Nevermind All Those Opposition Solutions; Obama's Opposition Has No Solutions!

One of the most interesting exchanges from President Obama's question-and-answer session with House GOP members earlier today was the one he had with Rep. Paul Ryan over the future of Medicare. As part of his recent set of policy proposals—which he's dubbed the "American Roadmap"—Rep. Ryan proposed some significant changes to how we deal with Medicare. Those over 55 at the time of passage would get see no changes, but those under 55 at the time would get vouchers to pay for medical care in their retirement years. The tax exclusion for employer health insurance would be replaced by a refundable tax credit for the purchase of health insurance. The idea would be to delink health insurance from employment while dealing with Medicare's massive unfunded liability and giving individuals more control of their health care spending—the last part being especially crucial, because, depending on how it works, it's arguably the only proven way of bring down health spending. You can debate the merits of the plan and its specifics, but it's plain that Ryan's done his homework on these issues.

Here's a snippet of Obama talking about the plan with Rep. Ryan:

President Obama:  I think Paul [Ryan], for example, the head of the Budget Committee, has looked at the budget and has made a serious proposal.  I’ve read it.  I can tell you what’s in it.  And there’s some ideas in there that I would agree with but there’s some ideas we should have a healthy debate about because I don’t agree with them.” The major driver of our long-term liabilities, everybody here knows, is Medicare and Medicaid and our health care spending. Nothing comes close.  That’s going to be what our children have to worry about. Now, Paul’s approach, and I want to be careful not to simplify this, I know you’ve got a lot of detail in your plan, but, if I understand it correctly, would say, we’re going to provide vouchers of some sort for current Medicare recipients at the current level – No?

Congressman Ryan: No – we protect the program for Americans 55 and above [those in and near retirement]…

Obama:  I understand – there’s a grandfathering in….That’s why I said I wanted to make sure that I’m not being unfair to your proposal.  I just want to point out that I’ve read it, and the basic idea would be that, at some point, we hold Medicare cost per recipient constant as a way of making sure that that doesn’t go way out of whack, and I’m sure there some details…

Ryan:  We increase the Medicare payments with a blend of inflation and health inflation.  The point of our plan is, because Medicare as you know is a $38 trillion unfunded liability. 

Obama: Right.

Ryan: It has to be reformed for younger generations because it won’t exist. It’s going bankrupt. The premise of our idea is look, why not give people the same kind of health care plan we here have in Congress? That’s the kind of reform we’re proposing for Medicare. [applause]

Obama: As I said before, this is an entirely legitimate proposal. …There is a political vulnerability to doing anything that tinkers with Medicare.  And that’s probably the biggest savings that are obtained through Paul’s plan. And I raise that, not because we shouldn’t have a serious discussion about it, I raise that because we’re not going to be able to do anything about any of these entitlements if what we do is characterize whatever proposals are put out there as well, you know, that’s the other party being irresponsible….

There are two points I would make about this exchange, one in Obama's favor, one against. The first is that Obama is right that Republicans, with their relentless demagoguery of anything that smacks of Medicare cuts, have taken a situation in which it was already going to be very difficult to reform Medicare and made it nearly impossible. I don't think you can blame Rep. Ryan for this. But it's made future GOP reforms even less likely.

The second point, though, is that it's more than a little irritating to see Obama speak so well of Ryan's plan and say that it's the sort of thing that deserves "serious discussion." Problem is, throughout the health care debate, Obama didn't want to have that discussion. He didn't want to talk about any plans to significantly reduce entitlement spending, or severing the links between insurance and employment.

Indeed, not only did he make almost no effort to incorporate opposition ideas into his legislation, he wasn't willing to recognize the existence of legitimate opposing ideas at all. Instead, he chose to caricature his opponents as having "no solutions." That's not true now. It wasn't true then. But Obama's approach to most policy and political debates has been to reiterate the notion that his way was not simply the best way, but the only way—or at least the only legitimate, acceptable, reasonable way. His conversation today with Rep. Ryan, I think, is a tacit admission that that's just not the case.

In July, Reason Senior Editor Michael Moynihan spoke with Rep. Ryan about why we don't need more college entitlements:

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  • Mr. FIFY||

    When Party A is in power, they expect Party B to bend over forwards in agreement. This is called "bipartisanship".

    Reverse A and B as needed.

  • The Libertarian Guy||

    It's when A and B work together... that's when you know we're gonna get fucked.

  • ||

    sad that gridlock is the best outcome we can get...

  • ||

    You know how there was a secret map on the back of the Declaration of Independence in that stupid movie? Well, in real life, on the back of the first page of the Constitution is the word, "Gridlock, aſſholes, gridlock!!"

  • ||

    The weird thing about it is not only did it use the word "gridlock" but it had blue prints for a 747 and an ad for the Ipad...

    There is other information there as well but in order to keep the time continuum in harmony the only thing i can say is if you live in California then i suggest you move.

  • ||

    "Gridlock, aſſholes, gridlock!!"

    Most excellent, Mr ProL.

  • ||

    Shoulda been "are the words." Asshole came second, once I realized that a long s was needed.

  • The Art-P.O.G.||

    Most good indeed, though.

  • OMG||

    Not sad. It's not a bug, it's a feature

  • ||

    All both sides voting for something does is give each side the opportunity to avoid responsiblity and call anyone who objects a nut. I mean who can object to a bipartisan idea?

  • juris imprudent||

    Yes, much better that A and B gridlock in disagreement over who gets to fuck you first.

  • The Libertarian Guy||

    The term "double penetration" comes to mind... which should elicit a Steve Smith response any moment now.

  • STEVE SMITH||

    STEVE SMITH DOES NOT SHARE HIS VICTIMS!

  • The Libertarian Guy||

    Eighteen minutes, Steve? You're slow tonight, bro!

  • STEVE SMITH||

    I WAS RE-DECORATING MY RAPE ROOM. AND CLEANING THE BLOOD.

  • The Libertarian Guy||

    Yeah, yeah... it rubs the lotion on its skin, blah blah yadda yadda...

  • juris imprudent||

    One hopes the Repubs have this exchange on tape so that come the run up to the election when the Dems are saying the Repubs have no alternatives...

  • ||

    Ryan is the best of a sorry GOP lot.

    Jeb Hensarling, OTOH, was exposed as a complete liar with his "triple the deficit" crap after Obama correctly pointed out that the Bushpigs left a $1.3 trillion deficit for FY 08/09.

    This FY is projected at $1.35 trillion.

  • EJ||

    mo shrike bush left about a 1 trillion, of which a good chunck of that the dems including obama voted for... now mr O is doubling down and increasing it more

  • The Libertarian Guy||

    Still too much debt, shrike. Even a shill for the left like you should be able to see that fact.

  • Mr. FIFY||

    True... Obama voted for lots of spending, and yet here he is bitching about how much got spent when he was a mere senator who voted for said spending.

    What a prick. But then again, McCain wouldn't have been any better.

  • B.P.||

    Obama complaining about debt from previous administration for which he voted in favor = okay

    GOP congressmen showing up to photo ops at stimulus-funded projects for which they voted against = not okay

  • The Libertarian Guy||

    Yes, B.P.... we get it, both parties suck.

    You DO agree, right?

  • ||

    They both suck, but only one lies about being "fiscally responsible" while creating 85% of all debt to date and hides shitty wars in supplemental budgets.

  • Mr. FIFY||

    You're seriously saying Democrats are fiscally responsible?

    That is funny, comrade!

  • Gilbert Martin||

    Which party originated the concept of "entitlements"?

    That was the very epitome of fiscal irresponsibilty to begin with.

    More money has been spent on entititement and welfare programs than has been spent on all the wars the U.S. has ever fought combined.

  • ||

    Run against Social Security/Medicare then.

    I would vote for someone that honest.

    Chance = .0001%

  • ||

    What's hidden? Is it really so difficult for people to take the regular budget for a fiscal year, and add the supplemental war spending for the same year to come up with the total budget for that year? How is it any more transparent to put the war funding in the regular budget? Shit, I'd say its less transparent.

  • ||

    hides shitty wars in supplemental budgets.

    Not just wars. TARP I, TARP II, and the auto bailouts all were supplemental as well, as "emergency spending."

    Of course, TARP II went into FY2009 despite being passed once Obama was in office, so it's pretty absurd for Obama to blame that part on Bush.

  • ||

    Hey idiot, you're behind the times.

    Obama's also paying for his wars through defense supplementals.

    Which anyone who knew shit about defense appropriations saw coming. ...which ruled out the Obama-loving press corps and the morons (you) who were relying on them.

    Look it up.

  • ||

    After that, you might want to find out how Kosovo was paid for...or the Korean and Vietnam Wars during Truman and LBJ.

  • ||

    McCain wouldn't have been any better.

    No he is more fiscally conservative. We would have gotten the bank bail outs but not the stimulus...or a substantially smaller stimulus.

    We also probably would not have gotten the GM bail out.

  • ||

    On a side note we would also be at war with China, Iran, France, New Guinea, the State of Wyoming, and Springfield Illinois.

  • Sudden||

    Wyoming would win.

  • ||

    "WOLVERINES!"

  • ||


    China, Iran, France, New Guinea, the State of Wyoming, and Springfield Illinois.

    hahahahaha. funny shit.

    seriously though, i doubt obama is any less "warlike" then mccain...

  • Leif||

    Wyoming? Why Wyoming?

  • Sean W. Malone||

    Those bastards have it coming...

  • zoltan||

    We wouldn't have gotten the GM bail out by the guy who suspended his campaign because of the poor, wittle car companies?

  • Gilbert Martin||

    The Democrats were in charge of Congress for the last 2 years of the Bush presidency.

    They are every bit as reposnbible as Bush is for every single cent of spending that occured from the first nanosecond that they took over.

    Oh and the big O himself voted for a hell of a lot of those spending bills.

  • The Libertarian Guy||

    Doesn't matter to Democrats. Nothing they do for the next three years will be their fault... ever.

  • Sudden||

    Wha? Congress has the power of the purse?

    People always seem far to quick to credit/blame the Prez and far too slow to credit/blame the Congress.

  • Tony||

    How often did the Democratic majority get what it wanted during those two years?

  • The Libertarian Guy||

    Too often, Tony.

  • Mr. FIFY||

    When either party gets what they want, it's we little people who suffer.

  • ||

    Twice I recall.

    A minimum wage hike and the end to the Enron Loophole which brought crude prices down in the summer of $147 bbl oil.

    Bush tried to veto that.

  • ||

    shrike, you don't recall the farm bill?

    Bush vetoed that, Obama voted for it.

  • ||

    the end to the Enron Loophole which brought crude prices down in the summer of $147 bbl oil.

    Good to see that shrike doesn't believe in Peak Oil either.

  • ||

    Sorry, you're a little confused. Most of the projected deficit comes from Medicare Part D, the Bush tax cuts (EGTRRA and JGTRRA), and the wars in Iraq and Afghanistan. None of which Obama was able to vote for (he probably voted for the war funding but not the initial wars), and none of which the Democrats were responsible for.

  • ||

    after Obama correctly pointed out that the Bushpigs left a $1.3 trillion deficit for FY 08/09.

    Including the farm bill... that Bush vetoed and Obama voted for.

    Also, the $1.3T for FY2009 includes TARP II, which was passed after Bush left office. Supplementary spending counts, whether it's wars or not.

  • Eric A.||

    "after Obama correctly pointed out that the Bushpigs left a $1.3 trillion deficit"

    Surely you mean "the Obamamonkey," yes?

  • PIRS||

    Here are some things Obama would probably say does NOT deserve "serious discussion." During the tea party protests I passed out this flyer I paste below. By the way, feel free to use it for yourself.:

    Five Common Sense, Free Market health-care Solutions

    1. Allow insurance plans to be sold in more than one state or region.

    2. Allow self-employed who buy their own insurance the same tax benefits as people with employer-based coverage.

    3. Expand availability of Health Savings Accounts which give the consumer greater control over spending.

    4. Legalize the re-importation of medications

    5. Reduce government regulations and red tape on the insurance industry. Heavy regulation creates an “iron triangle” effect enabling the largest companies to set the rules through their influence over politicians.

    Additional resources

    Cato on Healthcare
    http://healthcare.cato.org

    Reason Foundation on Healthcare
    http://reason.org/areas/topic/health-care

  • The Libertarian Guy||

    Nice ideas, but how do they make Democrats more powerful?

    See, that's why they won't be implemented - they would create a power drain, and professional politicians don't like that sort of thing.

  • ||

    Allow insurance plans to be sold in more than one state or region.

    So Aetna, UHC, etc sell in all states now - just a slightly tweaked product for each state based on the state insurance commission. A uniform product wouldn't increase competition at all in the big states and would scarcely cut costs.

    Tort reform is another non-starter. Its being done. Texas capped awards at $250,000 and premiums still went up.

    Amazing that NAFTA restricts pharma purchases from Canada, isn't it?

  • Mr. FIFY||

    So it's government-ladled healthcare or nothing, eh, shrike?

  • ||

    I am opposed to universal health care.

    But I am really opposed to forced spending of nearly 1/3 of USA healthcare expenditures on Medicare folk in their last year of life.

    We have the most inefficient system possible now.

    Its like taxing workers to repair all cars made before 1975.

  • The Libertarian Guy||

    It's either/or, shrike. Unless someone finds a way to fix it without turning it into a government-run anti-utopia, them's the choices.

  • PIRS||

    "But I am really opposed to forced spending of nearly 1/3 of USA healthcare expenditures on Medicare folk in their last year of life."

    It sounds like what you are actually opposed to is human physiology. If you don't like the human body the way it is build a better human body.

  • ||

    Yep - its an intractable problem. Obama tried to cut $500 billion out of Medicare and got hammered.

    17% of GDP and going up.

  • Mr. FIFY||

    Based on your responses over the recent Supreme Court decision, one wonders why anyone should engage in conversation with you, shrike...

  • ||

    If he had his way, no one would be able to...

  • Kent||

    I am opposed to compulsory school attendance and taxpayer support of schooling.

    I am really opposed to forced spending of 4.2% of GDP on K-12 schooling, virtually none of which is consumed by "Medicare folk" in any year of life.

  • PIRS||

    There are smaller companies as well. Smaller companies may not be able to afford dealing with the red tape it takes to sell their products in fifty separate jurisdictions. This would allow them to compete. It would also allow the end customer to decide which state's regulations they prefer.

  • olafmetal||

    Unless Insurance companies all moved to the same state like credit card companies did already.

  • Sudden||

    Legalize the reimportation of medicines

    Why not put the price controls on and approve only 35% of newer, expensive drugs that come to market to begin with? Why bother paying the importation costs?

    Oh that's right, we already subsidize the Canadians failure to pay market rates for these products. If we started this importation business (which is a roundabout price control since the only reason Canadian drugs are cheaper is because the Canucks decree such by law), say hello to shortages. Global shortages.

  • PIRS||

    I think what would happen is that the drug companies would simply level the global price. We Yanks would no longer have to bear the bulk of the R&D costs. Canadians would have to pay their share as well. That is why some Candians are actually upset at thought of us Yanks "using them as a drug store". You would think they would be happy to get a cut of the deal. They know they would then have to pay their fair share of R&D.

  • ||

    So Aetna, UHC, etc sell in all states now - just a slightly tweaked product for each state based on the state insurance commission.

    It's a hell of a lot more than "slightly tweaked" for certain states, especially those with lots of mandates or guaranteed issue and community rating. But certainly the change would only really make a difference if it were allowed to get around state mandates, which there's no way it would.

    Glad to see you're admitting that Obama and the Democrats' whining about monopoly insurance providers in some states is bullshit, though.

  • Joe||

    Wrong! You misunderstand why selling insurance across state lines would decrease the cost of health insurance. The goal of the selling a product across state lines would be that the state insurance commissions would not have the power to regulate the product benefit design, i.e. states would lose their power to enforce stupid and costly mandates unless all states did.

  • ||

    Nonsense! "State insurance commission" is just a plebeian friendly word for government sponsored insurance cartels. It's the cartels that, in part, make the system so expensive. The other major factor is US less medical professionals and medical capital per person than most of the industrialized world. How does one make a scare supply less expensive? You make the supply more plentiful. Allow more medical professionals to migrate to the US; encourage the recognitions of more medical schools in the United States; foster more grade school children to excel in the arts and sciences.

  • Chad||

    PIRS|1.29.10 @ 6:22PM|#

    1. Allow insurance plans to be sold in more than one state or region.

    Great! All the insurance companies will flee to Texas (or whichever clever state lowers the bar even further and pays out fat subisidies), and the only thing available to buy will be crap insurance that will drop you the day you get sick for any inventive excuse the company can muster. Check-eating dogs and confused mailmen will multiply a million-fold.

    2. Allow self-employed who buy their own insurance the same tax benefits as people with employer-based coverage.

    Just lower taxes and get rid of the loopholes....much simpler.

    3. Expand availability of Health Savings Accounts which give the consumer greater control over spending.

    A libertarian arguing that people are too stupid to save on their own? What next? I am utterly shocked by your admission that we need a nanny-state. Why would any sane person want to have their capital locked up in a limited-access account with arcane spending rules and terrible investment choices?

    4. Legalize the re-importation of medications

    Because shipping drugs to Canada and back will magically make them cheaper? And don't you see the mile-wide hole in this plan? Big Pharma will tell Canada and friends that they only get discounts if they ban *exports* to the US.

    5. Reduce government regulations and red tape on the insurance industry. Heavy regulation creates an “iron triangle” effect enabling the largest companies to set the rules through their influence over politicians.

    By implementing HSA's as a core piece of your plan...HSA's which require me, the government, and my insurer to track every pill I buy? Boy, THAT will sure cut down on the paperwork.

  • distinguished gentleman||

    "Because shipping drugs to Canada and back will magically make them cheaper? And don't you see the mile-wide hole in this plan? Big Pharma will tell Canada and friends that they only get discounts if they ban *exports* to the US."

    This argument presupposed that there are no pharmaceutical companies in Canada and Europe whom produce there own competitive drugs.

    List of pharma companies in canada
    http://www.tipt.islamcan.com/companies.shtml

    Europe
    http://www.farma.com/en/pharma.....es_europe/

    No need to ship drugs to Canada and back when we can directly import them.

    "all the insurance companies will flee to Texas (or whichever clever state lowers the bar even further and pays out fat subisidies), and the only thing available to buy will be crap insurance..."

    You don't think there would be one company that would offer better coverage at a higher price? If Apple A is tart and scarcely sustains you but has the lowest price due to state subsidies and no regulations for quality in the apple business, Will consumers never seek a competitive Apple that is priced higher but is a better value for the money? Even if the subsidies were so helpful that every single company moved to Texas, there is no reason it would kill the competitive market for quality.

    Has this one state monopoly with terrible coverage scenario played out in the nationally competitive auto insurance industry, for example? I haven't seen any evidence of it.

  • PIRS||

    "This argument presupposed that there are no pharmaceutical companies in Canada and Europe whom produce there own competitive drugs."

    I know there are Canadian and European drug companies. The problem I am getting at is that some governments implement price controls on these drugs. The drug companies go along with these price controls and squeeze the R&D money they need from consumers in the United States. If you allow reimportation there is a game change. The drug companies can no longer count on the United States as the land of R&D money and would no longer tollerate the Canadian price controlls.

  • Chad||

    That's my point: Drugs in some other countries are lower because of price controls or negotiated prices with Big Pharma, not because of some magic in the free market which makes drugs cheaper if you make an extra pit stop in the supply chain. Big Pharma will counter our move to (re)-import drugs from Canada by telling Canada that if they want the drugs at the price they are used to, they can only buy what they use and can't re-sell outside the country. Do you think Canada is going to give up its low prices for our benefit? Me neither.

    Most of the drugs nowadays are mostly made in China and India anyway, just like anything else.

  • PIRS||

    "Do you think Canada is going to give up its low prices for our benefit?"

    Not willingly. Do you really think it could stop tourists and Snow-Birds from making a side business of reimportation? No. New York now has a thriving black market in cigaretts because of extra taxes. If we remove the regulations on OUR end it need not be a black market from our perspective - only in Canada. Sort of like the Underground Railroad in reverse.

  • Chad||

    Not willingly. Do you really think it could stop tourists and Snow-Birds from making a side business of reimportation? No.

    Completely? Of course not. But we are already in the situation now where these imports are illegal...and how much of a black market is there? Not much of one. Most people aren't interested in evading the law to save a few bucks on pills.

  • PIRS||

    "But we are already in the situation now where these imports are illegal..."

    They are illegal on both sides of the border at the moment. Not on both. That is the point. If it were illegal in Canada but not in the United States they would be nearly powerless to stop the sales.

  • PIRS||

    "But we are already in the situation now where these imports are illegal..."

    They are illegal on both sides of the border at the moment. Not on both. That is the point. If it were illegal in Canada but not in the United States they would be nearly powerless to stop the sales.

  • Joe||

    The significant increase of GDRs (Generic Dispensing Ratios) have done a great deal to mitigate RX plan cost trends in the last decade. I remember the GDRs were in the 35%-40% range in 2001 and are now around 70%. RX plan paid trends (which directly affects your insurance premiums) use to 15-18%. They are know around 10%. Not ideal, but definitely better. Shorten drug patents while simuataneously reducing the FDA standards (allow the Pharmaceutical Companies to set their own standards and prove the safety and efficacy of their products) and enforcing a meaningful tort reform, and you will see both the cost, quality and availability of pharmeceuticals increase.

  • PIRS||

    "All the insurance companies will flee to Texas (or whichever clever state lowers the bar even further and pays out fat subisidies), and the only thing available to buy will be crap insurance that will drop you the day you get sick for any inventive excuse the company can muster."
    Have you ever read a contract before signing it? It is usually recommended. If you wish to purchase crap insurance you will certainly have that option. However, there will also be markets for far superior insurance plans. Why do you assume everyone in the country would be clamoring to buy crap insurance? In fact, some insurance companies might use moving to a state with MORE regulation as a marketing strategy. "Hey, look at us, we are in a state where we can't even LEGALLY screw you!" could be a line from one of their commercials.
    "A libertarian arguing that people are too stupid to save on their own?"
    Apparently you do not know what HSA's are and what their purpose is. They allow people to build up a savings account that builds tax free interest. That is the point. I do not advocate people be forced into having one. Merely that it be an option for those who want one.
    "Because shipping drugs to Canada and back will magically make them cheaper?"
    No, because the drug companies would realize they need to even out their pricing structure. Canada banning exports to the U.S. would be even more difficult than fighting the failed war on *some* drugs. These are drugs that are legal in both countries for some purposes. The USA would have no incentive to help Canada enforce such a ban on their side if it were legal to import on our side.

  • The Libertarian Guy||

    "Apparently you do not know what HSA's are and what their purpose is. They allow people to build up a savings account that builds tax free interest."

    That's why Chad hates the idea.

  • Chad||

    Adverse selection: The great market failure that destroys private market health insurance, and that you seem to know nothing about.

    Here is how it works. Let's say insurance company decides to offer a wide-ranging plan with very substantial benefits, at a higher price, like you suggest. What happens?

    All the sick people flood to this plan, and healthy people flee it. This drives up costs even more, squeezing out even more healthy people, which repeats until you are left with a few very sick people paying through every orafice in their body and then some, and still not keeping up.

    The only way to defeat adverse selection is to insure everyone all the time. Everyone else on earth has figured this out, except the American right.

    Canada banning exports to the U.S. would be even more difficult than fighting the failed war on *some* drugs.

    Is there some huge black market in illegally-imported Canadian drugs today?

  • PIRS||

    "All the sick people flood to this plan, and healthy people flee it. This drives up costs even more, squeezing out even more healthy people, which repeats until you are left with a few very sick people paying through every orafice in their body and then some, and still not keeping up."
    Your little story has built in false assumptions. First of all, there are plenty of healthy people who are willing to pay more to have the peace of mind of knowing that if they ever did develop some rare blood disorder they would be covered. Second, a product on the free market can never be raised to the point no one would be willing to buy it. There is no product. The company would simply lower the price or readjust the product. A product of to high a cost is an unsold good. Even the most greedy company on Earth does not want an unsold good - this defeats the purpose.
    "except the American right."
    Do you think I am among the "American right"? Really, tell me what my beliefs are in other political areas.
    "Is there some huge black market in illegally-imported Canadian drugs today?"
    Yes
    http://en.wikipedia.org/wiki/BC_Bud

  • Chad||

    So you are counting on people being *irrational* and over-paying for insurance to prevent adverse selection. Do you really mean to undermine the entire concept of free markets in order to save one element of it?

    The reason the individual market is so screwed up right now is that it can't find a way to defeat adverse selection. Sick individuals are forced into high-risk pools (which almost always only exist because the states require it) and everyone else winds up with crappy high-deductible, pray-that-you-don't-get-sick plans....exactly what you would expect adverse selection to cause. Things would only get worse if it weren't for the regulations that largely prevent it. If we had mythical "free market" health care, it would look like what our individual market looks like right now, only worse. I don't know anyone in their right mind who would give up their employer-based or public insurance for what they can get privately.

    Note that the one huge advantage of the employer-based system is that it largely defeats adverse selection, which is why this system has endured so long.

  • PIRS||

    "So you are counting on people being *irrational* and over-paying for insurance to prevent adverse selection."

    Irrational? Over-paying? Judgmental are we? Different people have different wants, needs and values. This is a fact of life. The great thing about the free market is it can cater to a wide variety of wants, needs and values. There is nothing irrational about that.

    "The reason the individual market is so screwed up right now is that it can't find a way to defeat adverse selection."

    Wrong, the reason the individual market is so screwed up right now is that we do not have a free market in health care or health care insurance.
    "If we had mythical "free market" health care, it would look like what our individual market looks like right now, only worse."

    On what basis do you make this claim?

  • Chad||

    Wrong, the reason the individual market is so screwed up right now is that we do not have a free market in health care or health care insurance.

    Ahh, the tried and true libertarian response to all market screw-ups: blame the nearest government policy or program.

    You really don't understand adverse selection, even though it has been well understood by economists for nearly a century.

    Since libertarians like little analogies, let's reduce the world down to three people: You the insurer, SickBob, and HealthyJane. Let's assume SickBob has diabetes, and You expects him to have $10,000 in health care costs next year on average. HealthyJane, of course, is healthy, and expects to only have costs of $1000. Let's say You figures that he needs to charge a 20% premium to cover costs, profit and the risk of the bills being higher than normal. Let's say that both Bob and Jane are also willing to pay this 20% premium, in return for their reduced risks.

    So what price should You charge? Well, he has to collect $13,200 to make a fair profit. But he clearly can't charge $6600 each, or Jane will walk away. He will have to charge them different prices to get both to buy. So in the perfect free market, he would charge them $12000 and $1200 respectively. But note the problem: SickBob is paying a very large amount, because he is already sick! Clearly, the market cannot insure against pre-existing conditions!

    Well, unless one locks in a lifetime contract. The sick person would not really be able to leave their contracted insurer, because any OTHER insurerer would charge them insane rates because they are already sick.

    There is no way around it, at least than anyone has found. With private insurance, healthy people leave or significantly reduce coverage, driving up the costs of the sick...WHICH IS WHAT WE ARE INSURING AGAINST IN THE FIRST PLACE.

  • WhereYou'reWrong||

    SickBob doesn't need insurance (coverage to offset an unexpected expense) at all -- he needs affordable ongoing care. Trying to turn insurance into a maintanance plan just drives up the cost of care, which drives up the cost of insurance. Why pay overhead to an insurance company if all they're doing is acting as an agent to the transaction of paying for predictable expenses? And why should SickBob be able to force HealthyJane to pay for his care given that it's not her fault that he's sick? What we need is to get market forces back into the health CARE side to help drive prices down through competition and innovation (after all, if SickBob can force his insurance to pay for his care at BigExpensiveHospital without regard to cost, what's the incentive to find a cheaper alternative, say, SmallWal-MartBasedClinic?). Want lower insurance costs? Lower the cost of care. Trying to lower insurance costs without lowering the cost of care is just assbackward.

  • Chad||

    So what if SickBob's situation was worse, and it was $20000 per year...$30000.....$40000....at what point do you admit there is a fundamental problem? How many people do you have to bankrupt, as SickBob likely would be?

    The market *cannot* cover for pre-existing conditions. The government can try to make it do so, directly or indirectly, and that is how we got to where we are. But this is just the government trying to stuff a square peg into a round hole. The better solution, repeatedly demonstrated around the world, is just to insure everyone all the time. It is FAR simpler that the crazy Rube Goldberg schemes one would have to try to concoct to get around adverse selection issues in the private market.

    What I don't understand about libertarians is that they don't seem to even LOOK at how other countries do things. For example, Japan has *much* higher co-pays than we do, which, not surprisingly, keeps their costs under control. There is nothing incompatible about this "market" mechanism and universal coverage. Of course, Japan limits out-of-pocket expenses and subsidizes the poor, so no one goes broke.

  • WHereYou'reWrong||

    What if his treatment is a billion dollars a year? What if you reach a point where "What if" isn't a valid argument? May I remind you that there is a point beyond which all your favored government systems decide that treatment is not cost effective or too expensive and refuse to fund such treatment? Too bad, SickBob, hospice is cheaper, especially when you're OldSickBob. Buhbye, Bob.

    In a free market, SickBob is free to find others who may voluntarily assist him and others like him -- form a charity, perhaps, get Jerry Lewis to hold a telethon (hasn't been a bad idea for MDA that has helped millions of people), raise money or solicit assistance in any of a number of ways. And, certainly, any system that would LOWER costs would assist him in this -- but Chad doesn't want lower costs. He doesn't want any system where SickBob might be able to hold his head high and pay his own damn bills.

    Chad claims libertarians refuse to look at other countries (which, by the way, we have) while he refuses to look at any solution that doesn't end with forcing taxpayers to pay for everyone's care (up to the point of rationing).

    So, why all the dishonesty about your aims, Chad? Why bother with post after post arguing minutia of insurance this or drug importation that when you have no other aim but to create some sort of "right" to the labor and property of others? You don't give a shit what the actual cost of health care IS or what the details are, as long as you can get somebody else to pay for it. You think that you get to force other people to do what you want because you are you, the great and powerful Chad, so everybody else better bend over and take it. In other words, you are still a petulant child who believes others exist to serve him instead of as ends in themselves. Your arguments, deespite the policy smoke and mirrors, always boil down to "Because I said so!"

  • meow||

    "In a free market, SickBob is free to find others who may voluntarily assist him and others like him -- form a charity, perhaps, get Jerry Lewis to hold a telethon (hasn't been a bad idea for MDA that has helped millions of people), raise money or solicit assistance in any of a number of ways."


    HAHAHAHA

    HOHOHOHO

    HEHEHEHE

    HAHAHAH

    rich, very rich

    HAHAHAHAHA

  • WhereYou'reWrong||

    Do you have anything against the many self help groups and societies that exist to help others with diseases? This is a serious question, asshole. Why is actually doing something to help others that doesn't involve simply saying "let the government do it" a laughing matter?

    Have you never seen a community event held for someone who, through an unfortunate accident or disease needs medical care (I have attended bake sales, barbeques, and other events that have raised money for those in need -- I don't wait for Obama to do something for me).

    Have you never heard of the Will Rogers Foundation, St. Jude Children's Hospital, Shriner's Burn Centers, or the Muscular Distrophy Association? These are real organizations who are doing something about health care for real people, not some fictional SickBob, without holding a gun to anyone's head. And there are many more.

    Go ahead -- look them up and find out how people with brains in their head tackle problems in the world without praying to Obama to save them.

    If you think the idea that no one but government can do anything about the problems of the world is a laughing matter you ae a dumbass of the first order.

    You think access to helth care is a problem? Stop your stupid snarking and go do something in the real world -- you don't have to wait for government to take over and screw things up first.

    But it's easier to sit in your mother's basement and laugh.

  • Chad||

    So your "solution" to millions of Americans being bankrupted by high health care costs is charity?

    And you guys wonder why you get 2% of the vote if you are lucky...

  • ||

    Chad, your argument is too simplistic to be realistic. There is no way there are as many really sick people in the health insurance market as really healthy people. Comparing the cost of covering one healthy person and one sick person one-to-one is unrealistic. There would be 10 or 20 healthy people to make up for the costs of the sick person.

  • The Libertarian Guy||

    "Just lower taxes and get rid of the loopholes....much simpler."

    Whoa, Chad! You just hit on something here.

    Too bad you don't mean it across the board.

  • Colonel_Angus||

    States and the federal government shouldn’t be determining what insurance companies are required to cover in their plans. Individuals are capable of determining the level of coverage they want. If an insurance company has a reputation of screwing people over, market forces will lead to other companies becoming more popular. There is very little need for laws about insurance coverage other than those against fraud.

    Insurance doesn’t need to cover predictable medical needs such as yearly physicals and breast inspections. It doesn’t need to cover care for common symptoms like colds and penis ulcers. It doesn’t need to cover common disorders with predictable needs like thyroid problems, diabeetus, and restless leg syndrome. Of course, nothing should stop people from purchasing coverage that cover all of these things, but it will cost more and should.

    There is nothing irrational about a healthy individual purchasing coverage for unpredictable expensive diseases and injuries. Most people won’t ever need it, but it is still wise to have such coverage because there is no way to know if you will need it. It becomes a voluntary socialization of costs, no need for government intervention.

  • Sudden||

    Another thing I wish got more play would be how portability of health coverage would essentially get rid of the pre-existing conditions debate for the most part. If you had health insurance that wasn't dependent on employment, you wouldn't have to worry about switching providers when switching jobs and therefore, you wouldn't have the worry over whether the next insurer is willing to take the risk on you. You would have the same provider that you got when you were younger and healthy, the same one you paid insurance premiums to for year and years just in the event that something horrible should happen.... you know, kinda like the way insurance is supposed to work.

  • Chad||

    Well, until that insurer jacks prices, screws you over, or goes out of business. Choosing a private insurer-for-life as a kid is utterly insane, and surely NOT the way insurance is supposed to work.

  • RM||

    Nor should insurance companies be forced to suck it up and have to redistribute costs because they aren't allowed to deny selling their product to certain people.

  • Porcupine||

    No, no! Listen to me, people--listen! We must stick them with quills! It's the only solution!

  • B.P.||

    On the photo: Which advisor taught Obama that imperious, chin-in-the-air pose? Stop it, please.

  • Mr. FIFY||

    Nobody taught him that. It's his natural inner self, shining through like a beacon of hopey.

  • PIRS||

    I had a neighbor with that same pose. It is an arrogance thing. No, it isn't a race thing either because this neighbor of mine happened to be white. He, like Obama, was exeedingly arrogant.

  • The Art-P.O.G.||

    You probably think Jughead Jones is arrogant, too.

  • MJ||

    I am not sure who taught hime that, but I think his first name was Ben or something.

  • ||

    Ryan/Jacket/Stache '12

  • ||

    You know, that picture of Obama. . .it reminds me of that shot of Kurtz in Apocalypse Now. When he lifts his chin while looking at Willard in the shadows.

  • Kurtz||

    I've seen horrors... horrors that you've seen. But you have no right to call me a murderer. You have a right to kill me. You have a right to do that... but you have no right to judge me. It's impossible for words to describe what is necessary to those who do not know what horror means. Horror... Horror has a face... and you must make a friend of horror. Horror and moral terror are your friends. If they are not, then they are enemies to be feared. They are truly enemies! I remember when I was with Special Forces... seems a thousand centuries ago. We went into a camp to inoculate some children. We left the camp after we had inoculated the children for polio, and this old man came running after us and he was crying. He couldn't see. We went back there, and they had come and hacked off every inoculated arm. There they were in a pile. A pile of little arms. And I remember... I... I... I cried, I wept like some grandmother. I wanted to tear my teeth out; I didn't know what I wanted to do! And I want to remember it. I never want to forget it... I never want to forget. And then I realized... like I was shot... like I was shot with a diamond... a diamond bullet right through my forehead. And I thought, my God... the genius of that! The genius! The will to do that! Perfect, genuine, complete, crystalline, pure. And then I realized they were stronger than we, because they could stand that these were not monsters, these were men... trained cadres. These men who fought with their hearts, who had families, who had children, who were filled with love... but they had the strength... the strength... to do that. If I had ten divisions of those men, our troubles here would be over very quickly. You have to have men who are moral... and at the same time who are able to utilize their primordial instincts to kill without feeling... without passion... without judgment... without judgment! Because it's judgment that defeats us.

  • ||

    Yeah, that Kurtz.

  • ||

    I was thinking more Mussolini, but yeah, Kurtz will do.

  • ||

    Actually, now that I look at the picture again, I can see that he's just making sure that Biden parked the car in the right spot.

  • ||

    -chuckle-

  • Leif||

    Actually, he's just angling his face to the sun. If he stays in the same place long enough, you can see his face slowly turning to follow the sun's trajectory.

  • Leif||

    Actually, if you witness this, it's not that the sun is following an independent trajectory. Rather, it is fleeing in shame, embarassed at being out-shone by the magnificence of Obama.

  • PIRS||

    +1

  • Jerry||

    I haven't seen the vid, but I'd love to see the USA introduce some kind of PMQ.

  • PIRS||

    I agree. I have thought that for some time. I grew up watching Yes, Minister and Yes, Prime Minister so even as a kid I knew about them. I would love to see that.

  • ||

    can yo imagine the fucking banality of the questions coming from our shit-brained congress? it would be worse than the f!cking media!

  • PIRS||

    There are a handfull of members who would ask decent questions. I think Ron Paul would. Flake might. Rep. Paul Ryan might. But, for the most part, your are indeed correct.

  • The Art-P.O.G.||

    I want to see this. As much as people rag on whoever the president is, all the ones I can think of except for maybe Gerald Ford could probably make much of Congress look dumb.

  • strat||

    Admit it. You all want to see Michele Bachman let loose on camera.

  • EscapedWestOfTheBigMuddy||

    Allow insurance plans to be sold in more than one state or region.

    So Aetna, UHC, etc sell in all states now - just a slightly tweaked product for each state based on the state insurance commission. A uniform product wouldn't increase competition at all in the big states and would scarcely cut costs

    PIRS is expressing it wrong. The thing that needs to be done is to stop the state insurance boards and commissions from interfering in the freedom of contract by making me buy a policy that covers acupuncture and fertility treatments.

    The people in favor of this nonsense always try to frame as making the companies cover X, Y, or Z. Well, the insurers are more than happy to cover that stuff, they just hike their prices to cover the new cost and make bigger profits. Good deal for them.

    The people who get screwed are the ones who suddenly find themselves with the choice of buying coverage they don't want or going without. Which is to say: me.

  • Almanian||

    Ditto

  • Fist of Etiquette||

    If you turn that picture 90 degrees clockwise, I bet that's exactly what Obama looks like when he's flying back and forth to the Fortress of Solitude.

  • The Art-P.O.G.||

    Ha! Awesome.

  • boomshanka||

    Yeah, remember what happened when Dems did try to include a Republican proposal? Republican Sen. Isakson supported end-of-life counseling, or what some like to refer to as "death panels." They made it pretty clear that attempts to compromise were moot. Tell me which Republicans, in particular senators, would have supported HCR if Ryan's proposals were included.

  • boomshanka||

    Re-read your two points: 1) "Republicans, with their relentless demagoguery of anything that smacks of Medicare cuts, have taken a situation in which it was already going to be very difficult to reform Medicare and made it nearly impossible."

    and 2)"throughout the health care debate, Obama didn't want to have that discussion."

    So you happen to know that Obama didn't want to have that discussion, even though you admit that Republicans already took it off the table. After Republicans chose to scare seniors into thinking Democrats were going to cut Medicare, they made it politically impossible to discuss it, let alone incorporate it into the bill.

    You people are deluded.

  • The Art-P.O.G.||

    I'm still looking for the contradiction, unless you think it's impossible to blame Democrats and Republicans for the fugly mess that the health care debate turned into.

  • boomshanka||

    I don't think it's impossible, but I do think Suderman should at least try to provide evidence that Obama was unwilling to discuss ways to reign in Medicare. He just "knows" Obama didn't want to, despite evidence to the contrary.

  • Tony||

    Obama wants a deficit commission which is basically a euphemism for an entitlement program cutting commission.

    He's always wanted to reform medicare. It should be beyond the pale for Republicans to simultaneously go hysterical over medicare cuts and socialized medicine. But confusing and scaring old people is what they do.

  • The Art-P.O.G.||

    Yes, the Republicans (like the Democrats) exploit the vulnerabilities of their constituencies. You're damn right about that.

  • ||

    Um, this was a pretty smart analysis that looks at the bad arguments of both parties. One party made a bad situation worse for political gain, the other party ignored all disagreement to hammer together a bill that couldn't make one member of the opposition happy.

    Why is that when the lefties were out of power, they always screamed about how dissent was fantastic, but now they want to talk about "bipartisanship." It's fucked up. WHy is the burden always on conservatives to be "bipartisan." If they try to pass something when they're the ones in power, and democrats resist it one hundred percent, you don't hear the dems crying about "bipartisanship."

  • ||

    Trollcat answers:

    http://trollcats.com/2009/08/dream-on-obama-trollcat/

  • ||

    Seems to me the only thing Obama is good at is giving speeches.

    R
    www.be-invisible.es.tc

  • The Art-P.O.G.||

    You already said that. I'm beginning to think you use canned responses, anonymity bot.

  • PIRS||

    Canned? How could you be so crass and insulting. He has well thought out, deep and insightfull responses that add much to the threads.

  • Leif||

    So deep and insightful that they are always relevant.

  • ||

    "Doesn't matter to Democrats. Nothing they do for the next three years will be their fault... ever."

    Spot on and here's the video to prove it.
    http://www.youtube.com/watch?v=3BkIh1R5utY

    President Leon anyone?

  • max hats||

    har. After cheering on the tea-partiers and throwing the kitchen sink at the health plan, now it's "waaah, why won't you compromise with us??" - the cry of the loser. Music to my ears.

  • Leif||

    Max sweetie, why don't you take the article to your Grade 3 teacher and ask her to explain to you who is ostensibly asking for "cooperation?"

  • ||

    Yeah, obama doesn't want cooperation, he wants acquiescence. The republicans aren't really asking for compromise either. This issue isn't about compromise, or else they would have hammered out a healthcare bill that would have at least made one republican happy. This is about the fundamental aspects of economics, which is why the issue is so polarized.

  • jester||

    Obama watches No. 7 Hoyas blast No. 8 Duke

    This is exactly the kinda shit that makes me second guess the sentiment that Obama would transcend racial politics. What a douchebag. You do the math.

  • ||

    Message from Mr. Dooley to Mr. RichN, please note:

    Leon IS the president!!!! That's what that inauguration thingy that dominated television was all about, a year ago.

    Budweiser can tell you about how you build product loyalty, sir!! Budweiser is my beer--and the beer of just about everyone over the age of 70 who sees those skits about Leon/Obama no matter how bad and bitter it tastes!!

    So, no, I don't think we should urge Obama's handlers to stop him sneering , or to attempt to hide his contempt that he so proudly shows for his fellow Americans, the Supreme Court, or the congresspersons they have elected. Nor should we attempt to stifle the promulgation of the Mussolini/Obama pose. It's good for us to see this.

    Our call should be for MORE Leon skits, not fewer!!!

    God Help us all

  • Ernie the Bear||

    It seems like most here will agree that the less Congress does, the better, so I'd like to see some organization sponsor an "Obstructionist of the Year" contest, open to anyone in the House or Senate, with a $1Million prize for the winner. I don't know how you'd go about structuring that legally, but it shouldn't be too hard, right? Start with "Obstruction Monthly" magazine, with articles about the most obstructionist things that were done that month. That way, you're part of "teh press" right off the bat.

  • ||

    This whole thing was a trick bag. The Rs pretty much had to let him come and perform this kabuki dance, but I don't think anybody should expect any actual bipartisanship. What raises my gorge is his condescending, patronizing attitude, as if he were still teaching law students.

    Maybe they should have lowered him from the top with a pink tutu and a magic wand, so they'd know whom they were dealing with.

  • ||

    the problem i have with republicans about the whole health care situation is, they had control of the whitehouse for 8 years and had control of the house and congress for about 6 years, and had senate for about 4-5 years, and not once did they try to tackle health care reform. Now the republicans are coming out of the woodwork waving their health care bills, claiming they want healthcare reform. I just dont think the republicans really want reform judging from their actions of when they controlled things. and before you start calling me a liberal or democrat, i'm actually apart of the Centrist party. i really dont care which side gets credit for healthcare reform, as long as it gets done and that the proposal can be done, and isnt just smoke and mirrors..

  • sathi2000||

    I understand – there’s a grandfathering in….That’s why I said I wanted to make sure that I’m not being unfair to your proposal. I just want to point out that I’ve read it, and the basic idea would be that, at some point, we hold Medicare cost per recipient constant
    http://destinationsoftwareinc.com

  • Replica||

    So you happen to know that Obama didn't want to have that discussion, even though you admit that Republicans already took it off the table.

    www.wholesale-order.com

  • Replica||

    nice, thanks your post...

  • Jewelry||

    I really agree with your opinion, thanks for share.
    www.wholesale-sale.com

  • Nike Dunk Low||

    thanks

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