Obamacare

The Single Payer Threat Is Real

Republicans should start taking liberal health care efforts seriously.

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Two years ago, if you had asked me about the prospects for a single payer health care system to be adopted in the United States, I would have said that there was essentially no chance in the foreseeable future. Single payer would be too expensive and too disruptive to both patients and providers. Even if you could cobble together a semi-functional legislative plan, the politics would never work. Short of catastrophe, there was no way it would ever happen.

But since the 2016 election, I have become slightly less confident in my assessment. I still think single payer in America is quite unlikely. Yet the possibility now strikes me as a little higher — if not in the near term, then a decade or three into the future. And the odds that some sort of hybrid quasi-single-payer system that significantly expands the role of government in the financing or provision of health care have increased even more.

The reason why I've changed my thinking is that over the last year or so Democrats and progressive activists have found a new energy in trying to make it happen. During the Democratic primary campaign, Bernie Sanders backed single payer to great effect, and has spent the summer working on a Medicare-for-all bill. Public support for single payer is rising this year. One new poll this month found that a majority of doctors are in favor.

Single payer supporters don't yet have a workable plan. But they do have a goal. And that goal means that liberals are starting to grapple with the very issues that I always believed would prevent it from happening. Those who oppose greater government intervention in the health care sector should take this as a wake up call.

As it turns out, drawing up and passing a single payer health care plan isn't easy. State based single-payer plans in Vermont, New York, Colorado, and California have struggled to get off the ground, simply because they would be so expensive to run. As Reason's Eric Boehm has written, many estimates find that these programs would cost as much as states are already spending for their entire annual budgets. And those are the estimates from supporters: Less favorable projections suggest that these programs could cost far, far more. Financing these sorts of programs would thus require tax hikes so large that even liberal states have balked.

But serious single-payer supporters are pointing out other problems too: Earlier this month in The Nation, Joshua Holland argued that plans based on the idea of expanding Medicare, the federal health care program for seniors, to the entire population would face nearly insurmountable obstacles. For one thing, Medicare pays doctors and other health care providers far lower rates than private insurance. As Olga Khazan writes in The Atlantic in a separate article on the challenges and drawbacks of single payer, some doctors would inevitably refuse to participate. And the rates are low enough that many hospitals simply couldn't survive if all services were billed at the typical payment rates for government programs. Those who liked their doctors would not necessarily be able to keep their doctors.

Indeed, it's difficult to overstate just how disruptive a transition to a full-fledged single payer system would be: Under the most sweeping plans, every single person who currently gets private insurance through their employer or through the individual market would be thrust into an entirely new government-run plan. Every single health care provider in the United States that does business with private insurers would have to completely reorganize their billing and financing structures. Every person who works for a private health insurance company would be be out of a job — or would have to go work for the government, either as a contractor or an employee.

It's hard to imagine a transition of this magnitude like this going smoothly; the rocky rollout of Obamacare's online health insurance exchanges — a much smaller event — is instructive. The technical and administrative challenges of designing and implementing a nationwide single payer system would be far greater.

Like I said, single-payer advocates don't have a workable plan. And the more technocratic amongst them are starting to realize it. Holland's article is framed as an argument that universal coverage need to take the political and policy challenges seriously, and work through the details.

You can already see this happening. Holland gives space to the idea of "Medicare for More," which would allow more people to buy into the federally run program, creating a more gradual transition in which individuals were allowed to opt into a new system, rather than forced out of their current plans. Allowing people to buy into existing government health care programs isn't an entirely new idea, but it is one that seems to be gaining traction.

Nevada's legislature recently passed a bill to allow state residents to buy into its Medicaid program; the plan was vetoed at the last moment by Republican Gov. Brian Sandoval. But even Sandoval appeared to encourage more exploration of the idea, saying that his veto "does not end the conversation about potential coverage gaps or possible solutions, including Medicaid-like solutions."

This week, meanwhile, Sen. Brian Schatz, a Democrat representing the state of Hawaii, said he would soon propose a plan to allow individuals to buy into Medicaid through Obamacare's exchanges, using the law's federal subsidies toward their premiums.

The buy-ins have problems too — most notably that no one has really laid out in detail exactly how they would be priced and administered. As a jointly run federal-state program with lots of state-by-state variation, Medicaid is more like 50 separate programs than one uniform benefit. The proposals so far have not resolved basic questions about benefit design or how premiums would be set. Nevada's bill was just four pages long. It wasn't really a plan so much as a declaration that the state should start coming up with a plan.

But that is exactly why I have changed my mind about the possibility of single-payer, or something that moves us closer to it. No, there's no plan yet. But health care advocates and policy experts on the left have settled on a goal, and are now expending effort on trying to come up with ways to achieve it, or at least move in that direction. The end result might not be a fully socialized health care system. But it could produce something much closer to it than we have today.

This is similar to what happened after the failure of the planned health care overhaul under President Clinton in the early 1990s. Democrats and their allies regrouped, and looked for alternative mechanisms to move towards universal coverage guaranteed by the government. Although it took almost two decades for liberal wonks, activists, and politicians to come together, it eventually paid off in the form of Obamacare.

Republicans, in contrast, have no idea where they stand on health care, or what they really want. Republicans, after all, gave us RomneyCare in Massachusetts, the plan that served as the model for Obamacare, and then spent seven years opposing the law after Democrats adopted the Massachusetts model as their own. The party's lack of a unified goal is, if anything, even more apparent now than it was during the Obama years, when at least the party was united against Obamacare.

Following the collapse of the GOP health care bill last month — the least popular major legislation in decades — governor John Kasich (R-Ohio) and DemocrJohn Hickenloper (D-Colorado) are putting together an Obamacare rescue plan. The Trump administration is continuing to pay illegal subsidies to insurers, on a month to month basis, even while threatening to cut them off. Senate Majority Leader Mitch McConnell, who is arguably the party's legislative strategist, admitted. this week that he didn't have a clear plan. "On the effort to make dramatic changes on Obamacare, the way forward is somewhat murky," he said.

For much of the public, then, the national health care debate looks like an argument between two sides, one of which is proposing an ambitious and increasingly popular goal it hasn't figured out how to make work yet, the other of which is proposing something, well, murky. That's not an argument that Republicans are likely to win.

In the very short term, neither single payer nor its more gradual variants have much of a chance, so it may be tempting to dismiss them as possibilities. But in the longer term, Republicans and other critics of government-run health care will need to figure out how work towards clear goals of their own. And they will need to take the advice that liberals are now giving their allies, and start sweating the details.

They will need, in other words, to take both the policy and politics seriously. In this, they will start from behind, because liberals already are.

*Correction: This piece originally named Brian Sandoval as the senator from Hawaii introducing the Medicaid buy-in plan, rather than Brian Schatz. Apologies for the error.






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  1. As someone who is currently in the Veterans health system (a pseudo-Single Payer health system), you don’t want single payer nor anything close.

    Dealing with government bureaucrats is the worst.

    1. If they force single payer on us, it will be time to stop them, by force if necessary.

      1. They’ve been forcing Republican horseshit on us for years. Can I kill people now?

        1. Typical leftist asking when he can start killing people

          1. I’m asking Last of the Shitlords, who has repeatedly called for the murder of people whose politics he disagrees with, exactly what the criteria are for when I get to start shooting.

            1. Why do you equate force with shooting?

              1. Don’t bring a knife to a gunfight.

            2. Yes he’s a real autist

              Your criteria for punching them is whether or not they disagree with you. We’re still figuring out the shooting thing, but stay tuned, I’m sure the next protest will clear that right up

            3. You took “force” to the extreme, fucking extremist. Is there no middle ground anymore?

              1. Later on in the thread he talks about killing Democrats more specifically.

                1. No, I discuss the need to have AG Sessions put all of you in prison. Which would help avoid the unpleasantness of a domestic war to root out you communists. Most prominent democrats are guilty of a myriad of felonies anyway. And apparently, it’s now ok to investigate petiole to see if they have ever committed a crime. You know, like you traitors do with Trump.

            4. Tony, you commie scum don’t have to die. Even though you have no right to exist, have no soul, and therefore aren’t even eal people, it would be perfectly acceptable to have all of you leave forever, and go someplace like Venezuela, or Antarctica. we just don’t want you polluting our good country with your evil Marxist bullshit.

              1. I’ll assume you speak for all libertarians here until one of them calls you out.

        2. Tony, you leftist trash are already violent. Please come try it where I live. I would relish the opportunity to greet you. On a side note, totally unrelated, I would love to show you my new M4 rifle. It’s really awesome.

          1. Where do I submit a complaint about death threats on this site?

            1. What death threat? You offered to throw down. I’m just accommodating you. It isn’t a threat if you say you want to kill us, and then I merely invite you to try. But it’s not fair when someone hits back against you progtards, is it?

          2. You’d think you fucktards would have calmed down since Obama left office.

            1. You mean the way you all keep threatening a coup against your new president? Or the way you riot and rage everywhere you go? You’re just pissed that we won’t lie down and take it. Which you people need because you’re all gutless cowards, and weak little pussies that have to out on Marks’s and gang up ten to one on anyone to have a chance of winning a street fight,

              Tony, you’re the kind of punk that tries to start shit in a bar, but when the other person stands up, ready to beat your stupid ass, you whine and cry for the bouncer to fight your battle for you and act like you’re the victim. No one likes that. And that’s part of why everyone hates you.

              1. The new president is a Russian stooge and a traitor, but nobody’s suggesting anything but constitutional means of removing him from the office for which he is the least suited human ever to occupy it.

                1. No, his predecessor has that distinction. You really are subhuman garbage. You should be thankful we tolerate your continued existence.

                  1. You seem stable.

                2. U S Grant was pretty awful. Plus he killed all the indians.

                  1. Fine, relative to historical context.

            2. We would have if you’d left this group, too…

        3. Hillary Clinton will NEVER be president !!! LOL x forever and ever!!!

    2. You should refuse it and buy private insurance then. I mean, obviously.

      1. With Obamacare deductibles? No way.

        1. So the single-payer alternative is better than Obamacare?

          Okay let’s meet each other halfway and do single-payer. Problem solved!

          1. Do white supremacists get healthcare too

            1. Probably more than average what with all the genetic defects that come from fucking cousins.

              1. I mean do they receive single payer or do you decide they don’t deserve it?

                1. The whole point is universal coverage. My robust, healthy tax dollars will go to pay for treatment of their cousin-fucking defects. It takes a village.

                  1. Tax dollars? I doubt that. You are likely the beneficiary of government money.

                    1. Call me a reluctant capitalist.

                    2. Funny, I usually call you asshole fuck face that jacks off random animals. Still trying to shorten it up.

          2. Its pseudo-single payer. Single payer you cannot refuse because there would be not much free market alternative health care.

          3. Or get rid of government interference in healthcare. If we need some extra money for the transition, we should just take it off you commie punks. Opyou all love redistribution of wealth anyway. Win win right?

          4. I certainly don’t want to support others with my premiums. I already support others with my taxes, and yet I’m penalized. That’s the “progressive” way.

        2. Single payer looks good when you can’t afford the only insurance the gov’t will let you buy. Has anyone noticed Obamacare is relatively easy on kids (via Medicaid) but once you hit voting age you lose coverage?

      2. Sure.

        Where do I pick up my tax credit?

        1. ROADZ!!!!!

          Is basically the gist of every arguement To y has ever made.

      3. Its against the law to not have health insurance, so I cannot refuse healthcare coverage without breaking the law.

        We cannot get catastrophic health insurance plans anymore because they violate ObamaCare.

        Just like a lefty to take what someone says about a terrible government run program and say, just refuse it. When my main point is how bad the VA health system is.

        1. It’s not a crime to refuse to have health insurance.

          But surely there are better alternatives to the most socialized form of healthcare we have. So why not ditch it in favor of one of them? As is well known, Obamacare was dreamed up by the free-market fundamentalists at the Heritage Foundation. Pretend it’s called Romneycare. Surely it’s better than what you have, since free market is always better than socialism.

          1. free-market fundamentalists at the Heritage Foundation

            When did the Heritage Foundation start hiring free-market fundamentalists?

          2. The best alternative is free market capitalism. I’m glad you finally see it our way.

            1. Meaning what in this context. Pay or die?

              1. False choices are so hot today.

                Let me guess: if the government doesn’t pay for a certain procedure, they’re not exactly sentencing someone to death, are they?

                1. Too late in the day for a trolley problem session. I just asked for a description of what a free-market in healthcare would look like, and whether it would include anything resembling a “pay or die” scheme. You can say yes. I already know it does.

                  1. No trolley cars. Just pointing out the public option includes something resembling “pay and die anyway.”

                  2. As opposed to the tragedy of commons single payer system where one is forced to pay and still die.

                  3. I just asked for a description of what a free-market in healthcare would look like, and whether it would include anything resembling a “pay or die” scheme. You can say yes. I already know it does.

                    What do the chains look like on someone who isn’t wearing chains?

                    Contrary to your stupid and reductive characterization, a free market would leave doctors free to have some people pay, some not. Some to pay more, others to pay less. They would be free to make those decisions without a universal government mandate issuing a one-size fits all solution for all situations.

                    Is it starting to make sense yet?

                    Of course it isn’t.

                    1. That sounds like it would work out just fine.

                    2. I’m glad you agree.

              2. No it means plenty of competition to lower prices (like here in Mexico) and charity (be it personal or church or societies) to take care of the really needy.

                1. If charity were sufficient to pick up the slack of the marketplace (at least you acknowledge it), then why hasn’t it ever done so? Why didn’t it do it the moment healthcare was invented?

                  1. Why didn’t it do it the moment healthcare was invented?

                    It did, dipshit. Healthcare was a fundamentally charitable institution for centuries. It’s only been since about the 1960s that that’s changed.

                    What is it about the history of human healthcare that changed in the 1960s?

                    You’re so ignorant it hurts.

          3. Stop calling what you want health insurance, you dishonest shit weasel. Call health maintenance. Call it health care. Insurance doesn’t cover every fucking band-aid required.

      4. ACA made the plan I had illegal so my insurer stopped offering it. I did manage to get one that covered less things than I had before, has higher premiums, and higher deductibles.

        1. Enjoy your expanded freedom, fellow citizen!

        2. Fucking kulaks think they deserve better stuff for less money.

          /sarc

    3. Probably at least as bad as dealing with insurance company bureaucrats. Private health care will never go away entirely. Rich folks can just pay for concierge doctors.

    4. People are malleable. If it’s the government, it can’t possibly be wrong. You might never get treated and die, but by golly, they’re paying for your healthcare and you should be grateful.

    5. As someone who is currently in the Veterans health system (a pseudo-Single Payer health system) and been homeless and without health care most of the last 8 years, I am thankful for the health care I get. Because shitty health care is better than none.

      1. I got a colonoscopy that removes two polyps that I would have otherwise gone without and a lense reacement5

        Americans are fucking spoiled brats.

    6. This is true. My dad is a vet, and puts up with massive amounts of bullshit. Replace the VA with a voucher system to let veterans go to the provider they choose.

    7. Indeed, and once you turn 65, it’s single payer for the rest of your life.
      The Boomer bulge will also push us toward socialized medicine.

    8. And as a Canadian I can but tell you to STAY AWAY.

      But I’m afraid you’re done. This is one of the last hills progressives need to climb and they will get there even if it means dying on it.

  2. “Two years ago, if you had asked me about the prospects for a single payer health care system to be adopted in the United States, I would have said that there was essentially no chance in the foreseeable future.”

    Any estimates on how long until REASON swings over to the single payer bandwagon?

    1. It will be whenever the invites to the D.C. cocktail parties is placed in jeopardy.

    2. Serious question: why do you continue to comment here?

      1. You’re not a Libertarian, so why do YOU continue to comment here?

        1. It’s true that I am not affiliated with the Libertarian party. But I’m pretty sure that applies to a lot of people who comment here regularly, so it doesn’t strike me as a requirement for commenting.

          1. It applies to me, I don’t affiliate myself with the LP either but it’s because the LP itself isn’t actually very libertarian in my view. They’re sounding more and more like social justice warriors every day.

            1. The LP proper has always been a resoundingly unimpressive organization. A political party for people who embrace individualism and largely despise politics is somewhat doomed from the outset.

              1. Agreed, it’s essentially an oxymoron.

                1. Yeah, how do you get a bunch of basically anarchists to vote for you. It’s a problem.

          2. I didn’t say LP. I said Libertarian and you don’t seem to support Libertarian fundamentals.

      2. “Serious question: why do you continue to comment here?”

        Serious answer: Unless I’m on your lawn, Fuck Off.

        1. You’ve got my vote.

    3. Before they swing, they will set up justifications.

      We will have to create a new term like “TDS” for their clear departure from Libertarian fundamentals and support for single payer.

    4. “The Libertarian Case for Single Payer”.

      1. Actually if libertarians were smrt, they would take advantage of the current chaos and propose single payer plans of their own (some of which might actually be functional instead of dadaist reimagings of healthcare).

        The easiest target would be insurance that repackages what is already covered by law for emergency rooms. Have it contracted through PHS or somesuch. Slip in Rand’s proposals to cover the rest as a “compromise” position.

        As of late, I am unimpressed with the weaponized autism of the LP. Just put a recording of “taxation is theft” on endless repeat on the mothership voicemail and turn off the lights. Nothing else of value is coming from the ranks.

      2. Each single person pays their free market cost. Single payer.

    5. Do you seriously think they will?

      And I mean actually supporting it, not just writing policy analysis that discusses the pros and cons of various possible universal healthcare proposals and then being accused of being all in for single payer.

      1. Yes, I think they will. Just like you said. Step 1 will be the policy analysis. Step 2 will be the capitulation. Instead of the preferred, which is: Step 1: denounce it in no uncertain terms. Step 2: Go to Step 1.

        I happen to believe going down swinging is the morally correct path. It may not change the final result much, but it leaves you with your dignity intact. And there’s always a chance it might have an effect, however slight. But capitulation = failure.

        I’ll give an example: Look at the effect one soft-spoken old man (Ron Paul) had on the public discourse simply by being persistent.

      2. Yes, because the Republicans are stuck in something similar to what the Democrats are in.

        Dems are the party of “nothing Trump”. Any beyond that they have no message, hence their sucktacular growth rate.

        Similarly, the Republicans for seven years have been the party of “nothing Obamacare”. And when the time came for them to actually do something about it, they had nothing. This will contribute to their sucktacular growth rate.

        So in lieu of an alternative, Dems will more than likely continue to build on the Obamacare debacle and offer up another, even worse one, for the masses to swallow. The pendulum will swing back to Blue, they’ll have their majorities, and they will jam single-payer down our throats with or without a realistic plan.

        Because right now there is no alternative.

        1. True. All the republicans have to do is largely follow Trumpfiscal agenda (support deregulation, tax reform, ACA repeal, etc.) and they will be successful.

        2. It’s almost like you expect either party to go against their medical donors to do stuff that would actually reduce cost.

  3. Can we at least stop calling it “single-payer”? That’s just a euphemism to hide its true identity: government-run healthcare.

    1. Then it’s already “government-run.” The elderly and poor take up most of our health dollars, and they’re covered by Medicare and Medicaid, which most all providers accept. And if you accept it, you follow the fed’s rules.

    2. A lot of people think of Single Payer as being more like school vouchers – i.e. the providers would be privately managed, but the funding would come from the government or some government-sponsored enterprise like Fannie Mae/Freddie Mac.

      1. Ugh, and look how THAT turned out.

        1. Yeah – it’s still a shitty idea, but a lot of its supporters won’t see “it’s government-run healthcare” as an accurate criticism.

      2. The language around these debates gets complicated due to the varying levels of control the government has over health care.

        Universal health care – any system that achieves universal or near-universal insurance coverage (which doesn’t always guarantee care). This requires varying levels of government involvement. Some countries like Switzerland and Singapore have relatively private systems where the government subsidizes and regulates purchase of private insurance. Note the use of the word relatively there. Other countries like Germany and the Netherlands offer public health insurance programs to buy into, but it’s not mandatory and complements private options.

        Single Payer – when the government runs one mandatory health insurance plan for the whole population. There may be supplemental private insurance available, depending on the country.

        Socialized Medicine – the most total form of government-run healthcare, this is essentially the NHS in the UK. Not only does is there single payer insurance, but most/all hospitals and clinics are owned and operated by the government, and most/all doctors, nurses, etc. are government employees.

        1. Correct classification. And the USA has examples of each .

          Single Payer is basically Medicare and Medicaid . Doctors get paid by the government , but compete against each other for business . The availability of doctors will greatly depend on reimbursement rates ( very poor for Medicaid, acceptable for Medicare for the time being).

          Socialized Medicine. That’s the VA system. Health care is provided by federal employees at federally owned hospitals. It is similar to NHS and plagued by the same problems.

        2. The distinction between Single Payer and Socialized is essentially trivial; it’s akin to the difference between a government agency and a government subsidized, government sanctioned monopoly. The difference is nominal.

          And ‘universal health care’ is quite ambiguous as well. We already have universal access to emergency care.

          What people mean is *more* universal healthcare. How much more? No one seems to know how much more they want. All of it, I guess.

          1. I disagree that the difference is trivial. That’s not a defense of Single Payer, but I think a system where hospitals are directly owned by the government and doctors have to work directly for the government is worse than one where that’s not the case. Obviously there’s still indirect influences at play, but I think nationalizing the entire health care industry is clearly worse than nationalizing just the health insurance industry.

      3. I don’t think that’s what single payer is. Single payer is like in the UK where the government owns the hospitals, employs the doctors, etc. Most places with universal health insurance don’t have that system. I don’t want any of those systems, but it’s silly to act like some aren’t better than others.

        1. Or maybe it’s what Calidisident says.

          In any case, not all “universal healthcare” systems are the same or are single payer.

          1. That’s really all I’m saying – not all people advocating a thing they are calling “Single Payer” are in fact advocating the same thing, and they are certainly not all arguing for a 100% government-owned and run healthcare system. Some are, obviously, but not all.

          2. Canada’s an example of Single Payer without the complete takeover of hospitals, doctors, etc. like there is in the UK.

  4. Short of catastrophe, there was no way it would ever happen.

    Obamacare was just the catastrophe they needed.

    1. Some said ObamaCare worked as designed because it was designed to implement government takeover of the health insurance. Since government run healthcare has been implemented via Medicare and Medicaid, shuddering of the private health insurance market was all that was left.

      1. I think it’s a mistake to see a single intent behind it. There were a lot of cooks in that kitchen. Some of them I think sincerely believed that right-thinking technocrats could design a system for the nation that would be a net benefit for society. A lot of them were academics who were just stroking their own egos (like Gruber). Some were industry people looking to leverage some cronyism. Some were simply power hungry people who get off on taking control of people’s lives.

        And this is why the Federal Government sucks at doing pretty much anything – it doesn’t matter what any particular individual’s intent is. The result will be a confused clusterfuck of compromises, cronyism and conflicting goals no matter how pure-hearted the original idea may have been.

        1. “The result will be a confused clusterfuck of compromises, cronyism and conflicting goals no matter how pure-hearted the original idea may have been.”

          Yep. But the alternative is some despot designing policy from the ground up using only his own eternal wisdom. Democracy is messy and leaves everyone a little unhappy with the outcome, but that’s kind of like any group decision making everywhere.

          1. But the alternative is some despot designing policy from the ground up using only his own eternal wisdom.

            No, it isn’t, Oh Great Purveyor of Non-Binary Dualisms.

            It’s not “US Federal Government or Hitler.”

            We can have this thing we call “local control.”

            I know it’s really, really scary for Democrats, but it has worked before, and it can work again.

            1. So localities get to make messy, compromised policy. That totally fixes the problem you were talking about and isn’t just a change of subject.

              What about policy that must by necessity be made at the federal level? As in stuff that affects the country as a whole? That’s really all it has jurisdiction over anyway, technically.

              1. So localities get to make messy, compromised policy. That totally fixes the problem you were talking about and isn’t just a change of subject.

                If you weren’t an utter moron with no actual life experience you would realize that the smaller and more localized the group, the more aligned their interests and the less messy the compromises.

                So once again, you reject the obvious solutions because they don’t result in utopian perfection, but you think we’re the unrealistic utopians.

                What about policy that must by necessity be made at the federal level?

                Only those things that are in fact necessarily handled at the federal level should be handled at the federal level. Of course, to you that’s absolutely everything.

                1. “Local jackbooted thugs should decide things instead of federal jackbooted thugs” is quite a watering down of libertarian principles, and if all we’re debating is at what level of government a policy decision should be made, then we’re really only talking about details and not principles.

                  Where I live the local thugs are a much more immediate threat to my health, life, and happiness than any feds. But I don’t run an interstate drug ring.

                  1. And this is your fundamental trouble in trying to understand things – it’s only ever jack-booted thugs with you. You are either putting your boot on someone else’s neck or someone else is putting their boot on yours.

                    Negotiation and compromise are quite simply foreign concepts to you, which is why you see no difference at all between local compromise and top-down Federal impositions.

                    1. Okay, the next time I have a couple drinks and want to drive somewhere, I’ll “negotiate” with the jackbooted thug who pulls me over. What kind of Candyland are you talking about?

                    2. Thus proving my point that your only concept of government is jack-booted thugs.

                      You don’t see any element of local control other than police? Are there no more localized legislative bodies than the US Congress? Or are you just not aware of them?

                      Or are you arguing that police shouldn’t be local, that they should all be Federally controlled, because that would be better . . . for some reason?

                      What are you getting at?

                    3. I’m saying that just because a government is more local does not mean it is better in any sense of the word. You’re just talking about what’s practical. That’s not a philosophical difference. Sure I think local governments should handle zoning in their jurisdiction and other things like that. And states should handle state things, and the feds should handle fed things. The fact that you guys seem to worry most about the feds does skew your priorities way off of caring about actual freedom, in my opinion, since most of us never actually have to deal much with the feds.

                    4. I’m saying that just because a government is more local does not mean it is better in any sense of the word.

                      It’s none of your business, actually, to judge whether or not you think someone else’s local government is “good” or not.

                      The point is that it is local, and thus of necessity involves less imposition on individuals by individuals who are far away and have no common ground with them.

                      The fact that you guys seem to worry most about the feds does skew your priorities way off of caring about actual freedom, in my opinion, since most of us never actually have to deal much with the feds.

                      That’s a really, really stupid point to make in a thread where you are advocating a Federal takeover of healthcare, and we are arguing against Federal healthcare.

                      Would you like to discuss state-level Single Payer? I have to warn you, I may start talking about State government if so . . .

                    5. Another spurious strawman…………

              2. None of which should involve healthcare. Which should have nothing to do with the federal government.

          2. Democracy blows

            1. Grownups are people who have learned that life is full of painful compromises. Also precocious 5 year-olds.

              1. But only if those compromises are made with everyone else in the entire Empire, rather than just in your neighborhood. That’s grownup thinking.

              2. Are they also proggie losers who comment on libertarian blogs constantly?

              3. “There are two sides to every issue: one side is right and the other is wrong, but the middle is always evil. The man who is wrong still retains some respect for truth, if only by accepting the responsibility of choice. But the man in the middle is the knave who blanks out the truth in order to pretend that no choice or values exist, who is willing to sit out the course of any battle, willing to cash in on the blood of the innocent or to crawl on his belly to the guilty, who dispenses justice by condemning both the robber and the robbed to jail, who solves conflicts by ordering the thinker and the fool to meet each other halfway. In any compromise between food and poison, it is only death that can win. In any compromise between good and evil, it is only evil that can profit. In that transfusion of blood which drains the good to feed the evil, the compromiser is the transmitting rubber tube . . .

                When men reduce their virtues to the approximate, then evil acquires the force of an absolute, when loyalty to an unyielding purpose is dropped by the virtuous, it’s picked up by scoundrels?and you get the indecent spectacle of a cringing, bargaining, traitorous good and a self-righteously uncompromising evil.”

                Ayn Rand

                1. You don’t even see how that Rand passage is fascism in a paragraph.

                  1. I’m not seeing “private property but with heavy government control of the economy” anywhere in there

                    1. More the sense of “kill all people who don’t fit my conception of human correctness” that runs through all her trash.

                    2. Tony, that is YOUR creed. Slaver piece of shit.

                    3. Funny how much “fascism” has lost its meaning. It’s no longer a system of government apparently. Perhaps the progs realized Obamacare is pretty much fascist in nature since it retains a private system but tells them how to run their business

                2. You forgot the next paragraph:

                  “He moved one hand, took her two wrists and pinned them behind her, under his arm, wrenching her shoulder blades.”

              4. That’s true.

                One concept of a libertarian is someone who has a high threshold for consensus before desiring government intervention. Because, if we need government for externalities, we should also recognize that government itself can be one, huge externality.

                So, a libertarian might be ok with a law that 95% of everyone agrees with, and thinks that, for controversial issues closer to 50-50, adults should remain free to work the issue out between themselves as needed.

                Meanwhile, the democracy whimps scream to their teacher about how unfair it is for 51% of the population to not get its way, and shove its will down the other 49%’s throat.

                I leave it as an exercise to the reader: which group is more adult?

                1. “for controversial issues closer to 50-50, adults should remain free to work the issue out between themselves as needed.”

                  What does that mean specifically? What if the controversial question is “Should we go to war with Germany?”

                  Requiring anything but 50+1% means you passively endorse the minority position, whatever it is. There really is no such thing as doing nothing.

                  1. “There really is no such thing as doing nothing.”

                    That would be a great point, if part of my argument relied on that assumption.

                    1. The choice is passing or rejecting a proposal. Why should rejecting it automatically get the benefit (to the tune of a 95% threshold!)? It must be because the status quo is automatically assumed to be better until proven extremely otherwise. But the status quo is just another set of policies.

                    2. If a super-majority requirement always favors the minority, then a super-majority requirement would result in absolutely no change in the law.

                      This seems somewhat contradicted by reality.

                      I leave it as an exercise to you to find your own logic error.

                    3. It favors the minority until the threshold is met, which, duh. But it means that 6% will always get their way over 94%, which is absurd. You might as well just install a dictator.

                    4. Tony:

                      But it means that 6% will always get their way over 94%, which is absurd.

                      Sorry, but you’re not thinking hard enough.

                      Think hard and see if you can come up with a scenario where one group wants to pass or repeal a law, and one doesn’t, and one group as 6%, and one group has 94%, and the 6% doesn’t get what it wants.

                      it’s not hard if you try. Really squeeze that brain of yours, and see if you can find it.

                    5. If the threshold for passing or repealing is 95%, the 6% will get its way. Of course the 95% would be perfectly free to simply rewrite the rules to something sane, being that they’re the 95%.

                    6. Tony:

                      But it means that 6% will always get their way over 94%, which is absurd.

                      Tony:

                      If the threshold for passing or repealing is 95%, the 6% will get its way.

                      Who said the 6% are always opposing the pass or repeal?

                      Let me guess: you don’t get by in this world using logic, do you?

                    7. If nothing can be passed or repealed without 95% agreement, then a minority of at least 5%+1 will get its way over the majority on any proposal that does not reach the threshold. I think I just said the same obvious thing twice in one sentence.

                      But I didn’t major in nerd, so maybe I am actually missing something.

                    8. You’re missing the part where you show your point that the minority always gets its way, equivalent to a dictatorship.

                      You know: the part where you just don’t restate the obvious.

                    9. Listen, I know this is hard for an Oklahoma yokel to understand, but super-majority requirements don’t actually just give minorities dictatorial powers.

                      In fact, I don’t mean this to sound condescending, but we explain constitutional republics to social studies children: sometimes, 51% of the people shouldn’t get what they want, even when they agree with each other, if it means screwing 49%. (Or maybe even 10%: see: gay marriage).

                      If it makes you feel better: I think a 50% threshold would be fine for repealing a law. You should like that: it sounds democratic.

                      Of course, at that point, you could throw a lot of the civil rights amendments out of the constitution, possibly, and maybe delayed that a good bit. But, hey: you love democracy, because, without votes, everything is equivalent (or something).

                    10. And, quite frankly, I think you’re taking this “no policy is a policy, too” business to such a bizarre place that it’s practically newspeak: where you try to eliminate an idea by defining it away.

                      For example: I can choose my friends. The government doesn’t choose for me. There isn’t a law telling me who I have to be friends with, or can’t be friends with.

                      That idea, the concept that people are left to make decisions for themselves, rather than having decisions made for them as a matter of policy: is still a concept. What value you get out of declaring “The policy to let you choose your friends is a policy just like friend regulation!”, I get what you’re saying, but the place you’re trying to take the point is borderline psychotic. Yeah, they’re equivalent, except in ways that actually matter, in which case, it’s a complete false equivalency to pretend they’re the same.

                      A person so eager to ignore the obvious should really ask himself why.

                    11. YOU want to install a dictator. Do you listen to yourself?

                    12. Do you ever write entire stream-of-consciousness narratives on every wall in your room?

                    13. Nine people are going to order three pizzas to share. Six want pepperoni, three want anchovies.

                      Tony: “I think all three pizzas should have pepperoni. The majority getting its way is more fair than the minority imposing its will. But those crazy libertarians think the minority should get their way instead and have anchovies on all the pizzas.”

                      Libertarians: “Get two pizzas with pepperoni and one with anchovies, dumbass.”

                    14. Libertarians: “Get two pizzas with pepperoni and one with anchovies, dumbass.”

                      RACIST!

          3. Which is why we should follow capitalism not democracy.

            1. One dollar one vote. Freedom for those who can afford it?

              1. *Whoosh*

          4. I love false choices.

      2. Worked as designed by the Heritage Foundation? ObamaCare is very close to RomneyCare.

  5. Fortunately Republicans lawmakers are very serious people who are skilled at governing and strategically thoughtful at statecraft.

    1. Unfortunately, Democrats are socialists who want to control the means of production in health care and more.

      Watch your backs freedom loving people.

      1. If there were a lot less democrats around then we wouldn’t have this concern……….

        1. You guys should get a room. You can discuss murdering Democrats and the finer varietals of truck nutz.

          1. We would fit right in with lefties discussing murdering everyone who is not a socialist.

            Funny how lefties always equate protecting yourself from socialists with rampaging murder.

            I guess socialists know all about rampaging murder.

            1. I thought we were delicate snowflakes who couldn’t take being called by the wrong pronoun? Are we also rampaging murderous thugs?

              1. Absolutely.
                I seem to remember what happened to the Donner party when a bunch of snowflakes got together.

          2. Murder? Better that most of the democrats just renounce all their beliefs and get behind the libertarian movement. And for the antifa thugs, and other violent socialists, it isn’t murder when you’re fighting back against their rioting and raging. It’s self defense.

    2. They prove that government doesn’t work.

  6. Providers and insurers are only hurting themselves by becoming too expensive. Sometimes it’s tempting to throw your hands up and say “screw it–let’s try single payer.” That sense is out there. Something needs to happen because things that can’t go on forever, won’t.

    1. Providers and insurers are only hurting themselves by becoming too expensive.

      And do you see this as just an arbitrary development within the industry?

      1. I’m sure it has absolutely nothing to do with mandated services and underpaying government insurance programs for people who use the vast majority of healthcare in the United States.

        That would be crazy right?

        /sarc

        1. It’s greed I tells ya! Greed!

        2. Mandated services meaning we don’t check people’s pockets for insurance cards before saving their life, right?

          Damn government regulations interfering with the pristine beauty of the market!

          1. Mandated services meaning we don’t check people’s pockets for insurance cards before saving their life, right?

            Is that really the one and only mandated service, or are you being intentionally dishonest and misleading because you’re kind of like that?

            1. And who is this “we” checking people’s pockets before saving their lives, Kemosabe?

            2. That’s the big one, right? If hospitals could simply refuse treatment to people who couldn’t pay, we’d have solved a large part of the cost problem.

              Or don’t you realize that libertarianism (as usually presented) is a bag of ridiculous nonsense that treats economics as the only activity humans engage in, with little things like morality and saving lives as mere afterthoughts?

              1. If hospitals could simply refuse treatment to people who couldn’t pay, we’d have solved a large part of the cost problem.

                As usual, you’re changing the subject from emergency life-saving care to “treatment people can’t pay for.”

                You seem to feel that people shouldn’t have to pay for healthcare, since “morality and saving lives” is more important than economics. By extension, you seem to feel that doctors and nurses shouldn’t get paid for what they do.

                Is that correct?

                1. It’s sad that you’re so far down the rabbit hole of homo economicus that you’ve forgotten intellectually what actually living a human life is like. Don’t you do it every day?

                  Obviously nobody is calling for the enslaving of doctors and nurses. But thanks so much for yet another insightful contribution to the discussion. As I said below, when single-payer comes, blame yourselves for being too stupid and hysterical to come up with any alternative.

                  1. Obviously nobody is calling for the enslaving of doctors and nurses.

                    But you just said that healthcare shouldn’t be subject to economics, and people who can’t pay for care should be treated anyway.

                    The logical extension of that is that if a starving doctor sees an indigent person who needs care, that doctor has an obligation to provide care whether that doctor is going to be paid or not, right?

                    Or do we not do logic anymore?

                    If you think healthcare should not be subject to market/economic forces, then you have to remove doctors and healthcare providers from the system of payment that makes it an economic function. How else do you determine prices and what money goes where from the All-Seeing Single Payer?

                    1. You’re not getting this and you’re doing it on purpose. Economics is the science of scarcity, and yes healthcare like everything else has scarcity. But because it is considered a basic human need in modern civilizations, we pool resources to subsidize extra healthcare. Aircraft carriers were thin on the ground until we decided to do the same to make more of them. The contractors who build the ships, however, are not slaves, as they are permitted to quit any time they want and, uh, they get paid. I’ll let you take the analogy back to doctors and nurses.

                    2. Well, that’s not counting the wage slavery.

                      I think I heard Ben Carson talking about that.

                    3. It’s hilarious that you declare that I’m not “getting this” immediately prior to conceding my point that “Economics is the science of scarcity, and yes healthcare like everything else has scarcity,” and then moving the goalposts and pretending that you weren’t just reprimanding me for implying that healthcare is subject to economics.

                      Remember how the sub-thread started with a discussion of why prices have been rising?

                      Do you remember how you started out by claiming that mandated services don’t effect healthcare prices? And then declared that, well, okay, they do, but we here suck because we shouldn’t be thinking about prices, just about what healthcare people need? And then declared that this doesn’t entail forcing doctors to perform mandated services? And then declared that, well, okay, it does but you’ve only ever been arguing that someone else should pay for it?

                      Which then entails you arguing that keeping the market for something restricted in supply but ensuring a payer for any service anyone wants won’t lead to higher prices?

                      Are you starting to see why so many people here think you’re a dishonest moron?

                  2. Factually speaking Bernie Sanders is indeed calling for enslaving doctors and nurses, they just avoid the use of the word ‘slave’.

                  3. “Obviously nobody is calling for the enslaving of doctors and nurses.”

                    You should look at how single-payer health care works in Japan.

              2. That’s one of them, but your ignorance on what constitutes a mandated service is so juvenile it’s like having a conversation with a six year old about where babies come from.

                Nevermind the fact that you bemoan how expensive healthcare is, to the point where you advocate for government takeover of it, then when it’s pointed out that government policies you’re in favor of caused the price explosion you stick your head back up your own asshole and scream into your intestines about ‘fair’.

                Well, ‘fair’ is everyone not receiving care right? Because that’s what your new favorite policies result in. You can bitch and moan about how everyone deserves a unicorn, but that doesn’t mean there’s actually a unicorn to give.

                You’ll never understand though. You’re just incapable of basic reasoning. I’m not sure if it’s brain damage or willful retardation, but you’re broken Tony. You’re broken and you want to break the rest of us too.

                1. I’m not advocating anything. I’m not a healthcare policy expert, as you have noted. I simply observe that other societies have figured out how to achieve universality at on average half the cost per capita. And actual policy people know perfectly well why, and the math isn’t even that esoteric if you know anything about risk pools.

                  Obviously nobody sane would advocate a policy that increases costs and decreases care availability. That’s why that approach is left to the libertarians.

                  1. Literally every single thing you said in your above post is factually incorrect. All of it.

                    1. Well, I should say except the part about you not being an expert. That part is factually correct.

                    2. It would be better if he disclosed that he is a gibbering moron (although this is quickly obvious to even the most casual observer). At least he can leverage that to a 90% discount at the mind readers.

              3. Yes, libertarianism is centered private property rights. Anything else is secondary. But no libertarian worth a damn doesn’t have some other set of morals to guide them. It’s just that those additional morals may not fall under the banner of libertarianism. If I watch a man drowning and do not save him, I have not violated the nonaggression principle, but I have been a shitty human

                It’s almost not worth explaining the basics to a cretin that tries to understand libertarianism through a comments section and articles from a libertarian-lite publication

                1. I’m hardly the first to criticize libertarianism (particularly the popular Hayek brand) for insisting that all human interactions are economic in nature.

                  It’s why Hayek had to be subsidized by rich crazy people instead of becoming an actual respected economist on his own, like Keynes.

                  1. Look at that, Tony referenced a real libertarian thinker! I assume you don’t have a copy of The Road to Serfdom that you’re referencing though

                    But lol @ Keynes. Have fun breaking those windows

                    I still don’t get how that idea of human interaction would exclude morality though. Value gained through interaction can be monetary, but it can also be more abstract, like making me feel better about myself

                    1. The most rapid and far-reaching advancement in human well-being in history happened directly as a result of the massive government works program known as World War II, which coincidentally was also the most destructive endeavor ever undertaken by the human species. How much of a role did the free market play in this unprecedented advance in technologies (including the technology of governing)? As much of a role as the US federal government said it would play, that’s how much.

                      Tell me how a theory of homo economicus even conceives of such a chain of events, let alone does better than it.

                    2. No moron, it was the result of cheap and plentiful electricity. The war just pulled us out of an economic rut you socialists sustained with your bullshit policies throughout the 30’s.

                    3. No, the war did not bring us out of the depression. Bombs do not produce any value outside of death. Government spending on things necessary for war were factored in as a part of GDP; it is hard to believe there was not cronyism on the part of price negotiations, and when you look solely at GDP, there is a gigantic dip right after the war, yet no one talks about the Depression of ’46 because it was just as artificial as the bump itself. Unemployment is sure to go down when you force millions of working age men overseas to fight in a war. Private sector indicators were on a slow upward tick prior to the war, which is why that Depression of ’46 wasn’t actually a big deal. I don’t doubt that some of the Keynesian stimulus provided an artificial boost to the economy; that’s actually not remotely surprising. Austrian economics just says that those artificial boosts often prop up failing industries and produce cronyism and thus do not allocate resources properly

                      Also, the greatest increase in the well-being of humanity did not occur in the narrow window of the 30s to 1945, and if you’re saying the technology produced during that time helped, you are again using broken window economics

                      Also, chill with the homophobia man

                    4. I always forget you guys have a highly convenient alterna-history at the ready for whenever the 40s come up.

                      We can’t get anywhere without a baseline of accepted facts. I would blame the quasi-scientific nature of economics for your ability to weasel out of them, but I think it has more to do with the fact that libertarian economists, with their fat subsidies, have muddied the waters for so long, keeping it as unscientific a field as possible.

                    5. Maybe I just read more than Vox

                      The numbers are out there for all to see, including that Depression of ’46. All that’s different is whether you take the Keynesian view, that demand is all that drives the economy, or the Austrian view, that we have to consider capital/supply. I provided no new “facts”, just an interpretation you aren’t familiar with. But if you disagree, feel free to call for more war for all the economic benefits it has

                      It’s also funny when you don’t think there’s money all over your side. Keynesian stimulus is great when you’re one of the businesses getting the government money. Why wouldn’t you support those programs? Also entertaining that we all know the billionaire libertarians, but most of the famous billionaires out there are on the left. Somehow this means that the Kochs are driven by self-interest but someone like Elon Musk is driven entirely by altruism

                      As far as keeping things unscientific, you have a point about dogmatic Austrian economics, but I feel like you derived it from checking Wikipedia. I think empiricism has a place in economics as with any science, but I also think the Austrians’ warnings about it are also important. Hayek’s fatal conceit is still brilliant. Also, despite your sniping about how he produced no value absent rich donors, the man got himself a Nobel on the merits of his work

                    6. The same Nobel awarded to mainstream economists year after year? Or is only his legit?

                    7. Nice strawman there you racist. Some of them do contribute interesting points. I don’t reject all of mainstream economics, you racist. Way to miss the rest of my point too you despicable racist piece of shit

                    8. I always forget you guys have a highly convenient alterna-history at the ready for whenever the 40s come up.

                      Yup. The idea that the most destructive conflict the world has ever seen was a bad thing to be avoided and not some great boon for society is the alterna-history.

                      So glad to see Democrats sticking to their principles.

              4. Whereas democrats pretend all moral and economic dilemmas are resolved by the phrase “let government do it.”

                1. Straw man as you well know, but another helpful contribution to the “Well, that was stupid” pile libertarians are contributing to this discussion, hastening the imposition of a universal system for want of any alternative.

                  1. Not really. “Assume government” is the democrat’s primary argument.

                    It goes like this:

                    “In a free market, there’s no guarantee you’ll get medicine. So, let the government guarantee it.”

                    You might as well toss the question to God. Scarcity still exists, economic calculations still need to be made. They’ve just been tossed to bureaucrats and politicians, which are, by definition, a huge externality.

                    Yet democrats act as though government waves a magic wand and the word “No” just goes away, along with scarcity, in a futile attempt to have someone else pay for everything.

                    Sorry, but 50%+ income taxes doesn’t leave one more free unless they have huge medical bills, which everyone doesn’t. The freedom you want for some comes at a cost that you just try desperately to wish away, or assume “the rich” (whoever they are) pick up the bill (they’re probably not real people, anyway).

                    1. Everyone eventually has huge medical bills. (Except those who die young and quickly, I guess.)

                      Take a fairly simpler example, Social Security. It’s a rather large transfer of wealth from the young to the old. But it’s necessary because it acknowledges that old people can’t work (and we shouldn’t ask them to as a moral society), and even the most prudent of them can’t predict how long they’ll live or what illnesses they’ll have. It’s just a clever innovation for solving a problem that exists because we’re human. It increases freedom on a massive scale, despite being a massive tax that isn’t even progressive. That it uses government to increase freedom is a problem with your philosophy, not mine.

                    2. Everyone doesn’t have huge medical bills justifying tax rates the equivalent of multiple retirement plans over the course of their entire income-earning lives, so, that’s really not an argument, although you’d desperately like it to be that simple.

                      I know you’d like to change the subject and talk about SS, but I really don’t care about your personal, subjective freedom evaluation of SS. I don’t have a philosophy of “Gee: I have a vague preference for freedom, and will concede the validity of any argument that ends with ‘that sounds like freedom to me!'” So, cool story, bro.

                    3. I think it needs to be pointed out that Tony really did just make the argument that the best thing to happen in the 20th century was WWII.

                      Remember – he’s on the more moral side!

                    4. But people can’t predict their medical expenses, and more than that they have often no choice but to pay them. That’s why it’s dealt with by an insurance model. All these government schemes are is translating it to a public insurance scheme. The principle of risk and risk pooling is the same. It’s not the death of freedom, it’s just efficiency.

                    5. It’s not the death of freedom, it’s just efficiency.

                      Spoken like a true fascist.

                    6. You can call it whatever you want to, it’s still question begging.

                    7. So, people don’t know what their medical expenses will be, but they know they will be huge, and they know they have to pay them, even though they don’t have to pay them, so we need public health care because risk, pool, insurance, efficiency.

                      OK.

                      Let’s just spit ball here and come up with an empowering win-win scenario, with synergy and innovation, featuring out-of-the-box thinking, and buying in to our core competencies.

                    8. Old people dying en masse is less freedom than them not dying en masse. Sorry if you’re going through a postmodern relativism phase.

                    9. That’s a great argument, as soon as you show that, now, old people never die.

                      Everyone dies.

                      What we do, is we have health and income programs that buy them extra time to live.

                      And the fact that you don’t know this shows that you really have no idea what economic calculation you’re doing, or what you’re even buying, much less how awesome it is to force everyone to buy it regardless of their individual values, or the value of others.

                    10. Is your argument that old people are doing just fine because they already get single-payer healthcare?

                      Every public policy will chafe someone’s ass. Isn’t the little lesson about “in a democracy, or any other system, not everyone gets his way all the time” in this thread? I don’t mean to be condescending but this is something people learn as children. So Libertarians are never going to have the “values” that allow them to be content living in a partially socialized economy. Ever consider not being a libertarian?

                    11. That’s a great point: we don’t have single payer healthcare, it’s failed every time it’s been tried, so get over it.

                      Are you making your own argument, or someone else’s now?

                    12. I don’t mean to be condescending

                      Don’t lie.

              5. If we harvested the organs of commie traitors to defray medical costs, it would be a nice hedge against higher insurance premiums. Not so good for the commie traitors though.

                1. If we harvested the organs of commie traitors to defray medical costs, it would be a nice hedge against higher insurance premiums

                  This really is the level of utilitarianism that Tony has achieved here. He would choose Republicans, though, obviously.

          2. Indeed, everyone in medicine only got in medicine to watch poor people die. My doctor is a verified psychopath who despises helping poor people

            1. No doctors ever helped the indigent for free before they were forced to by the government. This is known.

              1. It’s kinda depressing when the left believes that everyone is a horrible and evil person deep down, but that they can use government to do away with all the darkness in our hearts

                1. Yeah – and I’ve never understood who it is that they think is in government when they think that people tend to be so evil generally speaking.

                  1. So, so on the nose. It’s good ol’ Hobbes vs. Locke.

                2. And that somehow, all these evil people are perfectly beneficent when, and only when they become government bureaucrats, and elected officials (but only for the right party).

          3. Because before mandated care medical people were just leaving people to die in the streets.

            Actually its socialists countries where medical people are leaving people to die on the streets and in care facilities.

            1. I guarantee if we go single payer that our cancer and heart disease survival rates will go in the toilet just like every other socialist shithole.

              1. My wife recently had a cyst and was doing some online research about home remedies.

                There was a striking difference in attitude between people in the USA vs. the UK. All of the advice she found was from the UK – there was literally no sense in the UK that you see a doctor for a cyst. You would just get laughed out of the clinic. You couldn’t even get a doctor’s advice on a cyst – you just had to go it alone with the best advice you could get from your neighbors.

                In the USA, of course, the attitude is “why would you even try to take care of anything by yourself when you can go to a doctor?”

                Single-Payer advocates think we can have the benefits of both the USA’s system and the UK’s system. It doesn’t work that way.

                1. We are the USA, and we have demonstrated an ability to innovate our way to the top. But damn libertarians and their pessimism. No universal healthcare and no solar power either!

                  I don’t see why it’s written in stone that we simply must forego universality in order to maintain our cutting-edge hospitals for rich people and charity cases. I’ll assume that’s sort of what you mean and aren’t actually saying that the poor should go without healthcare so that the bourgeoisie can have short waiting lines.

                  1. Because universality requires the government to initiate force. In language you can understand it requires violence. Why do support violence? It’s kind of sick dude.

                    1. He supports violence so he can have others pay for his stuff at the same time taking wealth from those that have done better in life than he.

                    2. Then government “initiating force” may not be a bad thing, if universal healthcare is the kind of thing it can achieve. Check your premises, as the Ayn says.

                      Not that you don’t think government should never initiate force. A guy walking on your lawn is not force when compared to what you think government should be able to do to him.

                      But then we’re twisting and turning the definition of force so that it describes whatever fancy.

                  2. I don’t see why it’s written in stone that we simply must forego universality in order to maintain our cutting-edge hospitals for rich people and charity cases.

                    It would involve observing reality. Things that are “written in stone” don’t matter – words, words, words, as a confused young man once said.

                    I’ll assume that’s sort of what you mean and aren’t actually saying that the poor should go without healthcare so that the bourgeoisie can have short waiting lines.

                    What the fuck is wrong with you that you can’t listen to anyone else, ever? Have you ever experimented with trying to accurately summarize the views of someone you disagree with? You know – a basic fucking Turing test to show you’re not an AI?

                    What happened to poor people before Obamacare? Hell – we don’t have Single Payer right now, yet I’m sitting inside a hospital that literally serves poor and indigent people all day long – how is that possible?

                    1. Medicaid? A single-payer government healthcare system!!!!

                      Maybe I’m bad at addressing arguments but you just said the poor have no problem what with that free-market Medicaid they have.

                    2. You are correct – you are extremely bad at addressing arguments. And you know what? You just now failed once again.

                2. All of the advice she found was from the UK – there was literally no sense in the UK that you see a doctor for a cyst. You would just get laughed out of the clinic. You couldn’t even get a doctor’s advice on a cyst – you just had to go it alone with the best advice you could get from your neighbors.

                  You mean like this NHS page?
                  http://www.nhs.uk/conditions/s…..ction.aspx

                  1. You mean like this NHS page?
                    http://www.nhs.uk/conditions/s…..ction.aspx

                    I’m sure many people in the UK find that webpage extremely useful. NHS for the win!

                    1. I’m sure many people in the UK find that webpage extremely useful. NHS for the win!

                      I know you’re being snarky – but I’ve lived in both places. And for this sort of routine/family stuff, this is where even the NHS is much better than our system (and NHS is usually near the bottom compared to other countries). Except dental – but that’s really a Brit thing. Knee replacements for an 80 year old or advanced stage cancer or difficult diagnoses (by that I mean actual difficult diagnoses not ‘milk the system for multiple opinions’)– well that’s where NHS sucks.

            2. You apparently are not familiar with the health care systems of countries like Japan, Australia, Canada, Sweden, etc. People are not dying in the streets from lack of health care there; that is what happens in the US. A friend of mine in the US recently died because he could not afford the operation he needed. But at least insurance company executives are being paid.

              1. Your friend was free to move to those countries, have you pay for the surgery, or purchase an insurance plan (that was not illegal under the ACA). But the expectation is that people who chose to cover those costs for themselves should also pick up the tab for others. And why is it assumed your friend would have had that surgery and it would have been successful?

  7. One new poll this month found that a majority of doctors are in favor.

    In Paul’s single-payer plan, Doctors make $150 a week like all government workers should.

  8. And that goal means that liberals are starting to grapple with the very issues that I always believed would prevent it from happening. Those who oppose greater government intervention in the health care sector should take this as a wake up call.

    I was trying to google the old (and I mean old) Reason article where one of your predecessors wrote that America would eventually get a single-payer plan, come hell or high water. But I can’t find it. Sure, it was during the Clinton healthcare debates, but a lot of us have been awake on this for a very long time.

    I will admit that back in the 90s, I was pretty sure we’d have single-payer by now, so the timeline is certainly off, but remember folks, we’re the only industrialized country in the world that isn’t fully socialist… so I still say it’s a matter of time.

  9. Sodden thought while reading this. The biggest problem is the cost; you try paying doctors half of what they get now, and many will go bankrupt with school debts or find some other occupation.

    There are two opportunities here. For libertarians who hate occupational licensing, this is a great hook for loosening the AMA grip on doctor licensing. Flood the market with foreign doctors (an immigration hook).

    And for Dems, they can suddenly forgive school debts. Although, since the primary result of that (in this case) would be even more doctors finding other occupations, even Dems are not stupid enough to do it so simply.

    1. So you favor lowering the median competency level of doctors? That’s what will happen. I’m not against letting more in from foreign countries, at least the ones where their training and education are somewhat close to our own, but ‘flooding’? I don’t want every other doctor to be Nick Riviera.


  10. Two years ago, if you had asked me about the prospects for a single payer health care system to be adopted in the United States, I would have said that there was essentially no chance in the foreseeable future.

    Funny, but I’ve been saying for 6 or 7 years that’s it’s inevitable.


    1. For much of the public, then, the national health care debate looks like an argument between two sides, one of which is proposing an ambitious and increasingly popular goal it hasn’t figured out how to make work yet, the other of which is proposing something, well, murky. That’s not an argument that Republicans are likely to win.

      Suderman doesn’t really get this right in my opinion. It’s a war between people who are promising simpler and free healthcare for everyone regardless of fesability and people who are promising something murky.

      The part that’s a disconnect is it doesn’t matter if Republicans are murky or crystal clear; if they aren’t promising more ‘free’ bennies from the public treasury, they lose. This is the central reason why the left will win this battle. It’s because things like results and fiscal sustainability do not matter so making arguments with appeals to reason are going to fail.

      Obamacare taught me that it doesn’t matter if a program works, or if it screws over the majority of the country. If it promises more goodies at the expensive of the public treasury people are going to be for it. Hence the road to hell is already paved for us.

      1. The last hope we really had that single payer wouldn’t happen was a full repeal of the ACA by Republicans. Since they have failed, there is no hope left that this isn’t going to be our end destination. Sure, we’ll claw and scrabble to avoid it but ultimately we’ll be dragged there against our will.

        Thanks, Democracy.

        1. I think this is probably right, but as I said above I think what we’re going to see is a government-sponsored insurance corporation that will be semi-private and will fund care that is provided by privately-run facilities.

          This is already the path of least resistance, as it will be the government’s natural response as more and more insurance companies withdraw from markets.

          1. At first, perhaps, but it won’t matter functionally it will be an enormous and unsustainable spending trajectory that will only inflate the costs of services while reducing the amount of providers in the system.

            Since it’s a system designed to fail, it will fail. I don’t think anyone expects full-on Soviet style government owned means of production but functionally speaking that’s what it will be; regardless of it’s labyrinth structure designed to fool people into thinking that isn’t what it is.

            1. Eventually, yeah, although as I said above I suspect a lot of the system’s architects suffered from such a level of hubris that they actually did think it was going to work.

              I think the government-insurance program will run at a massive loss and be funded through debt until it can’t be funded anymore, at which point it will start cutting back on what it will pay for, and a parallel private “supplemental insurance” market will emerge as it always seems to.

              We will continue to fund it, of course, long after it has stopped providing real benefits.

              1. Probably, which will also have the bonus effect of destroying savings in the United States.

                It’s…going to be bad. Very bad.

                1. If we’re not here to fund the expanding Empire, what are we here for?

                  1. Spicy meme’s and knowing we’re fucked but being unable to change the end result?

                    But hey, on the bright side I’ll have the bonus of being proven right a whole lot over the next few years and decades so I’ll probably wear out the phrase ‘told you so’.

                    I’ll admit, I do like being right but in this case I sincerely hope I’m wrong.

      2. Muh ROADZ to HELL! Who will pave them?

  11. Perhaps, I’m just a little more cynical than the author and others here, but was there any real doubt that the Progressives would ultimately win … in all areas of our economy. Sure, on rare occasions expansion of government initiatives are rollback, but the net is a continuous stroll toward state control of the economy. It’s just too sweet of a siren call for most voters – free stuff (food, health care, housing, schooling, etc). Personal responsibility and market discipline just doesn’t sell.

    1. It would sell better if it had a track record of actually working. We went just a little in the direction of neoliberalism with Reagan and the ensuing decades, and all that happened was our money got transferred upward to sit in offshore bank accounts and purchase bigger yachts. Exactly as mainstream economics would predict.

      1. Just an FYI, you really lose people when you out yourself as a Marxist and say the N-word

        1. It is a word with meaning even if the Bernies made a $2 whore out of it.

      2. I’m afraid it’s neo-liberal progressive policies grounded in centralized government with a track record of failure.

      3. It’s sort of comical to use Reagan as an example of shrinking gov’ment. That not withstanding, income inequality has been growing right along with the size of the state here in the US of A.

        Speaking of a track record of working – how is Venezuela doing?

          1. Yeah, Venezuela’s socialist policies are dumb. Good job pointing that out.

      4. It always comes down to money bitching, doesn’t it?

      5. It sold quite well from 1776 to 1935.

  12. Uh, Republicans finally now control the White House and Congress. Of course the threat of single payer is real.

    1. If our feckless GOP can ngressional leaders could ntinue with their stellar track record, they won’t be in charge for long.

  13. For one thing, Medicare pays doctors and other health care providers far lower rates than private insurance.

    Which is why I’d sure love to know how the poll question was framed to get a majority of doctors on board with single-payer. (No I haven’t yet clicked through the link)

    I strongly suspect that whatever this majority of doctors thinks they’re going to get are going to end up sorely disappointed when the real thing rolls out. Just like Venezuelans after an election.

  14. It’s mind boggling that people are demanding LESS freedom. Do they also want one type of phone or car or shirt or any of the thousands of goods and services they enjoy. Should all restaurants be Taco Bell?

    1. Do you want Demolition Man? Because this is how you get Demolition Man!

      1. I just had that exact discussion at the gym a few hours ago. Where the Hell is John Spartan when you need him?

        1. Knitting a nice sweater.

    2. If the choice is a free crap government car or me paying, a lot of people will choose the free crap.

      1. I’m not so sure. Have you seen a Trabant?

        1. People hear “single payer” and think everybody gets a Cadillac. Or Mercedes. Janis Joplin was ahead of her time.

        2. They choose the free crap government car until they actually see what the free crap government car is. Then, they wish they could pay for their own car but it’s too late. There’s only the free crap government car.

          Bait and switch is only illegal if you’re not the government.

          1. And then taxes go up, and no one knows why.

        3. If you like your Trabi you can keep your Trabi.

  15. But in the longer term, Republicans and other critics of government-run health care will need to figure out how work towards clear goals of their own. And they will need to take the advice that liberals are now giving their allies, and start sweating the details.

    IOW – it’s just a matter of time. Because if there is one thing that conservative/libertarian critics have demonstrated for close to 3 decades now it is – details don’t matter and we have no clear goals/vision of our own. That ain’t gonna change until the healthcare system itself is entirely government-run and the criticism has to morph from ‘keep the status quo’ to ‘change the status quo’. At that point, single-payers will turn conservative (defending the vision they implemented) and conservatives will remain conservative (can already see that with Obamacare – don’t upset what already exists). And the only critics will be either petty (wastefraudabuse, googoo, ‘shorter lines’, etc) or visionary (who haven’t shown up yet and may not exist).

    1. It isn’t that the goals are unclear, it’s that most American’s are simply not interested in more freedom. More freedom is a non-starter from the beginning. It’s a failure to acknowledge that fact that’s staggering, if anything.

      We’ve lost, at least for the time being. We’ll have to wait until the inevitable rationing and lines before people might start to listen again.

      It hurts, but it’s the truth.

      1. That’s nonsense. This has nothing to do with some fear of freedom or a desire for free stuff. It has everything to do with our current system being an absolute cluster$%^& of confusion. Yeah – hospitals are there but those aren’t points of sale. Nor can they compete with each other – and anyone who thinks that that will happen if cardiologists put heart surgery prices on billboards is an idiot. So ok – you purchase ‘insurance’ – but only if you don’t need it now because if you do know that you can’t purchase it – and this has to be repeated every year until you do incur expenses and then maybe the hospital will be reimbursed and maybe not. And if not, then they are gonna make you pay on top of what you already paid and you’re gonna have to hire lawyers to figure out what the hell you’ve been paying for.

        Ok – well maybe I can get a job and they’ll deal with the bullshit. Whoops just got laid off and dammit companies aren’t offering insurance to as many employees now so right back to the BS. Well maybe I can avoid seeing the doctor until I turn 65. Hey guess what – I got diabetes now – and I’m jacking up the price for everyone else.

        It is no accident that the only people who think the current system works are the ones who don’t ever have to actually figure out how it works because someone else is doing that for them. THAT is the impetus behind people saying DO SOMETHING DIFFERENT.

      2. wait until the inevitable rationing and lines before people might start to listen again.

        Oh – and don’t bet on this. Rationing is happening now via price – and rationing via price ALWAYS occurs in a market system.

        Even an NHS system (with the most overt rationing) will be:
        MUCH worse for the 5% or so of seriously ill people
        Inconvenient but cheaper for the 15% or so of generally unhealthy people
        MUCH cheaper for the 80% or so of healthy people – without the confusion of our system

        And lines/rationing won’t apply to the wealthier because they will always have the means to find alternatives.

  16. Why not just label “Single payer” as “Hey, it’s the VA for all”?

    Because the VA is KNOWN for quality service and care…

  17. Sure-single payer could be financially feasible if people were willing to accept less such as:

    No more than basic or palliative care for anyone over 75
    No assistance for high-risk pregnancies or children born with major birth defects
    No coverage for fertility treatments or ED
    Only one or two options for any drug
    No treatment for any but the most serious of mental disorders.

    Given how progs seem to hate anyone having any choice and complain about overpopulation, I can see how they like this.

    1. I don’t know. “Progs” have been pushing for most of those things.

      I think a lot of them really believe that you really can have it all, if only the rich will just pay their “fair share”.

  18. It’s hard to imagine a transition of this magnitude like this going smoothly; the rocky rollout of Obamacare’s online health insurance exchanges ? a much smaller event ? is instructive.

    Sheesh, Peter — that’s why there will be lots of “Navigators”.

    Think of the JOBS!

  19. None of you but Calidissident has a fucking clue what you’re talking about. This is supposed to be the kind of thing you guys care about. If we get single payer rammed down our throats it will be in part because its opponents chose to be hysterical morons instead of thoughtful interlocutors.

    1. I’ve worked for hospital finance departments for more than a decade, please tell me more about your feelings-based approach.

      1. I might have excluded you except for “most American’s are simply not interested in more freedom.”

        That’s exactly what I’m talking about. Utterly empty bullshit. Forget the fact that you’re defining freedom as “paying much more than what other civilized people do for healthcare as opposed to paying less.” Just the fact that you are even talking in this language. It makes you unserious. Like, I’m engaged in feelings and you offer up that shit as, what, stolid objectivity?

        1. We don’t pay more the costs are just hidden everywhere else and the only reason health costs have gone up is BECAUSE of government interference in the free market. We can’t even buy across state lines. Absurd.

          1. Yet more serious, thoughtful contributions to the healthcare policy debate.

            At least you use more words than the president, whose comprehension of the subject is “we need to do the state lines thing.”

            Of course neither of you knows what the fuck you’re talking about. (We already did the “state lines thing”–in Obamacare. It didn’t save the world.)

            1. Actually each state still decides if you are allowed to buy across state lines. So it’s still a government decision. Nice try though.

              1. It’s mostly an insurance company decision. And largely irrelevant to anything.

                1. Oh bullshit. Health insurance has been a protected market for decades. Nothing has changed there. When you can open up the phone book (an anachronism, I know). And the yellow pages have a number of health insurers even beginning to approach the number of property casualty insurers, then you have competition. As it stands, I have three options in my area for a policy, and I’m pretty sure that number is dropping to two here soon.

                  If we also went to a loser lays system for malpractice suits it would save a massive amount of money.bring back health care savings accounts, and have any remaining subsidies work like backpack vouchers (althoughii personally loathe any government subsidies) and that s Lives a lot of problems.

                  None of this is rocket science. It’s jut that socialist assholes are salivating over the prospect of controlling people’s lives this way, and a lot of RINOs are on the take. Which makes it hard to get things done and fix this shit.

            2. Tony is actually right in a way about the insurance companies deciding whether you can buy across state lines. Even if the state says you can buy across state lines, you won’t be able to take advantage of it if insurance companies don’t build doctor and hospital networks in your state. Many times insurance companies don’t enter new markets because the ROI for building up those networks isn’t there. Then you can stuck with the same near-monopoly conditions.

              1. I’m guessing that if protectionist policies and punitive regulations are removed that their would be plenty of companies looking to do more business that would be willing to do the work.

        2. Forget the fact that you’re defining freedom as “paying much more than what other civilized people do for healthcare as opposed to paying less.”

          This is why you annoy people so badly. You just don’t listen, but then come back with this smugly superior attitude based on a complete straw man.

          Why do we pay more than what other civilized people do for healthcare? It’s been explained to you again and again and again, but you just refuse to hear it.

          It’s not freedom that raises prices. Our doctors get paid double what doctors do in other countries. Why? Because there’s no freedom in the market for doctors. There’s no freedom in the market for hospital construction. There’s no freedom in the pharmaceutical industry.

          ObamaCare and Single Payer do not address this issues. They are in fact a refusal to address these issues but instead are simply a shell game to hide how much money is being wasted.

          But you’re too busy with your moral preening to internalize any of that.

          1. No our doctors do not get paid double as a general rule. The Swiss pay comparable for instance. And drug prices are higher here because the US is the ONLY major free market on the planet. We subsidize oir eurotard betters (but since when is that limited to drugs and medical devices?). Drug prices are alsi higher here because of a sclerotic FDA. So in both cases the cause is Tony’s precious government.

            We also are far more generous on end of life care than the enlightened ones, so I guess Tony really is ready to throw grandma off a cliff.

            1. We subsidize oir eurotard betters (but since when is that limited to drugs and medical devices?).

              We do do that, too – but I was referring most directly to the FDA restrictions on the market, which are at least in part what allow US prices to be so inflated that we can subsidize Europe.

              Didn’t know that about the Swiss – I think my source where I read that was looking more at France, UK & Germany, but it’s been awhile so I may be fuzzy.

              1. I don’t think the french or germans do too badly either. But it’s difficult to make a blanket statement. Thanks to medicare (government for the WIN) RSU values exist for all ICD codes and they HEAVILY favor procedures. That means that an orthopod in the US gets paid an obscene amount for being a glorified carpenter while an IM hospitalist who has to keep the surgical patient alive after the post op 48 gets paid far less. So depending on the specialty a US doc might make well over 2x what a eurotard does or they might make the same or even less. Really hit or miss.

                1. Medicare is not the one who is the main force behind keeping the fee-for-service (with all the coding crap that results) system. Yes – they are bureaucrats so they will keep it bureaucratic. But it is DOCTORS and HOSPITALS who want that system in place. Because they have zero interest in taking on any financial risk (eg a capitated system or the slew of other payment systems that other countries have put in place for even a govt program of limited eligibility) – and they simultaneously insist on being paid very well despite not taking on any risk.

        3. The irony is you are a prime example of someone who is not interested in more freedom Tony.

          Once again you say something that makes me unsure if you’re actually retarded or an excellent satirist.

          1. I am very much interested in more freedom. That’s why I think healthcare should be cheaper and universally available. People who don’t have to worry about how they will get their healthcare needs met are FREER PEOPLE.

            But then you guys have the most restrictive definition of freedom of any political philosophy on earth, right? Simply and exclusively “freedom from government.” (Something you don’t seem to give a shit about the moment someone tries to trespass on your property.)

            1. False. You specifically ask for things to make healthcare more expensive, and you endorse enslaving providers to make care ‘universally available’ which it already is.

              Try again.

              1. If costs are not lowered then the project is a failure. I’m suggesting we try something that seems to have worked elsewhere (universalizing the risk pool), because it makes fucking logical sense and you don’t have any counterproposal except to call names and beat up straw men like “you want to bring back slavery.” That bit is really convincing that you have serious ideas.

                1. Me, too!

                  I am very interested in more freedom. That’s why I think taxes should be minimized or eliminated. Don’t you agree?

                  I mean, all other things being equal, people are more free if they keep more of their money, right? Isn’t it that simple?

                  1. Depends on whether paying taxes to support a government healthcare scheme is actually cheaper than people paying for healthcare in a private scheme. That’s the whole point of doing this, to save people money. Surely we’re not pretending that tax money all goes into a black hole and serves no purpose, because that’s what I feel like you people think sometimes.

                    And it’s a damn shame because this argument has really convinced a lot of Americans that taxes are a burden more than anything else instead of the price we pay for civilization. Then politicians cut taxes but can’t eliminate any of the programs people like. Then you complain about the national debt!

                    1. Tony:

                      Depends on whether paying taxes to support a government healthcare scheme is actually cheaper than people paying for healthcare in a private scheme. That’s the whole point of doing this, to save people money.

                      Actually, that’s a gross over-simplification of freedom, which is really a complicated question concerning not just monetary cost, but technology, labor, availability, quality, and the values of every person involved.

                      For someone trying to propose centrally planned solutions to important issues, you don’t seem very up to it.

                    2. Again you’re coming to the table assuming that there is some kind of status quo that equals freedom relative to a proposal. What libertarian world are you even talking about that leaves people free to determine all of these variables for themselves? Certainly not the United States in 2017. Is such a scheme even conceivable in theory?

                    3. Orwell would be proud.

                    4. That would be great, if I suggested we adopted policies which would have led to and stabilized to the status quo.

                      I’m sure these are great responses to the arguments for whoever is living inside your head, making them.

                    5. Depends on whether paying taxes to support a government healthcare scheme is actually cheaper than people paying for healthcare in a private scheme.

                      Where all sentient creatures who have any experience with the world whatsoever have observed no cases of a government service being actually cheaper than the same service provided in a “private scheme.”

                      But this time Hope will triumph over Experience!

                    6. That’s a big claim. Care to cite? Electricity gets deregulated in one state and fucking skyrocketing costs and corruption hell breaks loose.

                    7. Electricity gets deregulated in one state and fucking skyrocketing costs and corruption hell breaks loose.

                      I sure hope you’re not talking about CA, because that would betray a level of sheer ignorance and cherry-picking that is, well, completely typical of you.

                      For the sake of teaching basic words to retards, “deregulation” =/= “privatization.” Please learn something about public utilities in CA before making an even bigger jackass out of yourself.

                      Government-worshipper that you are, you must have a long list of things that the government handles more efficiently than the private sector.

                      Please share.

                    8. Yeah, healthcare, but you’d have to go by literally all the evidence in the world.

                      Also large-scale infrastructure. Buying up individual plots of land and building countless toll booths seems awfully tedious compared to eminent domain and taxes.

                    9. Healthcare is debatable at best. Other countries may spend less per capita, but they arguably get far less. Yes, it’s distributed more to the poor and the rich have to come here, but you’re going to need to do better than just declaring that there’s more value there.

                      Large-scale infrastructure, don’t make me laugh.

                      Do you know what I do for a living? I build large-scale infrastructure, mostly for public agencies. I am literally on the cost-negotiating end of it.

                      Your assertion that government builds large-scale infrastructure at a lower cost than the private sector is . . . absurd on the face of it.

                      You fail.

                    10. You don’t need toll booths anymore. Some places just scan the vehicle license and send a bill to the registered owner. People who regularly use them can set up an account on the internet. No one has to stop or even slow down.

                      The market innovates. Government doesn’t. That’s why the VA is a disaster and things like laser eye surgery, which is relatively untouched by government, are cheap and safe.

            2. You’re advocating for positive rights. We advocate for negative rights. The problem with what you advocate is that it requires the initiatory use of force by the government. We call that tyranny and it is in no way freedom.

              1. I think one of the main things Tony fails to realize is that his concept of “Freedom” involves getting lots of free shit from other people. That this compromises the freedom of those other people never occurs to Tony – he thinks we can all have it all and no one will have to give up anything.

                His jack-booted thugs will make it work.

                Freedom!

                1. “Please ignore the fact that I demand other people pay tribute to a government that will fight wars, imprison trespassers, and otherwise commit violence against people on my behalf. That’s the GOOD kind of jackbooted thuggery–the nonmetaphorical kind.”

                  1. Translation: “If you don’t like my government program, then, suddenly, my vague hand-waving about democracy goes out the window, and I hang every program I hate on your neck, whether you like it or not. Nee-neer, nee-neer!”

                  2. “Please ignore the fact that I demand other people pay tribute to a government that will fight wars, imprison trespassers, and otherwise commit violence against people on my behalf. That’s the GOOD kind of jackbooted thuggery–the nonmetaphorical kind.”

                    Yup. That’s what this place is all about. We’re constantly advocating more war, more imprisonment, and arbitrary government violence.

                    You sure got us pegged! And it only took you, what, like eight years to figure all that out?

                    1. That’s not what I said. But you do think those are legitimate uses of government–the stuff that involves beating, shooting, and imprisoning people, right?

                      Just no healthcare for poor children. Too much violence!

                    2. That’s a great point, as soon as you pretend that everyone already agrees with your uses of government, making the use of violence, and government itself, pointless.

                      Way to go, bro.

                    3. Only if it’s done in RETALIATION. The proper function of government is to defend individual negative liberty with the retaliatory use of force, period.

                    4. Why is it OK to extract taxes from me to pay for government thugs to commit violence in RETALIATION if the principle is that government force and taxes are bad because they are violence?

                      And why is metaphorical violence like having government-run healthcare worse than shooting trespassers? Anyone is seriously more likely to fall victim to a heart attack than an armed robbery. What kind of warped priorities are these?

                    5. Tony:

                      And why is metaphorical violence like having government-run healthcare worse than shooting trespassers? Anyone is seriously more likely to fall victim to a heart attack than an armed robbery. What kind of warped priorities are these?

                      Why are you asking gibberish questions?

                    6. Your answer is “Because for some reason we think that human agency is the only impetus of harm governments should pay attention to.”

                      I’d like to know that reason, if you please.

                    7. OK…are you going to answer your own gibberish question like you just did?

                      If you need someone else to argue with, please let me know (and try to skip gibberish questions).

                    8. Bpppbecause Tony gibbers. It’s in his progtarded nature.

                    9. No. Government force and taxes are bad because they are INITIATORY violence. Do you understand the difference between initiatory and retaliatory? It doesn’t seem like it.

                    10. That’s not what I said. But you do think those are legitimate uses of government–the stuff that involves beating, shooting, and imprisoning people, right?

                      Despite your dickish phrasing to describe functions of government you also agree are legitimate – yes the government should enforce laws and punish people who try to initiate force or abrogate other people’s rights.

                      Your attempt to make it sound like we support these functions because they involve beating, shooting, and imprisoning is dishonest and shitty. But par for the course for you.

                      Just no healthcare for poor children. Too much violence!

                      No, fuckwit. What we’re trying to explain to you is this – come closely so you can hear:

                      A GOVERNMENT RUN HEALTHCARE SYSTEM WILL BE WORSE FOR POOR PEOPLE THAN A FREE MARKET SYSTEM.

                      At least be fucking honest about what our position is. But that would involve you having to make real arguments, instead of smugly beating up strawmen.

                    11. Yes I favor government use of violence for certain purposes, same as you. But I do not believe that taxes are bad because they amount to government violence. Besides the problem that taking taxes is not actually violence, your argument is rendered hypocritical when you endorse those functions of government–and only those functions–that use actual, literal violence. It’s comically contradictory.

                      You can claim that some mythical free market healthcare system, even if it were possible in the physical universe, is better for the poor than a system that deliberately subsidizes healthcare access for the poor, but you’d have to back that up with facts and figures, not the tautology that the free market is better because it’s the free market.

                    12. I don’t know why you’re suddenly babbling about taxes and violence, but whatever. You don’t think the government should have a monopoly on violence, I’d be interested in your argument. It’s a discussion I’ve had with the AnCaps before, and I’ve never gotten a very satisfactory answer out of them.

                      In regards to why the free market is better, I offer a simple observation:

                      1% of 1,000,000 is more than 99% of 100.

                      In short, that’s why a free market healthcare system is better for poor people than a subsidized government-managed healthcare system.

                      You won’t understand that, I know, but maybe some lonely progressive somewhere will read this discussion and have a lightbulb go on.

                    13. But Tony says that 99% of 1,000,000 is even greater (not understanding the 99% impediment prevents the number from getting to 1,000,000).

                  3. You just described several things that are actually enumerated powers of the federal government under the constitution. You know something else about the constitution Tony? Nowhere is the word ‘healthcare, or the words ‘health insurance’ mentioned.

                    1. Murdering political opponents is also not endorsed by the constitution, but you seem to be all over that.

              2. Comrade IceTrey, your only freedom are the chains that bind you.

            3. If progtards would quit interfering with my right to deal with trespassers as I see fit, then I wouldn’t need to involve the government. It’s people like you that try to remove my right to defend my land and belongings with force. I’m perfectly happy to not bother with the cops and stop thieves and home invaders myself. But then I have to worry about horseshit about ‘excessive force’, or it being frowned upon to execute intruders.

      2. Tony has the news explained to him by Vox and Now This! videos on Facebook. He knows things

        1. And I’ll bet he’s seen some stuff too.

  20. Nevada’s … Republican Gov. Brian Sandoval….

    …Sen. Brian Sandoval, a Democrat representing the state of Hawaii

    Do they really have the same name or is this a fuck up?

    Republican governors John Kasich (Ohio) and John Hickenloper (Colorado)…

    Hickenlooper is a Democrat, not a Republican.

    1. Do they really have the same name or is this a fuck up?

      Nevermind, answered my own question. HI’s Senator is Brian Schatz. I assume that’s who Suderman meant.

  21. Single payer works great in a lot of countries, as Trump loves to point out. There’s no fucking way our government could ever make it work though.

    Also, single payer does not mean government owned and operated hospitals. So if you bring up the VA or NHS in a single payer argument you are immediately outing yourself as being clueless

    1. Saying single payer works great is certainly outing your intelligence as well.

    2. Hey Magni, thanks for setting the rules for any discussion for us. We really appreciate your comradery.

    3. I assumed “understanding the basic definition of the thing you are arguing about” was a rule by default

  22. Those who oppose greater government intervention in the health care sector should take this as a wake up call.

    They should have taken that call when the (false advertising alert) Affordable Care Act was ‘debated’ and passed.

  23. Having gone through the medical system with the deaths of both parents, I honestly do not see how it could get any worse. And both of them had insurance.

    And at the same time, it can’t get any more expensive. We pay like twice as much as any other country does. Somehow it cost $1200 to move my father from one hospital to another, a distance of like 3 miles.

    1. Perhaps we could agree on the problem, and then libertarians can blame government cronyism and liberals can blame capitalism, and we can move on from blame and fix the problem.

      1. What if the problem is too much government intrusion?

        But you won’t allow yourself to even consider such a notion, amirite?

        1. But that’s literally the only possible problem with any policy to you, isn’t it? Anyway, sure, that’s how you can interpret it. I’ll interpret it my way, and then we can get over what philosophy has the bigger dick and we can use science and reason to solve the problem.

          1. That’s not actually an answer to my question – you realize that, right? Right?

            1. But the problem “too much government intrusion” is obviously, and by far, trumped by the problem “people dying needlessly,” especially when you define “too much” as miserly as you do. The answer is that it’s not the main problem. The problem is not enough government intrusion.

              1. But what I asked you was:

                What if the problem is too much government intrusion?

                But you won’t allow yourself to even consider such a notion, amirite?

                And it turns that I was correct – you won’t allow yourself to even consider the possibility.

                1. I clearly considered and rejected it.

  24. I believe too few people recognize why Democrats want GASP (Govt As Single Payer) so badly: It would at least quadruple the already obscene number of federal Union employees.
    .
    They drool over the prospect of converting literally millions of medical and insurance company workers to the federal payroll and public employees unions. Can you imagine the growth in cash from all those members? Remember how badly they wanted all TSA workers federalized?
    .
    The movement toward GASP should be called “Dues for Democrats.”

  25. The author claims ‘Single payer would be too expensive and too disruptive to both patients and providers.’ and ‘ Single payer supporters don’t yet have a workable plan.’ as a basis for rejecting Single Payer?

    -We spend $3.2 T each year and pay about twice as much per capita as any other developed nation with Single Payer. If we simply reduced our costs by 1/3, we’d save over a Trillion each year, and unlike our present system, we would cover everybody. How is that expensive? Repeating this nonsense is akin to insisting on paying $50,000 for a $25,000 Corolla..but only if it guaranteed to not start 2 times a week. The illogic just blows me away. This is a chart of all developed nations who have Single Payer (except the US).

    bit.ly/2vZE3IP

    – Would it be bad to to remove the middlemen from the equation? Would it be bad to remove the stranglehold Big Medicine and Big Pharma have if it meant a massive savings every year? How problematic would it be for me to chose another doctor to service my needs…Right now, I have only have one choice; Humana. In other words, I have no choice of doctors or hospitals. I get whatever Humana has available.

    – There are 30 sensible, working models around the world to chose from and modify as needed. Is it really incumbent on those who look at how well it works in other countries to produce a gift warpped plan? Not in our country. We need to get everyone in lock step.

    1. Big Medicine and Pharma have a stranglehold BECAUSE of government interference in the market. Why can’t you understand government creates the problems? Just the FDA alone adds billions to the cost of health care and people die waiting for them to approve drugs.

  26. August 12, 2009

    As members of Congress return to their states and districts to debate the merits of the Democrats’ proposals for health care reform, critics of the proposals may repeat the phrase used by some Republicans, newspaper editorials and bloggers that ‘the American health care system is the envy of the world.”

    If so, they should read the results of a recent Harris Decima poll in Canada that found a 10-to-1 majority of Canadians believed their system was “superior” to the U.S. system. They might also note that a 70% majority of Canadians thought their system was “performing well”; and that a majority favored an expansion of public sector health care (i.e., “government-run” health care in the current debate) over private sector health care.

    These are some of the results of a recent Harris Decima telephone survey conducted between June 4 and 8, 2009 by Harris/Decima among 1,000 Canadian adults.

    1. Yeah, socialized medicine might be the only thing keeping Canada from splitting apart.

      1. And Canada’s approach with no abortion laws evidently works better than turning doctors into narcs and expert witness whores for a prohibitionist asset-forfeiture Sharia looter state.

    2. Hey, Germans thought gassing Jews was a great idea. Indoctrination works.

      1. Leftists do love mass murder.

    3. I used to work with a dual US – Canada citizen (born in Canada) that lived on the border. He used to say the same thing. When he had shoulder surgery he opted to have it in the US.

  27. Guess Obamacare’s here to stay despite predictions of its imminent demise every year or so. I wonder if this is the same reason contributor a couple years ago that informed us ignorant people that Obamacare couldn’t railroad us into single payer health care no matter what. Time to panic, I guess.

    I can’t shake off the feeling that this country would be better off if NYC and DC were dismantled and dumped into the ocean.

  28. Primary care physicians who have moved to Direct Primary Care (DPC) are learning that a significant cost factor is both government and private insurance.

    Government causes the problems we have in our current medical system. It is time for:
    – HSAs into which anyone can make contributions – government, employer, individual, charity, etc.
    – True catastrophic insurance. We must get rid of the idea that insurance pays first dollar.
    – Better use of the internet to make both pricing and performance more transparent.
    – Make it easier for different payment models. DPC seems to be working. Cash-only surgical centers are significantly cutting costs.

    In short, get the government and the insurance company out being the 3rd party and put the patient back in control which is only way to reach prices we can live with.

    1. Government meddling and an obsession with “insurance”.

  29. The main reasons for high health care costs are (1) health insurance companies, which provide no actual health care, but take 25% of our health care dollars; (2) a block on government negotiation with health care providers; (3) obscene profits siphoned off by pharmaceutical companies; (4) legalized bribery of legislators by allowing corporations to use profits to pay legislators to vote their way. They have had single payer health care in Australia for almost 50 years, and it works. It works in Canada. It works in Japan. It works in Sweden. As soon as we get corporate money out of politics we will finally hear the voices of the people, instead of the voices of the rich.

    1. (5) Americans have poorer health habits.

  30. I too am worried by the threat that we might end up paying less and having much better health outcomes while relieving American business of an unnecessary financial burden.

    1. Yes, that was my experience as a businessperson working in Japan: lower costs, better outcomes and little financial burden to businesses.

    2. The threat is to the ideology that would be severely damaged if it ever paid attention to the statistics that bear out these facts. But it’s not like libertarians are strangers to ignoring data that devastates their worldview, so how much of a threat is it really?

      1. “But it’s not like libertarians are strangers to ignoring data that devastates their worldview, so how much of a threat is it really?”

        You are absolutely projecting. Just like a progtard.

  31. ” some doctors would inevitably refuse to participate. ”

    Force them to.

    And while you are at it, make private pay, cash pay, and private insurance illegal.

    Problem solved.

    [[disclaimer: i don’t actually support that]]

    1. I’m sure that the government would force them to wear shock collars to ensure their compliance with the state’s wishes. Maybe threaten to turn their information over to antifa if they don’t o,any ball.

      I’m sure Tony would approve.

  32. Fighting the threat of universal health care may require an explanation for why it works in many other countries, better in some than others, and all the systems cost less than the US system. People have easier access to this info than previously.

    The biggest threat might be President Trump. He made positive noises about single payer even recently. What if Dems win control of Congress when he’s still in office? Maybe he’d like to do this for his supporters.

    1. Only if he hates his supporters.

  33. I had extensive medical treatment in Japan and a little in Australia and would take either of those country’s healthcare systems over what exists in the USA.

  34. Talk about throwing coals on an out-of-control fire.. There was a time when ALL doctors would come to your house and offer medical services for the price of monthly TV service.

    Nope, couldn’t have that!!!! Throw in some government and make it UNAFFORDABLE FOR EVERYONE! Thank goodness my Dentist isn’t on some government plan. I’d have to remortgage the house just to get my teeth cleaned.

    Why people are so stupid as to think government has fixed anything by communism is beyond me.

    1. I know many people who have gone to Mexican dental clinics run by Americans just on the other side of the border from AZ. Even with travel expenses they’re saving 70-80% relative to the local cost for the same services.

  35. But serious single-payer supporters are pointing out other problems too: Earlier this month in The Nation, Joshua Holland argued that plans based on the idea of expanding Medicare, the federal health care program for seniors, to the entire population would face nearly insurmountable obstacles. For one thing, Medicare pays doctors and other health care providers far lower rates than private insurance.

    That’s how single payer works everywhere. In fact, Medicare still spends 2-3x as much per patient as European single payer systems, so they need to cut more.

  36. Single payer is one of those issues where there’s a progressive divide between activist level and big business / higher ups. The latter will refuse to pay for it.

    Who could stop California from implementing single payer at state level? Democrats run the joint at virtually every level. But it went nowhere in Sacramento. It’s a given that the 1% very quietly told Kevin De leon that they weren’t down with the plan that would almost place a gigantic tax hike on their investors.

    1. Single payer is one of those issues where there’s a progressive divide between activist level and big business / higher ups. The latter will refuse to pay for it.

      Don’t bet on it. Right now, businesses spend a shitload of money and time on providing healthcare for employees. With single payer, they can rid themselves of all of that.

      Democrats run the joint at virtually every level. But it went nowhere in Sacramento. It’s a given that the 1% very quietly told Kevin De leon that they weren’t down with the plan that would almost place a gigantic tax hike on their investors.

      California is a huge state and is essentially bankrupt. Furthermore, they realize that if they push this through, companies and employees will leave the state by the millions. But the situation at the federal level is entirely different.

      1. The burden for paying for single payer will almost certainly fall on big business. Wer’e talking about paying for the healthcare for 300 plus million people, not some group plans. Most small-ish businesses don’t provide healthcare.

        1. The burden for paying for single payer will almost certainly fall on big business. Wer’e talking about paying for the healthcare for 300 plus million people, not some group plans. Most small-ish businesses don’t provide healthcare.

          You got it backwards. Right now, big businesses must provide healthcare while small businesses get away without it. With single payer, all businesses will be forced to pay for healthcare since it will be like a tax. That means less of a burden on big businesses and more of a burden on small businesses that currently don’t have a health plan.

          (Of course, in the end, it’s we the people that pay for all of this anyway.)

  37. Peter still calls looters “liberals,” like a 1932 Republican prohibitionist or German nationalsocialist. So guess what? Reality comes as a complete surprise!

  38. “The liberals have a goal for health care. It’s not clear how they would make it happen, but they have a goal.

    The conservatives have a goal for health care. It’s not clear how they would make it happen, but they have a goal.

    The liberals’ goal is bad.”

    That’s about as deep as this piece goes. Where to begin? I’m on my way out and don’t have the time. I will point out a couple of things, though — it’s interesting that (as MANY polls show) doctors prefer single-payer — even if some will be paid less …and it would be hard for them not to participate if virtually all doctors in the nation were paid the same way.

  39. The equation is simple: the GOP did nothing to change Obamacare because they liked it, now the next step is to implement Universality either to avert the crashing of Obamacare, or in the fallout of it as you stand on it’s crumbling ashes and declare that “there’s only one option that can save us now and that’s universal healthcare”. They will implement in a hamfisted legislate way, and politically they will unabashedly lie about the shortcomings of the “free market system in healthcare”, and the “miraculousness and human right of Universal Healthcare”, get the media to lie about it, and everyone in Hollywood will join in on the party.
    This can be accomplished with either party in charge of the House/Senate/Presidency.

    1. You don’t make any sense. We already have universal healthcare: that’s the healthcare mandate.

  40. Someone should remake the movie “John Q.”, but instead of an HMO as the villains, have a government health manager, or whatever they call it.

    1. It wouldn’t be believed. The Government can never be the bad guy in a Hollywood film. If they remake the Bundy Stand Off they would totally change it. The Ranchers will be all noble and being threatened by an Oil Company. The accidental fire damage will be to Oil company property and the brave ranchers will Occupy an unmanned Oil facility. The then will say “Based on a True Story. LOL

  41. Ma.,already has single payer and the new wannabe governors in Mi. and Il. all pledging to have insurance plans of their own. State run plans seem better than the Fed. More control by the citizens if that’s even possible.

  42. “some doctors would inevitably refuse to participate.” Oh they will correct that issue. Look at California’s plan. California’s plan made it illegal to buy insurance or pay cash for services covered under the California plan. If it was covered under the California Single Payer plan you had to use their plan for the service. So if MRI’s are covered you couldn’t pay cash or get a supplemental plan that covered them as well even if the wait times were dramatically higher and you wanted to pay to cut the line. Doctors will not have a choice cause they will pull some stunt like this by declaring nearly everything “covered”.

    1. It all sounds pretty unconstitutional. Although that never stops progressives.

  43. This, like so many issues, is basically about money. And of course ayn rand acolytes don’t want to spend any of their raison d’etre on poor peoples health. Thats the whole story.

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