Obamacare

ObamaCare is a Trojan Horse for Socialized Medicine

Why Medicare-style insurance will kill our health care system

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President George W. Bush concocted the connection between al-Qaida and Saddam Hussein to justify the Iraq invasion. Now President Barack Obama is concocting an equally fantastical theory to justify a de facto government takeover of health care.

He is claiming that the way to slash health care costs and achieve universal coverage is by creating a Medicare-style government insurance plan that is open to everyone. In the world that Obama and other universal health care advocates inhabit, Medicare allegedly has done a far superior job than private plans of keeping a lid on rising medical costs. Forcing these plans to compete with a plan modeled after it will—in Obama's words—"keep them honest and keep prices down."

But before demanding honesty from others, Obama will have to show some himself, especially concerning the performance of Medicare.

That Medicare is in serious, serious trouble no one can dispute. Its projected unfunded liabilities over 75 years, from 2007 to 2082, are about $36 trillion, according to the latest Medicare Trustees report. If current trends persist, by the end of that time Medicare will be devouring 19% of gross domestic product—or $3 trillion, an amount equal to the entire U.S. budget right now. It will take a heartburn-inducing 135% increase in payroll taxes to bring it into actuarial balance.

Despite Medicare's dismal record, Obama and his comrades hold Medicare up as an example for the private sector. Why? Because between 1997 and 2006, Medicare's health spending per enrollee grew 4.6% annually while that of private plans grew 7.3%. By tapping this 2.7% difference, they argue that they can perform the triple miracle of reining in escalating health care costs, and at the same time extending health insurance to the 46 million uninsured without imposing any extra cost on the economy.

But this is 21st century snake oil.

Medicare hasn't controlled costs by discovering some wonder drug to deliver new efficiencies that the private sector doesn't have. In fact, the Government Accountability Office lists Medicare as a "high-risk" program, thanks to its long-term financial problems and its vulnerability to fraud. Rather, Medicare has cut costs by deploying the economic equivalent of leech-therapy: slashing payments to providers. The only reason providers haven't been bled out of existence is because they have offset these cuts by raising prices charged to private insurance plans. In effect, then, the good performance of Medicare that Obama and Co. tout has been purchased by beggaring the private plans that they deride.

There is a rich literature testifying to this phenomenon. A study last December by Milliman Inc., an independent consulting firm, commissioned by America's Health Insurance Plans, found that underpayment by Medicare and Medicaid accounted for nearly an 11% increase in the health care costs of private plans. This means that on average a privately insured family is forced to pick up about $1,800 extra every year of the government's slack. Private plans, all in all, are subsidizing government programs to the tune of $90 billion annually.

Milliman's findings are far from ground-breaking. They merely confirm previous research, including a 2006 study by Jack Zwanziger and Anil Bamezai in Health Affairs, which found a clear correlation over the years between decreasing government payments and rising insurance premiums in California. They calculated that a 1% relative decrease in the average Medicare price is associated with a 0.17% increase in the corresponding price paid by privately insured patients.

"Policymakers, in considering the implications of decreasing Medicare and Medicaid payment rates to health care providers, must include the likelihood that some of this reduction will result in higher payment rates by private payers," they concluded. "In turn, higher hospital payments will tend to increase health insurance premiums and reduce private insurance coverage."

In making his case for universal coverage, Obama disregards this reality and emphasizes a different cause for the rise of premiums, namely that private plans are being forced to absorb the cost of uncompensated care for the uninsured, who land in the emergency rooms because they can't get timely treatment. Cover the uninsured through universal health care, he says, and things will be dandy again.

But the fact of the matter is that uncompensated care costs only $40 billion—or about 2% of the $2.26 trillion that the U.S. spends on health care. This is less than what department stores lose to shoplifting every year. "Underpayment by the public programs dwarfs any problem created by the uninsured," says Greg Scandlen, director of the Heartland Institute's Consumers for Health Care Choices program. Indeed, the problem for private plans is not so much that they are being forced to subsidize the uninsured as the publicly insured.

Obama told the American Medical Association in a major health care speech Monday that doctors shouldn't regard a public insurance option as their enemy, but as their friend. He is lying. He has already proposed slashing $200 billion in reimbursements to hospitals to pay for universal coverage. And, if past is prelude, this trend will only accelerate if a government-run insurance plan becomes available.

But ultimately this public option will not be sustainable because it will set in motion a downward spiral in which the more it grows, the more it will raise the costs of private plans. This will drive patients out of these plans and into the public plan, which, in turn, will grow more and eventually drive the private plans out of business.

How will the public plan sustain itself once it has killed the very host it is feeding off? Essentially, by embracing a taxpayer funded, government-run, single payer system. Obama pooh-poohs those who suggest that the public plan is a Trojan horse for socialized medicine. But then Bush too pooh-poohed those who suggested that Iraq would become a quagmire.

Shikha Dalmia is a senior analyst at Reason Foundation and writes a biweekly column for Forbes, where this column originally appeared. Ben Tonkin provided research assistance for this column.

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  1. The claim of “rich literature” in support of cost shifting would be much more credible if there were numerous peer reviewed studies to support it. As it is, one industry-funded study which has not been peer reviewed can hardly be taken as strong evidence.

  2. What! The gubmint leeching off the private sector? No. I don’t believe it. That could never happen. We must repeal the 16th and 17th amendments that’s the only way to stop all of this. Maybe march on Washington and hang them all from lamposts but we’ll save that as a last resort.

  3. The problem with this argument, like so many apparently fact-based arguments against single-payer health insurance, is that it cannot deal with the most profound facts about health insurance in the U.S. Here are a few:

    * If you have chronic health conditions and lose your insurance, no private insurer will insure you.

    * People without adequate medical insurance will suffer and die unnecessarily.

    * For people without medical insurance, Medicare, whatever its multitude of problems, provides access to medical care for people who would not otherwise have it.

    Any argument that does not take these facts into account is simply an argument that ignores the real problems with healthcare in this country.

  4. As it is, one industry-funded study which has not been peer reviewed can hardly be taken as strong evidence.

    I actually agree the wooden headed socialist.
    Blind pigs/acorns etc.

    Instead I suggest that we rely on the track record of government cost estimates. We will take what the cost estimate is and triple it, take what benefits are expected (how much is U.S. life expectancy expected to increase above extrapolating current trends anyway?) and halve that, and then present it to the American people.

    When I say that the government estimates for a program are overly optimistic to the point of being downright fabrications, which I often do, I have NEVER been proved wrong by events.

    We can’t afford this pipe in the sky noonsense that won’t increase people’s health one fucking iota.

  5. EXCERPT:

    For about a hundred years, America has been a nation of accumulating medical controls. Each new regulation was passed with the same justification made for the previous one: This measure will sufficiently correct the failings of the free market and thus save the free-market system. And the result? Today’s “crisis in health care” — as the welfare statists themselves call this iatrogenic disease. The more band-aids are applied, the more wounds appear! And with nothing but band-aids in their bags, these “liberals” (often the same aging advocates of past regulation) can now prescribe only covering the patient head to toe — i.e., the final move to the outright socialization of all medicine. What this says about the microcosm of medicine is obvious; what it means for our mixed economy is ominous.

    READ THE WHOLE STORY.

  6. “Any argument that does not take these facts into account is simply an argument that ignores the real problems with healthcare in this country.”

    Here are some more facts for you Tom:

    Healthcare is not a right.

    Your welfare is not anyone else’s responsibilty.

    The federal government has no legitimate Constitutional authority to set up a mandatory participation health care system.

  7. We already have socialized medicine. We have a socialist president. The last one was a socialist as well. Other than Ron Paul, who is not a socialist in Congress?

    What is really becoming tedious is the notion that if one claims that we already have socialized medicine or that Obama is a socialist, then one is a “shouter” or an “extremist” or “lacking credibility” or “damaging libertarianism” and the like. I have had enough of that sophomoric non-sense. Its time to rout that rubbish.

    Cathy Young, in her column yesterday regarding the reactions to Mr. von Brunn and David Letterman, oce again demonstrated that libertarians are not immune to this intellectual clap trap.

  8. “To justify the invasion of Iraq, President George W. Bush concocted a connection between al-Qaida and Saddam Hussein.”

    [citation needed] [by-line needed]

  9. If you have chronic health conditions and lose your insurance, no private insurer will insure you.

    This is not true, there are laws to counter this, and even if it were they still may receive care without insurance through manifold programs public and private, federal, state and municipal.

    People without adequate medical insurance will suffer and die unnecessarily.

    More people will die as the public option compresses the health care economy. This is unavoidable, and we see this in nations where it is done. The health care pie gets smaller, outcomes are much worse, and care must be rationed. Your Rx is death for many more Amercians.

    For people without medical insurance, Medicare, whatever its multitude of problems, provides access to medical care for people who would not otherwise have it.

    True, but so far as I know Medicare elimination is not on the table.

    Although it should be.

    It is economically impossible to subsidize something without causing inflation. However if we decide (and we seem to have) we must subsidize something the least damaging way to do it is the simplest.

    Give the people that need it the money they need.

    This protects the only mechanism that works to counter inflation, competition. You don’t make them spend it in any particular way and you don’t take it back if they don’t use it.

  10. “Instead I suggest that we rely on the track record of government cost estimates”

    Yeah – like the original projection when Medicare was initiated that the 1990 cost would be $12 billion vs the actual 1990 cost of over $100 billion.

  11. “To justify the invasion of Iraq, President George W. Bush concocted a connection between al-Qaida and Saddam Hussein.”

    [citation needed] [by-line needed]

    Al Qaeda-Hussein Link Is Dismissed

    The Sept. 11 commission reported yesterday that it has found no “collaborative relationship” between Iraq and al Qaeda, challenging one of the Bush administration’s main justifications for the war in Iraq.

    Along with the contention that Saddam Hussein was stockpiling weapons of mass destruction, President Bush, Vice President Cheney and other top administration officials have often asserted that there were extensive ties between Hussein’s government and Osama bin Laden’s terrorist network; earlier this year, Cheney said evidence of a link was “overwhelming.”

    Now go back to your room.

  12. Your welfare is not anyone else’s responsibility.

    Isn’t Atlas Shrugged difficult to read with your ejaculate making the pages all stick together?

  13. “To justify the invasion of Iraq, President George W. Bush concocted a connection between al-Qaida and Saddam Hussein.”

    [citation needed] [by-line needed]

    Done:
    cite provided

  14. faithkills, are you suggesting that the govt simply pay for the poor to buy a policy with a private insurer?

  15. “Isn’t Atlas Shrugged difficult to read with your ejaculate making the pages all stick together?”

    I’ve never read the book.

    Don’t need to.

    The only thing I need to read to know that your welfare is not anyone else’s responsibilty is the United States Constitution.

    1. Like it says in the PREAMBLE?

  16. If Obama is serious about controlling costs, I wouldn’t mind if he put a lid on profits and salaries in the pharmaceutical industry. Much of what they sell is overpriced and doesn’t work as well as we are led to believe.

    With Obama’s plan, the richer people will subsidize the poorer, but that is largely what he is about anyway.

  17. faithkills | June 19, 2009, 4:07pm | #

    More people will die as the public option compresses the health care economy. This is unavoidable

    Really. That is an odd claim, given that just about every developed nation, all of whom have public systems, have better health and longer lives than we do…for 2/3 of the cost.

    The facts are the facts. Our hybrid public-private system is a nightmare that is both expensive and ineffective. A pure “free market” system will NEVER EVER EVER EVER EVER happen, so get over it. A single payer system, despite its flaws, is far better than what we have now.

  18. Why do so many people say health care in the U.S. is broken? Seriously…why? And how will we know when it’s fixed?

  19. And how will we know when it’s fixed?

    When everyone is equally sick and poorly cared for, just like Chad and Tony want it.

  20. “When everyone is equally sick and poorly cared for, just like Chad and Tony want it.”

    damn. wallflower status again.

  21. Doug | June 19, 2009, 4:40pm | #
    Why do so many people say health care in the U.S. is broken?

    We spend 50% more than everyone else, yet have shorter lifespans than other developed nations.

    And how will we know when it’s fixed?

    When the above are no longer true.

    It is not just health care, though. The entire layout of our communities fosters lonliness, stress and a lack of exercise. This is actually a bigger factor than inadequacies in our health care system.

  22. Between Medicare, Medicaid, and private insurance, who knows what something really costs when the market is completely distorted. When government became so involved in medicine, it gave us the corporate model we have today. Get government out the picture, open up competition and provide an incentive for medical savings accounts to cover the basics.

    http://www.ronpaul.com/2009-06-19/ron-paul-how-to-solve-the-healthcare-crisis/

  23. The only thing I need to read to know that your welfare is not anyone else’s responsibilty is the United States Constitution.

    “We the people, in order to…promote the general welfare…do ordain, etc.”

  24. “A single payer system, despite its flaws, is far better than what we have now.”

    Nonsense.

    The definition of better is what is better for me personally compared to what I’ve got right now.

    Single payer doesn’t pass that test, so it’s not better.

    And that’s that.

  25. “We the people, in order to…promote the general welfare…do ordain, etc.”

    PROMOTE, Tony.

    PROMOTE. Not provide.

  26. Do we entertain lectures on the sanctity of life from murderers? Do we prick up our ears when rapists want to complain about our misogyny? Do we care when violent people call them themselves pacifists?

    Tony and Chad are vocal advocates of theft. Who gives a fuck about whatever else they have to say?

  27. Lexicon,

    Yeah… How do you promote the general welfare without providing things? Big posters that read “Go general welfare!”?

  28. The definition of better is what is better for me personally compared to what I’ve got right now.

    Single payer doesn’t pass that test, so it’s not better.

    And that’s that.

    You must be a real hit at parties.

  29. faithkills, are you suggesting that the govt simply pay for the poor to buy a policy with a private insurer?

    Yes. And allow them just to buy catastrophic coverage if they choose and pocket the rest. This is the least inflationary and cheapest method possible, barring not helping at all.

    Really. That is an odd claim, given that just about every developed nation, all of whom have public systems, have better health and longer lives than we do…for 2/3 of the cost.

    They have drastically poorer outcomes. Interestingly Mankiw just made a post about this. http://gregmankiw.blogspot.com/

    When you get cancer you want to be in the US. An aside.. this will really suck for Canadians who now have to come to the US for care.

    The facts are the facts.

    True, and I suggest you avail yourself of them.

    Our hybrid public-private system is a nightmare that is both expensive and ineffective. A pure “free market” system will NEVER EVER EVER EVER EVER happen, so get over it. A single payer system, despite its flaws, is far better than what we have now.

    Tell that to people who die waiting for treatment. It’s not ‘flawed’, it’s lethal. You can’t be turned away in the US and this has an economic cost but you will get care. Your ‘solution’ will reduce the total total amount of healthcare available and will kill people just as it does where it has been instituted.

    We haven’t had a free market solution since the AMA took over, and it’s been going down hill. It’s too bad because it worked well.

    Why do fascists and socialists and progressives never understand economics?

  30. We spend 50% more than everyone else, yet have shorter lifespans than other developed nations.

    The cost of living here in Alaska is, on average, 28% higher than 46 other states yet don’t live better off than them. Does this mean something is broken?

  31. Tell that to people who die waiting for treatment.

    Obviously, there can’t be too many of these mythical people, or they wouldn’t be living longer than us.

    The proof is in the pudding.

  32. They have drastically poorer outcomes. Interestingly Mankiw just made a post about this. http://gregmankiw.blogspot.com/

    Oh, I admit that we have slightly (not drastically) better sick care in certain situations, but that only emphasizes little bang we are getting for our buck. Instead of prevention, we are wasting hundreds of billions on very marginal efforts fix problems after the fact.

  33. From the report:

    “For the 75-year projection period, the actuarial deficit is 2.00 percent of taxable payroll, 0.30 percentage point larger than in last year’s report. The open group unfunded obligation for OASDI over the 75-year period is $5.3 trillion in present value, and is $0.9 trillion more than the measured level of a year ago. In the absence of any changes in assumptions, methods, and starting values, the unfunded obligation would have risen to about $4.6 trillion due to the change in the valuation date. “

  34. Jesus Christ, Chad, do we need to have a conversation about causation and correlation?

    Do you know how many factors contribute to longevity, health insurance coverage (stress–not health care) being only one of many, many factors. To simply point to average lifespan and national health insurance system and claim some direct causal connection is either retarded or dishonest. I will give you the benefit of the doubt and assume you are not retarded.

  35. ben tej | June 19, 2009, 7:41pm | #
    Jesus Christ, Chad, do we need to have a conversation about causation and correlation?

    Do you know how many factors contribute to longevity, health insurance coverage (stress–not health care) being only one of many factors

    Agreed. Lifestyle is the biggest factor, but you won’t support solving those problems either. Instead, it’s all SUVs, suburbs and Big Macs, all the time.

    By measure after measure, however, our system is both a failure and expensive. In a few situations we perform better than most, but those situations are a minor part of the whole, and we spend enormous sums for minimal gain. In the meantime, we don’t spend even minimal money to get at the root causes of much larger parts of the problem, like our unwalkable communities.

  36. Chad, can’t people in the suburbs live healthy if they want to? People aren’t being forced to eat big macs, and its not that difficult to find ways to exercise.

  37. zac | June 19, 2009, 10:42pm | #
    Chad, can’t people in the suburbs live healthy if they want to? People aren’t being forced to eat big macs, and its not that difficult to find ways to exercise.

    You are missing the point. With the proper community layout, people don’t need to find ways to exercise, because it is part of your normal life. Instead, we have a layout which makes both walking and cycling difficult and impractical.

  38. I understood your point. Mine was that there’s not really a policy issue if the problem is just that people are able but not willing to exercise and eat right. I don’t believe that’s something that should be forced on them, a system where people can choose to live healthy or not to seems to be a freer one.

  39. zac | June 20, 2009, 12:53am | #

    +1…but these ideas seem foreign and disturbing to people like Chad.

  40. I understood your point. Mine was that there’s not really a policy issue if the problem is just that people are able but not willing to exercise and eat right. I don’t believe that’s something that should be forced on them, a system where people can choose to live healthy or not to seems to be a freer one.

    Zac, the current system essentially forces me to own, use and pay for a car, which is a much much much larger impingement of our freedoms than a having to walk ten minutes once in a while. Indeed, the average Joe probably spends far more on his cars than he does on taxes, and libertarians seem to believe that taxes are some all-powerful freedom limiter. So why isn’t the necessity of owning a car just as bad?

    The “cars = freedom” meme is bull-manure. Any extra “freedom” you get from your car is cancelled by the day you have to spend at work each week to pay for it. I have spent about four years of my life with no car, and another seven or so where my car was not my primary tool for commuting. I was every bit as “free”, if not more so, during the four years without a car.

  41. At some point, can’t the doctors simply refuse to accept pastients under the government plan?

    They are already doing this with Medicaid and Medicare. Is Obama going to force them to accept these patients?

  42. “Yeah… How do you promote the general welfare without providing things? Big posters that read “Go general welfare!”?”

    Making citizen A pay for citizen B’s healthcare isn’t “general welfare” in the first place.

  43. “Zac, the current system essentially forces me to own, use and pay for a car, which is a much much much larger impingement of our freedoms than a having to walk ten minutes once in a while. Indeed, the average Joe probably spends far more on his cars than he does on taxes, and libertarians seem to believe that taxes are some all-powerful freedom limiter. So why isn’t the necessity of owning a car just as bad?

    The “cars = freedom” meme is bull-manure. Any extra “freedom” you get from your car is cancelled by the day you have to spend at work each week to pay for it. I have spent about four years of my life with no car, and another seven or so where my car was not my primary tool for commuting. I was every bit as “free”, if not more so, during the four years without a car.”

    LOL

    Congratulations on contradicting yourself all in the same post.

    If you lived without a car for years, obviously “the system” is not forcing you to own one.

  44. Chad-

    If communities aren’t set up to let people walk and bike how did you get by for 4 years without a car then? Did someone bring you food? There is a walking path outside my living room window, paid for by taxpayers, that I have yet to see a single walker on in the year I have lived here. It has nothing to do with community setup. People are lazy, or pressed for time and can’t bike to the store, besides it is easier to fit a whole weeks worth of groceries in my car than the back of my bike. If people want to exercise they will. I don’t need a government mandate for it.

  45. Chad, I’ve lived without a car for three years. I walk absolutely everywhere. So do most people I know. I live, of course, in an urban area. It’s not as congested as New York, so driving is a feasible option, but most people prefer walking or taking public transit over driving to avoid the congestion. The point being, I agree that the design of our cities may often contribute to people driving more than walking–and that where the design more easily facilitates walking, people will often take that option.

    However, I find myself wondering–what is your policy prescription to that? Put zoning codes in place that outlaw single family homes or ban construction on property larger than .5 acre?

    Before this gigantic real estate meltdown, I remember reading a number of stories about a movement towards urban-suburban living, that is, people moving towards condo or loft-style living in smaller suburban centers where they can walk to their coffee shop, to restaurants, to the pharmacy, etc. This movement was not a result of policy prescriptions, but people exercising their interests through the free market.

    Look at the splits between rural and urban populations–110 million people live in central cities while only 59 million people live in rural areas. Another 82 million live in urbanized areas that are not in central cities but in the broader metropolitan region and another 30 million live in what are called urban clusters. Basically that can be interpreted as about equal numbers of people live in urban areas as suburban areas (110 vs 112 million) and much fewer people live in rural areas.

    I wish the census bureau provided the same splits for 1990 to see where the trend is going, but I couldn’t find them. I guess they didn’t have enough data points to do the same split for the 3-year american community survey either, so we’ll have to wait until after this next census to see where the trend is going. Anecdotally, though, my guess would be that the suburban numbers were relatively larger in 1990 and that they’ll be even smaller in 2000–but that’s just based on personal observations and this, unfortunately, single data point.

    My whole point being again, what public policy proscription will generate more movement to urban-style living (and this is conceding your argument that this style of living generates better health, though I think that is an argument still worth taking up as well)? And why do we need this kind of public policy solution when it seems this movement is happening anyway?

  46. Excellent article. My question is how do we stop ObamaCare, and what groups are actively working on this?

  47. If you want to know what it’s like to have government run medical care where you can’t choose your doctor, visit your local psych wards. They have locks on the doors to keep the patients in.

  48. Hello:

    Thanks for providing this discussion forum.

    I do believe the original subject of this thread is about the health insurance reform?

    I am 62 years old. My wife of 40 years is 58. We still continue to be able to afford private coverage. We are both very active and in good health. We both continue to be employed, myself part-time and the wife full-time.

    Can someone tell all of us what the combined CEO’s and fat cats and various board of directors salaries and advertising and marketing budgets are of the top 10 publicly-traded health insurance corporations?

    Then to add to that, what’s the stock market investors cut of the action?

    Plus don’t overlook this. What is the amount for the lobbying and legal expenses for those lobbyists in both Washington DC and every state in the Union?

    Oh, and then there are the expenses paid out for the various associations who run copious amounts of bat-crazy spin-and-spew fact twisting BS through the myriad of print, TV and internet news outlets throughout the country.

    What’s all the above add up to?

    And here is an eye-opening stat from Health Care for America Now:

    Profits of the 10 largest publicly traded insurers increased 428 percent from 2000 to 2007, from $2.4 billion to $12.9 billion.

    Has your wage or salary gone up 428 percent?

    Now let’s get serious, how much does all of that truly benefit the doctor/patient relationship?

    On another note: Our family of three has had the fortunate opportunity to have had health care coverage continuously with the same system since 1982. Over that 27 year period our total outlay for the premiums has been $175,500. Presently our coverage costs $725 per month for only the two of us now.

    Thanks to our genetics, our lifestyle of healthy living practices, preventative care, and our fortunate situation of no catastrophic hospitalizations, in addition to the stress alleviated by having health care — over that same period of time our total doctor and medical bills, including co-payments have added up to a yearly average of $859.72. That’s a grand total of $23,212.50 over the 27 years.

    I wonder if there’s any chance of getting a rebate on what we’ve saved the system?

    I’d be more than happy if reform could bring about a reduction in our premiums, say down to about $300 a month.

    Cutting out all that overhead of the for profit publically traded weasels and the myriad of leeches that profit on the citizens of our country could sure go a long long way to doing just that.

    Now if my wife and I were to pay only 300 bucks a month in lieu of the 725 bucks currently paid (see: breakdown above) where do you think the 425 bucks we would save would eventually end up? Anyone here wish to venture an answer?

    Would there be any cost benefit to the working folks of the nation?

    Let’s just say there are 100 million who could place 425 bucks saved from health insurance premiums per month into the economy in a productive way. What kind of boost would that be to the entire national economy in a year? In 5 years? In 10 years?

    425 X 12 is $5100

    425 X 12 X 100 million is $510 Billion

    425 X 12 X 100 million X 5 years is $2.55 Trillion

    425 X 12 X 100 million X 10 years is $5.1 Trillion

    Oh and about those CEO’s top total compensation packages from 2008 based on information gathered from the U.S. Security and Exchange Commission?

    Aetna’s Ron Williams – CEO Compensation
    Total Compensation: $24,300,112

    CIGNA’s H. Edward Hanway – CEO Compensation
    Total Compensation: $12,236,740

    UnitedHealth Group’s Stephen Hemsley – CEO Compensation
    Total Compensation: $3,241,042

    WellPoint’s Angela Braly – CEO Compensation
    Total Compensation: $9,844,212

    Coventry Health Care’s Dale Wolf – CEO Compensation
    Total Compensation: $9,047,469

    Take your time and think about that and let it soak in.

    .

  49. Gilbert Martin | June 20, 2009, 10:15am | #

    If you lived without a car for years, obviously “the system” is not forcing you to own one.

    Half that time I wasn’t in the US. The other half, I was in the 1% of the US where it is halfway practical to live without a car, and also poor enough (a college student) that I didn’t buy one. Anyone with significant money would have had one. The seven years I had a car but didnt it regularly were also when I was in college.


    My whole point being again, what public policy proscription will generate more movement to urban-style living (and this is conceding your argument that this style of living generates better health, though I think that is an argument still worth taking up as well)? And why do we need this kind of public policy solution when it seems this movement is happening anyway?

    It would be a combination of many things, but the two things I find most important would be an appropriate tax on energy and/or pollution (including CO2), and a strong investment in public transportation. Obviously, any sort of energy tax would make the urban lifestyle more attractive for a variety of reasons. So would public transportation, which also has the side effect of causing high density development around the stations. We also need to be much smarter about zoning, and push towards more integrated areas rather than separate business and residential areas.

  50. You libertarians are a curious lot. I don’t have to care about my fellow man because the Constitution tells me so? What’s the idea, that you shouldn’t have to pay for his health services with your hard-earned dollars? That he should be left to his own devices because, poor, he cannot afford the exorbitant and escalating cost of care, or, sick, cannot obtain care offered solely by a private industry which itself has no earthly interest in his welfare because he threatens to reduce their bottom line? Not your mess?

    Cast aside the moral question if you will. You can’t ignore the soaring, scandalous inefficiencies of our system – much longer, anyway, without thorough reform. Revenues are highest before the fall, and revenues are very high.

    PS – Get real.

  51. What’s the idea, that you shouldn’t have to pay for his health services with your hard-earned dollars?

    You’re right, man, that idea is crazy. Hey, you, pay for my health care.

  52. Chad, who built our roads? That’s right – the gov’ment. They created suburban sprawl by putting the trains out of business. That not withstanding, if you wanted to live in a urban center, you could make that choice. There are (were) no shortage of jobs in a city environment. The fact is, you chose not to and now want the right to whine about it. You are like every other liberal I know – blame everyone else for your problems.

    As for waiting lists – 800,000 (out of 33 million) are on a waiting list right now in Canada. That’s not a problem at the fringe.

  53. mcred, I’m sorry to hear that personal responsibility is so passe by you. This country thrived on it for quite some time. That said, this country in 2007 gave over $280 billion to various charities even after being taxed the bejesus out of.

    As for the inefficiencies, where do you think medical advances come from? Who provides the R&D capital? America produces 90% of new drugs. Foreign countries (through their single payer system) demand steep price concessions through threat of violating the patents. That means Americans are left to pay the R&D tab.

  54. David Small | June 22, 2009, 8:22am | #
    Chad, who built our roads? That’s right – the gov’ment. They created suburban sprawl by putting the trains out of business.

    Exactly. The government picked a “winner” that turned out to be a loser that massively degraded our health and environment. We should not be working to mitigate the damage we have caused.

    That not withstanding, if you wanted to live in a urban center, you could make that choice. There are (were) no shortage of jobs in a city environment. The fact is, you chose not to and now want the right to whine about it. You are like every other liberal I know – blame everyone else for your problems.

    The problem is you or me as an individual. It is the subsidy-laden incentive structure which has caused tens of millions to move to suburbs and therefore consume twice the resources. If you choose to live in the ‘burbs subsidy-free, so be it. Many people wouldn’t.

  55. So, your solution to bad gov’ment policy is to add more bad gov’ment policy. It’s the same old recipe. Gov screws something up, then blames someone else, then inserts itself further into the process. Wash, rinse, and repeat.

    I and my family live in an urban center. I take mass transportation to work and drive a car about once a month. If it wasn’t for the small kids, I’d get rid of the car completely and rely on Zipcar. These were choices that I made because I disliked living in the Burbs.

  56. So, your solution to bad gov’ment policy is to add more bad gov’ment policy. It’s the same old recipe. Gov screws something up, then blames someone else, then inserts itself further into the process. Wash, rinse, and repeat.

    No, I am advocating replacing bad policy with good policy. Or are you the type that simplistically believes that all policy is bad?

  57. Give me an example of “good policy” sans the inevitable market distortions. I’m willing to bet most people in the 50s thought the gov’ment building roads was “good policy” as you put it.

    And once again, you could live somewhere that meets your “ideals”, but you choose not to. It’s easier for you to complain and force everyone to follow your ideology.

  58. Obviously, there can’t be too many of these mythical people, or they wouldn’t be living longer than us.

    What do they put in the progressive koolaid that truncates cerebration so well?

    Life expectancy has little to do with health care. We’re talking about health care. You are 3 times as likely to survive prostate cancer in the US compared to the UK and twice as likely than in Canada. Colon Cancer over twice as likely to die in the UK and 10% more likely to die in Canada. There’s a reason people come here and pay. It’s because they will die where they are.. and may not even be seen before they die, or before they are too sick to justify expensive treatment.

    Oh, I admit that we have slightly (not drastically) better sick care in certain situations

    No it’s in most situations, and it is indeed often quite a dramatic difference.

    You libertarians are a curious lot. I don’t have to care about my fellow man because the Constitution tells me so?

    We care, more than you. That’s why we fight against you trying to set up a system where more people will die.

    One thing at least is nice. You fascists aren’t pretending like you aren’t trying to get single player, like your leader Obama is.

  59. David Small | June 22, 2009, 10:24am | #
    Give me an example of “good policy” sans the inevitable market distortions. I’m willing to bet most people in the 50s thought the gov’ment building roads was “good policy” as you put it.

    Oh, where do I start? How about the court system? I am kind of fond of that one.

    And once again, you could live somewhere that meets your “ideals”, but you choose not to. It’s easier for you to complain and force everyone to follow your ideology.

    So could you. Do you not realize that your argument cuts both ways? Go buy a ship and live in your perfect libertarian utopia in the middle of the ocean. Don’t complain when the pirates kidnap you, either.

  60. Do you not realize that your argument cuts both ways?

    Right cuz libertarianism is indistinct from anarchy. Everything you type is straw man or reductio.

    The problem is we had the only libertarian state, but you tools for the statists have set about the task of destroying it. Why can’t you let one be? There’s no libertarian nation to go to, but every other nation in the world is some flavor of collectivism, pick your poison and go.

    What you take as a matter of faith is that there is a government that wishes you well. All of history shows this is not true. All forms of collectivism are merely rationales for the rich and powerful to become more rich and powerful at the expense of you and me. Socialism, Fascism, Theocracy, etc, it all ends up exactly the same with minor differences in window dressing. Whether the justification is ‘for the party’ or ‘for the state’ or ‘for god’.

    I like the idea of utopia too. I just recognize any such must be administered by men, and by men who wanted that job, which are never good men. So we observe that the greatest quality of life and happiness has been enjoyed by the most free peoples.

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  62. My only point is that if you take the Bible straight, as I’m sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won’t get the full deal by just doing regular skill english reading for those books. In other words, there’s more to the books of the Bible than most will ever grasp. I’m not concerned that Mr. Crumb will go to hell or anything crazy like that! It’s just that he, like many types of religionists, seems to take it literally, take it straight…the Bible’s books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on…the Bible’s books were written by people with very different mindsets…in order to really get the Books of the Bible, you have to cultivate such a mindset, it’s literally a labyrinth, that’s no joke

  63. My only point is that if you take the Bible straight, as I’m sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won’t get the full deal by just doing regular skill english reading for those books. In other words, there’s more to the books of the Bible than most will ever grasp. I’m not concerned that Mr. Crumb will go to hell or anything crazy like that! It’s just that he, like many types of religionists, seems to take it literally, take it straight…the Bible’s books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on…the Bible’s books were written by people with very different mindsets…in order to really get the Books of the Bible, you have to cultivate such a mindset, it’s literally a labyrinth, that’s no jokeI like the idea of utopia too. I just recognize any such must be administered by men, and by men who wanted that job, which are never good men. So we observe that the greatest quality of life and happiness has been enjoyed by the most free peoples.

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