Yes, There Was A GOP Debate

Obviously I didn't blog along with the GOP debate in Iowa. (Were any readers up at 8 a.m. Central Time wringing their hands at my lack of coverage? Requests for a refund should be sent to dweigel-at-reason.com.) If you crave recaps, check out Jonathan Martin, Liz Mair, and Ana Marie Cox. The last take includes this one-two-three series of posts:

8:42 AM GS still trying to get Rudy to say what his Iraq policy is. Rudy giving a constitutional law lecture; manages to not cite any concrete event in Iraq but he does imply that he brought democracy to New York! Before he was mayor, "People were afraid to go out at night… people were afraid to to the movies or buy groceries." Uhm, wow. Sure: New York in the early 90s was totally like Baghdad in 2007! Just with more porn and fewer suicide bombers.

8:46 AM Mitt: "I'm not a carbon copy of President Bush." No, he's not a carbon copy of anything, researchers have been tweaking him ever since he was developed in lab in 1992.

8:49 AM Political correctness apparently bad. When did this become a hot button issue again? What decade are we in now?

There was, reportedly, a huge reception for Ron Paul, but it's Mike Huckabee who's one-linered his way out of the back of the field and into a tie for fourth place with McCain, with 8 percent of the vote.

Comments

[crimethink]

Sorry, Dave, I've just become addicted to your liveblogging of debates. It just doesn't feel the same without it.

I don't know what I'll do when the election season is over. I better get some counseling.

[joe]

Medical savings accounts are a sick joke.

The solution to a lack of health coverage for lower-income people (who don't pay taxes, and can't afford to put much aside in savings) is to reduce the taxes they don't pay, on money they can't actually put into savings.

Brownback (or was it Gilmore) at least had a grounding in reality when talked about letting people buy health insurance across state lines. I don't know how much of a solution it is, but at least it isn't flagrantly illogical, like Rudy's shtick.

[joe]

er, s/b "...poor people, who don't pay MUCH INCOME TAX..."

[joshua corning]

The solution to a lack of health coverage for lower-income people (who don't pay taxes, and can't afford to put much aside in savings) is to reduce the taxes they don't pay, on money they can't actually put into savings.

I thought we had a problem with rising health care costs?

Oh yeah we do....and tax credits and health care savings accounts do work at lower health care costs...which helps everyone rich and poor.

[joe]

Guiliani puts them forward as a solution to the lack of coverage, joshua. So you're admitting that's bull?

Regardless, HSAs are far too small a portion of the health care economy to have any noticeable effect on health costs (even if you assume that sick people are going to be able to negotiate costs and services like ordinary consumers in a real market), and the realities of how much money people have to put aside for medical bills guarantees that HSAs can never grow to be big enough to have significant effects on the cost of health care.

[joe]

Besides, individual solutions like HSAs, by definition, eliminate the ability of an individual to take advantage of the wonderful power of actuarial statistics.

[joshua corning]

Guiliani puts them forward as a solution to the lack of coverage, joshua. So you're admitting that's bull?

Lack of coverage is due to high health care costs. Lower health care costs and more people get coverage.

Also the people who don't have health coverage who get free health care when they go to the hospital will cost the system less...100$ aspirin might even drop to 50$ aspirin.

Oh wait you were implying that people without health care insurance do not get any health care ...sorry joe, i didn't mean to kill your whole argument that universal health care coverage is needed to save poor people.

[tarran]

Uhm joe, have you noticed that things that the government subsidizes such as health care and college tuitions tend to see price rises well above inflation?

If you want to make stuff affordable, you have to stop subsidizing it. Then as people cut back on consumption the price comes down so that more people can afford it.

The secret to improving poor people's access to medical care is to reverse the interventions that cause it to be more expensive. So while Medical Savings Accounts might directly benefit the middle class, they will alo encourage people to consume medical services in a more price-conscious manner, encouraging lower prices for all.

[joshua corning]

and the realities of how much money people have to put aside for medical bills guarantees that HSAs can never grow to be big enough to have significant effects on the cost of health care.

Sorry joe you are dead wrong. HSAs are for check up care. For open heart surgery you get catastrophic health care insurance which is really cheap.

[joe]

Lack of coverage is due to high health care costs.

Only some of the lack of coverage is due to high costs.

Only some of the costs of health care can be brought down through bargaining.

Only some of the people spending HSA money will be abe to bargain.

And only a small segment of the population is ever going to use HSAs.

We're getting pretty close to the sub-atomic scale here, in terms of a broad economic effect on health costs.

[joe]

joshua,

As usual, you interpretted your misunderstand of my point as an inocrrect statement by me.

"HSAs never grow to be be big enough" was a statement about the size of the role they might play in the health care economy, not the dollar value in the accounts. It wasn't a point about the cost of catastrophic care, but about the market penetration.

[joshua corning]

So while Medical Savings Accounts might directly benefit the middle class, they will alo encourage people to consume medical services in a more price-conscious manner, encouraging lower prices for all.

See joe...poor people can and do buy plasma TVs which are produced and sold in a free market...the reason why is because the free market makes them cheap.

A freer market would make health care cheap.

[crimethink]

There's a limited supply of doctors, nurses, physicians assts, and lab techs. There's a limited supply of medical equipment. There's a limited supply of hospital space.

There's an unlimited demand for health care.

Maybe I'm just thinking inside the supply-and-demand box here, but why do we expect that there exists a plan that will allow everyone to get all the health care they want?

[joshua corning]

It wasn't a point about the cost of catastrophic care, but about the market penetration.

HSA's do compete against free loader friendly Medicare/Medicaid and subsidized health care insurance currently....so if your statement is that under current rules subsidies and regulations HSAs do not compete then you are correct...but i think that is the argument...to make HSAs more commercially palatable.

[crimethink]

Seriously, joe, how do you think we should decide who gets health care and who doesn't? Waiting lists? Boards of bureaucrats?

[crimethink]

A freer market would make health care cheap.

Let's not overstate our case, joshua. Routine checkups and basic medical care probably would be far less expensive in a free market, but care that requires cutting-edge equipment, highly trained personnel, and/or needle-in-a-haystack drugs is never going to be cheap.

[joe]

But thank you for bringing up a point I was about to make: HSAs are for check up care.

What this actually means is that the pre-tax money you put into an HSA disappears at the end of the year if you don't spent it, and the amount you can put in is capped.

It's not like 401k, where you can put aside an asset that can grow, with-pre-tax money. If HSAs worked like that, they might be useful, given that medical bills for people who get sick or injured are the leading cause of personal bankruptcy in this country. If HSAs allowed people to build up an asset that light, they might take care of that problem.

But no, HSAs are for peoplel to put a few hundred bucks a year in, to pay a few hundred bucks a year out in that same calender year, in order to save the federal income tax lability on that few hundred bucks.

This is what is going to drive down the cost of health care, expand health care access to poor people, and bring about improvements in our health care outcomes.

Faith based trickly down Tax Cut Fairy cloudcookooland, is wot.

oh, yeah, Mr. Free Care corning, let me ask you something: do you and your kids only see a doctor when someone's sick enough to go to the emergency room?

When formulating policy, if you're going to sacrifice justice and humanitarian concerns in the short term for efficiency, you shouldn't do so in the name of a poicy as massively inefficient as using emergency rooms for primary care.

[joe]

tarran, joshua, I've already made a few points several steps beyond how as DEMAND KURV works in the abstract. Your smug assumption of your superior understanding of economics is getting in the way of actual economic thought here.

crimethink,

I think I'll stick with a discussion of policy and outcomes here. Maybe we can argue First Principles some other time.

I want everyone to have access to decent health care without having people go broke, and I'm not overly concerned with ideologically-based statements about why we musn't make that happen.

[M]

Where oh where can one finally see this thing?

[SIV]

letting people buy health insurance across state lines.

I assume the advantage in this is buying cheaper insurance from a state that does not mandate types and levels of coverage. I would expect Congress would step in and "standardize" the mandate eroding the cost savings.

[crimethink]

I want everyone to have access to decent health care without having people go broke, and I'm not overly concerned with ideologically-based statements about why we musn't make that happen.

But you see, that's the heart of my point. I question whether it's even possible to fulfill your desire for everyone to have access to "decent" health care, which is bound to include some awfully expensive stuff in many cases, no matter how ingenious we are in searching for a plan to do so.

In any case, my point isn't that it mustn't happen, but that it simply can't.

[joe]

joshua corning,

Please, don't get me wrong. I think the basic ideas of MSAs/HSAs is a good one. I used to use a Child Care spending account that my wife's workplace used to offer as a benefit, to pay for daycare.

A vehicle to allow people to set aside pre-tax money for health expenses is a good idea for the middle class that makes up most of the population of this country. The effect it actually has - people having more money to cover their medical costs - is a good one. I'm not agin 'em.

I'm against the dishonest manner in which some politicians, like Guiliani in particular, promise the sun and moon from these accounts, for their own political purposes. They're not going to have a large effect on either health care access or health care costs. Politicians just claim that they will because it's red meat for a certain political base, and because it's a way to look like you're doing something to the rest of the electorate.

[Michael Pack]

To me ,food and shelter are more important than health care yet we leave these mostly to the market.Until we put the burden of insurance on the individual instead of the employer we will never have true reform.Health benifits should be taxed like other income.Big business gets to pay a share of wages tax free and employees use their insurance like anything people feel is free.There's also way to much coverage.Can you imagine if car insurance covered tune-ups,brakes,tires and oil changes?

[joe]

crimethink,

Pshaw! You wouldn't support taxing people for a health care system, even if God himself came down and told you that John Edwards had an affordable plan to completely solve all our health care problems.

So don't shed croccodile tears about how, sigh, you'd just loooooove to have a working universal system, but gosh darnit, it's just not possible.

You convince yourself that nothing can ever work better than the Market because you don't want anything to work better than the market.

Same thing as Bush vetoing the bill to expand children's health care; he isn't afraid it won't work, he's afraid it will, and everyone will see it work.

[Cesar]

There is no such thing as "universal" health care. Either its left up to the market and some people just won't be able to afford certain things (like I can't afford a new computer I need right now), or a government run system will ration care and some people will go without. To use the computer example, if we were in a Soviet-style system the new computer would be "free" but I'd be on a waiting list for five years, if i qualified at all.

[Cesar]

BTW, I'm one of those "40 million Americans" and I'm doing just fine without health insurance, thanks. Thats right--I'm choosing to be uninsured! The horror!

[joe\'s neocon apprentice]

Pshaw! You wouldn't support invading Iraq, even if God himself came down and told you that George Bush had an affordable plan to completely turn Iraq into a liberal democracy.

So don't shed croccodile tears about how, sigh, you'd just loooooove to have a successful war in Iraq, but gosh darnit, it's just not possible.

You convince yourself that nothing can ever work better than not invading Iraq because you don't want anything to work better than not invading Iraq.

Same thing as the Democrats passing the bill to stop the surge; they aren't afraid it won't work, they're afraid it will, and everyone will see it work.

[crimethink]

Clap, joe! Clap!

Tinkerbell's dying!

[joe]

Cesar,

Doctors limiting care to the proper course of treatment is not the same thing as bureaucrats rationing the amoung ot money to be spent per patient. You are lumping together unlike things under the rubric "rationing."

[joe]

Cesar,

You are a minority of that 40 million, and I hope you won't get deposited in a Massachusetts hospital when you get sideswiped by a tractor-trailer.

[joe]

crymthink,

You got me; I don't think that people having less wealth is the equivalent of them being napalmed.

Guilty as charged.

[crimethink]

You wouldn't support taxing people for a health care system, even if God himself came down and told you that John Edwards had an affordable plan to completely solve all our health care problems.

If there's anything that could turn me into an atheist...

[Vermont Gun Owner]

Were any readers up at 8 a.m. Central Time wringing their hands at my lack of coverage?

I was up at 10 am Eastern (when several sites had mistakenly said it would be played) and missed the first hour of the 'debate'. I was at a Meetup, and we looked to see if we could find any blogging of it. I suggested Reason, and actually was disappointed to discover your "lack of coverage."

[Cesar]

You are a minority of that 40 million, and I hope you won't get deposited in a Massachusetts hospital when you get sideswiped by a tractor-trailer.

You may think its a stupid decision, and thats fine. But I've weighed the risks, and since I'm in my 20s, healthy, and a non-smoker with no history of non-smoking related cancers in my family, I think its pretty safe to go without it. Many of my friends--who are of a similar demographic--are choosing to go without, too.

[joe]

Actually, crimethink, the problem with this: Pshaw! You wouldn't support invading Iraq, even if God himself came down and told you that George Bush had an affordable plan to completely turn Iraq into a liberal democracy.

...is that I actually would have supported an Iraq invasion if I thought it would work. As I've written. Several hundered times on these threads.

Which is exactly the opposite of yourself, and joshua; you're both made it quite clear on many, many threads that you would not support taxing people (Stealing! AT GUNPOINT!! With FORCE!!! COERCIVE FORCE!!! *SOB*) to pay for humanitarian benefits for other people. Damn dirty socialist commie blah blah blah - you've both made it quite clear that you don't go in for that sort of thing, on principle.

So, no, that didn't really work.

[crimethink]

Vermont,

I think Weigel was recovering from his rainbow party last night. I hear the blue lipstick is a pain to get off.

[Fluffy]

"Pshaw! You wouldn't support taxing people for a health care system, even if God himself came down and told you that John Edwards had an affordable plan to completely solve all our health care problems."

OK, describe the plan.

Also explain how it won't use rationing to prevent overuse of care.

Crimethink's point is that you can't make that square peg fit into reality's round hole.

I'll tell you right now that if you attempted to put in place a "free" health care system with no ration controls, I'd deliberately consume and destroy as many health care resources as possible, to make absolutely sure I wasn't a net loser under the system. And what I would do deliberately, many, many other people would do simply by temperament.

This is one of those times when market theory isn't an ideology, it's reality tapping on your shoulder. If you won't use price to control consumption of a good you have to ration it. And I simply will not accept a system of rationing as long as it's open to me to resist it. Sorry. You may think this is just me stubbornly setting out to refuse to understand the magical plan that's going to make health care free and make rainbows shoot out of my ass, but that's really too bad.

[Cesar]

Oh and Joe, if your dream version of a single payer Canadian style system passed, could people such as myself choose to drop out? Or will we be forced into it since the government knows better?

[joe]

Cesar,

I do think you've made a stupid decision for yourself, but that wasn't my point.

People who choose not to have insurance are a small minority. Most of the 40 million would very much like to have health insurance.

And if your rugged-individualist ass gets sideswiped by that truck in Massachusetts, I get to chip in for that, thanks. And if you end up in one of our fine institutions because you didn't get a checkup or see the doctor about the pain in your side until you collapsed with a kidney infection at work, I get to chip in for the incredibly inefficient cost of treating you way too late.

Unlike you, I don't object to being taxes to pay for programs that benefit the less fortunate. I'd just prefer to do so is a less appalling stupid and cruel manner.

[crimethink]

joe,

Whether I go for that kind of thing or not is not the question. If a bleeding-heart socialist looked at the problem, I daresay she or he would come to the same bitter conclusion.

BTW, I'm not saying that the Market will solve everything. I'm saying that the fact that the free market can't solve everything means that we have to have a plan based on coercion.

[joshua corning]

What this actually means is that the pre-tax money you put into an HSA disappears at the end of the year if you don't spent it, and the amount you can put in is capped.

If by disappear you mean goes into the pocket of the account holder thus giving a strong market incentive not only to be prudent in health care expenditures as well as an incentive to stay healthy...then yes it "disappears"

Perhaps you might want to look up how HSAs work before you criticize them.

[crimethink]

joe,

How 'bout we repeal the federal law that requires ERs to treat everyone who walks in the door, money or not? That would take care of your problem paying for Cesar's foolish treachery. 😉

(BTW, sorry you're functioning as the progressive pinata in this thread. You need to recruit more like-minded people to come to this board so we can spread out the on-picking!)

[joe]

Fluffy,

Nope. You descrive your plan first. Nyah nyah.

I don't believe your faith-based assertions about the impossibiity of what you don't want, and I'm not terribly impressed by market-fetishists' record of predicting the economic outcomes of public policies. I don't think our blinders allow to see what shape reality's hole is.

And, BTW, you too are conglating different concepts under the rubric "rationing." Rhetorical smoke and mirrors and Econ 101 simplifications do not a policy make.

[Cesar]

joe,

New England drivers aside, I wish you wouldn't have to pay for my potentially stupid decision, either.

I'm curious, anyway, if you agree with the Massachusetts-model of mandated insurance?

[joe]

Cesar,

I have principles, not a plan, but under my preferred system, you would be free to buy boob jobs and unnecessary X-rays with your own money if you wanted to, but you'd no more be able to "drop out" of the income tax and what it buys that you can "drop out" of paying for and being protected by your local police department.

You wanna hire security guards? That's nice. Hell, it might ever free up the police to make a couple extra swings on some other streets during they're shifts, since you're all set.

[joshua corning]

I'm against the dishonest manner in which some politicians, like Guiliani in particular, promise the sun and moon from these accounts, for their own political purposes.

Come on joe..."promise the sun and moon"...and..."for their own political purposes"

Isn't that exactly what every dem is doing when they push for state payed universal coverage?

Crimethink has this dead on imho.

[joe]

If by disappear you mean goes into the pocket of the account holder thus giving a strong market incentive not only to be prudent in health care expenditures as well as an incentive to stay healthy...then yes it "disappears"

Yes, that's exactly what I mean. Use it or lose it. If you don't guess right on your expenses, you either miss out on the tax savings, or you lose your money.

You might not know this up on Olympus, m'Lord, be we wee folk can't always predict the future, and through a lack of virtue, either.

[Cesar]

joe, how is an HMO bureaucrat deciding which procedure is "necessary" any different from a government bureaucrat doing the same thing?

[joshua corning]

And, BTW, you too are conglating different concepts under the rubric "rationing." Rhetorical smoke and mirrors and Econ 101 simplifications do not a policy make.

The waiting lists in England and Canada don;t look like smoke and mirrors to me...

In fact they look exactly like rationed health care.

[joe]

The other point I was making about the cap on HSAs, which joshua is avoiding like the plague, is that the cap and annual spending requirement means that you can't build up a significant nest egg in case of an expensive emergency.

BTW, joshua dear, writing Perhaps you might want to look up how HSAs work before you criticize them. isn't terribly impressive, when you have been unable to identify a single factual error I have made in describing them. You've made two feeble "it's not a bug, it's a feature" argument, and accused me of ignorance, but you haven't actually shown any inaccurate statements I've made.

But it clearly made you feel better. Are you getting a little flushered, joshua? No wonder - this isn't going very well for you.

[joshua corning]

Yes, that's exactly what I mean. Use it or lose it. If you don't guess right on your expenses, you either miss out on the tax savings, or you lose your money.

I don't know what crazy HSAs you are talking about but getting the money you don't spend on health care to spend how you want to (including health care) is not losing it. In fact I would call that tax free income.

[joshua corning]

The other point I was making about the cap on HSAs, which joshua is avoiding like the plague, is that the cap and annual spending requirement means that you can't build up a significant nest egg in case of an expensive emergency.

Catastrophic health care insurance...it is cheap and easily covered by a small part of your HSA.

By the way...nothing prevents you from buying standard health care insurance with money from your HSA.

[joe]

crimethink,

joe,

How 'bout we repeal the federal law that requires ERs to treat everyone who walks in the door, money or not?

And while we're at in, we can provide uninsured people with plastic bags, to make the process even more efficient. I'll pass. It's one of those bleeding-heart liberal things.

Cesar,

joe, how is an HMO bureaucrat deciding which procedure is "necessary" any different from a government bureaucrat doing the same thing? None at all. I believe I already addressed this question in my point about doctors.

[grumpy realist]

If we're talking about efficiency here, why is it that a broad range of companies with "socialistic health programs" end up paying less per person and getting near equal treatment?

US Health care is just inefficient, that's it. We spend too much time and money on a tug-of-war between the poor sap who bought health insurance and a mass of flunkies at the health insurance company looking for ways to deny payment (or in one case I heard, yanking a woman's health coverage two weeks before she was due to give birth.) Ditto for a similar tug of war between the hospital and the health insurance company. Thanks a lot, guys.

Why can't we have a double system, where those who want it (hopefully the majority) will pay for their NHS with taxes, get medical treatment from doctors who are paid salaries, not per operation; coupled with a much smaller private medical insurance system that will have its own private hospitals and provide extra insurance to anyone who wants it?

Japan's got something like this--a double-layered system to cover surgeries etc. if you want to get out of waiting lines.

The only thing I'd add for the US is a) the ability to opt out of the government version altogether (but then you're totally responsible for your own health--no emergency room visits.) and the caveat that you can't get back on to the governmental system unless you prove you are at least as healthy as other people in your category.

[Michael Pack]

I think it's funny when people say'if you get side swiped by a truck I'll chip in for that'.That would be covered under car insurance.

[Cesar]

None at all. I believe I already addressed this question in my point about doctors.

And what makes you think the feds won't pressure doctors in to using less expensive, less effective treatments in order to save money?

[joe]

Catastrophic health care insurance...it is cheap and easily covered by a small part of your HSA.

Which usually comes with a four- five-figure deductable for those "easily affordable" plans - a figure you're normally not allowed to build up in your HSA, or roll over.

And, once again, this is assuming you actually have money to put into an HSA, which is the problem with pretending that they are a way of helping poor people.

[joe]

joshua,

I believe you are mistaken about people getting their HSA money back tax-free at the end of the year.

[joshua corning]

Which usually comes with a four- five-figure deductable for those "easily affordable" plans - a figure you're normally not allowed to build up in your HSA, or roll over.

Um if you get the money you don't spend in your HSA what is preventing you from putting that into a savings account from which you can draw from in emergencies?

[Neu Mejican]

Fair Tax.

Discuss.

[Cesar]

Fair Tax.

I would be for it if and only if 1)the income tax is permanently repealed and 2) food and clothing are exempted.

[joe]

Cesar,

That is a possibility, sure, but could be dealt with if the law was strong enough. It's a danger to be vigilant against and to manage, but not one that cannot be overcome. Mainly by electing Democrats. 😉

Besides, have you seen how much money we spend on health care? I don't think a resource crunch is the biggest worry here.

[joshua corning]

I believe you are mistaken about people getting their HSA money back tax-free at the end of the year.

What part is wrong?

They don't get it back?

They are taxed for it?

Both?

[Vermont Gun Owner]

What part is wrong?

They don't get it back?

They are taxed for it?

Both?

I sure hope its not both...

[joe]

Um if you get the money you don't spend in your HSA what is preventing you from putting that into a savings account from which you can draw from in emergencies?

For most people, the fact that maintaining a large store of money for a low-probability event, rather than addressing some other need, is an irrational choice. If there were tax benefits, this might change on the individual level - although it would still remain irrational on the societal level to forego the benefits of risk pooling for the sum total of everyone's "catastrophic insurance prememium money."

[Neu Mejican]

Cesar,

I agree with the exemptions.
Medicine?

The Fair Tax means income tax goes away.

Could a carbon tax be worked in without complicating things too much?

[joe]

joshua,

I believe it varies from plan to plan. The MSA program I am familiar with had a use-it-or-lose-it feature, which is why I didn't do it.

Why do you ask?

[Cesar]

Medicine

Yeah, that too. But I think it should stop there lest we end up with millions of deductions like we have with the income tax.

Could a carbon tax be worked in without complicating things too much?

Maybe, I certainly think if global warming is as bad as everyone seems to think it is that a carbon tax seems to be the least worst option for reducing emissions.

[joshua corning]

Why do you ask?

Because the one I would support would be the one that you get to keep the unspent money tax free.

Call it the crazy libertarianish Joshua Corning health care plan.

The MSA program I am familiar with had a use-it-or-lose-it feature, which is why I didn't do it.

Well MSA doesn't control tax law...so you know you can't have it at the moment...

[joshua corning]

although it would still remain irrational on the societal level to forego the benefits of risk pooling for the sum total of everyone's "catastrophic insurance prememium money."

So people would tend not to put the unspent money into savings accounts but would tend to spend it on catastrophic insurance deductible insurance (i wonder what the deductible of that would be?)

I don't see this as a problem.

[Rick Barton]

joe:

Medical savings accounts are a sick joke

No they aren't. They would allow tens of millions of folks an option to pay for health care that yields a real financial improvement for them cuz it would reduce the taxes that they pay.

[Fluffy]

As I suspected, Joe refuses to describe a plan mechanism that will prevent individual users from overconsuming health care under a free system.

He refuses because there's only one.

And the record of free market "fetishists" in predicting outcomes is pretty good, actually. Particularly in health care. Fetishists said that Medicare and Medicaid would lead to socialized medicine, and socialized medicine is bearing down on us like one of Michael Vick's dogs. Fetishists said that Medicare and Medicaid would lead to extraordinary health care inflation, and it did. Fetishists said that Medicare and Medicaid would be sinkholes of fraud, and they are.

[joshua corning]

For most people, the fact that maintaining a large store of money for a low-probability event, rather than addressing some other need, is an irrational choice.

And what the hell joe?

Is the argument against HSAs that people spend their money badly so the government should run the whole thing?

I mean i have a closet full of cloths that i wore once but ended up not liking...i really don't think i need the state to tell me what cloths i should buy or worse bail me out when i am in denial that I fit large shirts not medium.

[Your Good Buddy Johnny Clarke]

Just for the record, we already have universal catastrophic care. If my drunken neighbor walks into the road and gets hit by a bus, he will be taken to a hospital, he will receive care, and if he's unemployed and doesn't have a dime in savings, nobody will really expect him to pay anything back. Or he'll be have to pay some pittance on a monthly basis.

[Neu Mejican]

Cesar,

I agree with the keep it simple philosophy.

The only tweak that probably needs to get in there is how services rather than products are taxed.

Seems only health care makes sense as an exempt service.

[Max]

The solution to a lack of health coverage for lower-income people (who don't pay taxes, and can't afford to put much aside in savings) is to reduce the taxes they don't pay

Poor people pay a lot of tax. The standard deduction is tiny, and SS/Medicare (15.3%) applies to the first dollar of income. Then there's state tax, sales tax, and property tax. The only escape is the Earned Income Tax Credit, but that is quite narrowly targeted.

Anyway, I agree that Health Savings Accounts aren't a solution to anything. Just another unneccesary complication.

[Neu Mejican]

Cesar,

Regarding carbon tax.

A plan I have seen described, that I think makes sense, is to restructure business taxes based on material throughput. The idea is that the only taxes the company pays are on material that goes out the door as waste. That includes the product when it is thrown away. This encourages efficient use of materials, recycle/recapture programs, and moves many products into the realm of services rather than durable goods. Interface carpets is currently working with this model to great success. You don't buy a carpet from them, you buy a flooring service. They own the carpet, repair it, maintain it, and replace it as needed to meet your flooring needs. They retain, recycle and reuse the materials that went into the original carpet reducing waste to almost zero.

Flexcar/zipcar et al are the transportation sector versions currently in operation.

[crimethink]

socialized medicine is bearing down on us like one of Michael Vick's dogs.

Yeah, but you can't douse a health care system in water and electrocute it...or can you?

[Max]

I'm not terribly impressed by market-fetishists' record of predicting the economic outcomes of public policies.

I am. Remember wage and price controls, gas lines, etc? Milton Friedman was right, and Nixon and the liberals were full of shit.

[Neu Mejican]

Re: Healthcare
How does Kirk Hamilton's book fit into this discussion?

http://go.worldbank.org/7M49XI1HT0

If productivity involves institutions that support human capital, what types of institutional support for healthcare is optimal?

[Kevinlin]

Isn't the popular HSA idea also include a plan for catastrophe health insurance for the case of major bills?

[joshua corning]

anyone else notice the Poll at Drudge...

Ron Paul is kicking ass

[Rick Barton]

Rudy faulted the Democrats cuz none of em mentioned "Islamic terrorism" in their debate. Oh horrors! If the Dems did mention it, they would have done well to point out that it has been the actions of our own government that have motivated terrorist tactics by some Muslims.

Rudy closed the question of his deserving conservative support when, in a previous debate, this big government Republican actually said that he would have attacked Iraq even if he had known that there were no WMD. (not mentioning the "terrorist/911 connection lies that the neocons in the Pentagon's OSP foisted on us to motivate the war.) He seems to have forgotten the conservative teaching, that troops should only be asked to risk their lives when our security is threatened. With his radical pro-war positions, Rudy is being disrespectful to our troops, and to our wallets as well. I can't think of a candidate who would be a worse choice to represent my party. Thankfully, among them, we have an excellent choice...

http://www.ronpaul2008.com/

[Neu Mejican]

I thought Brownback looked surprisingly good in this morning's debate. I definitely think it was nicely moderated this time around. A much more substantive debate than the CNN free for alls the last coupla rounds.

[crimethink]

Neu Mejican,

I'm not so sure about the moderation of the debate. Stephanopoulos shouted down Ron Paul if he went a couple of seconds over time, while he let Giuliani, Romney, and McCain go over time almost every time they talked (which was a lot). Also, those guys had roughly 8 questions each, while Paul got 4!

[Vermont Gun Owner]

I strongly feel that the debates should be formatted in the following way:

A question is asked and all candidates get a chance to answer it. They are given a certain amount of time (30 seconds, a minute, whatever). When they reach this point, they are cut off. When I say cut off, I mean their mic. It stops working when they hit the time limit. The next candidate gets to answer the question.

A possible variation would be an extra 30 seconds that could be used at any point the candidate wishes, in case there is one question that needs a much longer answer (or several that need an extra 10 seconds). This time could also be used to respond to an opponents answer. However, once the 30 seconds is used up, there is no extra time for that candidate.

[robc]

joe,

I dont know about the plan that was offered to you, but every MSA/HSA plan I have ever seen allows you to roll over unused money at the end of the year and build it up in the account, mainly because for the 1st few years, the amount in the account will be less than the deductible of the catastrophic plan, so you need to be able to roll over.

[Cesar]

Vermont-

I actually liked the idea of the green, yellow, and red lights being visible on the podiums that they used in 2004.

[e]

Fluffy
I'll tell you right now that if you attempted to put in place a "free" health care system with no ration controls, I'd deliberately consume and destroy as many health care resources as possible

That's a straw man; no one is proposing a health care system where you can have anything you want, as much as you want. Honestly, Fluffy, if the government provided everyone with free blood pressure, blood and urine diagnostic tests, would you be really be down at the clinic every morning pounding on the door demanding your hourly comprehensive diagnostic regimen?

crimethink

joe,

How 'bout we repeal the federal law that requires ERs to treat everyone who walks in the door, money or not?

See, this is the kind of red-blooded libertarian viewpoint that's so refreshing and hard to come by these days for some reason. "Screw the poor and let them die on the street!" Preach it brotha! Why can't libertarians embrace their inner Ayn anymore?

[x,y]

I'm against the dishonest manner in which some politicians, like Guiliani in particular, promise the sun and moon from these accounts, for their own political purposes.

And which Democrat do you support joe?

[Cesar]

Honestly, Fluffy, if the government provided everyone with free blood pressure, blood and urine diagnostic tests, would you be really be down at the clinic every morning pounding on the door demanding your hourly comprehensive diagnostic regimen?

Judging from all the drug commercials on tv right now, plenty of boomers will be knocking on their doctors door demanding free boner pills from Medicare part D in a few years.

[Vermont Gun Owner]

Cesar- Want to expand on this a bit? I didn't watch the debates in '04 as I couldn't vote anyway.

[Cesar]

Cesar- Want to expand on this a bit? I didn't watch the debates in '04 as I couldn't vote anyway.

Instead of the moderator cutting off Bush or Kerry, there was a little traffic light right below each of their microphones. Twenty seconds before time ran out, it would turn yellow. When your time was up, it would go red.

So each candidate was not willing to go over the limit, because if they kept running their mouth even when the light was red people would think "wow, what an asshole". It actually worked quite well.

[Vermont Gun Owner]

Okay, I don't like it quite as much as actually shutting them off, but certainly an improvement over the ones from this year.

[crimethink]

e,

Nice selective quoting. I was responding to joe's complaint that he, as a MA taxpayer, has to pay the medical bills for uninsured people.

You can't at the same time support free access to ERs to all comers, and then complain about the fact that people use it. Or at least you can't do that and avoid me criticizing you for it.

[e]

You can't at the same time support free access to ERs to all comers, and then complain about the fact that people use it. Or at least you can't do that and avoid me criticizing you for it.

Who's complaining that people use it? Not me. It's grossly inefficient,sure, but it's better than nothing. Were you using the proposal to deny access to ERs as just a hypothetical, but you don't actually advocate it? If so, I apologize for quoting you out of context, but I am confused about what point you are making.

[crimethink]

Cesar,

I'm still partial to electric shocks as "times up" indicators. Maybe we can combine the debates with a new Milgram experiment...

Rudy: ...as mayor of --
Mod: Time is up.
Rudy: -- New York City on 9/11...
Experimenter: Mr Giuliani, that's the 10th time you've gone over in this debate. Let's see, that means 350 volts...
Rudy: No! I have a heart condition, ple AAAAAARRRRRGGGGG

[crimethink]

e,

Well, there are probably odd jobs that non-payers can do around the hospital while you're waiting. Sort of like if you don't have enough money to pay the bill at a restaurant, they make you wash dishes (at least on TV).

More seriously, I probably would support repealing that law, first of all because it's none of the fed govt's business. I don't see how that's any more morally repulsive to deny medical care than to command people to work for free. Also, it's quite possible that hospitals would still treat all comers even without a law, for public image reasons.

And, frankly, I'm sick of mandatory ER care being used as a stalking horse for socialized medicine. "We're going to have to pay for it anyway when they show up at the ER, so why not insure them" is a common refrain among those elements.

[Wilhemina Mastiff]

Libertarians are so out of touch that they keep referring to the Vick dog story, when this week's killer dogs belong to Ving Rhames.

[Ayn_Randian]

Oh, joe, it's obvious you're just plugging your ears and screaming "YOU GUYS JUST DON'T WANT "FREE" HEALTHCARE TO WORK...BOO-HOO-HOO".

joe, the bottom line is you want someone in government to determine what's "necessary" and what's not.

So the pinata in all this is "well, of course we almighties in the Government wouldn't cover plastic surgeries! That's unnecessary!" Really, joe? What about the breast cancer victim who had a double mastectomy? What about the disfigured child (or adult?)? Is plastic surgery going to be defined as 'necessary' by the all-knowing bureaucrats based on the best sob story now?

[I\'m not a planner, but I play]

Ayn_Randian,

All we need is the right people in charge. They'll know what to do. Besides, I don't hear YOU offering a plan to solve all the health care problems!

[seer]

I agree with crimethink, we need electro-shock to stop these rogue terrorists... I mean politicians. Of course, they do both operate by spreading fear.

[Mr. Nice Guy]

"Is plastic surgery going to be defined as 'necessary' by the all-knowing bureaucrats based on the best sob story now?" And there are no all knowing bureaucrats in insurance companies that decide if this stuff is covered?

[Col DuBois]

MNG: But those all-knowing bureaucrats have to answer to The Market.

[e]

Also, it's quite possible that hospitals would still treat all comers even without a law, for public image reasons.

wow, what a relief! At first I was worried about the poor people bleeding to death out on the street, but it turns out it's "quite possible" they'll be treated anyway. For "public image" reasons, apparently - I guess some people think it's somehow morally required to treat sick people even if they can't pay for their treatment, and look favorably on hospitals that do so.

But I'm curious; would you, crimethink, find anything commendable about treating sick poor people for free? Is there any moral imperative "you must treat poor sick people" in your view?

If you don't believe there is any such moral imperative, why would you expect anyone else to believe in it, i.e. why would you expect any "public image" benefit to treating poor people?

[crimethink]

I believe there is a moral duty to treat sick people, yes. I also believe that there's a moral duty to abstain from sex until marriage, and to keep your body free of intoxicating drugs, but I don't support using the law to force people to fulfill those duties either.

Remember, it's not charity when you're giving away someone else's money (or labor).

[Fluffy]

"That's a straw man; no one is proposing a health care system where you can have anything you want, as much as you want."

Um, OF COURSE it's a straw man! I'm employing it precisely to get Joe to admit that's NOT the system he wants, and that he intends to ration care.

Joe is avoiding proposing anything at all, because he knows that as soon as he does I'll identify it as a rationing scheme and be all over him like white on rice.

And by the way, the system that comes closest to "a health care system where you can have anything you want, as much as you want" is a completely free-market system. If you're willing to pay for it, you can get all you want. That's closer than any universal system will ever get, because the only way for a universal system to work is to limit access to it by dictate or rule - one version or another of rationing, whatever you end up calling it.

[crimethink]

joe is afraid. I can smell it.

::sniffs::

Wait a minute...aw, crap. Never mind. That was just a week-old open cottage cheese tub under my bed.

[Ruthless]

Hard to believe, but the actual debate was far more interesting than this thread has been so far.
The trouble with health care in the US is that politicians keep passing laws forcing insurance companies to violate the principles of insurance. As one of the biggest lobbying forces, insurance companies are shamed into going along.
Politicians have a vested interest in screwing up health care just as they do in screwing up world affairs.
(Code name: war. Or to use Washington's euphemism: foreign entanglements.)
Each of them wants to create a dragon that they envision themselves riding in on a white horse in shining armor to slay.
Unfortunately they are better at creating dragons than they are at slaying them.

[crimethink]

Ruthless,

The point isn't to slay the dragon. You create a bigger, more threatening dragon to either eat the old one or make it seem small by comparison. Either way, problem solved...or should I say problem superceded?

[Mr. Nice Guy]

"MNG: But those all-knowing bureaucrats have to answer to The Market."
Yeah, true, but the gov ones have to answer to voters don't they?
I'm mixed about single payer or nationalized care. The market will always leave some folks uncovered, and charity may not pick it up, but the government often does some stupid things (health care managed by the guys who managed the Katrina response).
I do have to ask libertarians though, how much liberty does a person have when they are really really sick or working three jobs to pay for an uncovered emergency room visit? Isn't it possible that nationalized care could create more liberty (the exercising of meaningful lifestyle choices) for many people?

[iih]

joe, crimethink, Joshua,

I came here late and am trying to catch up... but has anyone considered leaving health coverage to churches, mosques, and not-for-profit organizations? I believe that this is the way to go. If I am financially able (i.e., above poverty levels), I should be able to decide on the health plan of my liking (including the possibility of choosing none at all -- my preferred choice for religious reasons). Now one is below the poverty level, then they received health insurance paid for voluntarily by kind hearts, through either religious or not for profit organizations.

[Mr. Nice Guy]

Oh,and what is it with those opposed to single payer or nationalized care constantly trying to get supporters to "admit" that rationing will occur. Rationaing occurs now all the time, without it insurance companies would go broke (they have to tell folks "you, and maybe even your doctor might htink that procedure would be nice, but we ain't covering it").

[Anonymous Bastert]

There's no such thing as a free lunch.

[Ruthless]

crimethink,
I stand corrected.
What can't everyone just lie back, get comfortable, and accept peaceful anarchy?
Peaceful anarchy is nowhere near rape!

[crimethink]

You can't give someone liberty. You can only take it away, or keep others from taking it away.

[crimethink]

MNG,

I think the main difference between accountability to the market and accountability to the voters, is that the market will punish you if you displease even a small minority of your customers.

Whereas, the voters can only punish you if you displease a majority of them, in a bad enough way that they consider punishing you to be a bigger priority than all the other considerations in their vote. The man who said that elections would eventually become formalities where the electorate rattled its chains was a very prescient fellow.

[Cesar]

I came here late and am trying to catch up... but has anyone considered leaving health coverage to churches, mosques, and not-for-profit organizations? I believe that this is the way to go. If I am financially able (i.e., above poverty levels), I should be able to decide on the health plan of my liking (including the possibility of choosing none at all -- my preferred choice for religious reasons). Now one is below the poverty level, then they received health insurance paid for voluntarily by kind hearts, through either religious or not for profit organizations.

In an interview Ron Paul said fresh out of med school in the early 1960s--pre-medicare, pre-medicade--he worked for $3 an hour at a Church charity hospital that would treat anyone that came regardless of ability to pay. He said post-government intervention in health care, they don't exist anymore.

[crimethink]

iih,

That would be up to the charities and churches of which you speak, I suppose. There's nothing stopping them from doing so now, and indeed much of the Catholic hospital system started out that way (though they've since become money-making machines).

[crimethink]

Cesar,

One thing we have to bear in mind is that as medicine has advanced tremendously in the past few decades, it has gotten much more expensive. Diagnoses that would have prompted a call to the priest, rabbi, or minister for last rites in 1960, now prompt a trip to the CAT scanner or MRI or to a specialist in a field that did not exist 47 years ago.

You can get 1960's cutting-edge treatment for bargain basement prices today (or at least you would if there were a free market in health care). Getting 2007's cutting-edge is a different story, unfortunately.

[Rick Barton]

joe,

I remember one time on one of these threads when you said to me that your reasons for opposing the Iraq war were never the same as mine or Move On's (BTW, I'm thinking that my reasons, based as they are on libertarian principles, are not the same as those of Move On). But anyway, your statement today still surprises me. What does "work" mean in...

"I actually would have supported an Iraq invasion if I thought it would work." ?

[iih]

Cesar, crimethink,

Right, 100% in agreement. If the argument of those for government-managed universal health care is that society becomes more humane (which is exactly I am strongly for free-choice care) towards the less fortunate members of our society, then they are mistaken. On the contrary, simply put, society ends up delegating government what citizens ought to do themselves directly, not inly increases bureaucratic costs etc, but also this "humanity" becomes vacant if society says "well, heck, it is not my task to do anyhow -- plus they over charge me for other's health care. That ain't fair." Society, then, becomes more bitter towards those receiving the "free" care and the whole humanity thing goes down the drain.

If I am really to be humane towards the less fortunate members of society, the only way to experience this humanity is if I consciously and actively, out of pure free-will, decide to give money for the health care of others.

[iih]

Rick Barton, joe,

Liberty can never be enforced. It took the citizens of what is now the USA 200 years to finally revolt and implement democracy. And it was not perfect. Since then, it took 200 more years to improve the system (some will argue that it was worsened). And it is not perfect yet. It will take many more years to perfect this thing we call democracy.

Similar statements can be said of other Western Democracies. But in none of these cases was democracy implement through foreign forces. The citizens have to work hard and evolve into creating their democracy in the shape and form that agrees with their society's moral and legal traditions (no matter how undemocratic they may seem -- see dark-ages Europe for example). It may take 200, 400, 500, 1000 years to succeed, but it will happen -- it is the human nature to seek freedom and liberty and to argue that some humans have more or less of this nature may in fact have some racist connotations.

Foreign intervention is allowed only if the nation in question has committed an aggression against another country (e.g., Taleban). This does not include the Iraq case.

So, no wonder why Iraq is not working, and won't work until Iraqis figure out how to get there. I am willing to wait on them.

[iih]

oh, and in the meantime, the US should get the hell out and exert the utmost pressure to stop Iran from intervening (they sort of already doing that anyways).

[Ruthless]

crimethink,
I'm optimistic science/computers will soon cure even the peskiest of diseases of the elderly at an affordable cost.
We just need to get past this bulge--you correctly refer to--and to all the obstacles thrown up by the politicians.
Before most of us can conceive of it happening, we will be able to self-medicate--as much or as little as we want.
And we will be able to deal with the issue of just how long we want to live.

[crimethink]

Ruthless,

Hopefully the Baby Boomers (present company excepted) will have died off before unlimited lifespan becomes a possibility. I really don't want to have to deal with them for all eternity, or at least till the heat death of the universe.

[crimethink]

iih,

What you say is correct. The funny thing for me in this debate was that the idea that democracy is a harder to instill than just having elections, didn't seem to make Rudy, Mitt, etc rethink the logic of promoting democracy at gunpoint. If anything, they were going in the other direction, saying we need to commit even more resources to reforming other countries in our own image, before we allow them to have elections. Romney even said we should have worked on fixing Lebanon's health care and infrastructure before their last elections, so as to keep Hez from taking power!

[Cesar]

crimethink-

I just loved it when Mitt called Pakistan, a brutal military dictatorship, someone we should support to "Strengthen democracy".

[Ruthless]

crimethink,
It's just their menfolk bugging us here.
Their womenfolk are lucious, juicy and easy pickin's.

[TEB]

Such bullshit. Excepting charity sucks. If one is starving, one may be forced to except charity, but it sucks. The only answer to health care is deregulation. "Poor" people don't need your phony sympathy. It is insulting and degrading. Few people in this world want to be "rich". Most just want to make a decent living. Socialist regulation is choking the life out of the whole country, and then the socialists accuse "free enterprise".How about just getting the goverment out of my health and wellfare? I may be "poor", but I don't need no help from no government bureaucrat.

[crimethink]

Cesar,

I forgot about that! I can't wait for someone to get the whole thing up on YouTube, since you can't watch it at ABC's website (the fools!).

Seriously though, Tancredo's comment about attacking Mecca and Medina if there's another terrorist attack -- and the applause that followed -- has to take the cake. It was like watching the rodeo scene from Borat, except Borat's from Colorado.

[iih]

crimethink, Cesar:

This whole fixing others' health insurance versus the US's was highlighted in an interesting exchange caught on camera up in NH. Have you seen it?

http://www.washingtonpost.com/wp-dyn/content/video/2007/08/02/VI2007080201294.html

Pakistan a democracy!!!! For God's sake, he carried a military coup against one of the rare cases where a democratically elected Muslim Female prime minister headed an overwhelmingly Muslim country, with nuclear powers, which we now find is critical to the war on terror. This very Benazir Bhutto government could have been the US's best means to promoting democracy -- but to no avail. How ironic! Or should I say, how interesting?

[iih]

Tancredo's stupid comment are not even worth the waste of time -- unless this is one of crimethink's creative ways to get me all heated up. He did this once to me before (I think it was crimethink), but I am not falling for it anymore 🙂 At least not when crimething and I do agree on an issue.

[crimethink]

Well, I'm not sure about Pakistan, but I know that if Saudi Arabia and Egypt turned into democracies overnight, we really wouldn't like the sorts of people who'd get elected there. Saddam's dictatorship, brutal as it was, was far better for our interests than whatever we're going to leave behind in Iraq.

When you're playing chess on the board of the world, you don't want your pawns moving themselves. That's why we usually prefer dictators in our spheres of influence.

[Rick Barton]

Kinda off topic, but anyone can promote international goodwill. I just did so with the folks of Lebanon in the comments section of a vid on You tube (I post as "RickeyRamone" there)

http://www.youtube.com/watch?v=CHVEPKFVcUw

[crimethink]

iih,

I find your lack of faith ... disturbing. 😉

Actually, the quote was one he made a few days ago, and he was asked about it at the debate. He reiterated his support for that policy.

[joe]

Fluffy | August 5, 2007, 3:05pm | #

As I suspected, Joe refuses to describe a plan mechanism that will prevent individual users from overconsuming health care under a free system.

He refuses because there's only one.

Actually, Fluffy, it's because I've got a life.

[iih]

Well, I'm not sure about Pakistan, but I know that if Saudi Arabia and Egypt turned into democracies overnight, we really wouldn't like the sorts of people who'd get elected there. Saddam's dictatorship, brutal as it was, was far better for our interests than whatever we're going to leave behind in Iraq.

Well you can not get it both ways -- you either believe in the people's (other people's that is) right to free choice and liberties to choose (and the subsequent pressures to figure out how best to deal with them), or the unrestricted right to invade, attack, or support dictatorships that will violate the others' right too choose for your own well-being. I would rather pick the first choice. Once people get in power, they can not operate a proper government without proper and respectful cooperation with the outside world -- otherwise the people will revolt again. E.g., Hamas is in a terrible position. If they continue their stance on Israel and their militancy, no one in the entire world will work with them (as long as the West keeps its pressures on them). They will have to change their stances, otherwise the Gazans, who will primarily suffer from the consequences, will either peacefully (through elections, one would hope) or by another violent "regime change".

When you're playing chess on the board of the world, you don't want your pawns moving themselves. That's why we usually prefer dictators in our spheres of influence.

And is that good for the US in the long term? If the US keeps looking underneath its feet, as it has in the last 40-some years, we will perpetually be in a middle eastern mess.

[joe]

Is the argument against HSAs that people spend their money badly so the government should run the whole thing?

No, you misunderstood. Again. Maybe you could be a little less quick to hit the flamaing strawman button. Hint hint.

It would, in fact, be irrational for most people to stow a large amount of money away, sufficient to cover a huge health care bill that probably isn't going to come. That's why most people don't do this. I'm not saying that people aren't behaving rationally, but that they are.

You could make an effort to think here, instead of jumping to whatever misunderstanding happens to make me look worst.

[crimethink]

Actually, Fluffy, it's because I've got a life.

And we hate you for it!

[joe]

Max,

Most of the people who don't have health insurace are low income and pay very little in income taxe. Health savings account tax benefits only apply to the income tax.

Remember wage and price controls, gas lines, etc? Milton Friedman was right, and Nixon and the liberals were full of shit.

Way to reach back into the archives. Do you think it means anything that you need to go back 35 years to find an example that makes your point? In my lifetime, the market fetishists' biggest predictions have been that Reagan's tax cuts would reduce the deficit, that Clinton's economic package would strangle the economy, and that there would still be a surplus after Bush's tax cuts.

[iih]

crimethink:

Though I do find your suggestions/ideas disturbing too, from now on, there will be more faith 🙂 but respectful disagreement will probably have to continue, otherwise why would H&R be an interesting place to be?

[crimethink]

iih,

Yes, I think I would agree with you. Ultimately, with a foreign policy of non-intervention, the rest of the world would have to figure out how they want to live for themselves. The tree of liberty needs to be watered with the blood of patriots and tyrants, not the blood of foreigners. (And in Iraq, it is we who are the foreigners)

[joe]

Joe is avoiding proposing anything at all, because he knows that as soon as he does I'll identify it as a rationing scheme and be all over him like white on rice.

Actually, I already answered that question. I've already told you where I answered that question. Why don't you scroll back through the thread, instead of pretending your already-answered quibble is some conversation-ender, just because you so desperately want it to be.

[iih]

Rick:

Do not worry about translating your comments, while most of the Lebanese speak French as their second language, they are mostly good at English (especially if they are internet users and youtubers). Even if they can't read it, they very well know that there are many more Americans who share you belief and good will wishes.

[Cesar]

Way to reach back into the archives. Do you think it means anything that you need to go back 35 years to find an example that makes your point? In my lifetime, the market fetishists' biggest predictions have been that Reagan's tax cuts would reduce the deficit,

No, they said they would increase revenues, which they did.

that Clinton's economic package would strangle the economy,

Two points about that. Firstly, he didn't raise capital gains taxes. Secondly, the advent of the widespread adoption of the personal computer and the internet offset whatever damage his tax hikes could have done to the economy.

and that there would still be a surplus after Bush's tax cuts

Again, they said his tax cuts would increase revenue which they did. Unfortunatley, his spending habits left much to be desired.

[joe]

And we hate you for it!

No, crimethink. You hate me for my interventionist policies.

It's funny because it's true!

[crimethink]

I'm not sure what we've disagreed on, iih...I hope it was not disrespectful. I save my disrespect for joe these days. :-O

Sorry, joe. If it makes you feel any better, arguing with strangers on blogs helps with my anger issues.

[iih]

crimethink:

Yes, I think I would agree with you. Ultimately, with a foreign policy of non-intervention, the rest of the world would have to figure out how they want to live for themselves. The tree of liberty needs to be watered with the blood of patriots and tyrants, not the blood of foreigners. (And in Iraq, it is we who are the foreigners)

I am glad to say that I perfectly agree with you. You have put very well indeed. (Could someone actually have stolen your identity, with whom I had disagreements or was it not crimethink... Oh I am tired now, may be I am confusing things).

I would add though that non-intervention is a very difficult thing to implement (including hear in the US). It requires a lot of cool heads thinking. The response to the Taleban was justified (albeit poorly implemented), but not Iraq.

[joe]

Rick,

I remember that thread, too. Funny.

What I mean is, if I thought that using American military force to overthrow Saddam was going to lead to that government being replaced by a stable, liberal, republican government, I would have supported the invasion.

[iih]

joe, crimethink:

I think this is getting funny and enjoyable indeed. I have mostly agreed with joe on some issues, but, joe, for God's sake, are you really an interventionist?

[Rick Barton]

iih,

Thanks. Yeah-I think and hope that you're right about both of your points, especially the second one

[iih]

crimethink:

No hard feelings whatsoever.

[crimethink]

He's a health care interventionist. He's voting for intervention after he voted against it!

Yes, joe, I know that's so 2004, but it's just so perfect.

[crimethink]

Wow, this GOP Debate thread is turning into a massive group hug. Let's just keep the naughty parts 3 ft away from each other at all times, boys.

[joe]

iih,

I'm only an interventionist on domestic economic issues, like health care. I believe in interventions in the market to achieve things like universal coverage.

The joke comes from what people like Bush and Guiliani say about terrorists "they hate us for our freedom" - which brings the retort, "no, they hate us for our interventionists policies."

crimethink doesn't have me for having a life. He hates me for my interventionist policies.

Ha ha ha, tap tap, is this thing on?

[iih]

Rick:

You will be surprised! Everyday Arabs are kind of schizophrenic when it comes to the US. If asked how they felt about US policy, the will mostly say that they are pissed off. If asked would they like to go work and live in the US, undoubtedly the majority (or at a sizable minority) will say that they would love to.

All what any US government really needs to do in the ME is: (1) respect the middle-easterners and start to treat them as intelligent human beings (and they really are), (2) be just and evenhanded in their approach to the palestino-Israeli conflict, and (3) fairly trade (especially in the energy-sector) with oil rich countries, and (4) stop supporting dictators.

And I wuold add my personal favorite: (5) stop US aid (both military and otherwise) to Egypt and other countries in the region.

[iih]

crimethink:

:-)))))))))))))) I am keeping my 10 ft!

joe:

I thought you're a military interventionist. Thought was kind of against your former positions on other issues.

[crimethink]

Oh, I get it now, joe. I actually hate you for your freedom too, and for your goatee. If you don't have a goatee, ignore that last part, but I just always pictured you having one.

[iih]

TEB:

If a poor person rejects to receive "sympathy" from anyone, they are free not subject themselves to it! All I am saying is that non-socialized health-care encourages stronger humanitarian institutions, and, I claim, a more cohesive society.

[crimethink]

iih,

My argument is, that if most people in the society are willing to pay to give health care to the poor, you won't need govt to do it; and if most people in the society aren't so willing, then govt won't do it.

My problem with the current landscape is that socialized medicine is often sold as someone else paying for health care for the poor, the old scam of claiming to be generous because you spend other people's money.

[e]

crimethink
I believe there is a moral duty to treat sick people, yes. .. but I don't support using the law to force people to fulfill those duties either.

What about the hypothetical situation where there was a person who was unable to afford health care, and yet also, unable to obtain health care through charity? Unlikely, perhaps, but surely it is possible? If you will grant the possiblity of this hypothetical situation, then we have a dilemma because we have two moral imperatives:

"1. Sick people must be treated"
"2. Property must not be taken by force"

and there is an apparent conflict between the two: that is, we must make a choice to sacrifice one moral rule for the other. You seem to regard 2. as more important than 1., and I am curious why that is. Other people might subscribe to both 1. and 2., but find 1. as more important than 2. This latter group of people, which includes myself, believes that human life is more sacred than the right of property.

[iih]

e:

But wouldn't you agree that this policy (1. more important than 2.) that this is an incentive to (1) have more people be less productive to provide for their own health care, and (2) will make the quality of the due health care of a lower quality? Don't you also agree with what I say above:

All I am saying is that non-socialized health-care encourages stronger humanitarian institutions, and, I claim, a more cohesive society.

If government replaces these humanitarian "charity" institutions, then society will value the life of poor and sick people? If nothing else, it is no longer a personal affection towards the less-fortunate in our society ("let the government handle those poor, unproductive, money-sucking bastards" would be the attitude -- and is the attitude of extreme right-wingers.)

[iih]

crimethink:

My argument is, that if most people in the society are willing to pay to give health care to the poor, you won't need govt to do it; and if most people in the society aren't so willing, then govt won't do it.

And if the latter case holds, then this means that there is something wrong with society on the moral side of things -- morality being something religious and other social institutions' business, and certainly not government's. But we are in agreement!

[e]

iih

But wouldn't you agree that this policy (1. more important than 2.) that this is an incentive to (1) have more people be less productive to provide for their own health care, and (2) will make the quality of the due health care of a lower quality?

For the sake of argument, I will grant both of those; however, you seem to be a utilitarian rather than a libertarian: You are claiming that the empirical results of government policy (that is, having socialized medicine versus not having it) are what is important, not the moral principle "property must not be taken by force". You have no moral problem with the government taking property away from its rightful owners; you simply don't think it will produce good results in the end. If it were somehow proved to your satisfaction, that the net advantages of socialized medicine outweighed the disadvantages, you'd have no problem with it, correct?

morality being something religious and other social institutions' business, and certainly not government's.

iih, morality has no necessary relation or dependence on religion; people wrongly confuse the morality and religion frequently, because religions like to promote themselves as moral authorities. And government is definitely involved in morality - if "murder is wrong" and "stealing is wrong" are among your moral principles, then how are you going to see these principles upheld, if not by government force?

[libertreee]

nd there is an apparent conflict between the two: that is, we must make a choice to sacrifice one moral rule for the other. You seem to regard 2. as more important than 1., and I am curious why that is. Other people might subscribe to both 1. and 2., but find 1. as more important than 2. This latter group of people, which includes myself, believes that human life is more sacred than the right of property.

I think the answer is rather plain here. It is indeed a long standing Christian principle, and also of other belief systems, that you cannot be forced to help those in need. The Good Samaritan was blessed because he chose to help the man beset by robbers; those who did not help are not actually condemned. A man who sees another man drowning is not OBLIGED to jump in and save him, or even borrow a rowboat to attempt a rescue. If he does so, it is out of praiseworthy concern for his fellow man, but is not required of him ethically.

The political mandate to try to offer universal health care will result in the unintended consequences that are avoidable by voluntary markets--such as shortages, lack of capital investments, bureaucratic decision makers, health care czars, etc.

[SIV]

...if "murder is wrong" and "stealing is wrong" are among your moral principles, then how are you going to see these principles upheld, if not by government force?

VIGILANCE

[johncjackson 3rd]

I didn't read all the replies, so I apologize if this has been established ( I would HOPE someone already did)..

I read a lot of misinformation on HSAs in early replies of the resident HnR socialists.

1. As far as HSAs not helping with the "coverage" aspect. Well, HSAs REQUIRE a high deductible ( low premium) health plan. And really, thats all anyone needs. Pay for routine visits and protect yourself from the catastrophies. That's what bankrupts people, not checkups. Is it perfect? No. But it would be great if LOW premium high deductible coverage was more widespread and affordable. The HSA aspect ads some responsibility while allowing for tax advantages,etc. When I run the numbers, there are very few circumstances that having a "full coverage" $0 deductible comprehensive plan makes economic sense. One of the biggest problems is people who EXPECT the "free gas fillups and oil changes" variety of "insurance ( isn't insurance meant to insure against things like emergencies, not tummy aches?)" for "free."

2. HSAs don't expire, you dont lose the money. Thats something else ( MSAs?). It's more like an IRA that you pay deductibles, copays, and other qualified expenses out of. You keep the money and can accumulate it. I think it makes good sense for a lot of people.

Now, I'm no big fan of Rudy, but I do agree that moving "healthcare ( whatever that means)" more int the hands of individuals and encouraging low premium coverage is a step in the right direction. I realy dont see why people don't get the concept of budgeting for health services like they do groceries, rent, utilities, auto insurance,etc.

disclosure: I have a high deductible individual family plan. No HSA right now.

[Cesar]

Believe it or not, I'm an atheist and I still think murder, adultery, theft, and lying are still immoral.

It doesn't come from religion, its just within me. And I think the feeling that these are all immoral acts are inherit in every non-psychologically disturbed human being.

[SIV]

In regard to HSAs I would be quite happy with one in lieu of my employer contracted insurance, particularly if I could pay for non-catostrophic level services at a rate comparable to the insurance company.The amount actually paid the physician or lab through insurance is quite reasonable and rather than paying the "rack rate" I should get a further discount for cash up front.There will be no paperwork and reimbursement lags and hassles.

[iih]

e:

If you really want my honest answer for your question, there are three components to it:

1. Delegating what should be society's humane role towards its disadvantaged members to government, first and foremost, reduces the overall society's humane treatment of its own citizens and weakens its fabric (for government will do that for us, which defeats the purpose of social fabric cohesiveness and strength).

2. My own personal beliefs prevents me from having to have health care. As a resident of Massachusetts, I believe that government is violating my religious right to decline health insurance. Why should it be compulsory if I do not want it? Or if I do not want to receive much worse health care quality than my money can afford?

3. What if people get treated for things that I morally object too (and morality here varies from one person to another). Why should I pay for the treatment of drug addicts or drunk drivers?

I have nothing against having some sort of program/laws (preferably not run by the government) that give immediate health care to people in emergencies, regardless of whether they have a health card on them or not -- even if drunk drivers and drug addicts). But after their treatment, depending on the case (if they are victims to some crime or are transgressors such as drunk drivers), hey should either be treated on society's expense (preferably through charity and humanitarian institutions and not the government) or they have to be punished (in the case of victims of their own crimes, such as drug addicts, or drug addictions --not that I think that this should be a crime-- they willfully got into) later by repaying society back for the expenses.

[iih]

e:

By the way, aside from being a resident on MA, I have residence in Canada and originally came from Egypt. Canadians do not have a great health care system. In some cases you have to wait many many months to get basis (nonemergency) operations performed. Egypt has a really crappy socialized health care system that everyone pays for, but no one ever thinks of it in case of a medical problem.

[Akira MacKenzie]

Believe it or not, I'm an atheist and I still think murder, adultery, theft, and lying are still immoral.

Isn't it "odd" that arguments statists use for government sound eerily similar to those used by theists to promote God?

Statist: "Without government(i.e. the form of government I support), people will rob rape and kill without end; therefore, you can't trust people to govern themselves. You need government."

Theist: "Without a belief in God (i.e. the God that I worship), people will rob, rape, and kill without end; therefore, you can't trust people to devise morality on their own. You need religion."

[Rick Barton]

joe:

What I mean is, if I thought that using American military force to overthrow Saddam was going to lead to that government being replaced by a stable, liberal, republican government, I would have supported the invasion.

That certainly sounds like a less disastrous situation than we are in now, but I would still have opposed the invasion unless it was in response to a real and imminent threat.

But let me ask you this; would you still have supported the invasion knowing what we know now of the absence of WMD and the lies about terrorist connections?

[jh]

joe said: "I have principles, not a plan"

We figured out the bit about you not having a plan a long time ago. I suspect the part about you having principles would be hotly contested in these parts.

[Rick Barton]

iih,

All what any US government really needs to do in the ME is: (1) respect the middle-easterners and start to treat them as intelligent human beings (and they really are),

But Of Course! Most certainly!

(2) be just and evenhanded in their approach to the palestino-Israeli conflict, and (3) fairly trade (especially in the energy-sector) with oil rich countries, and (4) stop supporting dictators.

And I wuold add my personal favorite: (5) stop US aid (both military and otherwise) to Egypt and other countries in the region.

On your point (3), I don't think the government should be involved with the energy trade. However, I find all your other points containing so much good policy advice that I will use my "influence" to push for, upon the election of Ron Paul, your services being employed to help disengage the US government from the whole Mideast, which will likely lead to greater economic engagement of Americans in the region to the wide spread mutual benefit of the folks of all nations involved.

[jh]

"letting people buy health insurance across state lines"

While I support the idea of free markets, the example given by the wannabe who came up with this quote (Huckabee?) was BS, implying people in Massachusetts currently paying $500 or so per month would get the same rates as people in Missouri or whatnot paying about $175 per month. As a former health insurance underwriter, I can assure you that health insurance in urban areas like Boston will be way more expensive than an identical program in rural Missouri. When I worked at Blue Shield of California, the rate for a plan in the rural counties was about half that of the same plan in urban areas like SF or LA.

[jh]

joe said, to justify not answering a question about his beloved universal health coercion plan: "Actually, Fluffy, it's because I've got a life."

The huge number of posts you make on this site would strongly suggest otherwise.

[bob]

I can't believe nobody has commented on this quote regarding the Bush/Kerry debate:

"So each candidate was not willing to go over the limit, because if they kept running their mouth even when the light was red people would think "wow, what an asshole". It actually worked quite well.

Did anyone watch that debate and not think that both of them were complete assholes? (regardless of the semaphores)

[jh]

bob -- "complete" a-holes? You imply that each pegged out the maximum on a theoretical a-hole meter, whereas there is always room to "improve" upon that quanity. The red light thing gave them the possibility of bonus points on top of whatever they were actually saying.

And, considering that people are mad at Bush because he turned out to have betrayed some campaign promises -- that would indicate that his remarks weren't "complete". I strongly suspect Kerry would have been even more a-holish than he appeared in the debate, given power, though at least he would have been constrained by a Republican congress.

[jkii]

Pakistan a democracy!!!! For God's sake, he carried a military coup against one of the rare cases where a democratically elected Muslim Female prime minister headed an overwhelmingly Muslim country, with nuclear powers, which we now find is critical to the war on terror.

Pakistan's number one problem has been civil servant corruption. Democracy, when badly deployed, becomes a spoils system. That's why Bhutto got booted.

[Fluffy]

Joe, usually I am among those who defend you against the accusation that you're a troll, but for the purposes of this thread you can go fuck yourself.

You absolutely have not provided anywhere in this thread a description of how you would set up a free health care system that included no element of rationing.

Your responses to my request for one have ranged from "nyah nyah nyah no I won't" to "I won't because I have a life."

And fuck you again for calling it a "quibble". I asserted that there was no way to set up a "free" health care system without rationing. You said that my assertion was ridiculous and was rooted in a fetish for market principles. I asked you to prove that I was a mere fetishist by providing a description of a plan that would be universal and free but would not include any rationing. You have refused. My "quibble" is the whole of our argument.

[joe]

Rick Barton,

But let me ask you this; would you still have supported the invasion knowing what we know now of the absence of WMD and the lies about terrorist connections?

See, here we get into one of those Schroedinger's Cat situations. One of the things we know now about the WMD/terrorist connections arguments is that the administration and Republican press were systematically lying and misleading us about those subjects. Regardless of the strength of any other arguments, I would have opposed a war on those grounds alone, because as the wise man said, "a house build on sand cannot stand."

That's actually pretty close to where I was in the fall of 2002, when I made up my mind that I was against the war; I didn't know, as we do now, that there were no WMDs, but I knew that the administration was lying about the WMDs, and I did know, all the way back then, that there was no connection to al Qaeda and 9/11.

If the White House and lapdog press had been straight with us about their motives, there would have been no "defensive/pre-emptive" case to be made, and they would have been arguing about liberation and democracy. This, in turn, would have required quite a different set of actions in laying the political groundwork among the American public, and among our allies (something closer to what happened surrounding Kosovo, which Wesley Clark described so well). If this had been done, launching the war would have required much more post-war planning, consultation with allies, and work with forces inside Iraq. If these items had been in place, the mission would have had a much greater chance of success, and I might have supported it.

[joe]

Temper, temper, Fluffy.

You kiss your mother with that mouth? You wouldn't, if you knew where she's been.

[neil paul]

Joe,

your earlier mention that doctors would decide what care is necessary is not a response to the rationing issue.

It is simply true that doctors would like all the care that they can and can justify. Doctors are risk averse.

What happens when doctors want to offer care and the demand outstrips supply?

If price is not an issue since care is "free" then what factor will determine who gets the care and who doesn't.

IN other countries its often a waiting list combined with reviewing requested care to see if its really "needed."

THis is kind of like rationing.

Even though we spend a hell of a lot of money in our present system, its not a regime of infinite rescorces.

What would limit care? How would we afford unlimmited care?

Most every system of distribution of goods could be characterized as rationing. The only question is what basis would you want to see used, if its not ability to pay? There has to be a new control in place.

[joe]

neil paul,

I disagree. Under the current system, doctors are driven to be "risk-averse," ie, order more of the expensive tests that bring in the reimbursements that they and their hospitals depend on to keep afloat.

I do not agree that doctors' demand for medical care is infinitely elastic. I think you are just making an assumption that it is. We're also quite a bit wealthier than other countries, and put quite a bit more resources into health care. Thirdly, unlike HMO bureaucrats whose job it is to minimize the budget for medical services, government bureaucrats will be working with a different set of incentives, which involves spending their budgets to the limit to achieve the best medical outcomes. Between these three factors, I don't anticipate a large amoung of conflict between what doctors think is the proper course of care for their patients, and what the bureaucrats are willing to pay for.

You, and Fluffy, may not like my response, but a response it is.

[neil paul]

Joe,

"spending their budgets to the limit to achieve the best medical outcomes"

Most entitlement programs don't have a limit. Their budgets are not hard numbers that they must remain within. Instead they are semi-sophisticated estimates of what the program will actually cost. What happens if the budget is exhausted ten months into the fiscal year? Do we just wait two months to resume providing care? No, and that is why these programs don't have "budgets" in any real sense.

If a doctor can order a test and exclude a fatal condition that arises in one out of one hundred cases, they will do so. Same if it is a one in ten thousand chance.

Neither a doctor nor a beurocrat will be inclined to forgo such a test. I think it unlikely that any patient will be inclined to do so.

It is true that some gov't based programs in Europe are seemingly more efficient than ours. Do you believe that if we capture similar efficiencies that we will be able to afford the additional care that presently uninsured non users will step up to utilize?

Presently our system, with all the money that is spent, has waiting lists for many specialties. Do you envision longer waiting lists, shorter ones or none at all under socialized medicine?

Some limiting factors will arise or the system will suck up enormous rescources, much as it presently does only more so. Mind you, ours is a country that just dropped 500 billion to a trillion on Iraq. Do you not forsee a situation in which rationing on some basis becomes necessary.

For the record, I don't mind rationing and I don't care if ability to pay is not the basis, even though my ability to pay may be greater than my new claim under the new rationing system.

I just think its important to have an idea of what the new limiting princibles will be, since I think its inevitable that we wil need some.

[iih]

Rick:

However, I find all your other points containing so much good policy advice that I will use my "influence" to push for, upon the election of Ron Paul, your services being employed to help disengage the US government from the whole Mideast, which will likely lead to greater economic engagement of Americans in the region to the wide spread mutual benefit of the folks of all nations involved.

It would be my pleasure! I wonder, what kind of "influence" do you have though?

[iih]

Rick:

On your point (3), I don't think the government should be involved with the energy trade.

By "fairly trade" I meant exactly what you are saying -- that they leave corporations operate on their own and not apply political/military muscle to help these corporations get deals that are unfair to, not the Arab governments for they have their good share of the corruption, but the actual people to whom this wealth really belongs (oil was found on public property in these countries).

Also government intervention for the sale of high tech military equipment should also be stopped. These usually come at the cost of other more important tasks these governments should be spending the money on and not high tech military equipment that will only collect dust.

[Rick Barton]

iih,

My current influence on the body politic is marginal and, even at that, only at the margins. But should my principled cohorts realize ascendancy, your delineation of "fairly trade" even further inspires me to help you to a position where you may bring forth your fair-handed visions to reality.

[Rick Barton]

Thanks joe-interesting:

One of the things we know now about the WMD/terrorist connections arguments is that the administration and Republican press were systematically lying and misleading us about those subjects.

It wasn't just the Republican press, it was also folks like New York Times, and the New Republic.

If these items had been in place, the mission would have had a much greater chance of success, and I might have supported it.

"If they could just get it right." We've heard liberals speak this way about government action before...

[iih]

Rick:

Count me in as a volunteer! Though I have to say that this vision of mine (and of many others, like yourself) seems to be too theoretical and a lot of interest groups are really fighting very hard against such ideals.

Not that I am saying that Syriana is not entirely unobjectionable, but the basic premise of that movie is more correct than otherwise (especially in regards to the like of that reform prince who gets killed at the end of the movie, regardless of who is doing the killing).