the government is going to do something about all the lobster, mansion and Corvette rationing, because having those are rights too, darnit.

Thank you. I was going to say Porsche, but otherwise you beat me to it.

ChicagoTom: Only libertarians and the GOP have future predicting powers, apparently.

Or perhaps liberals and the Democratic Party have history-denying powers.

|8.28.09 @ 6:16PM|#

When the Piggly Wiggly has a 'policy' that says that bread is 2 dollars, and they won't give it to me for 1 dollar, that's 'rationing'.

If I have a health insurance policy it should pay my medical bills for what my doctor deems medically necessary.

I am not asking for anything other than what I am owed. I pay for insurance, when I am healthy I expect them to pay if I get sick.


You analogies would be apt if I were saying the doctors are rationing because they wont treat me for free. But the point of insurance is to take care of my bills if I get sick. It isn't rationing when they pay for what I need, medically -- regardless of how much it eats into their profit margins.

robc|8.28.09 @ 6:17PM|#

I am hungry and Argentinian steak is calling my name. Unless it gets rationed. Wait, nope, I have cash in my wallet, no rationing!

Paul|8.28.09 @ 6:17PM|#

It's also pretty clear they ration knowledge of economics...

|8.28.09 @ 6:17PM|#

When the insurance company has a policy that it isn't going to cover certain treatments because of their price...

...don't buy that policy.

(or what they say is the limited effectiveness) it's rationing (and it is exactly what people are bitching that the government is going to do)

They don't have a choice as to whether they can pay for it or not.


(and I never called you names.)

Seward|8.28.09 @ 6:18PM|#

ChicagoTom,

Prices are high because so much of the healthcare system is protected and cartelized via government aid/interference.

Many insurance companies set their policy to deny valid claims and make their customers file appeals to get the coverage they pay for.

Well, that is basically a result of state policies which mandate minimum levels of coverage. Neither consumers nor insurers are thus able to create the sort of differentiated insurance packages they want to get or provide.

Insurance shouldn't be tied to my employer.

More government interference, in this case ta policy, explains this.

robc|8.28.09 @ 6:18PM|#

I am not asking for anything other than what I am owed. I pay for insurance, when I am healthy I expect them to pay if I get sick.

If they are violating your contract, sue the fuckers. If they are following it, whats your complaint? That is what you are owed.

If the contract says you have to get approval first, then you have to get approval first. Negotiate a better deal next time.

Dan|8.28.09 @ 6:18PM|#

Most goods and services are rationed by "affordability" -- the government enforces a background set of property rights and financial controls that determines who can afford what. Thus it is for Gucci, BMWs, and red wine. This method works for most people on most things.

Some goods and services, by the choice of voters, are rationed by something other than affordability, meaning some will get less than they could afford, and/or some will get more than they could afford. Thus it is for food (stamps), housing (rental vouchers), schools (public), and satellite navigation (GPS is taxpayer-funded).

Medicine is something that the public is increasingly unwilling to see rationed by affordability. So we are likely to have a new health insurance regime in this country. Those who experience such a change as "theft" will just have to lay back and think of England. Our system lets a big enough set of voters "steal" from another set of voters for such things as universal health coverage and universal kindergarten. Those who can not abide it are welcome to pull a Heinlien and build their own utopias on the moon, or at the bottom of the ocean.

The Angry Optimist|8.28.09 @ 6:19PM|#

If I have a health insurance policy it should pay my medical bills for what my doctor deems medically necessary.

No, it should pay for what the policy says it will pay for.

|8.28.09 @ 6:19PM|#

If I have a health insurance policy it should pay my medical bills for what my doctor deems medically necessary.

Damn, that's some fine insurance policy there. How much does that one cost?

Paul|8.28.09 @ 6:19PM|#

I pay for insurance, when I am healthy I expect them to pay if I get sick.

Then thank your lucky stars we don't have a universal healthcare system.

|8.28.09 @ 6:20PM|#

[B]ut using that wide of a definition renders the term meaningless. If I can't afford a BMW at the price i'm willing to pay, is that rationing?

Yes. Any more questions that an eight year old with a Dr. Seuss Dictionary can answer?

I don't know why this is so complicated for you folks. "Rationing" is is any method of allocation - government fiat, lots, price, whatever. Because we are used to rationing by price, we don't think of our pricing system as a ration system, but it is.

So is our circulatory system - it rations the use of oxygen, among other things.

Oh, and electrical transformers, that ration the allocation of electricity.

I could go on. "Ration" is a simple word to use. Why does it give you all so much trouble?

|8.28.09 @ 6:21PM|#

In 2006, 22,000 people died because they didn't have health insurance.

[citation needed. Moron.]

I wonder how many people in Canada, France, and England died because they didn't get care that they likely would have in the US?

Your whole argument rests on the premise that the care people need won't be available -- that's pretty flawed assumption.

ChicagoTom, I suggest you acquaint yourself with the level and amount of care that is available in places like Canada, France, and the UK.

Of course, the dodge is that what we provide that they don't isn't "needed". Who says what is needed? Why, the Almighty State, of course. Its a nice, tight tautology. "We provide all the care that is needed, because we say what is needed, and we provide the care."

And you personally RC Dean, have argued in defense of insurance companies use of rescission (like when people forget to tell their insurer that they once saw a dermo for acne, and then they are dropped if they get breast cancer) to deny claims to people once they get sick under the auspices of "fraud"

I seem to recall saying something along the lines of insurance companies should be able to enforce their contracts. Of course, insured patients should, too.

Will private insurers abuse their contracts, even breach them? Of course. Will people lie on their applications to get insurance? You bet they will. Should there be consequences for lying, fraud, breach, and abuse? Sure, according to the facts of the case.

I can only agree, as noted above, that the proposed solution to wrongful rescission is far, far out of proportion to the alleged problem.

|8.28.09 @ 6:22PM|#

Prices are too high and rising too much.

Getting the government involved will totally solve that.

Just as the government should impose price controls on cars; just think how much demand there would be for Turbo Carreras at the low, low price of $19,999.-.

And Porsche would love to import them at that price.

|8.28.09 @ 6:23PM|#

Those who can not abide it are welcome to pull a Heinlien and build their own utopias on the moon, or at the bottom of the ocean.

They use they old "love it or leave it" in England too?

|8.28.09 @ 6:23PM|#

"Rationing" is is any method of allocation.

I really don't think that rationing and allocation mean exactly the same thing, so that the term "rationing" is entirely superfluous, and we would lose nothing by banning it from our vocabulary altogether.

Jim Treacher|8.28.09 @ 6:24PM|#

ChicagoTom is really persuading me that the world should be as he wants it to be or it's not fair, and anybody who questions this wisdom is a bit fat stupid dum-dum.

|8.28.09 @ 6:25PM|#

And I like totally know they're rationing hot wimmen, cause I definitely don't have any of those.

I'm pretty sure this a joke, but it's hard to tell with you guys. You're right, of course. Those "hot wimmen" are also rationed - by the "hot wimmen" themselves, who decide who to associate with. In other societies, "hot wimmen" were rationed by their fathers, or sometimes village elders or feudal kings.

Again, I don't know why the concept of "rationing" is so difficult for you folks to understand. It very, very simple. If decisions are made, at any level, that something is not freely available to anyone, then that something is rationed.

Can we move the debate forward now?

The Angry Optimist|8.28.09 @ 6:27PM|#

No, 'dictionary', we cannot, because if anyone uses the term "rationing" properly, we get the intellectually stunted screaming "ALL IS RATIONING" and they are the ones who refuse to debate the proposition on its own terms.

|8.28.09 @ 6:27PM|#

All language is meaningless.

|8.28.09 @ 6:28PM|#

"Rationing" is is any method of allocation

This is all just semantics, but NO.

Hey, I'm a guy with a dictionary too.

rationing

A regulated allocation of resources among possible users.

OR

ra·tion (rāsh'ən, rā'shən)
n.
A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity.

A fixed portion allotted, as in by someone else, not you.

|8.28.09 @ 6:30PM|#

Anybody read robc's 5:45 pm post?

Isn't it ironic that he filters me out? I challenge anyone to reach back into cyberspace history to find a post of mine that contained six expletives within three lines.

Just sayin'-Those that filter others out yet frequently post expletive ridden comments do not do their positions any favors.

|8.28.09 @ 6:31PM|#

This really is excellent.

So the United States, where millions upon millions of our citizens either go without any health insurance, or might as well have, as they discover that their expensive policy in fact doesn't cover nearly enough to keep them from going bankrupt to pay medical bills if they get really sick some day, can now delude itself that this is okay, you see, because "it's not rationing".

It's really the perfect ultra-conservative statement, this one, entirely based on ideology and terminology, removing the sad, disgraceful, shockingly bad third-world health insurance situation for most of the population from scrutiny because "it's not rationing", because rationing, as we know, is only done by governments, and therefore....this denial of care is okay!

If a corporation, or a non-profit for that matter decides to ration anything-- it's not rationing! It's not done by the government! And as every conservative knows, anything done by the government is bad, and anything done by anyone else is okay!

The Red Cross sometimes has to ration medical supplies. But it's not rationing! Because they're not "the government".

Oy.

Dan|8.28.09 @ 6:32PM|#

Use the term "rationing by affordability." Semantic problem solved. Then we can proceed to the substance.

|8.28.09 @ 6:33PM|#

Regulate the shit out of insurance companies or get them out of the health care industry all together, and change the system so that rescission can't happen.

Fix Medicare first, fuckbiscuit. You worthless goddamn oxygen thieves have had more than four decades with over-65 citizens as your private fucking labrats for government to experiment upon in the healthcare context, and all you've managed to accomplish is to dig a $74 trillion hole. And now you want control over the rest of the healthcare industry, given the absolutely bang-up job you worthless cunts have done so far?

Go eat a giant bag of deep-fried cock.

|8.28.09 @ 6:34PM|#

I see what the problem is.

Ok, when you go to the store and make a deal with the store owner to buy 12 eggs and the store owner won't give you 12 eggs unless you give him $2, that's NOT rationing.

When someone else comes in and has the power to stop the store owner from selling you 12 eggs and he can only sell you 6, no matter what, that IS rationing.

There is a third party involved in rationing besides the buyer and seller.

So the feudal lord or father determining who gets the hot wimmins IS rationing, but the hot wimmins turning you down for a date is NOT.

Seward|8.28.09 @ 6:35PM|#

ChicagoTom,

As the Canadian Supreme Court stated in 2005 regarding Canada's universal health insurance system, access to a health care queue is not the same as access to health care. They thus declared the state's monopoly on funding those procedures via medicare in at least one of the provinces was unconstitutional because the state was doing such a poor job of providing such.

|8.28.09 @ 6:35PM|#

So the United States, where millions upon millions of our citizens either go without any health insurance...

"Our" citizens? I don't own any citizens.

Dan|8.28.09 @ 6:38PM|#

Juice you are so cleverrr!!! I'll bet you could beat a sewer rat at a game of checkers.

Joe M|8.28.09 @ 6:38PM|#

Just because you don't like my solution doesn't mean I don't want to fix the problem. I'm just a bit jaded on pretending like loosening regulations on the poor/innocent/victimized insurance companies is going to fix what's wrong with our health care system.

No one is on the side of the insurance companies. They operate as more or less local monopolies. They won't improve because they're not facing real competition. But deregulate by allowing coverage to cross state lines, and companies won't decide to improve out of the goodness of their hearts; they'll do it because they'll lose customers if they don't.

|8.28.09 @ 6:39PM|#

Chicago Tom-

What gives? That the insurance companies are rent seeking, serial contract breachers and unresponsive to their insureds does not induce a free man to conclude that the state will dictate his health care decisions.

I think the foregoing is what robc intended to convey.

|8.28.09 @ 6:39PM|#

Gee, why is corporate "rationing" preferable to government "rationing?"

This is a tough one. Let me think about it for a few.

Oh yeah, that's right, health industry companies make profit by making me -- and as many other people as they possibly can -- get better and continue to draw breath.

Whereas bureaucrats from government agencies would draw their incentive for keeping me alive from...well...

Private "rationing" is a disaster to be apologized for profusely as the people with skin in the game work to expand capacity, while government "rationing" is proof of a society's virtue according to liberalism's foul arcana. This is why there are more MRI machines in Philadelphia than in Canada (Google: mri machines philadelphia canada)

|8.28.09 @ 6:39PM|#

If private companies and individuals can do something, why can't the government do it?

|8.28.09 @ 6:40PM|#

Well, Dan. This bullshit about "our" citizens is bullshit.

I don't have citizens. You don't either. There is no "our" or "we" to any of this.

Use the term "rationing by affordability." Semantic problem solved. Then we can proceed to the substance.

So, use a Democratic talking point and problem solved?

Dan|8.28.09 @ 6:40PM|#

Exactly Joe M! Just like what happened when all the credit card companies reincorporated themselves in Delaware!

|8.28.09 @ 6:40PM|#

Gee, why is corporate "rationing" preferable to government "rationing?"

The government is a corporation.

alan|8.28.09 @ 6:43PM|#

Some of the progressives here seem genuinely confused about political versus economic means and are not making bad faith arguments. For them, I offer this lesson from last Summer's gasoline price spike.

Here we have a classic example of rationing by lining up. A week before, there had been a regional gasoline shortage as a result of fears regarding Hurricane Ike and the possibility that gasoline refineries in Texas would be shut down for months. Some gas stations raised prices, but others refused. The ones that refused ran out of gas. People sat in their cars for half an hour or longer in the hope of getting to a pump, and filled up their tanks.

Before the weekend was over, President Bush went on national television and warned against gasoline stations that gouged consumers. He said that there would be an investigation regarding accusations of gasoline stations that raised prices on Friday.

The message got through this weekend. Instead of raising prices, in an attempt to reduce demand for gasoline, thereby allocating gasoline that was in short supply by means of price, station managers simply let people fill up their tanks until the pumps were empty. Anyone who wanted gasoline after that was out of luck.

This is rationing by lining up. It is the alternative to rationing by price. Rationing by lining up creates no financial incentive for suppliers of the item in short supply to allocate new supplies to the region of the country which is experiencing a shortage. Instead, delivery schedules remain the same as they did prior to the shortage. This continues the shortage.

Whenever there are complaints about price gouging during a period of a shortage, sellers get the message. The next time there is a shortage, they hesitate to raise prices. They shift to the other allocation system: first come, first served. This subsidizes people who have a low value on their time. People who place a high value on their time prefer to pay extra money in order to attain their goals. But this is made illegal by the state. So, the shortage lasts longer than it would otherwise have lasted.

The official goal of the government is to make certain that everyone has access to the item in short supply. The government says that raising prices during a shortage is unfair. So, the result is the opposite of what the government's official justification was for holding prices down. There is an even greater shortage, because people buy more of the item than they need immediately. They have no incentive to reduce their consumption, thereby making available applies to those who were at the end of the line. There is no incentive for anyone at the front of the line to refrain from filling his gasoline tank. So, gasoline runs out before the line runs out.

The whole thing
here.

Sorry if it sounds like Sartre's No Exit to your progressive ears, but that is just the way it is.

|8.28.09 @ 6:43PM|#

Oh yeah, that's right, health industry companies make profit by making me -- and as many other people as they possibly can -- get better and continue to draw breath.

I don't know about all that.

I'm sure actuaries have figured out exactly when the premiums vs. payouts are maximized and then they don't care where you go after that.

Often profitable services do not equal good services.

Joe M|8.28.09 @ 6:44PM|#

Fluffy at 6:11, brilliant.

|8.28.09 @ 6:45PM|#

Juice | August 28, 2009, 6:35pm | #

(I first wrote) So the United States, where millions upon millions of our citizens either go without any health insurance...

Juice writes:

"Our" citizens? I don't own any citizens."

____


Our population is growing.

Juice: "Our" population? I don't own any population!

Our country is struggling.

Juice: "Our" country? I don't own any country!

Our brains are being assaulted by bought-and-paid-for insurance company lobbyists bent on stopping any reform that might derail their corporate gravy train.

Juice: "Our" brains? I don't own any br....

Fluffy|8.28.09 @ 6:46PM|#

Those who can not abide it are welcome to pull a Heinlien and build their own utopias on the moon, or at the bottom of the ocean.

Or we can poison the well.

I don't know why this is so complicated for you folks. "Rationing" is is any method of allocation - government fiat, lots, price, whatever. Because we are used to rationing by price, we don't think of our pricing system as a ration system, but it is.

There have been occasions during the history of this country where we have seen actual government rationing: where no matter how much you wanted to pay, you couldn't buy a given item without a government coupon.

People didn't like that, and so the word "rationing" gained a negative association.

When people say, "I don't want a system that involves rationing," they are stating that they don't want a system where you can't buy something without government permission.

It really doesn't add any clarity to the discussion to say "Price systems are rationing too!" Because you know what we mean, and we know you know what we mean, and all you'll accomplish is to force us to be painfully precise and say "fiat rationing" or "state rationing" every time we discuss this instead of just saying "rationing". Because it's tedious to ask for that level of precision when you already know the sense in which we're using the term anyway.

|8.28.09 @ 6:47PM|#

"Only libertarians and the GOP have future predicting powers, apparently."

Yes, because only they look at how the policies the liberals and leftists want to adopt have worked out in practice elsewhere. The lib/left ignore such experience completely, preferring their fantasy of "the government will do everything right". Sure it will.

The Angry Optimist|8.28.09 @ 6:47PM|#

Bill - it's fine to use "our" as shorthand for a collective description, but it is not OK to use "our" to assign collective responsiblity for individual problems.

|8.28.09 @ 6:50PM|#

Bill E Pilgrim thinks he has a country and a population.

Fucking collectivist.

There is no "our" or "we" to any of this.

My shit is not your shit. It's not "our" shit.

What about "our" roads? That's not yours or mine. What about "our" schools. Again, neither yours nor mine.

And maybe YOUR brain is being assaulted but MY brain is doing just fine thanks.

|8.28.09 @ 6:51PM|#

I don't get it. There are all sorts of port-siders just swimming in fithy lucre. Why don't they get together and form a health care collective - non-profit, obviously - that takes all comers regardless of age, medical condition, lifestyle, etc. and charge them the same, low premium for world-class treatment? They can even pay rock-bottom wages to their executives, completing the pontillist painting of a virtuous company.

Anyone think this is doable?

|8.28.09 @ 6:53PM|#

There are all sorts of port-siders just swimming in fithy lucre.

Why do I love that sentence so much?

|8.28.09 @ 6:54PM|#

The Angry Optimist | August 28, 2009, 6:47pm | #
Bill - it's fine to use "our" as shorthand for a collective description, but it is not OK to use "our" to assign collective responsiblity for individual problems.

__

So my use of "Our citizens" was the latter, not the former?

Astonishing.

It's similar to the conservative logic that forms the basis for this entire article.

I've got news for you: France has excellent health care at a fraction of the cost of ours. Ours, yes I used it again. Our health care. Our roads. Our bridges.

What silly people there are in the world.

Oh and expecting the standard conservative "Why don't you go live there then?" retort (I love it when "love or leave it" is what passes for discourse on conservative sites) don't worry. I did. Years ago. I know both systems, very well.

Mind you, there have been long waits, massive paperwork, and all the rest.

But those were entirely in the US sysytem.

I've never waited more than a week in France. For anything, from dermatology to surgery.

But hey, keep deluding yourselves. If you're rich, you're enjoying it, and if you're not, you're letting the rich delude you into thinking that US care is as good as it gets.

Believe me when I tell you it's not.

|8.28.09 @ 6:54PM|#

Because I misspelled "filthy?"

Dan|8.28.09 @ 6:54PM|#

FLUFFY: we can poison the well. I will make every health care provider's life a living hell by making sure I piss away as many resources as possible.
****************
I don't think you are just joking. I think you actually believe you can "stick it to the man" by sitting around in a doctor's waiting room all day. You are just that delusional.

The Angry Optimist|8.28.09 @ 6:55PM|#

So my use of "Our citizens" was the latter, not the former?

Astonishing.

yes. And seeing you have no logical rebuttal, and nothing more than anecdotal evidence with a sample size of one (you), I see you're not to be taken seriously. You can leave anytime you want.

The Angry Optimist|8.28.09 @ 6:56PM|#

Dan - he won't need to sit there all day. He could go, say, once a week and demand another prescription for some sweet, sweet meds.

Agent Smith, DHS|8.28.09 @ 7:03PM|#

Bill,

According to our records, you have never been to France. Could you step aside over here for a minute there are some questions we need to ask you.

|8.28.09 @ 7:05PM|#

The Angry Optimist | August 28, 2009, 6:55pm | #

So my use of "Our citizens" was the latter, not the former?

Astonishing.

yes. And seeing you have no logical rebuttal, and nothing more than anecdotal evidence with a sample size of one (you), I see you're not to be taken seriously. You can leave anytime you want.

_

You're saying "yes", that the phrase "our citizens" is assigning blame?

That was my rebuttal, the question itself. If your response is yes, the phrase "our citizens" is by definition "assigning blame"... and you're accusing me of not having a logical response? This is not "amazing" as I put it? Can you really not see that?

Re the rest, so is this the kind of echo chamber this is? Any evidence about other systems that doesn't fit the right wing cant isn't welcome? Was it rude? Did I use bad language?

Do you really think that there's no evidence about the lower cost of French health care, other than my word?

You know, I think I'll take your invitation however, this is not discussion, it's one-sided preaching to the choir. If what "Juice" has written above in some of the comments is acceptable discourse, and a logical, reasoned argument is not because you don't like it...

I'm sorry, I mean what is the point? "F***wits" over and over is reasoned discourse, yet an argument insufficiently broad and laden with attached data gets invitations to leave?

Yikes.

Well have fun, you won't learn anything or hear any opposing points of view this way, but I suppose writing obscenities at "progressives" makes good sport or-- who knows.

Bye.

The Angry Optimist|8.28.09 @ 7:08PM|#

oh good, you are leaving. The rest of your post was tl;dr.

|8.28.09 @ 7:08PM|#

The good news. 98% of the citizens of the USA either don't know what libertarianism is or think it is extremely stupid.

This post is a possible explanation of the latter group's opinion.

Agent Smith, DHS|8.28.09 @ 7:09PM|#

Yikes.

Well have fun, you won't learn anything or hear any opposing points of view this way, but I suppose writing obscenities at "progressives" makes good sport or-- who knows.

Bye.

Get the team over here, we have a runner. Repeat, we have a runner!

|8.28.09 @ 7:10PM|#

"What is unreasonable about, "If you want a fucking service pay for it your fucking self"."

There's nothing remotely unreasonable about this - and, as we live in a democracy, I think it's a perfectly fair question to put to a vote. Unfortunately, this question is being obscured by all sorts of yahoos who don't want the question to be - do we or do we not adopt a regulated system of healthcare for all. And it's pretty obvious why the opponents are phrasing it as a question of rationing, etc.

As for the comments about freedom to contract with insurers - again, this would be all fine and good if insurers didn't have all sorts of incentives to obscure the nature of their contracts with you (and use their significant bargaining advantages to make it impossible for you to actually negotiate a meaningful policy). Free markets only function efficiently if there is at least some transparency and equality in bargaining power . . .

Lady Di|8.28.09 @ 7:11PM|#

I would vouch for the excellency of the French Health Care System but I'm kind of dead at this time. That delay didn't really help matters.

mark|8.28.09 @ 7:12PM|#

I don't think you are just joking. I think you actually believe you can "stick it to the man" by sitting around in a doctor's waiting room all day. You are just that delusional.

So what about the colonoscopy example? What percentage of people should have one? 100%? Because if so then you're asking for a huge new investment in colonoscopies. What if all that colonoscopy money would have been better spent on something else, like a new childrens' wing in the hospital. Certainly they make decisions like this in other countries but why copy them? If you're Canadian you're much more likely to die of colon cancer. Is that an efficient outcome?

No thank you, I'll pay for my own butt scans if and when I demand them, and I refuse to pay for yours!

|8.28.09 @ 7:13PM|#

"...entirely based on ideology and terminology, removing the sad, disgraceful, shockingly bad third-world health insurance situation for most of the population from scrutiny..."

That's interesting, since the vast majority of the U.S. population is happy with their health care.

"Those who can not abide it are welcome to pull a Heinlien and build their own utopias on the moon, or at the bottom of the ocean."

Which will be free and prosperous, and subsequently overrun by voters who want to collectivize it.

|8.28.09 @ 7:16PM|#

Which will be free and prosperous, and subsequently overrun by voters who want to collectivize it.

"In 1945, Miss Mitford voted the socialist ticket. Having done her best to make England uninhabitable, she went to France to live."

- Evelyn Waugh

alan|8.28.09 @ 7:17PM|#

There's nothing remotely unreasonable about this - and, as we live in a democracy,

It isn't a democracy. Who the hell would want something that gruesome?

do we or do we not adopt a regulated system of healthcare for all

We already have a regulated system that effects all. HMO bill of 72 significantly changed the price structure to managed care.

Free markets only function efficiently if there is at least some transparency and equality in bargaining power . . .

Consumers are the deciders in a free market system unless private interest can collude with government through rent seeking which is the basic make up of all the current plans being considered.

|8.28.09 @ 7:17PM|#

Shorter Bill E. Pilgrim: "You proles are being oppressed by The Man and you don't even know it!"

Go squat-fuck a zucchini or seven, twatwaffle.

ChicagoMom|8.28.09 @ 7:18PM|#

Dear Tommy,

I should have told you before now, but...

You were always so adorable in your little footy pajamas, setting out the milk and cookies on Christmas Eve. So eager, so excited.

Tommy, honey.

There really isn't a Santa Claus. You can't get what you want by wishing.

Sorry for the inconvenience.
Love, Mommy

alan|8.28.09 @ 7:22PM|#

By the way Ron B., love your choice of accompanying pics. It is just sooo Soviet!

|8.28.09 @ 7:23PM|#

And since we know that all health care providers are hermetically sealed off from the rest of the economy, we have no worries that cramming down fees and reimbursements will have the slightest effect on anything else in society.

Paul|8.28.09 @ 7:26PM|#

I've got news for you: France has excellent health care at a fraction of the cost of ours.

France's system is remarkably close to our own. Something the Obama administration (and the supporters of single-payer systems never talk about).

Paul|8.28.09 @ 7:34PM|#

"Rationing" is is any method of allocation.

No it's not. Not even close. There is no fixed panel of experts in this country denying people care. There are individual insurance companies which may deny coverage for certain care, or may deny their own product (that being insurance) to people who can't afford it, but that's not rationing.

I like how we spent decades listening to progressives talk about how their preferred system wouldn't ration, then when they finally could deny no longer that a government healthcare system rations, they just called everything 'rationing'.

It's worse than watching a Michael Moore documentary.

|8.28.09 @ 7:34PM|#

My wife was recently hospitalized for a week traveling through Paris and diagnosed with a potentially serious condition; one of the possible causes we were told was cancer of the pancreas, if not caught very early, pancreatic cancer is usually a death sentence. Even with that immediate need and a staff doctor's referral to a specialist, it took just shy of two months for her to finally be seen and examined. Thankfully, pancreatic cancer was eliminated. The reason it took so long? The Paris region had only a few of these kinds of specialists serving a large area and they were booked for weeks. I think we'd all agree that's rationing, and this wasn't elective, it could have cost her critical time and possibly her life while a malignant tumor grew.

Of course this was Paris, Texas, and the provider wasn't free government healthcare, we shell out about 600 dollars a month to Aetna for her alone. Amazingly, at least according to the author of this laughably argued post, simply by changing the location and the name of the provider, this is magically no longer considered rationing!

|8.28.09 @ 7:35PM|#

Ouch...I just got a sharp, zucchini-shaped pain in my cognitive dissonance. Right after I read this:

Smart person:
I've got news for you: France has excellent health care at a fraction of the cost of ours.

Stupid person:
France's system is remarkably close to our own. Something the Obama administration (and the supporters of single-payer systems never talk about). (paren)) (disjoint)) sic()

You all should go back to arguing that the plan is bad because a dictionary someplace says so. Economics and critical thinking are hard; don't fret.

ice9

|8.28.09 @ 7:40PM|#

Right, and welfare, and food stamps, and medicare, and defense spending, and the VA, and the police, and the fire department, and roads.

Trust me, you do not want to bring up the VA in this discussion. It will not be helpful to your cause.

|8.28.09 @ 7:42PM|#

Of course this was Paris, Texas, and the provider wasn't free government healthcare, we shell out about 600 dollars a month to Aetna for her alone.

Sheesh...you wouldn't drive your old lady to Big D for an exam??

|8.28.09 @ 7:42PM|#

Also from Britannica:

Widely unappreciated is the fact that our current system (I almost succumbed to using scare quotes around that word) is a system of rationing: It allocates a lot of health care to some, some health care to many, and not much health care to some others. It does so on such bases as employment, wealth, age, and physical access. These may or may not be the optimal bases for rationing, and that is what the discussion should be about. Other systems ration by means of waiting lists and restricting the kinds of health care that are made available. These may or may not be the optimal bases. I do not know what the optimal bases are, but I do know that, until we have replicators, there will be rationing.

http://www.britannica.com/blogs/2009/06/health-care-rationing-get-over-it/

|8.28.09 @ 7:50PM|#

It allocates a lot of health care to some, some health care to many, and not much health care to some others.

Who is "it?"

|8.28.09 @ 7:51PM|#

From Merriam-Webster's Dictionary Online:

rationing -- 1 : to supply with or put on rations, 2 a : to distribute as rations -often used with out b : to distribute equitably c : to use sparingly.

I have an idea for Mr. Bailey's next post: a hard hitting expose of Webster's Dicitonary and the devious practice of writing in words like "government" with invisible ink. How they do this online could be yet another earth shaking post.

|8.28.09 @ 7:56PM|#

Fluffy | August 28, 2009, 3:26pm | #

"One thing not to like is that this will raise the price of insurance for healthy people beyond the point at which it makes economic sense to carry insurance."

I think the hope is that adding tens of millions of healthy people to the insurance rolls (re: by government force) will help offset the hits created by those who are ill and added.

The loss of freedom to not buy insurance might be the biggest loss.

The Angry Optimist|8.28.09 @ 8:05PM|#

Steven - I don't get it. You live in a podunk area and you're complaining about the lack of services?

you selfish asshole - Dallas is two hours away...but instead you waited two months until someone came to your tiny little town?

Get over yourself. You're not entitled to everything, anywhere, anytime, day or night. Sometimes you need to actually go seek stuff.

|8.28.09 @ 8:06PM|#

Thanks, Steven, for that scintillating demonstration that you're every bit as obtuse a twat as Ezra Klein.

The Angry Optimist|8.28.09 @ 8:09PM|#

what really irritates me about Steven is that he is willing to invoke the deathly nature of pancreatic cancer to scare us all...but didn't scare him enough to contract for an ambulance to get his wife seen in under 60 days.

Yo, Steven, obviously you weren't that scared. Why should we be?

|8.28.09 @ 8:16PM|#

I would prefer that people restrict the use of the word "rationing" to refer to a prohibition from buying through any other channel (such as existed in WW2), and "scarcity" for the sense in which everyone cannot have everything their hearts desire.

But it was the anti-reform side that first introduced the bastardized form of the word. Not even in systems in which the government operates hospitals and clinics (such as the British National Health Service, far more intrusive than most other systems or anything contemplated for the USA) is anyone prohibited from buying health care services outside the system.

The Angry Optimist|8.28.09 @ 8:18PM|#

kth:

Yes or no - in a government run system, dollars in must = dollars out, else there is a deficit/lack of profitability.

Yes or no - people will try to get services worth more than their tax dollars have paid for.

Yes or no - this will lead to having to deny treatment and force allocations.

Yes or no - this is commonly called "rationing".

|8.28.09 @ 8:20PM|#

Oh this is fun. Let's explore some more starting with some elementary logic: to falsify "Every X is Y" we only need a single one empirical example where X is not Y. The wiki even has a definition which falsifies the assumption that all rationing is government run:

Rationing is the controlled distribution of resources and scarce goods or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.

And goes on to use the term in specific, non governmental, contexts. The Webster link does that specifically as well; doesn't matter if you have a thousand other definitions from a thousand other reputable sources. All it takes is one counter example to falsify the assumption "All X's are Y's" and therefore prove it wrong to a 100% metaphysical certainty. Thus your assumption, like the thesis of the main post above, is falsified. Utterly. QED.
Simple, yes?
Let's try a more advanced and admittedly subjective lesson, an If/Then statement. IF you can't follow that trivial proof, THEN it certainly explains your serial confusion on this matter. IF you trust Ronald Bailey after reading this, THEN you are a fool. IF Ronald Bailey doesn't print a retraction, THEN he is a dishonest hack. Etc. If you want to get really fancy, we can connect those statements with a conjunction like AND, or, OR, and talk about De Morgan's Laws. Optimist, BC ... who wants another beating? I can hand you your heads all day.

SIV|8.28.09 @ 8:20PM|#

Sheesh...you wouldn't drive your old lady to Big D for an exam??

Seconded
I could potentially see a resident of Paris sticking with the "local" Docs but Dallas is just down the road.

|8.28.09 @ 8:22PM|#

I'm not anti-reform. I'm merely anti-fucktardery.

SIV|8.28.09 @ 8:22PM|#

When I was working in Paris I drove to Dallas to eat dinner a few times.

The Angry Optimist|8.28.09 @ 8:23PM|#

Steven - why don't you try to convince us all again how broken the health care system is because you refused to try a larger city for over two months?

That was a good story.

The wiki even has a definition which falsifies the assumption that all rationing is government run

Oh, well, if the wiki says it, then it must be true. ha.

the fact that you built your entire premise and argument on something no one ever said (i.e. no one ever said that rationing is an inapplicable term outside of the government context), then your whole sense of smugness should collapse in a heap of under-stimulated neurons that undoubtedly compose your mind.

SIV|8.28.09 @ 8:25PM|#

Hell Steven, if you are allergic to Dallas they have specialists in Shreveport and Texarkana.

|8.28.09 @ 8:25PM|#

The Paris region had only a few of these kinds of specialists serving a large area and they were booked for weeks.

Perhaps you should direct your outrage toward the Physicians' Cartel AMA.

|8.28.09 @ 8:27PM|#

Optimist, BC ... who wants another beating? I can hand you your heads all day.

The only beating you've been delivering is to your shrivelled little pecker.

|8.28.09 @ 8:28PM|#

My kid has a terribly sore throat.

I'm going to inject him with a syringe full of Windex to cure him.

What's that, you object?

Why, you must want my kid to have a terriby sore throat.

TallDave|8.28.09 @ 8:34PM|#

So, by this new leftist definition both the USSR and the USA had rationing.

Which worked out better? Anyone remember?

|8.28.09 @ 8:34PM|#

Rationing is the controlled distribution of resources and scarce goods or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.

I can think of a few times when I've seen a private company do this: iPod and iPhone sales, Stones concert tickets, etc. I've never seen it in health care. If an insurer is contractually obligated to pay for a treatment, by God they should.

|8.28.09 @ 8:39PM|#

OK, guys, you're dancing around the elephant in the room. I say it is the duty of the government to provide health care to all citizens, in the same way it provides police, fire, and medical care for the aged.

You disagree? So, do you want Medicare repealed? No? Do you want to go to all those fancy cardiology subspecialists whose training Medicare dollars subsidized? Hmmmmm?

Some honest answers guys.

|8.28.09 @ 8:40PM|#

So, do you want Medicare repealed?

Yes. Next question.

|8.28.09 @ 8:42PM|#

jeffersonian ---

You're some years less than 65, right? Going to live forever, aren't you? Never going to get a pre-existing, condition?

My, you're Superman!

The Angry Optimist|8.28.09 @ 8:43PM|#

I say it is the duty of the government to provide health care to all citizens, in the same way it provides police, fire, and medical care for the aged.

Providing the police is a public good - once you provide it, you cannot realistically exclude people from its use.

Providing the firemen is to prevent negative externalities of spreading fires that directly affect others.

Medical care is nothing more than a transfer payment from the wealthy, young and healthy (ergo punishing them for by and large making good life choices and forcing them to take responsibility where they have none) to the poor, old and sick.

robc|8.28.09 @ 8:43PM|#

France has excellent health care at a fraction of the cost of ours.

According to the post yesterday, A person make 3K Euros per month pays 350E out of their paycheck, plus their company pays 1200E. Also, there is a supplemental tax because that still doesnt cover all the health care costs.

I have an employee making $3k per month. I (nothing comes out of her check) pay $340 per month for her health insurance.

An E!=$ but close enough for comparison sake.

Hmmm...$1550+ or $340, which is bigger?

The Angry Optimist|8.28.09 @ 8:44PM|#

imadoc - you don't "get" a "pre-existing condition". You come down with something, then sign up for health care and unreasonably expect that condition to be covered - akin to trying to shoehorn preexisting damage to your vehicle into a *new* auto insurance contract.

robc|8.28.09 @ 8:46PM|#

it's a perfectly fair question to put to a vote

No, it isnt. My paying for your services should not be up for vote. Period. That is why we arent a pure democracy, so the majority cant shove shit like this down the minorities throat.

|8.28.09 @ 8:46PM|#

Angry Optimist!

Horribly simplistic, aren't you?

So, do we stop spending tax dollars on training physicians?

|8.28.09 @ 8:48PM|#

In all seriousness, there are plenty of good reasons to criticize or be worried about something as significant as government healthcare. But good grief, the thesis of the main post above is not one of them. Quite the opposite, it makes the author and anyone who defends it look like they're telling whoppers or just plain foolish. If I can shred it sitting at home with one eye on the TV and the other on my Whataburger, it's probably not a useful idea, and any half way clever stoned hippie that really bothers to try will destroy you if you try and pitch it in an open forum.
.
As far as changing or making up false definitions of words to suit your purpose or preserve an ill conceived, slender and questionable foundation, consider if we all used same tactic. From now on when you write "Steven," I unilaterally decree with no taksies-backsies by anyone it really means "Thank you for exposing Ronald Bailey's infantile reasoning and his defenders' intellectual bankruptcy." And BTW, no problem, I'm happy to help, and you're welcome.
.
Not real useful is it.

robc|8.28.09 @ 8:49PM|#

Steven,

Something prevent you from driving to Dallas and paying cash for a specialist?

Really, with your wife's life on the line you cheaped out and waited around in a pissant town instead of spending some coin?

|8.28.09 @ 8:49PM|#

You're some years less than 65, right? Going to live forever, aren't you? Never going to get a pre-existing, condition?

I'm closer to 65 than you might think. If I could get that 2.9% added to my pay for 40-odd years instead of forking it over to the Central State, I could save up enough to either buy health insurance in my dotage or pay my cardiologist outright.

Either way, it's better than living through the threat of the aggressive violence that is taxation.

|8.28.09 @ 8:50PM|#

I say it is the duty of the government to provide health care to all citizens, in the same way it provides police, fire, and medical care for the aged.

I say you're a utopian collectivist cocksucker who won't be satisfied until we're all equally destitute and miserable.

So, do you want Medicare repealed?

Yes. Next question?

Wacky Hermit|8.28.09 @ 8:51PM|#

Fine. Call it "rationing." I don't care what you call it. I WANT "rationing", "allocation," what have you, to be done by price. Why? Because price rationing can be easily overcome. Money is relatively easy to raise. Anyone can do it; my 11 year old daughter and her friend have done it. You have a bake sale. You put up a Facebook page. You put a can with a slot in it at the grocery store register. My friend's sister-in-law, who didn't have health insurance, recently died of a fast-growing brain tumor. Before she died, they were able to raise enough money to not only cover her treatment and care, but the family's extra expenses for quite some time and a trip to Disneyland. These are not rich people, they're working poor/middle class. They had a bake sale and accepted donations. You can walk into any bank and set up an account to accept monetary donations for causes like these. Then all you have to do is publicize it.

Government rationing, on the other hand: you'd have to give out a lot of blowjobs and/or bribes to all the right people, then cross your fingers and hope you made an impression on them. Sorry, but I'll take the bake sale over that any day.

|8.28.09 @ 8:52PM|#

I say it's the government's duty to provide health care to all Americans, thus we must enslave people like imadoc to provide such care.

Down with that, Doc?

robc|8.28.09 @ 8:52PM|#

OK, guys, you're dancing around the elephant in the room. I say it is the duty of the government to provide health care to all citizens, in the same way it provides police, fire, and medical care for the aged.

See above, Fucking slaver.


You disagree? So, do you want Medicare repealed? No?

Yes. Duh. Where the fuck do you think you are.

Do you want to go to all those fancy cardiology subspecialists whose training Medicare dollars subsidized? Hmmmmm?

Medicare underpays specialists. Im willing to pay for price for them.

Some honest answers guys.

You are an immoral fuck.

The Angry Optimist|8.28.09 @ 8:53PM|#

So, do we stop spending tax dollars on training physicians?

Yes. Next question, please.

|8.28.09 @ 8:53PM|#

TAO:

the fact that you built your entire premise and argument on something no one ever said (i.e. no one ever said that rationing is an inapplicable term outside of the government context)

Uh.


Like most left-leaning folks, Klein clearly doesn't know the definition of rationing. Take this one from Britannica:

Government allocation of scarce resources and consumer goods, usually adopted during wars, famines, or other national emergencies.

Then when someone pointed out there are other meanings, RC Dean responded: "Thus is a word stripped of all useful meaning."

Are you even reading these posts? Do you even have eyes?

I'm glad you finally admit that rationing does not necessitate government involvement. Cool.

Medical care is nothing more than a transfer payment from the wealthy, young and healthy (ergo punishing them for by and large making good life choices and forcing them to take responsibility where they have none) to the poor, old and sick.

Police departments are nothing more than a transfer payment from the wealthy, rural and white to the poor, urban and brown.

robc|8.28.09 @ 8:54PM|#

So, do we stop spending tax dollars on training physicians?

Hell yes!

They can pay for their own damn training and then charge their customers for it.

Get rid of the AMA monopoloy while we are at it.

The Angry Optimist|8.28.09 @ 8:54PM|#

yes, imadoc, you are responsible for providing health care, so you shouldn't have any problem doing it for free, right? Or are you going to shirk your responsibilities?

|8.28.09 @ 8:55PM|#

Jeffersonian--

No you couldn't. No one would sell you insurance, and the cardiologist would happily take the $250 for the office exam, but the hospital would want their 300K up front for your open heart and your next of kin would have to make weekly installments to keep your ventilator going.

Nice try

The Angry Optimist|8.28.09 @ 8:55PM|#

Police departments are nothing more than a transfer payment from the wealthy, rural and white to the poor, urban and brown.

there you go again, trying to draw equivalency where there is none.

Klein's argument was patently dishonest. He should have argued on the premises given, but he (like you) has to play word games because you know your arguments are weak.

robc|8.28.09 @ 8:56PM|#

Hey Steven,

You going to answer the question asked multiple times about why you hate your wife so much that you refused to pop for a trip to Dallas?

The Angry Optimist|8.28.09 @ 8:58PM|#

imadoc - still waiting to see when you're going to stop shirking your responsibilities and start working for minimum wage.

Why are you such a greedy, selfish bastard, doc? Do you hate the poor or something?

|8.28.09 @ 8:59PM|#

You guys are a HOOT!

Thank you for your insights into how to return to pre-WWII medicine, when 90% of hospitals were private and our infant mortality was truly third world.

THank you!

|8.28.09 @ 9:00PM|#

No you couldn't. No one would sell you insurance, and the cardiologist would happily take the $250 for the office exam, but the hospital would want their 300K up front for your open heart and your next of kin would have to make weekly installments to keep your ventilator going.

I'm certain I could get insurance...after all, no insurance company makes a dime on a policy they don't sell. I might not be able to get one under the current regulatory regime, but that's another State-created problem.

As I said, either way, I prefer to get rid of Medicare. If it's too expensive for me, it's too expensive to pass off onto my kids to pay.

|8.28.09 @ 9:01PM|#

TAO: Thanks for at least tacitly admitting you were making shit up when you said nobody claimed rationing was definitionally a government action. That was classy of you.

|8.28.09 @ 9:01PM|#

Angry Optimist

Sorry, guy. I've been patronized by far better minds than yours.

The Angry Optimist|8.28.09 @ 9:02PM|#

nobody said it was inappropriate to use rationing elsewhere, just that it's a giant red herring to say "everything is rationing".

Dude, really, listen to yourself. I asked this earlier, but according to you, DeepOmega, what IS NOT rationing? Name one thing.

|8.28.09 @ 9:03PM|#

Whacky -- the problem is it's not your daughter's bake sale. You're not going to get anywhere using that analogy. It's life and death, not raisin cookies. When it's someone else's life or death it's easier to talk in the abstract. Not so easy when it's someone you care about.

robc|8.28.09 @ 9:04PM|#

when 90% of hospitals were private

Ummm...and thats a bad thing why?

Most of the hospitals in my city are still private. For profit or non-profit, they are private.

robc|8.28.09 @ 9:05PM|#

It's life and death, not raisin cookies. When it's someone else's life or death it's easier to talk in the abstract. Not so easy when it's someone you care about.

Thats why the decisions need to be made in the abstract. Cant let emotions fuck with things.

The Angry Optimist|8.28.09 @ 9:05PM|#

Thank you for your insights into how to return to pre-WWII medicine, when 90% of hospitals were private and our infant mortality was truly third world.

yeah, there weren't any technological advances or anything that make the implicit argument here a false dilemma.

none at all.

robc|8.28.09 @ 9:08PM|#

TAO,

yeah, there weren't any technological advances or anything that make the implicit argument here a false dilemma.

none at all.

As I point out on NASA threads, without the space program we would be even more technologically advanced. Instead of satellites, we would have had DVDs about 1980. :) Probably have sexbots by now.

NASA wasted money by using it on really cool shit instead of what people wanted. Which is better porn.

Seward|8.28.09 @ 9:08PM|#

Wow, I expected this thread to die out some time ago.

|8.28.09 @ 9:08PM|#

Twenty thousand dollar pyramid style

Things that are not rationing:
1) A store selling a muffin for $3 when I asked them to sell it for two
2) The government raising postage on first class mail
3) When I don't buy a porsche

Things that are rationing:
1) A store implements a one muffin per customer rule
2) The government bans non-USPS mail carriers because there is a national shortage of bubble-wrap
3) When my local porsche dealer runs out of signature porsche-branded leather jackets and institutes a "first three customers per day get one" policy

|8.28.09 @ 9:09PM|#

yeah, there weren't any technological advances or anything that make the implicit argument here a false dilemma.


"Do you know what it's like to fall in the mud and get kicked... in the head... with an iron boot? Of course you don't, no one does. It never happens. Sorry, Ted, that's a dumb question... skip that."

Seward|8.28.09 @ 9:09PM|#

Oh, and threadjack: more signs that our robot overlords are on the way: http://news.cnet.com/8301-17938_105-10320851-1.html ;)

Seward|8.28.09 @ 9:11PM|#

On hospitals: the state and federal government put a lot of restrictions on where and when new hospitals can come into being. It is one of the dumber things that they do.

robc|8.28.09 @ 9:14PM|#

Seward,

Can you explain that at all? If someone wants to open a hospital, what possible reason is there to say no?

I cant think enough like a bureaucrat to even come up with a rationale.

|8.28.09 @ 9:15PM|#

yeah, there weren't any technological advances or anything that make the implicit argument here a false dilemma.

As if we would suddenly forget how to make penicillin if Medicare went away.

|8.28.09 @ 9:17PM|#

Angry optimist: yes, yes, no, no: just because no government health-care system provides breast augmentations doesn't mean they are not available to anyone who wants to pay for them.

alan|8.28.09 @ 9:18PM|#

Scroll up to the picture that accompanies this post.

It is from the WW2 era when there was heavy rationing of consumer goods.

Lady with a thoughtful, concerned look on her face gazes at shelves with a plenitude of goods.

Sign States: Rationing Safeguards Your Share

The meaning of the term was commonly understood even by those who worked for the government who wrote it.

Is there anyone who is going to tell me that they do not understand what it means, or is the concept 'but we do ration seems so clever to you, you are not willing let it go?

I provided a link above in case that in some capacity of good faith you do not understand how the word is commonly used when applied to Macroeconomics. In the 1970's we had gas rationing, how is that different from the practice of allocation that existed in the 60's or the 80's where the term 'rationing' is not commonly applied? Think about it.

The Angry Optimist|8.28.09 @ 9:20PM|#

kth - so you admit that people will try to get more value out the system than its inputs, but that does not mean things will be rationed?

Um, OK - and if you think that it's just going to be "superficial" surgeries (as if you are the defining authority for that) that are going to be denied, you're dreaming.

The Angry Optimist|8.28.09 @ 9:22PM|#

Things that are not rationing:
1) A store selling a muffin for $3 when I asked them to sell it for two
2) The government raising postage on first class mail
3) When I don't buy a porsche

Please explain how, under the expansive definition you've adopted, how these examples are not "rationing". You've rationed muffins according to price (that's the argument Klein is giving), so by your first example, you've implicitly conceded that you understand the entire post and are just being difficult.

I agree with you that a store setting the price isn't "rationing" - but Klein does not, and that's what we're arguing about.

Joe M|8.28.09 @ 9:24PM|#

Medical care is nothing more than a transfer payment from the wealthy, young and healthy (ergo punishing them for by and large making good life choices and forcing them to take responsibility where they have none) to the poor, old and sick.

TAO, I think you're wrong here. Assuming you mean government run health care, or something along those lines, it's not even neccessarily as you say. It is, in fact, worse. Older people tend to have more money than younger people, for a variety of reasons. So forcing younger people into the system is actually taking from the poor to give to the rich. And then denying the rich (i.e. old) care. What a perfect system!

The Angry Optimist|8.28.09 @ 9:25PM|#

So, DeepOmega, when Klein says "We ration health care the way we ration other goods: We make it too expensive for everyone to afford."

And Bailey says "that's not rationing"...you actually agree with Bailey, yes?

Seward|8.28.09 @ 9:29PM|#

robc,

You'd have to talk to a health care economist. I do know that there are a number of licensing, etc. requirements that limit the competition that hospitals face. I believe it also the case that there are a lot of restrictions on the ability of hospital corporations to cross state lines. Anyway, a lot of this has to do with the standard libertarian objections to public or quais-public licensing.

|8.28.09 @ 9:32PM|#

It depends on which sense you are imputing to "rationing". If you are using it in the sense that the OP takes issue with, then the government will most certainly ration care (that is, probably not pay for everything that everyone wants), just as private plans do now.

But if you are using it in the sense that the government rationed milk and eggs during WW2 (the more precise usage urged in the OP), then there's no reason to suppose that that kind of rationing will occur, since it does not routinely occur in other countries that have publicly-supported health care systems.

I only used boobjobs because public health care systems universally don't cover them, but feel free to substitute heart transplants if you like. A government board may decide not to cover them, or even not to cover them under some circumstances. But no one would be prevented from paying for a heart transplant themselves, or even from buying supplemental coverage in the event that they someday needed a specific procedure that the government coverage didn't provide.

The Angry Optimist|8.28.09 @ 9:35PM|#

I only used boobjobs because public health care systems universally don't cover them, but feel free to substitute heart transplants if you like. A government board may decide not to cover them, or even not to cover them under some circumstances.

What if reconstructive surgery is needed to drastically increase your quality of life? So, you've been paying into this system for say, 15 years or so, and when it comes time to get what you actually need, some arbitrary board is going to say "Sorry, we're glad to take your money without funding what you want."

Oh, boy, sign me up.

But if you are using it in the sense that the government rationed milk and eggs during WW2 (the more precise usage urged in the OP), then there's no reason to suppose that that kind of rationing will occur, since it does not routinely occur in other countries that have publicly-supported health care systems.

What would be the difference? I don't see the distinction you're drawing.

The Ghost of Augustus De Morga|8.28.09 @ 9:35PM|#

If you want to get really fancy, we can connect those statements with a conjunction like AND, or, OR, and talk about De Morgan's Laws.

For the unwashed: Union and intersection interchange under complementation. That is, two wrongs don't make a right, but three do.

Please, Steven, stop making a Boole of yourself.

|8.28.09 @ 9:36PM|#

Widely unappreciated is the fact that our current system (I almost succumbed to using scare quotes around that word) is a system of rationing: It allocates a lot of health care to some, some health care to many, and not much health care to some others.

Congratulations. You just described not only every health care system ever invented, but every system ever invented.

|8.28.09 @ 9:43PM|#

), then there's no reason to suppose that that kind of rationing will occur, since it does not routinely occur in other countries that have publicly-supported health care systems.



kth:

you may need to cut back on your crack ration...

|8.28.09 @ 9:54PM|#

Angry Optimist, you are clearly failing to see the very distinction that the OP was insisting upon. During WW2, people received ration cards for eggs and milk. It was illegal to buy or sell eggs or milk without the accompanying cards; moreover, it was illegal to sell or trade the ration cards. That is what rationing refers to in the strictest sense.

I would vote for a public option that was sufficiently generous that breast reconstructions following mastectomies or accidents would be paid for, which is why I specifically referred to augmentations (augment, to make larger). But if my fellow Americans opted for a more bare-bones public option, that would not mean that the government was rationing health care, since no one would be prevented from buying reconstructive surgery with their own money. It would only constitute rationing if the government commandeered the entire health care market, forbade anyone to buy or sell services outside of the public plan, and under those wider restrictions also limited what benefits were provided.

squarooticus|8.28.09 @ 9:56PM|#

Fundamentally, prices are a form of rationing: it's the market setting the cost of something in terms of the medium of exchange (dollars in the US) in order to balance supply and demand.

In a free-market health care system, the rationing of procedures/access to facilities comes in the form of prices that balance supply and demand, but price-based rationing causes the market to react in ways that promote expansion of high-demand resources.

E.g., if there are too few doctors in an area, the fees they can charge will rise, encouraging more doctors to relocate there.

In a single-payer health care system, rationing occurs in the form of time: instead of paying more in dollars to get a procedure, you pay by waiting longer for what you need. The problem with this approach is that it doesn't promote the expansion of high-demand resources, because the incentive to profit off increased prices does not exist.

E.g., no matter what the wait time is, what greater incentive does a doctor have for moving to a town that is severely under-served versus a town that is only slightly under-served?

The price signal to encourage supply to rise to meet but not greatly exceed demand is missing. This leaves central planning as the only answer for the development and allocation of resources, and we all know how well that works.

Note that this is a (rare) utilitarian argument from me. My arguments against government in general are primarily morality-based, but I just wanted to try to clear the air regarding the term "rationing". It's not clear to me that rationing should apply to price signals in a free market, because then the term loses the useful "inefficiency" connotation; but intellectually, it is a form of rationing, though one done by market forces rather than by committee. Still, I'm not sure the argument has a point as long as the distinction is understood by both sides.

|8.28.09 @ 9:57PM|#

kth sez: would vote for a public option that was sufficiently generous ...


thank god we don't have a democracy. no doubt many would vote for the fruits of another man's labor!

|8.28.09 @ 9:58PM|#

ransom147, do tell: among first-world countries that provide publicly-funded health care (i.e., all of them besides the United States), in which of them is it illegal to go to a doctor and pay him yourself?

Jordan|8.28.09 @ 10:00PM|#

To all the "healthcare is a right!" folks: if this is the case, why aren't you guys advocating drafting people into medical school since we have a shortage of physicians? Aren't you violating the rights of others by not providing them healthcare?

|8.28.09 @ 10:00PM|#

responding to your last post: I'd be fine with a public option that was incorporated like FDIC or the USPS, was paid for strictly by premiums rather than taxes, and any financial assistance in buying premiums required to be also available to competing private plans.

|8.28.09 @ 10:01PM|#

kth: canada

|8.28.09 @ 10:02PM|#

fdic and usps, two fantasic examples of government waste and deficiency! good idea!

|8.28.09 @ 10:05PM|#

too all the healthcare is a right folks,

were are my guns n ammo stamps?

|8.28.09 @ 10:07PM|#

Where did you hear that? From the Wikipedia article on Canada's Medicare:

Approximately 70% of Canadian health expenditures come from public sources, with the rest paid privately (both through private insurance, and through out-of-pocket payments). The extent of public financing varies considerably across services. For example, approximately 99% of physician services, and 90% of hospital care, are paid by publicly funded sources, whereas almost all dental care is paid for privately.[3] Most doctors are self-employed private entities.

The Angry Optimist|8.28.09 @ 10:08PM|#

kth - there's no reason to support an insurance company that looks like that, run by the government, because you could start your own right now that would do the same thing.

Seriously, if you aren't supporting any tax money go into the public system, then why are you supporting it?

|8.28.09 @ 10:17PM|#

kth: yes, but for shit their standard single payer plan does not cover. so if the plan covers it, get in line and wait.

that's why their sup court ruled the system was killing people...

Joe M|8.28.09 @ 10:26PM|#

What ransom said. It's illegal to pay for anything that is covered under the public plan. That basically excludes all the important stuff like heart surgery and such.

Joe M|8.28.09 @ 10:28PM|#

Damn, just stumbled upon this awesome Milton Friedman speech from 1978.

Right off the bat, he slams the AMA.

|8.28.09 @ 10:32PM|#

if they wan ted true competition they would deregulate the docs and the scrips, next week you get doc coupons in your sunday paper.


re: canada

also unmentioned is they have lotteries for gets a doctor, yet they serve a country w/ pop less than calif.

|8.28.09 @ 10:33PM|#

*for who gets

|8.28.09 @ 10:38PM|#

Angry Optimist, the reason for a public option so designed would be as a non-profit to compete with the private plans, that otherwise will potentially receive quite a windfall when mandatory coverage is enacted.

I tend to think that this fear is overblown, since participating plans will also be required to take all comers, and to rate by the community rather than pre-screening individual policyholders and charging them for pre-existing conditions.

People (i.e. opponents) are way too hung up on the public option. For most of us progressives, the real lynchpins are mandatory coverage and community rating, which are probably not much less noxious to libertarians than the public option. Myself, I can live without the public option, as long as the rest is there.

|8.28.09 @ 10:40PM|#

Well Canada sucks then. Many countries have publicly-supported health coverage, that have no such restrictions, so there's nothing inevitable about them.

|8.28.09 @ 10:45PM|#

kth:

i don't really give a rat's ass what other countries do to enslave their "citizens".

|8.28.09 @ 10:49PM|#

kth:

you've been polite to me, sorry about the snippyness. this argument is effecting allot of people negatively i suppose...

|8.28.09 @ 10:51PM|#

*affecting


stupid today...

tarran|8.28.09 @ 11:04PM|#

kth,

Since Canadian government medical care is administered by the provinces, there is a great deal of variation as to what people are allowed to do on their own.

It was illegal in Quebec to see a doctor privately until the Canadian Court overturned the provincial law in the case of a man who wanted to pay for his cancer treatment rather than to die on the waiting list. I believe this happened about 2 years ago, but am too lazy to google it.

|8.28.09 @ 11:06PM|#

ahem....we ration healthcare now. The free market (precious and godlike) excludes people who need it and favors those who don't. What a great system.

|8.28.09 @ 11:11PM|#

Try to keep up, Ray.

Joe M|8.28.09 @ 11:13PM|#

Hahaha indeed. Read the last 300 messages before commenting.

Jordan|8.28.09 @ 11:15PM|#

Go easy on Ray. He's not much further up the evolutionary ladder than Steve Smith.

|8.28.09 @ 11:18PM|#

tarran: didn't he guy die before he won?

|8.28.09 @ 11:19PM|#

Serious question/comment from a non-anarchist libertarian-conservative:

I am a bit torn on mandating purchase of some minimal health insurance. Why?

I am not sure how it would be that different than states requiring licensed drivers to purchase liability insurance on their cars. Yes, there is some purist loss of liberty, but for someone to go and cause an auto accident while uninsured, if they have little or no real assets to be subject to forfeiture in a tort as a fallback, isn't that almost like a theft with the damaged party as victim?

In this imperfect world I'm willing to require players to have some skin in the game.

*Not* requiring the young or healthy to buy insurance seems ideal, but there is the simple fact that everyone, if they're lucky, gets old. Market segmentation makes sense in lots of ways, but I don't know that its valid to ignore the dimension of time, that they move form one segment to another.

|8.28.09 @ 11:22PM|#

I guess Ray is one of those deep, nuanced thinkers who can simultaneously believe that
a) Denying credit to low income minorities who are poor risks is discrimination
AND
b) Extending credit to low income minorities who then default on it is exploitation.

|8.28.09 @ 11:36PM|#

The left is doing to the word "rationing" what it has done to the word "censorship."

Redefined it in their own image.

|8.28.09 @ 11:37PM|#

Just dropped in to say this has been a fantastic thread. At at least 5 times larger than the actual article and with a lot of actual discussion too! This is why I keep coming back to ReasonOnline.

|8.28.09 @ 11:38PM|#

Make that 50 times larger....

|8.28.09 @ 11:40PM|#

Not to mention that the IRS will be tasked to forward YOUR tax info so it can be assessed by the Health Rulers to see if you qualify (but didn't know it) for subsidized drugs, or if you paid for an acceptable insurance program. If not -- you are fined.

It's not up to the participants to take responsibility and CHOOSE the programs they want or would like to qualify for.

Question: Why is the pro-choice party pro Obama care?

Answer: Because they are not pro-choice.

alan|8.28.09 @ 11:44PM|#

I am not sure how it would be that different than states requiring licensed drivers to purchase liability insurance on their cars.

I would have to find the numbers to give an honest assessment, but I doubt if they are significantly different before the mandate than after on the number of uninsured involved in crashes. At least in my state, you see that story in the paper routinely of charges tacked on because a motorist was uninsured.

|8.28.09 @ 11:55PM|#

Jeffersonian | August 28, 2009, 8:40pm | #
"So, do you want Medicare repealed?"

"Yes. Next question."

Good plan. Throw the approx. 50 Million high-risk elderly that form the nations most powerful voting block into a private insurance market that doesn't want them at any cost. If this isn't the fastest route to socialized medicine yet proposed, it's gotta be at least tied for first.

mark|8.29.09 @ 12:42AM|#

Good plan. Throw the approx. 50 Million high-risk elderly that form the nations most powerful voting block into a private insurance market that doesn't want them at any cost. If this isn't the fastest route to socialized medicine yet proposed, it's gotta be at least tied for first.

Well you gotta buy them off. Just let people opt-out of Medicare, problem solved.

alan|8.29.09 @ 12:44AM|#

Good plan. Throw the approx. 50 Million high-risk elderly that form the nations most powerful voting block into a private insurance market that doesn't want them at any cost. If this isn't the fastest route to socialized medicine yet proposed, it's gotta be at least tied for first.

Let us say that as a matter of political expediency, at least in the short term of the current two year political cycle that is true.

Given, that Medicare went broke last year, falling short of the HI Trust Fund, and in need of at least 340 billion transferred to it from the general fund in a low ball estimate over the next seven years, at what point does the political expediency change from pissing off the seniors to dealing with the problem of the youth saying 'fuck it' with self imposed diminished expectations to a society that is squandering the wealth for short term political gain?

|8.29.09 @ 12:45AM|#

the limited part of the problem is NOT health care itself, but the money, and it is only limited by choice. The supply of money can be stretched by doing the one thing most needed and completely left out of this bill, that that is the biggest hunk of the health care dollar -- physician costs. All other "modern" countries control physician costs. Why is this reform not trying to? Control it by regulating fair charges, and bring them down.

Jennifer|8.29.09 @ 1:07AM|#

Concerning the plan to force everybody to buy health insurance, even the young people who might not want to, how is that going to work? Will it be "merely" an income tax increase, in which case it is not possible to owe more money than you made, or is it a flat-out bill akin to rent or mortgage that you have to pay whether you have the money or not?

When I was out of work last year I was extremely fortunate in that I'm my boyfriend's "domestic partner" for health insurance purposes. Had I gone with COBRA, those payments would've been about half of my total unemployment benefits, in which case I would've just crossed my fingers and gone without insurance at that time. Had I been legally forced to pay COBRA, those months of unemployment would've been much worse than they already were. And if I were forced to pay COBRA even if I were out of work and the unemployment benefits ran out ....

|8.29.09 @ 1:07AM|#

dojfraleigh is apparently unaware that price controls serve only to limit supply. what a sad state of existence...

|8.29.09 @ 1:16AM|#

jennifer:

it will be a tax credit for the poor, a fine for those who do not buy but could. all around effed up...

|8.29.09 @ 1:27AM|#

Despite any Christian charity I might have, robc is one of those guys I just wish would face some hard luck in his life, and find himself desperately of need of food, just so I could make a sandwich and piss all over it just before I hand it to him. I'd say the over/under on the number of times per month he jerks off while gazing lovingly at his Ayn Rand poster is 25.

|8.29.09 @ 1:35AM|#

ironyabounds:


so god gave man free will, but it's yer job to take it away i gather?

alan|8.29.09 @ 1:36AM|#

the limited part of the problem is NOT health care itself, but the money, and it is only limited by choice. The supply of money can be stretched by doing the one thing most needed and completely left out of this bill, that that is the biggest hunk of the health care dollar -- physician costs. All other "modern" countries control physician costs. Why is this reform not trying to? Control it by regulating fair charges, and bring them down.

Prices being untethered to the market is our present condition and is caused by previous rounds of regulatory red tape such as the creation of managed care with the 1973 Teddy/Nixon HMO Act.

Certainly, the legal sanction of the AMA as an exclusive monopoly is also a misappropriation of the regulatory (rarely does it not reflect rent seeking) scheme.

I recall the example Milton Friedman gave in Freedom of Choice of Jewish migrations during the 30s and 40's where in spite of there being a large influx of professional talent the number of new doctors added to the system did not reflect this migration for many years after because of the AMA's tight control of quotas.

alan|8.29.09 @ 1:43AM|#

IronyAbounds | August 29, 2009, 1:27am | #
Despite any Christian charity I might have, robc is one of those guys I just wish would face some hard luck in his life, and find himself desperately of need of food, just so I could make a sandwich and piss all over it just before I hand it to him. I'd say the over/under on the number of times per month he jerks off while gazing lovingly at his Ayn Rand poster is 25.

Why do so many liberals have the pretension that they own hard luck? Is it from a lack of experience with it or have you lived a life so cloistered that you don't know the last thing you will be willing to give up is your pride?

*|8.29.09 @ 3:08AM|#

Why do so many liberals have the pretension that they own hard luck? Is it from a lack of experience with it or have you lived a life so cloistered that you don't know the last thing you will be willing to give up is your pride?

They don't have any pride, and they can't stand to see anyone else have any either.

|8.29.09 @ 4:15AM|#

Strongly disagree. All insurance is a losing proposition in the macro sense - that is how insurance companies make money.

Not really. A dollar is not worth to same thing to everyone. People have vastly differing marginal utilities for a dollar. If you have a million dollars in cash equivalents, you don't need to insure against a $10,000 loss, because to you the difference between $990,000 and $1,000,000 is basically a rounding error. The marginal value of one more dollar for those two wealth levels is essentially the same.

If you have $10,001 in cash, you need to insure against a $10,000 loss, because the marginal value of a dollar at $10,000 in cash is WAY higher than the marginal value if you have $1 in cash.

Essentially, much of what insurance companies do is make a profit moving dollars from situations where they have a low marginal value to situations where they have a high marginal value, and pocketing some of the value they thereby create.

|8.29.09 @ 4:18AM|#

4:15 am should read:

If you have $10,001 in cash, you need to insure against a $10,000 loss, because the marginal value of a dollar at $10,000 in cash is WAY lower than the marginal value if you have $1 in cash.

rhhardin|8.29.09 @ 8:15AM|#

People at some point _prefer_ something else to health care. It's not that they don't have the money. It isn't rationing. It's individual preference.

In the 70s there was a freeze in Brazil. Coffee was wiped out.

Yet you could get all the coffee you wanted, just at a higher price, from a smaller section of the supermarket.

Obviously the poor are buying less coffee.

Suppose we remedy this. We hand every poor person entering the store $10, to cover the cost of a pound of coffee.

Do they buy coffee with the $10? No. They prefer something else to coffee at $10 a pound.

They ``can't afford'' coffee at $10 a pound, as we say. It's not that they don't have the money, but that they have a better use for it.

Suppose instead of $10 we give them a pound of coffee.

1. They're worse off, because they don't prefer it to what they can buy with $10.

2. We run out of coffee.

Then there actually would be rationing of coffee.

|8.29.09 @ 8:21AM|#

ironyabounds,

Seriously, go fuck yourself to death. robc is a better Christian, better human being, than a dried up little turd like you ever will be.

Even a hellbound atheist like me can see that, fuckneck.

Art-P.O.G.|8.29.09 @ 8:36AM|#

Gotta +1 your last post, SF.

Sly|8.29.09 @ 9:02AM|#

This response makes sense if you treat insurance as any other commercial enterprise. Unfortunately, health insurance doesn't follow these rules. Insurance deviates from traditional competitive models in two ways.

First, insurance companies have to employ risk selection to make sure they are always collecting more money in terms of premiums than they pay out in terms of benefits. You see this in all types of insurance, from auto to homeowners. The problem is that this will lead to varying levels allocative inefficiency depending on the demand of the insurance being provided (more demand, more inefficiency). Without "government intervention in the marketplace" in the form of non-profits created to insure more risky demographics (poor, elderly, chronically ill) many people wouldn't have coverage.

Second, and this is related to the first, is that insurance is a non-transparent transaction in terms of costs vs. benefits. While everyone can be certain that they will need some kind of medical care at some point in their life, there will always be some form of uncertainty as to how much you'll actually need. They know the costs of having insurance in very real terms, but they don't know the benefits.

This disparity creates an enormous amount of anti-selection, and consumers can't make rational purchasing decisions as a result. In many respects, insurance artificially inflates the level of anti-selection by collecting as much information on who their insuring as possible and limiting the extent of certainty that their policy holders have in terms of the benefits they believe they will receive should they need them.

Intervention can fix this, but some of the current forms of intervention the U.S. employs actually makes it worse. Relegating insurance regulation to state agencies, who want very profitable companies to tax (the original impetus behind McCarren-Ferguson, which gave supremacy to state law, was a reaction by the National Association of Insurance Commissioners to legal challenges to state taxes), has been a disaster. It's not just that insurance companies are exempt from Federal anti-trust statutes, it's that state insurance commissioners have been all too eager to promote heavy market concentration. And incentivizing, employer-based coverage, while well-meaning, has just served to create more anti-selection.

Positive intervention can come in the form of expanding the the risk pool to the point where risk selection becomes very difficult, or even impossible, and by mandating a clearly defined package of benefits. Other countries have done both in a variety of ways (not just single-payer) and have achieved better results. But none of those countries have relied on insurance firms to do it for them.

Fluffy|8.29.09 @ 9:10AM|#

I am a bit torn on mandating purchase of some minimal health insurance. Why?

I am not sure how it would be that different than states requiring licensed drivers to purchase liability insurance on their cars. Yes, there is some purist loss of liberty, but for someone to go and cause an auto accident while uninsured, if they have little or no real assets to be subject to forfeiture in a tort as a fallback, isn't that almost like a theft with the damaged party as victim?

The only reason the state has the moral authority to require insurance on cars is because the state owns the roads. Since they own the roads, they can require a license and vehicle registration in order to use those roads, and they can make carrying vehicle insurance a registration requirement.

If I owned a car that I intended to use only on private tracks, I don't acknowledge that the state has the moral authority to place any insurance requirement on the use of that car.

And with regard to your "theft" argument: when I was 22, it was about 1000 times more likely that I would default on my car loan, or on my credit cards, than it was that I would run up expensive health care debts and then not pay them. I didn't even walk into a doctor's office from my 18th to 30th birthdays. Should it have been illegal for me to have a car loan or credit card debt, since if I defaulted those costs went "to the system" and I had no assets for anyone to seize?

It's perfectly legal for a young person to engage in any number of activities that create a risk of bankruptcy. For most of those activities, the risk of their debts being thrown back on the system is infinitely greater than when they run the fairly negligible "risk" of not carrying health insurance. Half of all new businesses fail, which probably means that more of half of new businesses started by uninsured young people fail. Half of uninsured young people don't get cancer. Therefore, if we were truly concerned about young people not running up liabilities they can't pay, we should make it illegal for young people to open businesses, a lot sooner than we should force them to buy insurance.

There are only two reasons the reformers want to force young people to buy insurance:

1. To use their premium payments to pay for care for other people.

2. Because once they require insurers to accept people with preexisting conditions, any sensible person would drop their insurance and only buy it again once they were sick.

The "free ridership" argument makes no sense until after you wreck the price system by forcing carriers to accept people with pre-existing conditions.

MNG|8.29.09 @ 9:46AM|#

fluffy
It seems to me another reason people want to mandate insurance is that we have these cases of people thinking they don't need insurance, then they get hurt or ill in an unforesseable way, and then everyone else has to take care of their goofy asses.

You didn't walk into a doctors office from 18-30, well that's great, but I doubt you had an anti-disease/accident/whatever force field around you. You were probably more sensible than the average dude, and maybe more lucky. But a lot of people are neither, and then they end up costing us a great amount, because our society is simply not going to make them "pay for their mistakes."

I actually agree that this mandating everyone to buy private insurance is a bit messed up. The liberals should have the balls to go for single payer, if they don't they should seek certain minor reforms and forget this kind of half assed stuff. It'll satisfy and help just aboout noone.

I don't think your bankruptcy analogy works. Unless some young person can fool enough fools into giving him investments or money then he's probably not going to cost me much money, but all a young person has to do to cost the government enormous amounts is to get hurt/sick.

Besides, you probably remember how I feel about bankruptcy laws...

MNG|8.29.09 @ 9:49AM|#

And I always thought the moral authority the state had to mandate car insurance is to make sure people can cover something that may likely be their responsibility, i.e., they run into me and now owe me big $, or now have hurt themselves and show up at the ER. If they've been paying insurance premiums then their insurance can pay for that, otherwise society is sol. It's a responsibility thing.

MNG|8.29.09 @ 9:51AM|#

In fact, the bankrupt kid doesn't cost "society" in general anything; he costs his creditors when the bankruptcy judge gives them less than he owes them. The kid who shows up in the ER and for whom the government has to pay for care because he is uninsured, that kid costs everyone who pays taxes.

Fluffy|8.29.09 @ 10:06AM|#

In fact, the bankrupt kid doesn't cost "society" in general anything; he costs his creditors when the bankruptcy judge gives them less than he owes them. The kid who shows up in the ER and for whom the government has to pay for care because he is uninsured, that kid costs everyone who pays taxes.

Don't be an idiot. The government only pays if I sign up for Medicaid. If I show up at an ER, get care, and then declare bankruptcy because I can't pay my bill, the government pays nothing. The hospital eats my costs as a creditor, just like any other creditor eats the costs of people who don't pay.

This throws my costs on the system in the aggregate, but every last act of default in every area of life throws costs back on the system in the aggregate. This means that you haven't responded to my basic point at all: that young people are much more likely to throw costs back on to the aggregate system by defaulting on other debt than they are by running up health care debt.

And I always thought the moral authority the state had to mandate car insurance is to make sure people can cover something that may likely be their responsibility, i.e., they run into me and now owe me big $

Well, you were wrong. It's properly a condition of cars operated on the public way only. There are states that have moved beyond that, but those states are usurping a power they don't properly possess.

Fluffy|8.29.09 @ 10:14AM|#

Unless some young person can fool enough fools into giving him investments or money then he's probably not going to cost me much money, but all a young person has to do to cost the government enormous amounts is to get hurt/sick.

The stories you hear about people who need treatments costing six and seven figures are actually vanishingly rare. People driven into bankruptcy by health care debts are usually facing 5 figure debts. People in their 20's can EASILY have car loans and credit card debt in the mid 5 figure range and up. And higher if they started a business and/or did the Carleton Sheets real estate type thing.

The "young person default risk" thing is a red herring. The people offering that argument are much more concerned about using young people as milch cows by forcing them to buy community rated health insurance than they are in avoiding defaults.

Look at Sly's post: he takes a lot of words to say a pretty simple thing: that he doesn't want old and sick people to pay premiums that represent their actual risk. But the only way to avoid that is to force young and healthy people to pay premiums that are HIGHER than their actual risk. But when you price insurance higher than the actual underlying risk, a rational person won't buy the insurance. To Sly, the important question is what method to choose to force the majority of people to assume costs higher than their actual risk.

robc|8.29.09 @ 10:48AM|#

SF,

robc is a better Christian,

I refuse to make that call. Not my place to judge. :) I do use the word fuck more than your typical southern baptist.

I wonder why it bothers him so much for me to call a slaver a slaver. If you dont want to be labeled that, dont make demands on other peoples lives.

I think its funny that he thinks Im an objectivist. Rand would have kicked me out in about 2 seconds, mainly over that whole God thing.

robc|8.29.09 @ 10:52AM|#

our society is simply not going to make them "pay for their mistakes."

Just because our society isnt going to do it doesnt mean our government shouldnt.

Society != Government.

Government should say "fuck you, you were stupid". Charities may have a duty otherwise, and thats okay.

Jennifer|8.29.09 @ 10:53AM|#

jennifer: it will be a tax credit for the poor, a fine for those who do not buy but could. all around effed up...

Oh, Christ. And I can't wait to see how the government determines who can and can't afford to buy this. I have enough money in savings that, if my boyfriend and I both lost our jobs tomorrow, we could live for a couple of years on that money alone. Unless, of course, the government insists we must either spend $500 a month on mandatory insurance, or else pay a no-insurance fine of $498 a month.

Massachusetts does something similar with its mandatory insurance plan, and the hell of it is, the insurance people are required-by-law to buy is just as bad as the worst HMO horror stories you've heard. Yeah, almost everyone in that state "has insurance," but lots of them still can't afford actual "medical care." In fact, the poorest are less likely to afford care than before, because the $6,000 or $7,000 a year that a family might have used to pay for some doctor visits instead goes for premiums for an insurance plan with such a high deductible that, where poor folk are concerned, they may as well have no insurance at all.

It would be almost as bad as if my car insurance had a $10,000 deductible for repairs; ten grand is what I paid for the car when I bought it six or seven years ago.

MNG|8.29.09 @ 11:00AM|#

"the important question is what method to choose to force the majority of people to assume costs higher than their actual risk."

Well, this is probably part of it, as people don't necessarily think people deserve whatever risk they have, and so it might be a fairness thing. Similar to the logic courts often use to shift costs to producers who can then shift them across all consumers rather have them fall in swamping amounts on a few injured consumers.

"The government only pays if I sign up for Medicaid. If I show up at an ER, get care, and then declare bankruptcy because I can't pay my bill, the government pays nothing."

1. Isn't the hopsital prohibited from turning you away in a way that potential creditors cannot?

2. How many people do the latter, forego Medicare and declare bankruptcy? For the ones who go under Medicare we don't just pay the indirect costs of having overall prices raised to cover losses by the default of others, we directly pay for their care.

"It's properly a condition of cars operated on the public way only."

If that's their reason then it's not mine. I think car insurance should be mandated for the reason I gave, so I don't have some dumbass hit me and not be able to cover the damages.

MNG|8.29.09 @ 11:07AM|#

"I wonder why it bothers him so much for me to call a slaver a slaver. If you dont want to be labeled that, dont make demands on other peoples lives."

It's such a tiresome and stupid thing to do. It tries to equate the recognized evil of forcing someone to enrich you with compelling someone to do a morally correct act.

You don't mind "compelling" a tresspassing person off my land, or "compelling" a frauder to stop engaging in fraud. In fact, I bet if a drowning man were trying to climb into another man's boat you don't mind if the drowner "compelled" the boat owner to let him on the boat until he was back on dry land. To call all of this slavery is of course absurd, though it has people using force to make somebody do something they do not want to do. Likewise, it's hyperbolic, confused nonsense to say people who advocate "compelling" people to support care that reduces the suffering and deaths of others as "slavery."

If you are a Tolstoyian Pacifist Anarchist, then go ahead and call everyone else a "slaver." Otherwise please stfu (with all due respect :)) with such silliness.

MNG|8.29.09 @ 11:10AM|#

Jennifer
You don't have insurance? What happens (God forbid) if you or your boyfriend are told tomorrow you have some terrible disease or either of you get seriously hurt tomorrow? You don't have force fields or magic angels preventing that, you know. WTF would you do financially? WTF should society or the government do if you can't cover costs that occur because of this?

Fluffy|8.29.09 @ 11:12AM|#

To call all of this slavery is of course absurd, though it has people using force to make somebody do something they do not want to do. Likewise, it's hyperbolic, confused nonsense to say people who advocate "compelling" people to support care that reduces the suffering and deaths of others as "slavery."

I can respect all of your negative rights by doing nothing.

I can refrain from defrauding you by doing nothing.

I can refrain from assaulting you by doing nothing.

There's really no comparison between laws that compel you to refrain from action and laws that compel you to labor for someone.

ransom147|8.29.09 @ 11:13AM|#

milk = milk + filch?
Ha!

I wonder which they will go after first to pay for all this shit. Pension trusts or IRAs&401k accts.

ransom147|8.29.09 @ 11:17AM|#

*milch

ransom147|8.29.09 @ 11:32AM|#

Mng

So Jennifer is supposed to feel bad because she is allocating her resources away from insurance for now, but you want her to pay for crack heads too?

If she is unmarried and unemployed she is eligible 4 medicaid. According to your mindart what's wrong w/ that? Doesn't she deserve it as much as all the other prole you want to cover?

Howabout some continuity?

Fluffy|8.29.09 @ 11:34AM|#

If that's their reason then it's not mine. I think car insurance should be mandated for the reason I gave, so I don't have some dumbass hit me and not be able to cover the damages.

The reason why you think exercising a power might be wise, and the reason the state possesses a power, are not the same.

In any event, if my car does not enter the public way, it can't hit you and force you to cover the damages.

I imagine if you examine the legislative history of such insurance requirements, you will find that they began as conditions of obtaining a registration to operate the vehicle on a public way. This was because the first legislators faced with the problem of regulating the use of automobiles released that the only basis they had for doing so was their power to govern the use of public ways. Requiring operators to carry insurance before they drive is a good idea, but you also need a basis of authority to compel this good idea.

It was only after the public was so accustomed to license, registration and insurance requirements for cars that some states were able to exploit that learned subservience to go beyond their original authority and make it illegal to even possess an unregistered or uninsured car, regardless of whether you operate it on a public way.

ransom147|8.29.09 @ 11:34AM|#

*mind set

|8.29.09 @ 11:35AM|#

All the "free market" wizards really don't seem to understand oligarcy and monopoly power which can easily occur in a "free market" causing a market to not actually be free. Sad there really are no free market fairies to make it all right without outside intervention.

Don't even get me started on hidden costs.

|8.29.09 @ 11:38AM|#

people don't necessarily think people deserve whatever risk they have, and so it might be a fairness thing.

DRINK!

Curse you, MaunderingNannyGoat.

ransom147|8.29.09 @ 11:41AM|#

True enough fluffy. Alabama did not require ins til yke late 90s when they were finally pressured into it by the insurane companies that were not making the $ they were in other states.

|8.29.09 @ 11:44AM|#

compelling someone to do a morally correct act.

"Morally correct" being defined by you, of course.

Fuck off, slaver.

Tricky Prickears|8.29.09 @ 11:48AM|#

Holy crap. 390 comments in less than 24 hours. That's got to be some kind of record. Call the Guinness people (no, not the beer).

robc|8.29.09 @ 11:52AM|#

MNG,

That is why I didnt call any of those things "slavery". I called making me work for someone else for free against my will slavery.

Letting someone in the boat to avoid drowning doesnt require me to do any work. If he makes me drop him off at any location other than where I want to, however....

Also, paying for someone else's health care isnt a morally correct act. In many cases, it is the exact opposite.

To give a biblical example, Paul requires the church to support widows and orphans. But, not widows under age 50. They are too young to be leaches. Not Paul's exact wording but still his point. So, to a christian, helping an elderly widow is required, helping a youthful widow is actually bad for the widow, so would be immoral.

robc|8.29.09 @ 11:53AM|#

Fuck off, slaver.

Sweet, I think I have created a meme.

ransom147|8.29.09 @ 11:55AM|#

P brooks:

And I thought the republicans had a patent on legislating morality. Silly me!