Medicaid

Paul Krugman's Medicaid Myths

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If Mitt Romney wins the presidential election next month, writes New York Times columnist Paul Krugman, "Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts." Which is apparently how Krugman prefers to describe increasing federal spending on the program by more than $55 billion over the next decade, as the plan put forth by Romney's running mate, Paul Ryan, calls for. The Ryan plan would decrease federal Medicaid spending as a percentage of the total economy, but the total federal contribution would still go up over the next decade.

Krugman would have readers believe that these unthinkably savage cuts would have catastrophic results. Medicaid is "quite literally a lifesaver," he says. "States that expand Medicaid coverage show striking drops in mortality." Which is apparently how he prefers to describe a recent New England Journal of Medicine (NEJM) study showing that after Medicaid was expanded in three states, two (Arizona and New York) showed reductions in mortality compared to surrounding states, but one (Maine) showed an increase in mortality. And only New York showed a statistically significant state wide result.

But even that result isn't clear proof. That's because New York's post-expansion reduction in mortality was based on a comparison with Pennsylvania, which as Forbes blogger (and outside Romney health policy adviser) Avik Roy has noted, does not provide a great point of comparison thanks to its substantially larger immigrant population. So the study of three states versus neighbors showed one relative increase in state mortality, two relative declines, and, of the thre, just a single statistically significant showing in a state with a problematic control. This is not exactly unambiguous evidence, especially given Medicaid's long record of poor performance when it comes to improving health outcomes.

But since the evidence is somewhat ambiguous, let's stipulate for a moment that Medicaid does improve mortality. That's still not necessarily an argument for doubling federal spending on it and massively increasing enrollment, as called for by ObamaCare. Even if Medicaid did improve mortality, the important questions would be: By how much? And: Are there more effective alternatives? The Medicaid study's results suggest that, at best, the cost per single averted death is roughly $1 million. The NEJM study's data, meanwhile, suggests that Medicaid has the largest effect on the poorest populations, but ObamaCare's Medicaid expansion is focused on individuals near or above the poverty line. 

Back in July, when the NEJM study was first published to a round of self-congratulation from advocates of expanding Medicaid, Cato Institute Health Policy Director Michael Cannon put it bluntly: "Absent evidence that Medicaid saves the most lives per dollar spent, expanding Medicaid does not show how much politicians care about saving lives. It shows how little they care about saving lives, because they are willing to forgo additional reductions in mortality for the sake of…whatever else expanding Medicaid gives them." Krugman declares that "by any reasonable standard, this is a program that should be expanded, not slashed." Apparently it is unreasonable to consider the question of whether doing anything else might save more lives. 

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  1. “‘If Mitt Romney wins the presidential election next month…”Medicaid ? which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform ? will face savage cuts.”

    If the left is going to keep accusing Romney of being a libertarian anyway, then maybe he should just go ahead and become one.

    1. He knows we’d never let a Mormon join.

  2. “No, Mr. Bond, I expect you to die. After a long and quite expensive struggle with the bureacracy of trying to get your medication.”

  3. We are seeing the greatest Krugabi stimulus in history right now in the NE. Broken windows and destroyed homes for everyone. The boom is coming!!

    1. Hmmm. I must have missed last year’s post hurricane boom.

      1. The Rethuglican KKKongress stopped it – they didn’t want the credit to go to the Lightworker.

  4. Krugman has gone from liberal economist to Democrat shill in a short period of time.

    1. Democrat shill is his full time job….the “economist” thing is more of a hobby.

      1. That must be why he’s not very good at it.

        1. Not good at what…..? I find him to be such a blatantly ham fisted democratic shill that he convinces no one not already T o n y like in outlook. That he is a shitty economist….well that’s old news!

  5. You’re ignoring all the things medicaid does that aren’t directly related to saving lives. Medicaid spending is also about improving quality of life.

    Medicaid pays for:
    Therapy for kids with autism and other learning disabilities.
    Dental work.
    Nursing home care.
    As well as any non-lifesaving procedures and treatments you’d get at the doctor.

    1. So, you’re disagreeing with Krugman then?

      Is that right?

      1. No, Krugman makes the same point by saying “For those who get coverage through the program, Medicaid is a much-needed form of financial aid.”
        Like for nursing home care, special education services, dentistry, etc…

        1. If you want to argue for those programs, maybe you should do so outside the context of Medicaid.

          The fact that Medicaid has grown beyond offering crucial medical assistance to people who need it isn’t a good reason to let it keep growing.

          You know, very few people actually need braces. If you want to hold our economy hostage to justify giving special treatment to kids with learning disabilities–by conflating their needs with those of people who would die without heart medication?

          Then I’m gonna say you need to break out those nonessential benefits from the rest and get them approved within a separate program. You can’t just conflate people with learning disabilities with people who need heart medication–and then call me a selfish bastard because someone doesn’t want to pay for nonessential services through Medicaid.

          1. Your critisism should be aimed squarely at Suderman, who conflates these services with life-saving medical care throughout his column.

            It’s my fault he doesn’t know what medicaid covers?

            1. Considering Suderman’s article is aimed squarely at the claim that Medicaid decreases mortality, this comment is flat-out untrue. Point out to me where he claims braces decrease mortality?

              1. “The Medicaid study’s results suggest that, at best, the cost per single averted death is roughly $1 million. ”

                Suderman is lumping together the lifesaving and and non-lifesaving components of the program in this calculation.

                1. Actually, Suderman’s going off of the figure provided by the Accidental Economist, which you would know if you bothered to read any of the linked information. So they’re the one’s lumping in data points together in the first place. Suderman’s just responding to their assertion.

                  1. He’s not responding to it, he’s repeating it in furtherance of his argument. Meaning it’s his advocacy. Meaning he conflated the many elements of the program.

                2. No, Suderman is pointing out that if you divide the cost of Medicaid by the number of lives saved by Medicaid, you get a nice round $1MM.

                  Its the inclusion of all the “nice to haves” that runs up the bill per life saved.

                  If you want the amount Medicaid spends on the people whose lives are saved, well, that’s a different number, which is probably impossible to determine.

                  1. Right, but large portions of the cost of Medicaid aren’t designed to save lives in the first place. So including them in the lives saved/dollars calculation is misleading.

        2. For those who get coverage through the program

          For who exactly? 100% of those covered? 75%? 50%?

          I would posit that there’s always undeniably some benefit to someone that can be classified as “much-needed”, even to a heartless bastard like myself. But these blanket statements are so disengenuous that they completely undermine Krugabe’s argument.

          Pundits love to talk in absolutes. On the pro-government side, 100% of every government program is “much-needed”.

          Bullshit. Everyone knows that’s bullshit. And that’s why anyone who decries cuts as “draconian” or “abominable” or in some other hyperbolic apocalyptic term is completely full of shit. Because it means they are wholly unwilling to engage in a cost/benefit analysis.

          1. Middle class parents decide the benefits of braces don’t outweigh the financial cost–every day!

            But we’re all selfish bastards if we don’t want to pay for other people’s kids?

            It’s even worse than that. If you say you’re not sure you need to pay for other people’s kid’s braces, then you want take grandma’s heart medication away.

            None of it adds up. It’s all partisan bullshit.

    2. For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver.

      Bring it up with Krugman, dipshit. He has a comments section.

      1. Suderman agrees that Medicaid saves lives. He suggests other government programs may save lives more economically.

        1. Sorry joe, you must be *this* tall to comment here. You’ll be welcome at the Time Bandits fan club though, since you just barely make it.

        2. Did you even read the post:

          But since the evidence is somewhat ambiguous, let’s stipulate for a moment that Medicaid does improve mortality.

  6. let’s stipulate for a moment that Medicaid does improve mortality.

    I would be fascinated to know the definition of “improved mortality”.

    Because if keeping somebody alive for a few more weeks at great expense is the benchmark, we need a new and better benchmark.

    1. Why do you hate vegetables?

  7. I’ve got a question for all the pro-life libertarians.

    Why is it OK for the government to infringe on a woman’s personal liberty in order to protect the life of her child by banning abortion, but it is an unjust affront to personal liberty for the government to protect the life of her child through taxes that pay for its health care (medicaid)?

    1. Because abortions and state raised children are the only two choices.

      1. What’s the alternative? Currently private charity does not meet the demand for children’s health insurance.

        1. Thank you for providing a wonderful example of how government crowds out the private sector!

          Very well done!

          1. That changes nothing about the situation we face today.

            If your answer to my question is “well, if we didn’t have medicaid then there’d magically be enough charity so that no kid would ever go without health care”, I’d like to see some evidence for your claim.

            1. No, that is not my answer.

              The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it.
              The first lesson of politics is to disregard the first lesson of economics.
              -T Sowell

              Private charity will never fix everything magically, and neither will government.

              Which leaves a choice between charity or coercion.

              For any moral person (which you obviously are not) the answer is clear.

            2. In another post you claimed that we are no longer torturing people overseas. I’d like to see some evidence for your claim.

              1. That was for joe.

                1. Are you finished?

                  That was for sage.

                  1. What a porker!

    2. Killing children is not a freedom libertarians like.

      1. Libertarians are apparently OK with children dying of preventable medical conditions.

        1. How many Africans have you murdered today?

        2. “Libertarians are apparently OK with children dying of preventable medical conditions.”

          How many children have died for lack of braces or becasue of learning disabilities?

          You must have switched topics.

          1. Medicaid also covers prenatal care and children’s health insurance.

            1. Yeah, but you seem to be conflating that with all the nonessential services, too.

              If the growth of the program so as to cover all sorts of non-essential services is threatening our ability to keep providing essential services, then anybody that really cares about children dying of preventable conditions should be all about cutting those non-essential services out of Medicaid.

              1. It’s a false dilemma. I think the state can and should pay for both.

                1. Oh, NOW you believe in more than two choices I see. There is not an infinite supply of monetary value in this world, joey. No matter what, government will have to choose not only what to spend money on, but HOW MUCH. If spending more money on essential services would reduce mortality, and since the government DOESN’T have an infinite supply of monetary value, how can you justify splitting that finite amount of money between essential and non-essential services?

                  1. Because there’s more to life than avoiding death.

                    1. And you can’t get to that “more” if you’re dead. What you’re really saying is that more braces and other non-essential services are more important than saving more lives.

                    2. I’m saying that the choice between 1,000,000 sets of braces and 1 life isn’t clear cut. People regularly risk their lives to achieve a better quality of life.

                    3. Yes, it is. 1 more life is worth more than 1,000,000 straight teeth. And who are these people risking their lives if the government doesn’t pay for braces?

                    4. *1,000,000 SETS of straight teeth

                2. “It’s a false dilemma. I think the state can and should pay for both.”

                  What part of “fiscal cliff” don’t you understand?

                  Have you seen what’s been happening in Europe?

                  We cannot go on spending like we are. Even if we raise taxes. The Greeks can’t raise their taxes high enough to pay their debts.

                  Maybe that’s the part you don’t understand. Eventually? We will balance the budget. The only question is whether we do it on our own terms or whether the credit markets impose a balanced budget on us–like it did with Greece and Italy.

                  We cannot go on spending like we are indefinitely. No amount of tax raising will cover the way we’re spending.

                  You treat our fiscal problems like right wing neanderthals treat global warming–I’m here to tell you, Anthropomorphic Overspending is not a hoax!

                  1. If I were king, I’d cut military spending to pay for this.

                    I realize that’s a non-starter politically.

                    1. If I were king, I’d cut military spending to pay for this.

                      If you’re running a $1.2 trillion deficit every year, you’re not cutting anything–you’re still spending money you don’t have.

            2. Medicaid also covers prenatal care and children’s health insurance.

              Yeah, and 60 years ago, when there was no Medicaid, having a kid cost around $500, inflation adjusted. According to webMD, the cost of a non-Caesarian birth is roughly $10,000.

              But keep up with the line that subsidizing an industry lowers the cost of the product.

              1. Do you think the quality of medical care is the same as it was 60 years ago?

                I think the medical care we get is much better today, largely due to technological innovation, and that accounts for the majority of those cost increases.

                1. Do you think the quality of medical care is the same as it was 60 years ago?

                  Do you think it’s more complicated to have a baby now than it was 60 years ago?

                  I think the medical care we get is much better today, largely due to technological innovation, and that accounts for the majority of those cost increases.

                  And since the federal government is currently paying over $800 billion a year for medical care (with a 9% annual increase the last 30 years), how will increasing that coverage to over 300 million people lower healthcare costs?

                  1. Yes, I think it’s a lot more complicated to have a baby now because we have much better pre and post natal care. How many amniocentesis tests were we doing for Downs syndrome in 1950?

                    Covering everyone will lower costs because emergency room, crisis-based care is the most expensive type of medical care–and the only kind the uninsured and poor can get right now.

                2. And while we’re on the subject, what particular technological innovations do you think are being practiced now to justify a 20-1 inflation-adjusted cost differential for a regular non-Casaerian birth?

                  1. For one thing, the vast majority of births happen in hospitals now. They didn’t in 1950.

                    Premature babies used to die. Now they live with expensive care.

                    Ditto with lots of birth defects.

                    1. For one thing, the vast majority of births happen in hospitals now. They didn’t in 1950.

                      What?! 88% of births in 1950 were in hospitals, according to the National Center for Health Statistics.

                      Premature babies used to die. Now they live with expensive care.

                      Ditto with lots of birth defects.

                      The subject is the cost of a non-Caesarion birth, not the cost of treating preemies and those with defects long after the birth has taken place. Do you have any proof that these post-birth procedures have resulted in a 20-fold increase in the cost of a regular non-Caesarian birth?

                3. Why is it that health care’s the one industry where technological advancement consistently increases costs exponentially?

                  1. It could have something to do with the inelasticity of demand for health care, and the lack of substitutes.

                    1. Or subsidies, regulations, and market distortions could be a problem, as they are in every other industry the government gets involved in

              2. Yeah, one of the biggest problems is our hybrid system. I think a superior form would be…

                Now, note, I feel like Milton Friedman talking about the Fed here: I don’t think we should have a Fed, but if you’re gonna have one anyway, then here’s what I think we should do…

                We should separate the private system from the public system. Start creating government owned and operated ERs and provide care for essentially no cost. That’s the way poor people treat our non-government owned ERs anyway. They just show up, get care, and never pay.

                But if we stopped requiring hospitals to provide free care to the poor–and provide care to private pay patients at a competitive market price, too? We’d see these problems go away.

                The problem is that there is no private option. How do you expect hospitals to compete on price–and give tons of service away for free, too? Stop requiring private entities to accept Medicare and Medicaid patients–give those people free care in a government ER–and it would be better…

                Better than what we have now. I’m not saying that’s the way it should be,or that’s the way it is in a perfect world, but purely private hospitals with purely private patients would be better than what we have now. The poor would still have access to essential care, and the cost of care would plummet for private pay patients.

                Eventually, it would price private care so that a lot more poor people could afford it–of their own free will.

                1. So basically you support having VA healthcare for the poor, and a fully privatized system for the rest.

                  The problem with this model is that there’s very little incentive to buy health insurance, unless you’re already sick. If you’re healthy, you can save by not buying health insurance, and get government healthcare if you do happen to get sick.

                  1. The poor are already treating our private ERs like government owned entities. They take care and don’t pay for it.

                    Medicaid already treats our private ERs like government owned entities. Private hospitals lose money on every pure Medicaid patient they treat!

                    You want to provide a minimum level of hospital service to the poor? It would be better lower middle class private pay patients if they didn’t have to pay for their own healthcare–and poor people’s too!

                    Quality healthcare would be a whole lot more affordable to a whole lot more people.

                    You’re not worried about the quality of care at government owned and operated hospitals, are you? Because that would be an admission of guilt.

                    1. I think a much better solution than having a dual public/private healthcare system would be to mandate the purchase of health insurance, and to subsidize health insurance for the poor.

                      It works in Switzerland.

                    2. The ethics of siccing the IRS on people who decided they’d rather try to save their home than buy health insurance this year aside, …

                      I wouldn’t expect mandating healthcare insurance to solve the problem of the uninsured any more than requiring people to buy auto insurance solves the problem of uninsured drivers.

                      And it does nothing to solve the problem of Medicaid paying hospitals a fraction of what it costs to provide care. It does nothing to solve the problem of lower middle class and upwards people being charged by hospitals to cover the cost of their own care–plus the care the hospital was forced by the government to give away, too.

                    3. If everybody were covered by insurance, hospitals would no longer be shafted by poor people because their insurance would pay for their care.

                      I agree that programs like medicare and medicaid should pay hospitals the actual cost of the services provided.

                      And, again, this model works in places like Switzerland.

                    4. Last time I checked?

                      Medicaid paid an average of 12.5 cents on the dollar billed.

                      I’m not saying dollars billed is actual cost, but even if you assume they bill for twice as much as they really deserve?

                      Medicaid would cost us FOUR TIMES what it does now.

                      They cannot pay for the actual cost of service provided. That would cost—waaaaaaay–too much money.

                      I remember when they were debating ObamaCare in congress, and somebody proposed that instead of expanding Medicaid for more people, they just give them vouchers to buy private health insurance policies instead. But then they did a little digging, and they found out that expanding Medicaid would cost the government just a fraction of what it would cost to give them vouchers…

                      Gee, I wonder why! Could it be because private insurers ultimately have to cover the costs of the uninsured too? Why do you think your PPO is so obsessed with you only going to one of their member hospitals? It’s becasue they already have contract prices, and if you go to some other hospital they don’t have a contract with? They’ll gouge the fuck out of the insurance company.

                      Expanding Medicaid just made the problem worse. Now the hospital system has 20 million more patients it has to give and 87.5 percent discount to? It’s hard to believe that insurance premiums have gone up sense to cover the additional cost!

                    5. Hit and Run?

                      About that preview button…

                      I really want it back. And I’m willing to make a small donation to get it, too.

                      Who’s with me?

                    6. I’d love to see a citation for 12.5% of cost because the numbers I’ve been seeing were all in the 90’s.

                      Also, hospitals don’t have to take medicare or medicaid coverage. It’s not mandated. I imagine that if Medicaid were really paying 12.5 cents on the dollar, many more hospitals would refuse to take that coverage as payment.

                    7. You can’t refuse service to people for their inability to pay, and you can’t refuse service to people because they’re on Medicare or Medicaid. In fact, it’s part of the accreditation process, I believe. You can’t operate like that, or Joint Commission will shut you down. …local regulators may shut you down, too.

                      As far as hospitals refusing to accept payment form medi/medi patients ;honestly, there have been a lot of hospitals closing. And the determining factor is always the demographics around your hospital. If the demographics around your hospital don’t feature a lot of private pay insurance patients? Then you’re in trouble. You’re losing money.

                      When I worked at the hospital on the edge of South Central LA, the first thing our controller wanted to see from me every morning was the patient mix, which tells you the ratio of private pay patients to Medicare/Medicaid patients. Back then, we needed one private pay insurance patient for every eight medi/medi patients to break even. We couldn’t get that many–so the hospital had to close.

                      That’s why when you see hospitals close, it’s not the ones in the suburbs. It’s County USC. It’s MLK Memorial. Not the ones in Orange County, where the demographics feature plenty of private insurance. It’s the ones in the poor neighborhoods…

                      The people who went to our community hospital have one less ER to go to now. Talk about making healthcare inaccessible!

                    8. Derider,

                      You should take a look at this list:

                      http://projects.latimes.com/ho…..osed/list/

                      My quick count shows 39 closed Emergency Rooms in California. And there isn’t anything about expanding Medicaid that’s going to change that momentum…

                      To the contrary.

                      Looking at that list, I can tell you that almost all of them were in poor neighborhoods.

                      Talk about making essential healthcare inaccessible!

                    9. I think a much better solution than having a dual public/private healthcare system would be to mandate the purchase of health insurance, and to subsidize health insurance for the poor.

                      It works in Switzerland

                      This isn’t Switzerland, which is largely cultural homogenous, limits immigration, and has a population

                      In 2007 the Census Bureau reported that more than 14 million people without health insurance earned annual incomes of at least $50,000, with 7.2 million of them making over $75,000.

                      In December 2007, the Association of Health Insurance Plans issued a report showing that nationwide annual premiums for private health insurance policies averaged from $2,613 for individuals to $5,799 for families.

                      http://usgovinfo.about.com/od/…..estats.htm

                      In other words, you support forcing lower middle-class families to spend an additional 10% of their pre-tax income on health insurance, in an era when incomes for those in the 25-44 demographic have dropped at least 11-12% from their peaks.

                      What is it about a cash-based system that scares you so much?

                    10. has a population

                      That should say, has a population of 8 million.

                    11. I’m advocating subsidies for the poor to buy health insurance, like in Switzerland.

                      I don’t think you have an empirical example of a cash-based healthcare system that has measurable outcomes. That’s what scares me about them.

                    12. I don’t think you have an empirical example of a cash-based healthcare system that has measurable outcomes. That’s what scares me about them.

                      Wrong.

                      http://www.oftwominds.com/blog…..07-09.html

        3. Unlike non-libertarians who think people in poor nations should die of malaria because pesticide is icky. I can play gotcha all day.

          1. I’m all for DDTing the shit out of the Congo.

            I agree that some environmentalists have a crazy moral calculus.

  8. Medicaid spending is also about improving quality of life.

    For politicians, anyway.

  9. an unjust affront to personal liberty for the government to protect the life of her child through taxes that pay for its health care (medicaid)?

    Fuck off, Slaver.

    1. My question is, how is opposing a woman’s right to abortion any less of a “slaver” position?

      1. I dunno. Ask the kid. Oh, wait. You can’t. It’s dead.

        1. It’s just as dead if it dies of a preventable medical condition when it’s 2.

          1. In libero-retard world no one has responsibility for their actions.

            1. 2 year olds certainly don’t.

              If the parents are unable or unwilling to provide medical care for their child, the state shouldn’t care?

              1. Right! Hey, you’re getting good at this.

                1. So if we don’t care about parents killing their children by not providing food or medical care, why do we care about parents killing their children in the womb?

              2. Unable? The monthly cost of health insurance for a newborn is fairly inexpensive. As long as the child isn’t born with a congenital condition, it’ll likely be somewhere around $600/year with a max annual out of pocket in the range of $5k.

                1. And yet there are still children without health insurance.

                  1. And yet there are still children without health insurance.

                    What’s your point? That I should somehow feel responsible for them? It’s not my fucking problem you retard.

                    1. Do you think it’s your problem to save their lives from evil abortionists?

                      If the answer is “No”, then you’re being consistent. If the answer is “yes”, you’re not.

                    2. If the answer is “No”, then you’re being consistent.

                      Great. As a reward for being consistent I’d like to be no longer forced to pay for people I don’t care about. Any chance you could make that happen?

                    3. The seastead of your dreams is calling.

          2. Comparing deliberately killing a child to someone dying from an illness? WELP.

            1. Dying from a preventable illness, without the ability to control their own healthcare, while in the charge of another.

              What difference does cutting the umbilical cord make?

              1. The fact that you see no difference between deliberately killing an unborn child and a two year old dying from a lack of medical care shows that you are indeed one of the derpiest derps ever to derp the earth.

                Seriously.

                Derp off.

                1. I see no difference in the outcome whatsoever.

                  How is denying a child medical care any different than just stabbing it in the head? It can’t go out and buy it’s own healthcare.

                  1. How is denying a child medical care any different than just stabbing it in the head?

                    Do you give money to every beggar that you see? No?

                    Well then that’s no different than putting a bullet in their head!

                    Murderer! You’re a fucking murderer!

                    1. You can expect beggars to go get a job.

                      You can’t expect infants to go get a job.

                      See the difference?

                    2. So you think poor people should go out and get a job? That sounds a little too BOOTSTRAPS for a liberal.

                    3. Yes, and the parents are responsible for making sure their child has adequate care, not the whole world. If you can’t afford kids, don’t have them.

                    4. My question is: Why is the state responsible for ensuring the life of the child in utero, but not responsible ex utero.

                    5. My question is: Why is the state responsible for ensuring the life of the child in utero, but not responsible ex utero.

                      My question is: Why do you celebrate deliberately killing a child in utero, but consider it murder to deliberately kill the child ex utero.

                    6. I don’t celebrate killing children in utero.

                    7. I don’t celebrate killing children in utero.

                      Yeah right. Talk is cheap from a guy who kills homeless beggars.

                      Did you donate to the Jimmy Fund this year? No?

                      Well then you just denied cancer treatment to both children and adults.

                      Jesus H Christ you’re a fucking monster!

                      Who else have you killed through your malicious inaction?!?

                    8. Nope. I see no difference. No difference at all. You’re a murderer. Plain and simple.
                      Since inaction is the same as action, your inaction of not giving money to the beggar is the exact same thing as putting a bullet in his head.
                      No difference at all.
                      You’re a fucking murderer.

                    9. Take your meds.

                    10. You can expect beggars to go get a job.

                      No you can’t, stupid. This is the Bush Recession, remember?
                      There are no jobs for the beggars to get.
                      So by not giving them money you are murdering them.
                      You fucking murderer.

                  2. I see no difference in the outcome whatsoever

                    I suppose since there is a possibility that you suffer a fatal heart attack in the next 20 years, it makes no difference if I simply shoot you in the chest with a .45 instead. I see no difference in the outcomes.

                    1. There’s a difference between dying from a fatal heart attack, and dying because your parents denied you food, shelter, or medical care.

                      You can’t expect children to provide those things for themselves. Denying those things to children isn’t morally different from shooting them in the head.

                  3. Who is “denying” a child medical care? Last time I checked, we were talking about Medicaid, not a mysterious evil government bureaucracy forcing to let the baby die.

                    1. If you have a kid, and you don’t buy them medical care, they have been denied medical care. Children cannot be reasonably expected to buy their own medical care.

                    2. If you have a kid, and you don’t buy them medical care, they have been denied medical care. Children cannot be reasonably expected to buy their own medical care.

                      And if that kids dies while under your care then you should be charged with murder. How does that sound? Do you think that will keep people who can’t afford children from having them?

                    3. No, I don’t think that would be good policy.

                      I think it would be absolutely consistent with anti-abortion policy, though.

                    4. No, I don’t think that would be good policy.

                      Why not? It goes like this:

                      You have a child you KNOW you can’t afford to care for
                      Because you can’t afford to care for it, the child dies
                      You knowingly put the child in danger by having it
                      Therefore, you just murdered a child

                    5. I agree with the moral calculus. I think charging negligent parents with murder would have unintended consequences, and thus not necessarily benefit the children the policy seeks to help.

                    6. I think charging negligent parents with murder would have unintended consequences, and thus not necessarily benefit the children the policy seeks to help.

                      Any consequences couldn’t be considered unintended by any rational person. You have a kid you can’t/won’t care for and it dies, you’re guilty of murder. It’s not meant to benefit children, it’s meant to punish parents.

                    7. I’m more concerned with benefiting children than punishing parents, ergo I wouldn’t support this policy.

                    8. Medicaid = not giving a child medical care = murdering children.

                      Am I following you?

                    9. Not really.

                  4. How is denying a child medical care any different than just stabbing it in the head?

                    It is more than a little disturbing that there is anyone in the world who would seriously ask that question.

                    If the parents are able to provide the care and don’t, that might be almost as bad as murdering the child, but to people who are not responsible for the child there is no comparison.

                    1. I agree totally.

                      So you’re saying that a government mandate that parents buy health insurance for their children would be morally equivalent to government restrictions on abortion?

                    2. So you’re saying that a government mandate that parents buy health insurance for their children would be morally equivalent to government restrictions on abortion?

                      Wait, what? I am not familiar with the logic format, could you please lay out the ground rules?

                    3. That was in response to Zeb.

                      “If the parents are able to provide the care and don’t, that might be almost as bad as murdering the child, but to people who are not responsible for the child there is no comparison.”

                    4. See below: “Healthcare does not equal health insurance”

                    5. So you’re saying that a government mandate that parents buy health insurance for their children would be morally equivalent to government restrictions on abortion?

                      There is some rational basis for requiring parents to accept the cost for their offspring’s health. They are wardens of the child until the age of 18 is reached and would be considered criminals if they didn’t feed, clothe, and tend to the child in other ways.

                      Having said that one especially critical factor remains:

                      Health Insurance =/= health care.

                      Insurance is nothing but a third party financing mechanism. That is where the left has the entire debate profoundly misunderstood. Having insurance is not the functional equivalent of receiving care. The very function of insurance is to safeguard against exorbitant costs associated with the most serious and expensive conditions. However, insurance need not cover routine care, check ups, and one-off antibiotic treatments. Sadly, the insurance mandates proposed in the PPACA miss that point entirely, as bureaucrats and policy makers are wont to do since they merely seek control under the guise of compassion.

                    6. You say “there is some rational basis for requiring parents to accept the cost for their offspring’s health”.

                      This position is consistent with restricting abortion rights.

                      I’m not sure it’s consistent with maximum liberty, however.

                    7. Liberty entails a degree of responsibility. We believe that individuals are responsible for securing their own wants and needs. Having said that, a child is seen as a dependent (and treated as such in the tax code) and responsibility for that child’s basic necessities is seen as a responsibility of the parent. It is not and should not be seen as a responsibility of the public large.

                      Any parent will readily confess that when you become a parent, you sacrifice a great deal of liberty on your own accord as part of that decision. But it must be stated, reiterated, and understood that one simply does not become pregnant: pregnancy is the fruit of a specific behavior and that behavior can still be undertaken without fear of pregnancy if one simply takes a very simple and inexpensive precaution or two.

                    8. So you think it’s a legitimate function of the state to force parents to provide their children with things like food, shelter and healthcare?

                    9. I think it’s a legitimate function of the state to prosecute legal guardians for criminal negligence. I don’t think it’s a legitimate function of the state to inspect a parent’s pantry for nutritional mandates, dictate the appropriate square footage of a child’s quarters, or require a minimum-mandated health insurance policy.

                    10. Wouldn’t all those examples be evidence with which the state would prove a criminal negligence case?

                    11. So you think it’s a legitimate function of the state to force parents to provide their children with things like food, shelter and healthcare?

                      Thank goodness for the state, because without it I wouldn’t provide my child’s food, shelter and health care.

                      I only do it because the state tells me to.

                      In fact, it’s a wonder that the human race ever survived without the state telling parents to take care of their children.

                      This is definitely proof that government existed before society, because without the government telling parents to take care of their children, society wouldn’t exist.

                    12. Thank goodness for the state, without it I would murder my child in the womb.

                    13. Thank goodness for the state, without it I would murder my child in the womb.

                      How could you? That’s impossible! We all know that if the state doesn’t pay for something, you can’t have it. So unless that abortion is funded by the government, you can’t have it.

                      But at least you can still murder homeless people by not giving them cash, and you can continue to murder children by not giving to charity.

                      You fucking murderer.

                    14. If parents purchase health insurance and never takes the kid to the doctor are they negligible for failing to provide health care?

                    15. How is denying a child medical care any different than just stabbing it in the head?

                      So if I don’t slather my kid in Vapo-Rub when she has a cold, I’m stabbing her in the head?

                    16. If vapo-rub were preventing her from dying, then yes.

                      If not, then no.

                    17. If vapo-rub were preventing her from dying, then yes

                      But you didn’t say “prevention from death,” you said “medical care.”

                      Don’t try and backpedal now, squirt.

                    18. Obviously withholding medical care is only analogous to murder if the person actually dies. So unless Vap-o-rub will make the difference between life and death, it’s not germane to the discussion.

                    19. Obviously withholding medical care is only analogous to murder if the person actually dies.

                      Then perhaps it would behoove you to not make such an extreme and easily refuted analogy.

                  5. Why don’t people just shove food up their ass? It saves so much time! It all ends up in the same place anyway.

                    I see no difference in the outcome whatsoever.

                    derp

              2. I guess we should allow post-natal abortion.

                1. It’s more humane to give the baby a painless bullet to the head than to let him suffer from a disease.

                2. I guess we should allow post-natal abortion.

                  I agree. Let’s start with The Derider as punishment for murdering beggars.

          3. You win the derp prize for the day.

      2. “how is opposing a woman’s right to abortion any less of a “slaver” position?”

        It is also a slaver position. Just like making other people pay for the children you had even though you couldn’t afford them. There is an easy solution to the struggles of low income parents: don’t have kids if you can’t afford to pay for them.

        1. That’s blaming the victim. You can’t expect a woman to keep her legs shut.

        2. I prefaced the question by saying “I’ve got a question for all the pro-life libertarians”

          It seems like we agree that anti-abortion is not a consistent libertarian position.

          1. It is if you believe life begins at conception. I don’t believe that, but it’s not even close to a settled question.

            1. And it never will be settled because everyone just defines “life” to fit their position on the issue. Which is why I always just answer that life began 4 billion or so years ago and has done quite well since.

              1. I believe that at some point in the future medical science will progress to the point where a fertilized egg can be grown to an viable state in a laboratory, no mother required, at which point the question will indeed be answered.

                1. Unless this technological breakthrough somehow supplants all natural pregnancies, it won’t change anything.

                  1. Talk about missing the point.

                    1. How will developing an artificial womb determine when life begins?

                2. “Does life begin at conception?”
                  “No, only when the test tube is treated with OVA-217.”

  10. So there’s some slightly heavier than normal rains going on somewhere?

    1. I’ll just leave this here.

      1. Insert hippie lament about Dylan going electric…

        1. I’m pretty sure the hippies were the ones who liked his going electric. It was the folkies who were all pissed.

  11. I’d pay good money to see an owl rip that cat from Kruggie’s clutches.

    1. I think the cat died today. Though it could have been it’s sibling.

      http://krugman.blogs.nytimes.c…..-personal/

      1. Well, Doris ? who had a lot of health problems over the years, but always managed to hold up ? has had a tumor on her liver for several months

        Clearly, Doris should’ve had medicaid. It would’ve saved her. That evil pussy-hating GOP.

        1. I see what you did there.

          1. I, too, saw that – and liked it.

        2. You know what the fucked-up thing about this is? Kruggie is so emotionally broken that he forced his cat to suffer with a tumor for several months because he (or his batshit-crazy wife) was too selfish to take it to the vet and put the poor thing out of its misery a long time ago.

          Christ, I love my cat, too, but at least I’ll know when it’s time to let it go, and cancer is a fairly obvious benchmark.

          1. But that’s how you show someone how much you love them. You prolong their suffering as long as possible because their life is just so precious.

          2. Yes, I’m sure you know more about the quality of this cat’s life than its owner.

            1. Someone rocking so much alliteration HAS to know better than Krugabe. Alliterative people are inherently superior. It’s Stan Lee’s Law.

            2. Yes, I’m sure living with cancer leaves cats feeling just as robust and filled with pep as it does humans, you moron.

              1. And I’m sure every human being diagnosed with terminal cancer immediately commits suicide, you moron.

                1. Suicide by owl?

    2. The cat doesn’t deserve that.

    3. Some readers may know that for a long time Robin and I have had two sibling cats, Albert Einstein and Doris Lessing

      Whatever happened to naming your cat “Mr. Wiggles”? Do we really have to give our cats the names of literary figures? I can swing with the Einstein one because there’s some whimsy there. It’s like naming your cat Marcel Proust… *gag*

      It’s like saying “look at how smart I am!”

    4. We babied her along, getting her to eat by feeding her special treats, and she held up much longer than the vet expected. But several days ago she stopped eating and drinking, seeming increasingly uncomfortable, and this morning we did the necessary and had her put to sleep.

      Death panelist!

    5. I’d pay good money to see an owl rip that cat from Kruggie’s clutches.

      He didn’t raise that anyway. The GOVERNMENT raised that cat. The government paid for and built the roads it’s food was delivered on, enforced the license it’s veterinarian paid for, kept it’s caretaker in prominence. It’s not Krugman’s cat. It’s the government’s cat. A fat cat, if you will.

  12. How is denying a child medical care any different than just stabbing it in the head?

    I don’t know, Mister Bones. How IS denying a child medical care any different than just stabbing it in the head?

    1. Given the fact that children aren’t being denied medical care, except by a parent which simply refuses the care made available to them, this is a very strange argument from our good friend Joe, who’s been destroyed handily in this healthcare debate thing.

      I’m not even going to post all the links to free healthcare and the free transportation the government will provide to get you to your free healthcare.

      1. Yeah, emergency rooms can’t refuse service like that.

        1. Do you think it’s a good thing that the state forces hospitals to care for the poor without pay?

          1. Because everyone knows hospitals would NEVER write off losses without the government. Homeless orphan babies would be dying in the streets without a predatory credit card or payday birthday loan on hand.

            And then they’d be in wage slavery anyway, forced to crawl through dank diamond mines for pennies on the reichsmark, which would be the new currency of Amerika with those KKKapitalists in charge.

            1. Some charity would exist without government. I don’t think it would be enough charity to care for every poor, disabled, or elderly person.

              1. And neither is government healthcare. That’s not exactly an endorsement for the inefficient use of money, which government definitely is.

              2. I don’t think it would be enough charity to care for every poor, disabled, or elderly person.

                As a class, the elderly are the wealthiest group in the country. Not sure why they would need charity care.

                Similarly, I’m not sure why you assume that disabled people are incapable of providing for their own needs.

                Could charity provide for every poor person’s medical care? This is a wealthy and generous country. I’d be interested in finding out.

                1. Obviously some elderly people are both poor and unable to earn a wage.

                  The same is true of people with disabilities.

                  1. I’m sure glad government spending has totally eliminated that!

          2. “Do you think it’s a good thing that the state forces hospitals to care for the poor without pay?”

            I think if the government requires private enterprise to give services away, the government should pay for them.

            Regardless of whether you think people should care for free, there’s an open question about who bears the burden of the free care.

            If you think hospitals should just have to write it off? Then don’t complain about gouging and the cost of care. If you think think the taxpayers should have to bear it, don’t complain when they want to restrict it to the essentials.

            We could handle the problem of free care much better, and our refusal to deal with the problem is the primary cause of all our healthcare problems.

            Think of it this way: what if, instead of giving people EBT cards, the government just started requiring grocery stores to give out half their groceries for free? What would happen to the price of food? What would happen to the number of grocery stores out there? Where would the groceries be located? What would happen to food quality?

            Regardless of whether you think the government has a responsibility to feed the poor, you should see that some ways of handling that problem are worse than others. …and by requiring private entities to give away their products for free, the government is handling the problem of free healthcare in one of the worst ways possible.

            We can do better than the way Medicaid is now! …AND keep Medicaid.

    2. That’s RACIST Mistuh Interlocutor.

  13. Doris ? who had a lot of health problems over the years, but always managed to hold up ? has had a tumor on her liver for several months

    And he didn’t take her to the Tent-Show-Faith-Healer-in-Chief for the Laying on of Hands?

    Krugabe, I am disappoint.

    1. He had plans to, but it was the same weekend Elizabeth Warren was in town and Krugabe was frightened at the prospect of her serving filetted feline au jus.

  14. It’s like naming your cat Marcel Proust…

  15. Better than naming it Chairman Miao, I suppose.

    1. Or naming your pet chameleon Vladimir Blendin

      1. Or naming your mini schnauzer Ho Chi Mihni

        1. Or naming your Maine Coon cat Jesse Jackson.

    2. Better than naming it Chairman Miao, I suppose.

      No, no it’s not better than that. I bow to you sir, that’s a good one.

  16. Clearly the closest Krugs has been to pussy in eons.

  17. That picture never gets old

  18. By the way, anybody that votes for Obama becasue they’re afraid Romney is going to slash Medicaid?

    I’d love to think reforming Medicaid could be so easy as voting for Romney, but Medicaid isn’t about to be reformed becasue Romney becomes president–unfortunately.

    Medicaid sure as hell isn’t about to be reformed because Paul Ryan becomes the vice president. Reforming Medicaid is going to take a lot more than that.

    1. If Paul Ryan were at the top of the ticket, I’d actually have a lot more faith in Medicaid reform being a real possibility. Of course, there would be a significant obstacle in Congress, but I do think he’d actually pursue the matter forcefully.

      For all of Raul Ryan’s very real faults and some of his votes which I heartily disapprove of (albeit that I’m willing to write them off as being a loyal party member and not philosophically supportive of), he would be someone I might very well be able to vote for at the top of a ticket.

      But not as Romneybot’s second in command.

  19. If your answer to my question is “well, if we didn’t have medicaid then there’d magically be enough charity so that no kid would ever go without health care”, I’d like to see some evidence for your claim.

    I think you’re the only one here who believes in magic.

    1. I believe in magic. Just not that kind of magic.

      1. We all know your real handle is $parkl?, the Magical Commentator.

  20. Dear Derider,

    I choose to support an orphanage in Thailand and reconstruction in Haiti. However, due to insufficient donations we cannot help as many children as we’d like.

    Please immediately start turning over all your disposable income to me so that I may donate it.

    If you don’t, you are murdering Thai children and forcing Haitian families to live without access to shelter or healthcare.

    P.S. I find these needs a higher priority than braces for American kids. Sorry that you lost the moral equivalence game today.

    1. This would make total sense if I were advocating that the US military invade Thailand and Haiti to stop all abortions.

      I’m not.

      1. No, not providing healthcare = murdering kids, you said so yourself. SO you’re a murderer. His argument has nothing to do with abortion.

        1. Nah, they’re just dark-skinned foreign kids, so they don’t count.

          Right, joe?

        2. Yeah, that’s the problem. My argument has everything to do with abortion.

          Why is it OK for the state to save fetuses from abortion, despite infringing on personal liberty? Don’t libertarians reject saving children’s lives with tax-funded health care, because of the infringements of taxes on personal liberty?

          I’m not arguing that anyone has a personal responsibility to save every other human being on the planet.

          1. Don’t libertarians reject saving children’s lives with tax-funded health care, because of the infringements of taxes on personal liberty?

            No, we reject the forced invasion of a functioning healthcare market by inept regulators who are turning what could be a functioning, vibrant healthcare system into a dysfunctional, over-regulated one that by definition, infringes upon the liberties of both the patients and the people paying for the care and on the whole, makes healthcare worse.

            The moment progressive healthcare systems started denying people care is when you lose any moral high-ground.

          2. “Why is it OK for the state to save fetuses from abortion, despite infringing on personal liberty?”

            Offhand I’d say it’s because those who believe life begans at conception view the fetus as a human being who has a right not to be killed.

            Abortion is therefore actively harming another human being.

            On the other hand, refraining from subsidizing the existence of other people’s children is not actively harming them.

            So it’s not the same thing at all.

            It’s like the distinction between me pushing you off of a cliff and refraining from helping you when you are hanging off the edge of a ciiff by one handhold.

            In the first instance, I’m guilty of murder and and in the second guilty of absolutely nothing.

          3. So not only are you a dumbass, but you’re a willfully dishonest dumbass.

    2. You forgot to include the crucial point that if Derider refuses your entirely reasonable appeals to sympathy that you’ll send you goons with guns to his house confiscate all of his property (even that jointly owned with his wife) and imprison him for failing to “heart” the poor darkie children. And if he resists, well let’s just say that resistance is futile.

  21. I had to use Medicaid when I was laid off… I would have much preferred to have had a full-time job and to have used the associated health insurance.

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