Obamacare

You Don't Have to Support Universal Health Coverage to Support Caring for the Needy

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Liberals often accuse opponents of universal health coverage legislation of wanting to let the poor go without coverage — and suffer and die as a result. Let's be charitable and assume that liberals actually believe that this is the only possible alternative to universal coverage orchestrated by the government.

The problem, of course, is that it's not.

It is possible to oppose both the current fiscally rotten entitlement system and expansions of that system — like the 2010 health care overhaul now awaiting a Supreme Court decision — and still favor a basic safety net for the truly needy.

What might such a safety net look like? Here are a few basic principles.

It would focus effort and resources on providing care for the truly needy rather than on providing subsidies for seniors or the middle class. Right now we subsidize the health insurance of the middle and upper classes through the tax system, which has distorted the market for medical care for decades. The health care overhaul, should it stand, will add an additional layer of subsidies for households earning up to 400 percent of the poverty line, or nearly $90,000 for a family of four. Medicare is not means tested, and provides taxpayer-financed health coverage for the wealthiest cohort of Americans. It's a hefty transfer from the poor and young to the rich and old. Medicaid, meanwhile, is a deeply dysfunctional program that regularly fails the poor and, thanks in part to the perverse incentives of its joint financing system, is the subject of constant squabbling between state authorities and the federal government. American health care policy today offers lopsided benefits to politically influential groups like seniors at the expense of the poor and vulnerable.

It would do as little as possible to control prices or suppress price signals. Since World War II, medical prices have been systematically distorted and suppressed all over the Western world. As National Center for Policy Analysis president John Goodman extensively documents in his new book, Priceless: Curing the Health Care Crisis, individuals, employers, providers, and even payers — public and private — have been shielded from seeing the true costs of care, which has helped generate cost inflation and excess spending. A better health care system would be far more transparent to all parties, ensuring clear prices for specific services and service bundles throughout each layer of the system.

It would emphasize catastrophic coverage instead of subsidizing routine care. Rather than attempt to cover relatively predictable health expenses, a better safety net would focus on ensuring that health care expenses did not lead to financial ruin for the most needy. In other words, the focus would be on providing insurance against disaster rather than day-to-day comprehensive coverage, encouraging individuals to take responsibility for care that can reasonably be expected in advance while also offering some peace of mind that worst case scenarios are covered.

It would allow for flexibility and experimentation when possible. Because the price system has been suppressed for so long, and because so much of medical practice is directed or heavily influenced by government payment systems and regulations, any system would have to emphasize freeing providers and patients to experiment with new models of care, payment, and administrative practice. Experimentation should be locally driven rather than centrally planned, and, whenever possible, should not require obtaining advance permission, which tends to give competitors an opening to block competition. It would also need to free state and local governments to experiment with competing public health policies.

Would a system based on these principles be perfect? No, not even close. But it would provide more effective help to the truly needy while allowing and encouraging the sort of market-driven innovations that are desperately needed in the health care sector. Perfect, anyway, is not possible. It is unfortunate but true that people slip through the cracks in universal systems all over the first world: Cancer patients fight for access to treatments in the United Kingdom's politically driven socialized health care system; Canadians in excruciating but not-quite-life-threatening pain wait months for treatment and cost the country billions in productivity losses. Coverage, as we have also seen in the U.S., is not always a guarantee of care. It is not necessary to support government-driven universal coverage in order to support finding more sustainable and effective ways to care for those who need it most.

The Mercatus Center's Tyler Cowen laid out some suggested principles for supporters of free-market health care here. Reason's Nick Gillespie and Veronique de Rugy make the case against the current entitlement system in the cover story of Reason's August/September print edition, which is currently on newsstands. So subscribe now!

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  1. Let’s be charitable and assume that liberals actually believe that this is the only possible alternative to universal coverage orchestrated by the government.

    why is that charitable? To the contrary, it speaks to heart of liberal thought – if the govt is not doing it, it is either not worth doing or not being done “correctly.”

    1. Socialism: Confusing Society and State since 1850.

      1. Thomas Paine wrote about the confusion of society and state in 1776.

    2. It’s charitable because an alternative idea is that they’re being disingenuous.

  2. Suderman is on an alt+text roll.

    1. +1

  3. The “old people and children will die in the streets if you don’t have government health care” meme is so fucking established now, it doesn’t matter. The fact that there was no government health care until this century, yet somehow people survived, is irrelevant.

    People are stupid. Especially stupid people. And NutraSweet.

    1. But Episiarch if we had charity hospitals like the old days they would be run by churches. And you know what they would do? Not provide free birth control to their employees. Is that what you want? Monster

    2. The standard retort I get to that is, “Sure, but life expectancies were much, much lower. We only have our health as good as we have it now due to gov’t intervention.”

      1. People didn’t even know what a toilet was until Uncle Sam showed them.

    3. Without government assistance, Sugarfree would have killed himself with candy bars by now.

      1. This is true. A federal agent literally knocks them out of my hands when I try to eat one.

        1. I’m only surprised you haven’t managed to sneak around them yet, what with all the austere budget cutz.

          1. SF is much too precious of a national resource for budget cuts to affect his protection. They wouldn’t cut security guards at the Statue of Liberty, would they?

            1. But I’ve heard we’re going to have to fire all the teachers and fireman and police officers and military!

    4. Technically it was last century when Government health care started because we are 12 years into a new century.

      That said something that pretty much everyone forgets about is that there was no health care AT ALL, at least not in the modern sense that it actually worked as little as 150 years ago.

      Basically our grandparents grandparents grew up in a world where “medicine” had not changed significantly since the time of ancient Greece and the treatments used were as often as not more dangerous than the diseases/injuries they were trying to fix.

      Somehow this service which has existed for such a short term has gone from non existant to an a catastrophy if you don’t get it for free.

  4. It is possible to oppose both the current fiscally rotten entitlement system and expansions of that system ? like the 2010 health care overhaul now awaiting a Supreme Court decision ? and still favor a basic safety net for the truly needy.

    (puts ear to copy of Human Action) Mises says you’re all a bunch of socialists.

  5. “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
    ? Fr?d?ric Bastiat, The Law

  6. “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
    – Fr?d?ric Bastiat, The Law

  7. “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
    – Frederic Bastiat, The Law

  8. “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
    – Frederic Bastiat, The Law

  9. “Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion.”

    1. “Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
      – Frederic Bastiat, The Law

    2. “Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality.”

      1. “Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”

      2. FUCK YOU SQUIRRELS

        http://www.goodreads.com/autho…..ic_Bastiat

  10. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”

  11. And let’s also state the opposite truth as well-

    You can’t be for “Universal HealthCare” and not also rationing of said care. Meaning, if you want healthcare to be a “Human Right” then you must be willing to force other people such as Doctors and Nurses to provide said “human rights”.

    1. But rationing doesn’t happen. That’s just a right-wing meme to fool the electorate into voting rethuglican.

      /any number of our resident leftist

    2. It’s only rationing when evil capitalist insurance corporations deny care.

      When benevolent government bureaucrats deny care it is because they love you.

    3. Arguably, if the mandate is upheld, Congress could force people to become doctors under the commerce clause.

      After all, they would only be regulating the activity of not being a doctor, which of course has huge effect on the interstate healthcare market in the aggregate.

  12. “Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”

  13. “Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”

  14. I doubt that the Left will accept any plan that isn’t either “single-payer” or a stepping-stone to “single-payer” (and Obamacare is the latter).

    It’s funny that they prefer the cutesy euphemism “single-payer” to try to conceal that they mean “completely run by the government”.

    1. “Single Payer” as if it is funded and run by some shadowy billionaire. What a fucking newspeak term that is.

      1. John|6.27.12 @ 12:47PM|#
        “”Single Payer” as if it is funded and run by some shadowy billionaire.”

        Hey, good ol’ Warren figures he doesn’t pay enough taxes. Maybe he’ll volunteer to cover everybody’s medical care. Presto; ‘single payer’!

      2. The public hated “socialized medicine” so they had to call it something else to hide their intent. Every once in a while some asshole at Slate or something will write a “What’s wrong with calling it ‘Socialized Medicine’?” article.

      3. The larger crime is that it makes it sound as though the government’s only involvement is showing up to pay for people’s tabs like some red-white-and-blue wearing Santa Claus.

        It omits the part where the government uses its self-imposed “obligation” to pay for medical care to involve itself in determine what care people may get and when.

        More disturbingly for the healthy, it omits the part where the government uses its self-imposed “obligation” to pay for medical care to involve itself in any choice that may potentially affect your consumption of medical care. What you eat, drink, smoke, how and how often you exercise, your sexual habits, your recreational activities: all become the business of the technocrats in Washington.

        The only honest name for the system progressives want is Totalitarian Care.

        1. Good name. And remember liberals want the government out of your bedroom and its hands off your body provided your only concerns are sodomy and getting an abortion.

          1. I don’t remember who said it here first, but it went a little something like “progressives think the government should have the power to decide what goes into your mouth — unless it’s a dick.”

            1. That would be our Dark Crown Prince of the Iron Laws, RC Dean (IIRC).

    2. “Single payer” sounds good until you realize that they actually seriously mean single payer.

      As in “nobody EXCEPT the government is allowed to pay ofr health care”.

      Which of course HAS to be the case in a government run system. If you allow people to pay privately outside the system the private market will take over, richer people will pay for private treatment outside the system, and it will drain resources away from the government run system until onyl the shittiest doctors are left and there’s a gargantuan waiting list. You have to ban private payment or single-payer breaks down.

      It kinda reminds me of a joke my dad used to tell.
      He would say “Come the revolution, everyone will eat strawberries and ice cream!” and I would say “But I don’t like srawberries and ice cream.” and he would reply “Come the revolution, EVERYONE will eat strawberries and ice cream!”.

      1. I heard a similar joke. The punch line was:

        When the revolution comes, you’ll do as you’re bloody well told!

      2. But there are no true single payer systems in the world – not even the UK is single payer – they are adopting US corporate care and are seeing their costs shoot up with copays and other fees. But the hospitals are modern and nice with fresh flowers. And profits. Of course, in the poorer regions, things are pretty much the same – no profit in selling health care to the working poor.

    3. Actually this is not strictly true. You can have a single payer system in which all health care is provided by government employees and the government owns all the Hospitals and employs all the Doctors, or you can have a single payer system where private corporations and individuals provide the care and bill the government for it.

      Each system has advantages and disadvantages over the other and either would in some ways be an improvement over the partially socialized system we have now (although all 3 suck compared to an actual free market in health care)where government pays for around 70% of all health care in one way or another but the two systems are not the same thing.

      1. Great, a choice between a government run monopoly, or a government run monopsony.

        You do realize both those options suck, right?

  15. All these suggestions involve shifting power away from the government. Why would your average, garden variety degenerate politician want to do that? To save money? For the good of the country? Don’t make me laugh.

  16. But what about Preventative Care??

    I mean, if you don’t give Preventative Care? for free, then poor people will be too stupid to get it on their own!

    And what about Wellness??

    If you only want catastrophic coverage, then you oppose Wellness?!

    Why do you oppose Preventative Care? and Wellness?, you heartless libertarian bastards!?!

    1. Preventive care saves so much money. Insurance companies generally don’t pay for such because they are greedy and blind I guess. It couldn’t be that preventive care doesn’t save money.

      1. Doctors love preventative care. Couple hundred buck for a fifteen minute look-over? What’s not to love?

        1. I am sure they do.

      2. I wonder what kinds of regulations exist for doc-in-a-boxes and if there are just too many barriers to entry to start them up? It seems to me those are the perfect solution to “preventative care”.

        1. And how long before AI gets good enough that you can go to a website, feed in your symptoms, maybe use an Iphone app that acts like a tricorder and get diagnosed? Not treated, but diagnosed so that the people who run to the doctor every time they have a runny nose no longer do that. The MDs will have a stroke preventing that from happening.

          1. Probably around the same time climate scientists come up with models that accurately predict the future.

            1. I don’t think we are that far away from that. I think we are ten years maybe from lawyers being largely obsolete. If a computer can answer legal questions, why couldn’t one answer medical questions?

              1. If a computer can answer legal questions, why couldn’t one answer medical questions?

                Because laws are comparatively simple. They are written by man and a computer can use algorithms to decide what the correct answer should be; very similar to tax software. The human body on the other hand is very complex, with some diseases having similar symptoms.

                1. The human body on the other hand is very complex, with some diseases having similar symptoms.

                  Additionally you have to rely upon the patient telling the truth.
                  For example the patient can give symptoms, but omit that they drink a twelve pack every night, and get the wrong diagnosis.

                  1. ^This. A very large part of the “art of medicine” is the critical gleaning of the pertinent and useful information from the patient – a surprisingly complex and difficult task. Don’t scoff until you’ve tried to do it. And the various angles and approaches on getting that information are as vast as the number of patients that exist. Computers will never be able to do that.

                  2. Actually, algorithmic health care is already being done. When I was in teh Amry, the medics ahd the big book o’ flowcharts they would run through before you got to see the PA. It didn’t conclusively nail down diagnosis, but it eliminated a bunch of stuff.

                    1. That’s great if “eliminating a bunch of stuff” is to be the paradigm.

                  3. For example the patient can give symptoms, but omit that they drink a twelve pack every night, and get the wrong diagnosis.

                    Well, that explains why I got a pregnancy test when I told the doc I was sick to my stomach and hella moody every morning.

                2. Sure it is harder. But it is not impossible.

                  1. Sure it is harder. But it is not impossible.

                    Computer are limited by the intelligence of those who program them.

          2. So it would be the anti WebMD? Which, as best I can tell is only useful for driving hypochondriacs into panic attacks.

            1. I stopped using that stupid thing when it said I had cholera.

              1. If you weren’t on the Oregon Trail in a covered wagon, you didn’t have cholera.

                1. and if you were, you had dysentery

              2. See, I really started using it when it told me I had cholera. Of course, I treat cholera with opium, so there’s that.

            2. What?! It can do that??

            3. Hahaha, you should look at pregnancy websites/forums where pregnant women try to diagnose other pregnant women.

              1. My God was a sea of hormones, moodiness and insanity those websites must be.

          3. I was listening to Nikki Sixx’s morning program on the way to work Monday and his cohost was talking about going to some laser hair removal place and instead of the nurse physically being there, they handed her an ipad and she skyped what she wanted with the nurse. That might not piss off MDs so much but still utilizes technology in an inventive way that could possibly lower costs.

            1. That technology is great too. It means doctors can see more patients. MDs are not going to be happy about that.

              1. Actually I think MDs would rather see more patients. If technology can cut down on their overhead, that would make them happy as well. What might make MDs upset is now instead of seeing a doctor in my hometown, I can e-visit a New Delhi MD.

          4. What, like Web MD? Ok, there’s no digital medical evidence processing…

        2. I wonder what kinds of regulations exist for doc-in-a-boxes

          Clinics are almost unregulated (not to be confused with the people who work in the clinics).

          The challenge with doc-in-a-box is that they are mostly staffed with midlevels, who have to be supervised (per regulation) by a physician.

    2. Because poor people are only good for digging out blood diamonds for our diamond encrusted monocles?

      1. A diamond really doesn’t shine unless it is mined with the blood of the workers.

        1. And polished with their tears.

          1. Gadzooks, man, you don’t use the tears of the workers to polish your blood diamond monocle!

            That’s what the tears of their children are for.

            1. The children are workers, too, RC.

    3. Preventative care is running (expensive) tests on asymptomatic people.

      Does that sound like a recipe for thrift?

      1. Like I said above, if preventative care really saved money, insurance companies would be paying their customers to get it.

        1. Insurance companies do pay their customers–in the form of credits or lower premiums–when they take verifiable preventative measures. Believe it or not, insurance companies would rather pay a small claim on a treatable (or preventable) illness than a gigantic one on a catastrophic illness.

          1. Of course they do in cases where it actually saves money. But that set doesn’t include everything or even a majority of things that is sold as “money saving preventative care”.

            1. What we want is TARGETED preventive care, rather than the across-the-board preventive care the government wants us to have. The issue is how to do the targeting efficiently.

          2. I can think of two preventative procedures that insurance companies will pay extra for:

            Colonoscopies, and mammograms. Everything else is presumptively not cost-effective. And there’s a big argument about those.

  17. How about we get rid of the FDA. I bet that would reduce the cost of drugs right there.

  18. Get rid of the FDA and legalize drugs and tax them to fund medicare. Those to things alone might solve the problem.

    1. Actually when you add up what the government currently spends on providing health care it is likely that we could spend the same money and provide government funded health savings accounts on an income adjusted sliding scale to everyone with sufficient money in each persons account that they could reasonably afford to purchase health care on their own (either by purchasing insurance or just paying out of pocket).

      I don’t have all the numbers off the top of my head by across all levels of government we spend something like 1.5 trillion a year providing health care. With ~180 million households in the US that is an average of around $8000 per year per household. Rich people and smaller households get less and poor and larger households get more and it is governed pretty much like Health Spending Accounts are today (plus you can still make your individual deposits to your HSA) and realistically everyone could buy private insurance or self insure with that money.

  19. I’d add the clinic model would be a welcome addition to ensure low-income people can actually access routine and minor care. open before and after work, no appointment needed.

    1. I like the fact that you can go to the supermarket and get care as well. In store clinics are great.

      1. I think they’re great. and accessible. for the all bitching about inappropriate ER use, nobody seems to notice that it’s not only only because it has to treat you, it’s because it’s open. you don’t have to clock out, waste a couple of hours waiting for your internist to see you, and then go to pharmacy somewhere else.

    2. The thing is, my town has an excellent set of minor emergency outpatient clinics on the bus routes. I use them myself on the one occasion a year when I need to see a doctor. Its cheap, convenient, and the quality of care is pretty good. Of course, I pay for my own health insurance, so I’m motivated to (a)not make unnecessary doctors visits and (b)find the cheapest option.

      I think I’ve seen my GP twice in five years. One was the introductory appointment and the other was a followup to that after getting some labwork.

  20. This seems like a good time to present my idea for a less bad system of government-subsidized medical care for poor people: How about a system where the government pays a percentage of the costs of medical care for poor people rather than providing the typical copay + deductible-type insurance? It seems like this would make medical care more affordable for poor people while still giving them incentives to shop around, thereby putting pressure on providers to keep prices low. The percentage could be based on income in a way that doesn’t give people an incentive to make less money just so they can keep their free coverage.

    Keep in mind this idea comes from a man with a very limited understanding of the U.S. medical system, so go easy on me if I’m missing something.

  21. If you’re talking about helping the truly needy, the sort of people that can’t feed themselves without assistance, then you pretty much have to assume others will need to provide for their basic, routine care if they’re going to have any. Others may or not be the state, of course.

    Facilitating access to catastrophic insurance coverage is more important to people that actually some assets to lose to massive health costs. It’s pretty irrelevant if you’re broke and homeless.

    1. The catastrophic coverage wouldn’t be to protect the poor against the loss of their nonexistent assets.

      It would be there to protect providers against being bankrupted by providing care to the poor.

  22. When you look at Saskatchewan the birthplace of universal medicare, you see the death of charity. In the early 20th century hospitals were run by churches, or charities like the Red Cross, or as a business. Union hospitals were run by the community and municipal governments. When Saskatchewan introduced universal medicare, the first lose was co-op clincs that paid doctors a wage; doctors with political influence were able to use the new system to kill co-ops. In the 1990’s the NDP responded to growing costs by amalgamating health districts, so hospitals weren’t run localy, with the support of municipalities, but by a new level of government with no accountability. These health districts are less charitable and more out of touch with the communities they serve.

    1. Wasn’t the Canadian system expressly designed such that if you wanted to go private, you had to go into exile?

      1. Until recently it was illegal to pay for your own health care in Canada.

        1. Which is another point to harp on: Liberals like to suggest that government rationing and insurance rationing are the same. But the worst an insurance company can do to you is refuse to pay for your care. You can still start a kickstarter to raise money for an operation, you can still take out a loan, you can still scrape together the cash you need. There’s no guarantee you can get that care, but there’s a good chance. When the government denies you in a true single payer system (i.e., where supplemental insurance and cash for care are banned), you’re just straight up fucked.

        2. Yes, As I mentioned above, single payer actually means just that – ONLY the government is allowed to pay for health care. It’s an abolition of the private health care market.

          Since the Canadian Supreme Court ruled otherwise, the Canadian system is likely to start breaking down as patients and doctors start opting out of the government run system and engaging in a private payments. That will eventually lead to a two-tiered system with wealthier people pay for private healthcare and poor people relying on the increasingly cash-strapped and back-logged state-run system.

      2. When universal medicare was first introduced, it was promised it would not be an NHS system but a voluntary insurance. Since government insurance was free, costs went out of control, so the government responded with a single payer system.

  23. Universal health care is not about helping the poor. It’s about power. Currently, citizens have just enough power to eat past their ideal waistlines, to get knocked up when they can’t handle kids, to smoke near where their betters would rather not smell it.

    And their betters intend to take that power away in the name of compassion and charity.

    1. ^THIS

  24. It’s the “safety net” concept that throws the discussion off. For too many, the safety net means an entitlement to stay wherever one is on the socio-economic ladder. This means that someone struggling to stay middle class shouldn’t have to spend their meager savings on a medical emergency, and someone rich shouldn’t have to join the middle class just because someone in the family got cancer. The fact that both of these scenarios detract from being charitable to the actual poor is lost in the scrum.

    1. That is a good point. And it also means for many that the poorest person gets the same care as the richest, which is of course stupidly naive and unrealistic.

  25. I once tried shopping around for a non-emergency doctor’s visit (rash). When I asked how much it would cost, they asked whether I had insurance. When I told them I did, but wanted to pay cash, they acted irritated and said they couldn’t give me a quote because they didn’t know how much it would end up costing for all the services I may need. I ended up just going on WebMD and figuring out what was wrong. However, the medication needed for the rash was prescription only, and I would have to go to the doctor to get it. Fortunately, I checked out the active ingredients and found a non-prescription product that would work. Total cost: $4.

    The system is set up so that people are responsible for as little as possible, whether it’s payment, diagnosis, or treatment. I look at that “check with your doctor before starting an exercise program” as a legal disclaimer, but there are actually people that do this. I know runners who barely do 20 miles/week, yet visit multiple sports P.A.’s the minute their soleus gets a little sore because “your body’s trying to tell you something”. It a system that encourages cradling for low severity ailments, even with the incredible online resources we now have for self-diagnosis and treatment.

    1. I have no insurance and pay for all my medical services with my own money, and I totally agree with everything you said. Prices are freaking ridiculous, but most people have no idea of that because they pay a small flat copay and have no reason to care about the actual cost of the services they get.

      1. The only time I’ve successfully paid with cash for a doctor’s visit is at an urgent care clinic. I pay cash for dental services, and they seem to have less of a problem. Have you found that doctors will take less to avoid the insurance hassle? I’ve heard of that happening.

        1. I’m not sure, because until now I just accepted whatever they decided to bill me and never really pressed them on their prices. However, after my last bill for about $250 for a 15-minute follow-up visit about a medication, I’ll definitely be shopping around.

    2. I had an uninsured period of my life. I somehow got a doctor to see me for an ear infection. He told me he could write a prescription for something or other. When i asked about the cost , he said “No insurance? forget this prescritpion. A few drops of white vinegar twice a day does the same thing.”

  26. Any thing other than a pure cash subsidy is merely a power grab over the poor.

    If we can’t sleep at night knowing that some poor person can’t afford something we thing they ought to have, give them some cash. Anything where govt gets into the provision is a scam.

  27. The article fairly illustrates the difference between a social “safety net” and a “welfare state.”

    People tend to think they are the same, or that the latter is just a bigger version of the former. But they are not the same at all. One provides means-tested need-based help. The other relies on universal entitlements for rich, middle, and poor alike.

    You can have a strong safety net without a big welfare state. You can have a big welfare state with a weak safety net — which happens to be America’s situation.

    What drives the welfare-state model is the politics of resentment directed at means-tested need-based programs. By putting things like Medicare, Social Security and Obamacare on a “universal” footing, the programs are insulated against the “welfare-queen” pejoratives that sabotaged programs like AFDC, an that are poised to sabotage food stamps.

    If the Libertarians really want the type of reforms that that this article advocates, they can get them, but first they are going to have to ditch their reflexive, Tourrettes-like outbursts about “moocher” and “culture of poverty” to which they succumb every time they hear about a poor person getting some government benefit.

    1. If the Libertarians really want the type of reforms that that this article advocates, they can get them, but first they are going to have to ditch their reflexive, Tourrettes-like outbursts about “moocher” and “culture of poverty” to which they succumb every time they hear about a poor person getting some government benefit.

      How can we get them? Even if every libertarian in the country supported and pushed for these measures, it’s the Democrats and the Republicans–very few of whom are libertarian–who hold the power, and how many of them are pushing for reforms like these? Doesn’t seem like many.

      1. Well the “fusionism” with the GOP got you the deficit-financed tax cuts you thirsted for. Maybe you can work out another “fusionist” strategy.

        1. deficit-financed tax cuts

          Does not compute. The money I kept was not funded by government borrowing.

          1. You have your accounting books; I have mine.

            Anyway, either you achieve some further “fusionism,” or you don’t. It ain’t my problem.

            1. You have your accounting books; I have mine.

              You may want to recheck yours.

              1. And maybe you should check yours at least once.

            2. Help me out here, RAL. A scenario:

              My tax bill without a tax cut is $1000. My tax bill with a tax cut is $800. I keep $200 of my very own dollars.

              How is that $200, still safe and snug in my offshore account, funded by government borrowing?

              Analogy: I get a $200 discount on a monocle. The monocle sweatshop has a line of credit. Did that line of credit finance my discount?

              1. To use your hypothetical, the situation is that you are consuming $1,000 worth of government (not directly, but as a member of a self-governing people) while paying $800 in taxes and leaving $200 for some future taxpayer — perhaps yet unborn — as debt.

                If you had cut spending $200 along with cutting taxes $200, then it would not be a deficit-financed tax cut.

                That’s not what America did. (In fact, America increased government spending — viz., consumed more government — even while it cut taxes.)

                And please, spare me the ‘dynamic scoring.’ Real or not, it has no relevance to the specific point under discussion.

                1. How is America self-governing? The only directly elected branch of government happens to be the weakest, and even there, manipulation of voting districts and partisanship keep people from getting truly representative legislators.

                  1. If it’s not self-governing, what is it? A dictatorship?

                2. the situation is that you are consuming $1,000 worth of government

                  You lost me already. But, leaving that aside:

                  Why are you saying that the tax cut was deficit financed? Why isn’t it the spending that was deficit financed?

                  $200 was deficit financed, after all. Looks to me like what the government financed with its debt was what the government spent, not what the government didn’t spend (namely, the $200 it couldn’t spend because it was still in my bank account).

                  1. Why are you saying that the tax cut was deficit financed?

                    **************

                    Because we are measuring from the status quo ante. If the example involved raising spending $200 and keeping the tax exactly the same, it would be the spending increase that is “deficit financed” (as measured from the status quo ante).

                3. “To use your hypothetical, the situation is that you are consuming $1,000 worth of government (not directly, but as a member of a self-governing people)”

                  HHAHAHHAHA oh god for a minute i thought you might have been a serious commenter.

          2. The money you kept was a gift.

            That which is not taken is given.

            1. That which is not paid for now is borrowed, and paid for later.

              Tax cuts without corresponding spending cuts are, by definition, “deficit-financed.”

              Your argument amounts to saying “it’s my money so it’s fair to make a future taxpayer pay for what we are getting today.”

              1. Your argument amounts to saying “it’s my money so it’s fair to make a future taxpayer pay for what we are getting today.”

                Who’s “we”?

                You’re the one essentially saying that moneys not taken from me are an unfair gift from the state.

                The inefficient and corrupt spending practices of the state should not be encouraged by taking more money from the financiers of their schemes: the taxpayers.

                1. It’s a more sophisticated version of ‘tax cuts are subsidies!’, that’s all. The logic and intent is the same: to obfuscate the terms of the debate and convince people that raising taxes is the only ‘practical’ solution.

                2. Pay-as-you-go government does not “encourage” wasteful spending. Far from it, it sticks todays taxpayers and voters with the full consequences of their choices.

                  It is deficit financing that encourages overspending relative to revenues.

                  If the voting public had to pay today for everything they chose to spend money on today, they would vote to spend less in order to be taxed less.

                  1. Registration At Last!|6.27.12 @ 3:54PM|#
                    “It is deficit financing that encourages overspending relative to revenues.”

                    Uh, the deficits only exist *because* of expenditures.
                    Cut spending; presto.

                    1. Cut spending exactly as much as the deficit and keep taxes exactly the same, “presto.”

                    2. i would take that deal. Then we can start talking about cutting spending more and reducing taxes commensurately.

        2. I don’t want tax cuts, I want spending cuts. Total government spending is the true tax on society.

    2. The whole concept of welfare queens suggests a flaw in means-testing or need-basing, not an aversion to the concept.

      But regardless, a welfare state has the benefit (as opposed to a safety net) of not rewarding failure or punishing success. The problem with need-based programs is that they act as a regressive tax on the working poor (those earning in the range where benefits start to be phased out due to need/means).

      If we’re going to have any sort of safety net or welfare, it should be a simple per-capita payout combined with a flat tax (with no deductions, personal or otherwise). Tax rates should be set such that the median taxpayer is breaking even.

      1. The problem with need-based programs is that they act as a regressive tax on the working poor (those earning in the range where benefits start to be phased out due to need/means).

        You can address that by having the benefits phase out gradually so that every additional dollar earned still results in a net gain after deducting the amount of lost benefits.

        1. That’s exactly what I was getting at with my suggestion about medical coverage for poor people above. If you do it right, increased income will heavily outweigh the corresponding decreased benefits, so the welfare/safety net in question wouldn’t result in an incentive to earn/work less.

      2. Yeah, I think Charles Murray dealt with this in one of his more overlooked books (“In Our Hands”).

        As the GOP relentlessly demands more piss and fingerprints from welfare recipients, liberals might start to see this model as a better alternative.

  28. If we’d get something approaching a free market and more limited government, the increased prosperity would do wonders for all of us. Even if we still had a significant population of poor people, which I’m sure we would, relatively speaking, we could at least afford charities then.

  29. How about health insurance EQUITY?

    Say for every year you pay in you are covered for one month if you stop paying. That provides coverage for out-of-work illness and more importantly provides an incentive for the young and healthy to buy coverage early to build equity, without a forced mandate.

  30. A lot of preventative care saves vast amounts of money. What about vaccinations, PAP smears, colonoscopies and prenatal testing and nutrtion programs. Yes, many unneccesary medical tests are ordered, but don’t condemn prohylactic care that not only saves money, but saves lives and improves the quality of lives.

  31. Check out this new voter education website:

    http://www.VoteFacts.org

  32. What I have to say regarding this is not going to win me any popularity contests with those of you who share my disappointment in today’s SCOTUS ruling – but strong medicine tastes unpleasant… http://blastedfools.wordpress……-for-this/

  33. “It would emphasize catastrophic coverage instead of subsidizing routine care.”

    While there is no evidence in the US that these kinds of policies reduce costs – I’m paying $10,000 a year for $5000 deductible up from $4000 annually in 2003 with no claims paid by the insurer in a decade. The only years the rate increases slowed or reversed has been Obamacare took effect.

    But no matter, Obamacare includes high deductible insurance policies, with a proviso, over time, these policies must not result in significant unpaid doctor and hospital bills because patients can’t afford the care they must buy out of pocket.

    As Obama said, if you have a suggestion, tell us and we’ll include it. That is the reason the bill was 2700 pages. Malpractice? Ok, States rights prohibits Congress from doing it for the States, but funds for studying malpractice changes are provided to the States, although the States have already done malpractice reform with no cost saving on health care.

    The law even gives each State the authority to totally define its own system with Federal funding equal to the standard way provided to subsidize the new system that covers everyone in the State – this is what Vermont is working on. So, Peter, pick out a conservative/libertarian State and convince them to implement your plan.

  34. ” Canadians in excruciating but not-quite-life-threatening pain wait months for treatment and cost the country billions in productivity losses.”

    Yet, while the USA spends twice per capita for health care that Canada does, hundreds of Americans suffer pain and lost work and pay because their medical problems are far too expensive for them to afford. Most working poor single adults are not able to get Medicaid no matter how little they earn, until they end up in a hospital or nursing home.

    So, you are arguing that the US offers better care because people paying in taxes and in wages through their employer benefits about three to four times what they would in Canada getting good care while the janitor who cleans up at night gets no care until forced to the ER or into the hospital provides a superior health care to Canada??

    That is like saying Canadians suffer because five Canadians live in houses heated to 68 degrees at a monthly cost of $200, while four Americans live in houses heated to 72 at a cost of $500 and one lives in a house with no heat at 25 degrees because he can’t afford to pay even a $1.

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